Need Help Understanding Health Insurance?

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Jenifer Dorsey
2018-09-12 July 30th, 2015 |
Read time: 7 minutes

February is National Wise Health Care Consumer Month, a time to reconsider how we shop for benefits and services related to our own health. Consumer spending on healthcare is on the rise—20.6 percent of total consumer spending was healthcare-related in 2014, rising for the third straight year and hitting another record.1

While we may not be able to control what healthcare costs, we can educate ourselves and take certain actions to help lessen what we spend on it. While this list is by no means comprehensive, here are 11 ways to be savvy with your healthcare:

1. Buy coverage based on more than premium

The first step to being a wise healthcare consumer is obtaining health insurance benefits. Not only does health insurance help pay for unexpected medical expenses, it is also required by law (i.e., the Affordable Care Act) for most Americans. When you buy your Obamacare plan, be sure to make your selection on more than premium because it makes up only a fraction of what healthcare costs.

Consider applicable copays, coinsurance and deductible amounts. Look at network requirements. Take into consideration your healthcare needs throughout the year and how they might change—do you have a preexisting condition; are you at risk for certain illnesses or diseases; are you planning to have a baby or require surgery? All of these factors will impact which health insurance plan makes the most sense for you and how much you will pay for healthcare throughout the year.

2. Get to know your benefits

It’s important to understand what benefits you receive from your insurance plan before you use it. When your membership materials arrive in the mail, look them over closely. What are your plan’s copay, coinsurance and deductible amounts? How are prescription medications covered? Can you order prescriptions by mail?

Familiarize yourself with your plan’s network and how it functions. Are you required to get referrals to specialists from a primary care physician? Do you need to have certain types of care pre-authorized by the insurer? Where can you search for network providers?

If you have any questions as you look over your health insurance policy or prior to using your benefits, be sure to call your insurance company’s customer service department for clarification. Need help with terms? Check out our 10 Essential Obamacare Terms and 10 Essential Health Insurance Terms.

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3. Choose a primary care physician—and schedule a preventive care visit

Make sure you select a primary care physician (i.e., PCP) that you trust, someone who can become familiar with your health history as it changes over time. This individual can help oversee any ongoing treatment you require and also help you find additional healthcare providers for services beyond their scope.

Choose a PCP who is in your plan network, otherwise you may pay more for care or find that your health insurance plan doesn’t cover your care at all.

Once you’ve found a PCP, be sure to schedule an annual preventive wellness check-up. These appointments can help with the prevention and early detection of medical conditions and diseases. If you have an Obamacare plan, many preventive services are covered at no additional cost.

Make sure you pick a doctor with whom you feel safe and are comfortable speaking openly and asking questions. Click here to visit the U.S. National Library of Medicine and learn more about the different types of PCPs and how to choose one.

4. Use network providers when possible

In addition to choosing a network PCP, you will want to visit other healthcare providers and hospitals that participate in your health insurance plan network. In-network care is typically covered at a higher percentage, which means you pay less out of pocket. Furthermore, some health plans, namely HMOs, won’t cover care received from out-of-network providers. In emergency situations, you may not have much of a choice.

Provider networks are subject to change and information found online is sometimes out of date, so be sure to verify their network participation with your health insurance company. For more information, listen to our podcast about provider networks.

5. Review and save your EOB.

Prior to receiving a final invoice in the mail for your treatment, you will receive an explanation of benefits (EOB) from your insurance carrier administrator. This is a great way to educate yourself on how much procedures cost, what network coverage pays for, and what your insurance carrier pays for. It’s also important to save your EOBs until a bill arrives from your healthcare professional; compare the two as a way to ensure that you are billed properly.

6. Understand your treatment plan

If you’re sick and have been prescribed a medication or a procedure, make sure you understand the implications of the procedure or medication. In other words, ask questions.

For instance, if you need surgery, be sure you know the answers to questions such as: How long will the procedure take? What type of rehabilitation will you need afterward? Do you need to stay overnight in the hospital or is it a one-day procedure? Is it safe for you to drive yourself to and from the hospital?

If you’re being prescribed a medication make sure you know how often you should take it, the side effects of the medication, how long you’ll need to be on it, if it counteracts with other medications or supplements you take, if you can get the same medication in a generic form, and where it should be stored.

If you feel uneasy about the treatment your doctor has recommended ask for other options. See if there are alternative methods that are less invasive if the treatment recommended is invasive. Find out if you can correct the problem with lifestyle changes such as altering your weight, diet or environment before going on medication.

7. Ask about generic medications

In many situations, generic drugs can be a suitable substitute for brand name drugs. As a matter of fact, they are FDA approved like brand name drugs and are the same when it comes to dosage form, safety, strength, route of administration, quality, performance characteristics and intended use.2

Health insurance drug formularies often cover generic drugs at a higher percentage than brand name drugs. Speak with your doctor about whether or not generics are an option for you, and always verify that the medications your doctor prescribes are covered by your health insurance plan.

Want to learn more about prescription drug formularies? Listen to our formulary podcast.

8. Review your medical bills

When you do receive your medical bill, look it over carefully. Understand how much you will owe out of your own pocket after insurance and network deductions.

If your statement looks correct, pay it and keep a copy of your receipt for your records. If the statement doesn’t appear correct or has an error, contact the account office of your health care provider to review treatment billing and see what steps can be taking to right the incorrect invoice.

Struggling to pay out of pocket and meet your health insurance deductible? Consider options such as medical gap benefits that supplement Obamacare plans and a Telemedicine package with patient advocacy benefits.

9. Ask questions

Yes, it’s already been said in this article, but it’s an essential part of being a wise healthcare consumer. Whether you are shopping for a health insurance plan, sitting in the doctor’s office or paying your medical bills, if you don’t understand something or are uncertain about its value to you, ask.

You are your own best advocate. Make sure you gain the information you need to make informed decisions about your health insurance benefits as well as the healthcare you receive—and never, ever be afraid to get a second or third opinion from another specialist before you make a decision about treatment.

10. Commit to making improvements to your health

Do you feel like you need to eat better, exercise more and/or manage your stress effectively? Now it’s time to take action—even one small change has the potential to make a difference in your health.

Not sure where to start? Work with your healthcare provider. Maybe you haven’t been to the doctor or dentist in years. Talk to someone you trust and ask them to help you make the first step of seeing a doctor for a preventive care visit. When you’ve made the appointment, keep it.

Schedule it at a time when you know you will be able to go. Discuss with the physician a reasonable, attainable path to help you improve your health. Know that you’re not alone. Be aware of what’s happening in your life, and take control.

11. Think beyond Obamacare

There is an array of supplemental health products in the market—products that are intended to complement, rather than replace, your Obamacare plan. For just a few extra dollars a month, they can help with out-of-pocket expenses related to dental care, your health insurance deductible and coinsurance, critical illnesses, simple physician visits and more.

Visit healthedeals.com to explore supplemental plan options, or call the number at the top of your screen to speak with a certified advisor about supplemental products that can help lessen your out-of-pocket healthcare spending in the year ahead.

 

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Originally Published On July 30th, 2015

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