Once you have chosen the right health insurance plan for you and/or your family, your goal is to use it to stay as healthy as possible at the lowest out-of-pocket cost. It can take some work, but there are many ways to get the maximum benefit from your health insurance policy and save money as you do.
Being aware of every detail in your policy is essential to reach your goals. Your plan’s “Summary of Benefits and Coverage” will contain all relevant information. Make sure you understand all of the restrictions. If you are keeping the same policy, look for any new features that may be different from last year’s policy when renewing. Unfortunately, this may not be as easy as you would want.
Like any contract, a health insurance policy is complicated with a lot of details and legal language you may not fully understand. You may need help interpreting all the details specific to your policy.
The requirement for and the role of your primary care provider varies by your type of plan; be aware of the specifics for your policy. However, having and using a general primary care doctor will reduce the cost of your overall healthcare.
The Affordable Care Act names essential health benefits health insurance plans must cover. Some states require policies to cover more.
Be aware of any changes in your policy. Most will happen when you renew your policy, but some may occur during the year your policy is active. You should be notified if any changes happen during the year; make sure to read all mail you get from your insurance company. Don’t assume your renewed policy has all the same features as last year and ask about or look for any changes.
Once you are familiar with the rules and details, you must make every effort to stick to the terms of your policy.
One of the most important things is to know and stick to your network and formulary, including your primary care provider’s role in prescribing and referring to specialists. Unfortunately, this is not always straightforward and you have to be aware of situations where you mistakenly think you are staying in your network or sticking to the formulary.
Keep accurate records of your payments to know when you reach your deductible and out-of-pocket limit, or in case you need them for a denied claim. You must know if there are services that don’t count toward these limits, such as out-of-network tests or visits.
Know the situations when you have to submit reimbursement requests. This will usually be emergency visits and other services from non-network providers. Make sure you check with your insurance about the proper way to submit a claim. Be aware of any deadlines to filing, usually one to two years from the visit.
Get all necessary referrals and pre-authorizations from your primary care provider.
Be aware of any type of service that has an annual or lifetime limit, since you will have to pay the full cost if/when you exceed it.
The Affordable Care Act prioritizes preventive care by mandating that it be fully covered and include the most effective measures to maintain your health. Not only is it a lot better for you to remain as healthy as possible, it is more convenient and much less expensive overall.
While it is important to have routine visits, staying healthy goes beyond them.
Although it may not significantly impact your health, saving money can feel good. When it comes to saving money on healthcare costs, there are many ways you can reduce the cost of your medical care without affecting your health. On the other hand, trying to save money by avoiding healthcare visits when you need them will usually backfire and adversely affect your health and cost more.
Unless you are having a preventive care visit, you will be paying something for your visit. On the other hand, you will pay nothing if you elect to not have a visit. When you are contemplating the need for a healthcare visit there are three major things you need to consider.
2. Do I really need the tests, prescriptions/treatment, or procedures recommended by my healthcare provider?
In the case of tests, it is important to ask your provider whether the results of the test will impact your care or not.
Many conditions are self-limiting, will resolve on their own, can be watched without treatment in many cases, and only treated if they get worse. If needed, a prescription or procedure should have a clearly identified benefit and a detailed description of complications before you agree to it. On the other hand, don’t insist on treatments that your healthcare provider assures you will not treat what you have, such as antibiotics for viral infections or ivermectin for COVID-19.
If you do need a test, the cost of these tests vary significantly from one facility to another — even within the same network. Shop around to find the least expensive. Independent laboratories, clinics, and testing facilities are usually less expensive than the same services in a hospital setting. The same is true of most procedures.
Emergency rooms are the most expensive option, so it is best to avoid them unless absolutely necessary. It will be less expensive to use other acute care options.
Seeing specialists is expensive and should be reserved for situations where your primary care provider cannot treat you. You may have a higher coinsurance/copay when you see a specialist.
Sometimes knowing the difference between specialists will save money, for instance an optometrist usually costs less than an ophthalmologist for the same service.
For many older people and those with chronic illnesses, their medications are often the most expensive part of their healthcare. Aside from sticking to the formulary, there are other ways to save on prescription costs.
Obtain a drug discount card, such as the one from NeedyMeds, that may allow you to buy medication cheaper than using your insurance. There is a Drug Pricing Calculator that will give you the cost of your medication at various locations using your card. NeedyMeds has a comprehensive listing of Patient Assistant Programs for various medications, as well as available coupons.
You may be able to deduct medical expenses from your taxes.
With the growing access to Electronic Health Records, your test results are available to any healthcare provider in your network. In many cases this will prevent repeating tests, unless a more recent sample is needed. Healthcare providers outside your network will likely not have this access, so bring any results with you when you have an out-of-network consultation. Unfortunately, many of these consultants will only rely on tests from facilities they know and will likely repeat them.
Use a Health Savings or Flexible Spending Account, which you can add to with pre-tax wages.
Use a Healthcare Broker, Health Insurance Navigator, licensed online agent, and/or Health Insurance Exchange, to compare policies.
The NeedyMeds Health Savings News Podcast addresses various issues related to the high cost of medical care and discusses ways to reduce these costs. The first two episodes discuss follow-up appointments and drug costs.