While the current economy has stripped jobs — and therefore health insurance benefits — from many workers, there are still more than 200 million insured Americans. And more than ever before, they need your advice and good counsel on how to cost-effectively use their benefits.
One of the ways you can be a helpful partner to your clients is by advising them that now is not the time to cut back on doctor visits in hopes of saving the immediate cost. That’s because delaying care now can often result in more intense future treatment, with an even greater financial, health, and emotional impact. We’ve all heard horror stories like the one about a patient with a nagging cough who ignores their symptoms and eventually winds up in the hospital with pneumonia.
The overall point is that proper health insurance protects individuals from many of the financial consequences of care and hospitalization, and it is possible — even simple — to use health benefits while simultaneously keeping a lid on out-of-pocket expenditures.
With that in mind, following are a few tips worth sharing and discussing with your clients to help them keep a lid on future health care costs and use their current coverage more effectively.
- Switch to an HMO plan for greater cost predictability. For the past several years, people have been willing to pay more for PPOs in order to have access to bigger networks than HMOs typically provide. But for greater cost predictability, switching to an HMO usually provides fixed-dollar copayments instead of percentage-based co-insurance, making it easier to know the cost of medical services in advance. Plus, most HMOs have no annual deductibles.
- Look for an HMO that provides a narrow-network option. Some health plans offer smaller networks of cost-effective, quality providers in exchange for significant premium breaks.
- Use medical professionals within the health plan’s network, where copayments are lowest. Copayments are lowest when clients use health care providers within their health plan’s network. Using out-of-network providers typically results in higher copayments, or sometimes no coverage at all.
- Use preventive care benefits to stay healthy. Blood pressure and cholesterol checks, mammograms, pap smears, prostate exams, diabetes and cancer screenings, physicals, and similar services can keep policyholders from developing preventable conditions and can keep previously undetected conditions from getting worse.
- Call your doctor first instead of heading to the emergency room. Using a hospital emergency room for non-urgent care usually carries a higher copayment than a doctor’s office visit. So when your client needs medical treatment for a non-emergency, your client should first call their doctor, who can decide if they should come to the office, visit an urgent care center, or go to the emergency room. After hours, most doctors leave instructions on voicemail or with their answering services and can be paged.
- Use a mail-order pharmacy program. Many health plans offer a combination of cost savings and convenience through mail-order delivery of maintenance medications. Some plans provide up to 90 days of mail-order medications for the same copayment as a 60-day supply from a retail pharmacy.
- Go generic and save. Generic drugs are most often a lower-cost alternative to their brand-name counterparts — and they work the same way, according to the Food and Drug Administration.
- Take advantage of health coaching, health education, wellness benefits, and other free tools and resources. Many health plans offer free health coaching programs, health education materials, and wellness benefits. Professionally trained health coaches who are available 24/7, online health assessments, educational print and video materials, gym memberships, treatment cost estimators, medical group quality comparisons, and smoking cessation and weight management programs are just a few of the many resources available.
- Use discounts for health-related expenditures. Many health plans offer discounts on health-related products and services, such as athletic footwear and apparel; child safety products,; eye exams, eyewear, contact lenses, and vision correction surgery; fitness clubs; healthy living books, magazines, and videos; hearing aids and screenings; massage therapy; vitamins, herbal supplements, and other natural products; and weight-loss programs.
The bottom line is that it can be easy for clients to take care of their health while managing out-of-pocket costs, and each health plan has tools and strategies for helping their members be cost-conscious consumers of health care services.
Gina Stassi is commercial officer for Health Net Inc. She can be reached at 818-676-6310.