Category: Know Your Benefits

Save Money Researching the Cost of Healthcare

If you have the time, researching the cost of a healthcare procedure before your appointment may save you money, or at the very least ensure you aren’t surprised when you get the bill.

When dealing with a health condition, people can be consumed with their health as it may be a crisis or unexpected news. We’re more concerned with the implications of a diagnosis on our health than what it may cost us. For some, it’s the cost that will prevent them from taking the next step and getting the necessary treatment. That’s the time to pause and confirm what may be ahead of us financially. Having a clear picture of out-of-pocket costs can help to remove stress and allow you to focus on making the right decisions about our treatment.

Take radiology for example. The cost of an of x-ray can vary by provider. Health insurance plans negotiate the cost of procedures by provider in a given region further modifying the cost of a procedure. Many factors influence the negotiated price such as volume of care, clout and geographic area.

You may find if you’re willing to do a little research, you could save yourself a few bucks. You may need to travel a few miles, but the cost difference may be worth it. Often, we’re referred by our primary care doctor or specialist to a particular facility because they may be part of their network or practice. Don’t feel obligated to go where your doctor says you should go if your research uncovers a better negotiated price at another facility. Let your doctor know your situation; they should be understanding.

Use the Cost of Care Search Tool Offered by Your Insurance Plan

Most health insurance companies provide a search tool on their website allowing you to search for the cost of care for a particular procedure, and also give you a listing of providers in your zip code area who offer that procedure along with the cost. It’s essential that you ask your doctor for the full description and CPT Code of the procedure. The search tools require you be specific in your search. Otherwise, you may get incorrect results.

When you find the cost estimate from the online search tool, it typically applies the negotiated rate and any plan design features including whether you’ve met your deductible, giving you an estimated out-of-pocket cost for the procedure. If getting that test or procedure at another facility can save you money, go back to your doctor and ask them to give you the referral to that new facility. Your doctor will still get the results of the test sent back to them.

Use your EOB for Prior Costs

If you’re planning to get a test or procedure you received in the past, check out how much it cost. The EOB, or Explanation of Benefits, is the statement created when a claim is processed by your insurance plan. Log into your account on the insurance plan to search for old EOBs. If more than a year or two ago, the cost could go up due to inflation or other factors, but at least it can give you a ballpark to estimate the potential cost if performed by the same provider.

Price Transparency Tools

Over the past few years, efforts to increase price transparency to patients has yielded new sources of information the cost of care. While your insurance plan will provide the most accurate estimate on cost of care, there are other sources which can offer estimates which are not necessarily based on your specific health plan, but will offer an average cost of care.

Fair Health provides provides tools to estimate the cost of care based on claims for medical and dental services paid for by private insurance plans, including the country’s largest insurers.

Clear Health Costs is a journalism company from New York City bringing transparency to the health care marketplace by telling people what stuff costs using shoe-leather journalism, data journalism, investigative reporting and crowdsourcing.

Guroo.com was created by the Health Care Cost Institute (HCCI), an independent, nonprofit research organization. Guroo is powered by claims data contributed by some of the nation’s key health insurance providers. 

GoodRx helps you search for drug prices at different pharmacies and provides coupons. Insurance is often not used in conjunction with GoodRx.

Blink Health and BlinkRx offers discounted prescription prices on medications and can analyze your insurance, copay, and deductible to find your lowest prescription price.

Review and Compare

At the end of the day, you are in the drivers seat of your health care. Being health insurance literate means understanding your choices, finding the right care and knowing what your costs will be. You may not have the luxury of time to research costs in advance. Ask the doctor’s office or treatment facility what the potential cost may be. They should be able to provide that, especially if they are In-Network with your insurance. You can always call your insurance plan and ask them for insights on costs.

What is Health Insurance Literacy?

What is Health Insurance Literacy?

Are you health insurance literate?  People’s literacy lies on a spectrum of knowledge with the majority skewed to the least literate side.

Do you have the knowledge, ability and confidence to find and evaluate information about health plans, select the best plan for your own (or family’s) financial and health circumstances, and use the plan once enrolled?

There is common agreement by scholars, researchers and benefit industry professionals upon this definition, but what does this truly mean for the individual who has health care needs?  Following summarizes the key behaviors of a highly health insurance literate consumer:

  • Able to compare the key features of several health plans; understand the scope of covered services and the cost-sharing provisions associated with broad categories of services;
  • Assess the adequacy and fit of the provider network of his or her (or family’s) health and financial circumstances;
  • Assess the quality of each plan in terms of measures that are important to him or her, such as processing claims or customer services;
  • Understand Explanation of Benefits (EOB);
  • Understand his or her appeal rights; and
  • Know where to turn for more information and help

Additionally, knowing how to find a doctor, fill a prescription, how to use and pay for that medication, and understanding the health provider’s explanations are all essential measures of health literacy. 

Translating these concepts into behaviors that yield positive results is challenging enough without the healthcare system presenting unexpected obstacles.  In the end, we want our health insurance to cover the health services we receive and according to the plan design we pay for.  Low levels of health insurance literacy can result in unexpected and higher out-of-pocket costs, or the delay or avoidance of healthcare altogether.

Consumers must embrace their individual responsibility to make independent informed healthcare decisions. Stepping up their game and becoming more health insurance literate will improve their financial and healthcare outcomes.

Annual Benefits Open Enrollment: Seven strategies to make good decisions

Annual Benefits Open Enrollment: Seven strategies to make good decisions

Here are seven things to know to help you make good choices during your annual Open Enrollment period.

1. Review your current elections. Take inventory on what you’re enrolled in now. Refresh yourself on your current elections. Do you remember why you made your elections and whether still valid or relevant?

2. Participate in communication offered. Take advantage of communications, benefit sessions, FAQs, Webinars, and any other resources offered by your employer or insurance plan to become informed. Read the materials made available to you and compare to what you have in place now. You may have to dig into the insurance plan or employer website to find out more. Call your HR or insurance contact just to chat and ask questions. Unless you ask, you may not know what’s really changing. Health insurance literacy can be learned.

3. Account for any life changes that occurred over the past year or expect to happen in next year. This can influence your decisions. Here are some examples:

-A child reaching maximum age eligibility for your plan. Make sure your overage child has been removed from your health plan and that you’re paying the correct payroll contribution for enrolled family members. Systems may not automatically account for a change in coverage tier (Family to Employee plus Spouse, for example). Also, your overage child may still need health insurance. Find out how to obtain COBRA coverage when that occurs, or evaluate your options through http://www.marketplace.gov.

-Spouse gaining or losing other health insurance, recently married or a divorce. If you missed an opportunity to add or remove a spouse mid-year, open enrollment is the time to make this adjustment, and usually without having to provide documentation.

-Changes in child care or day care expenses. COVID-19 has changed the landscape for the use of child care. Temporary laws have made it easier for employees to change contributions to a Dependent Care Flexible Spending Account. Estimate whether you need to continue contributions for child care or day care expenses.

-Eligibility for Medicare. Turning age 65 has a host of health insurance questions. Find out whether your eligibility will change when you become Medicare eligible. You may not have to enroll in Medicare Parts A/B if still enrolled in your employer plan. Why pay for Medicare if not financially beneficial? The transition to Medicare may require further in-depth conversation with your employer’s benefits experts or Social Security.

4. Assess your healthcare needs for the next year. Ensure you and your family are enrolled in the right plans that fit your needs. What plans or benefit options are being offered for the next plan year? Did payroll contributions or premiums go up? Is your current insurance plan adding or removing any new benefits or items covered? Do you expect to have surgery or significant medical or dental expenses requiring a change in your plan options to maximize things? Asking yourself a few simple questions can uncover things you weren’t considering before.

5. Evaluate your contributions to a Health Savings Account or Healthcare Flexible Spending Account. The IRS limits for an HSA can increase from year to year. For example, in 2022 the limit increases to $3,650 for single coverage, and $7,300 for Family Coverage. Contributions to your HSA are a great way to reduce your overall taxes and save for future healthcare expenses which can be paid for using tax-free money. Plus, unused HSA funds roll over into future years. The healthcare FSA contribution limit for 2022 is $2,850.

6. Do you know the dates for Open Enrollment? This may be a simple thing, but can have significant impact. Employers or insurance companies or offer specific date ranges for when you can submit changes to your benefits each year. If you miss these dates, you’ll probably forfeit the opportunity to change unless you have a Qualifying Life Event next year like a marriage or a birth.

7. Check your paycheck and savings account to ensure your YTD contributions are as expected. Sometimes errors happen, contributions are missed, systems are not updated. If you find an error after the current calendar year/tax year ends, it may be hard or impossible to correct.

Are you engaging in consumer behaviors to get the most value of your healthcare spend?

Are you engaging in consumer behaviors to get the most value of your healthcare spend?

Ever since High Deductible Health Plans (HDHPs) emerged on the health insurance scene combined with the myriad of savings accounts as solutions to stem the increase in health care costs, an underlying and essential ingredient for success also poured into the mix.

We would need people to engage in the right kind of consumer behaviors in order to help slow down or decrease health care trend.   If people felt like they were in control of their health insurance and of the money being spent on their health care, then they might would be motivated to change their behavior to make cost-effective and quality-related decisions on their treatment.  Could they get the most value for their out of pocket spending?

Results are in.  The vast majority of people have not been engaged in consumer behavior as it relates to their health insurance and health care, and the future doesn’t look good.  While 40% of privately insured Americans are enrolled in a high deductible health plan1,  all Americans could potentially benefit in the long-run from engagement in consumer behaviors.

What exactly are these consumer behaviors?

  • Saving for future health care services
  • Discussing costs with a provider
  • Comparing prices
  • Comparing quality
  • Trying to negotiate a price

The March 2019 edition of Health Affairs published the results of a comprehensive study illustrating opportunities to enhance consumer behaviors.  As a benefits professional, I can attest at least anecdotally and empirically that there are significant opportunities to enhance consumer behaviors.  Generally speaking, each of these five consumer behaviors are aspirational, at best, given how our current health care system is designed.

The financial burden most Americans experience when faced with health care issues is real.  Conquering health insurance is at the crux of it all.  Americans enrolled in these HDHPs are on the hook for a lot of the out of pocket, at least initially, because of high deductible levels.

As of 2020, a medical plan is considered a HDHP if it has a minimum $1,400 individual deductible and a $2,800 family deducible.  Minimum.  We know from the 2019 Kaiser Family Foundation’s Employer Health Benefits Survey that the average deductible is actually much higher.

 

HDHP

with an HRA

HDHP

with a HSA

Average Employer Contribution

HRA – HSA

Individual Coverage

$2,583

$2,476 $572 – $1,713
Family Coverage $5,335 $4,673

$1,062 – $3,255

 

Health Reimbursement Arrangement (HRA):  Health Reimbursement Arrangements (HRAs) are employer-funded group health plans from which employees are reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year.

Health Savings Account (HSA) A Health Savings Account (HSA) is a tax-exempt trust or custodial account set up with a qualified HSA trustee to pay or reimburse certain medical expenses you incur. You must be an eligible individual to qualify for an HSA. Please visit the IRS site to learn more.

According to Kaiser, only 30% of Americans enrolled in a HDHP have either the HRA or HSA included. This means that another 10% of those enrolled in a HDHP do not have the luxury of an HRA or HSA. Having these types of savings vehicles allows for individuals and employers to make tax-advantaged contributions to help offset the out of pocket costs associated with the first-dollar responsibility a deductible requires each of us to pay.

It’s great that some employers deposit funds into savings account to help offset costs. However, the majority of Americans do not benefit from this strategy. Additionally, people with significant health care issues typically have out of pocket costs that go well-beyond their deductible.

Why are so few Americans engaging in health care consumer behaviors?

A number of challenges and impediments are faced by patients, providers and health care systems adversely impacting people from deploying the right consumer behaviors.

Patients who face high cost-sharing may forgo medical services or may not fill a needed prescription.  This can limit adherence to treatment, reduce the chance of health improvements, and even result in even more costs.  Health care providers would then see debt due to uncompensated care.  What often happens in the U.S. health care system in these situations is a transfer of costs over to those Americans who can pay their bills or to health insurance plans in the form of higher premiums subsidized; services are inflated to cover the uninsured or uncompensated services.

Health insurance literacy among Americans is low.  People are not always aware of what services are subject to their deductible, what is routine or considered chronic care. As a result, they are not able to predict or expect what their costs may be in the future.

One could also argue that it is not realistic for a person to actually choose where to get their treatment performed, let alone shop for the best price.

Shopping for the best price requires access to price comparison tools.  While health insurance carriers may offer online tools, this requires we also know what we’re researching in the first place. It’s not very common for a medical provider to offer an itemized bill in advance.  If they did, then maybe we could properly search costs using CPT or procedure codes. Even then, medical treatment often involves multiple providers, facilities, testing labs, and ancillary providers.  It’s not realistic to expect anyone to pull all of this together while also managing their own health to understand their total cost picture.

Providers must also be willing to negotiate. Enough said on this point.

The impediments of consumer behavior go beyond having tangible tools and practices in place to assist people.  Personal or psychological barriers to consumer behavior are at play.   The perception of futility is very real and can influence one to feel apathetic to the whole process. They may feel that their engagement in the first place would not have changed their decisions or outcomes.

The other 60% of Americans enrolled in a medical plan that isn’t a HDHP would still benefit from consumer behaviors that could lead to getting the most value out of their plan.  These Americans could still be required to pay large sums of money out of their pocket, whether through deductibles, coinsurance, and copays, as well as through ever increasing payroll contributions just to be enrolled in the plan.

What can be done to enhance consumer behavior?

Right now, emphasis is on the consumer to change their behavior and take control. Unfortunately, until the system changes, people need to do their homework, pay attention and ask questions of their providers and health insurance plans.

Employers and health plans can do more to promote, educate and facilitate health insurance literacy.

Health care providers could develop practices to engage patients on the costs of treatment options.

 

Notes

  1. A Survey of Americans with High-Deductible Health Plans Identifies Opportunities to Enhance Consumer Behaviors, Health Affairs March 2019.

 

Understand your health insurance  coverage for COVID-19 treatment

Understand your health insurance coverage for COVID-19 treatment

Health insurance companies are taking proactive and supportive positions when it comes to COVID-19.  According to public announcements made by many of the national insurance carriers in the United States, the cost of testing for COVID-19 may be covered at 100%.

What type of treatment and services should I expect to see billed to my insurance?

All of the major insurance companies, including Medicare, have indicated they will cover the cost of testing at 100%.  This means no co-pays or coinsurance, and not applying the fees towards your deductible. LabCorp, one of the largest clinical networks in the world, may charge around $51 to provide the results of the test.  Insurance companies are scrambling now to setup their systems to accept new claim codes for the COVID-19 test.

Beyond covering the lab testing itself at 100%,  you may see variations at each insurance carrier on what and how they are covering treatment related to COVID-19.  Even within each insurance company, employer groups may decide to cover services differently.  For example, self-insured medical plans can opt-out of paying for the COVID-19 testing at 100% and require that you contribute your co-pay or coinsurance. While most probably won’t opt-out, it’s prudent to know whether your employer group is self-insured and if they plan to opt-out of covering this test at 100%.

COVID-19’s affect on the economy may trickle down into people’s pockets if they get sick and require sustained medical treatment.  You may feel that it’s not your fault you got COVID-19 and don’t want to bear the cost of treatment.  It’s not uncommon for people to have large medical plan deductibles where they have to pay upwards of $3,000, $4,000 or more before the plan starts to pay.  Given that we’re at the beginning of the calendar year, most people probably haven’t met their annual deductible yet.

While it’s financially beneficial to covered members if a health insurance plan covers the cost of testing, people may wonder how their health insurance will cover treatment if they get sick from COVID-19 and end up in the hospital or needing extensive treatment.  At this point, it appears your health insurance plan will cover such treatment the same as any other illness or diagnosis.

For a limited time, you may also see insurance carriers do the following to support customers:

    • Waive customer cost-sharing for office visits related to COVID-19 testing

    • Waive customer cost-sharing for telehealth screenings for COVID-19

    • Makes it easier for customers to be treated virtually for routine medical examinations by in-network physicians

    • Waive early 30-day refill limits on prescription drugs

    • Provide free home delivery of up to 90-day supplies for Rx maintenance medications available

    • Offer supportive resources for customers, clients and communities for managing anxiety and improving resiliency (EAP)

If you do get sick from COVID-19 and need to be out of work for an extended period of time (say more than a week), you may want to consider applying for short term disability benefits. Your employer or state-funded disability plan may pay a portion or all of your salary while out on an approved short term disability.  A COVID-19 diagnosis may require a quarantine period of 14 days which could meet the definition of a disability under your plan. Ultimately, your doctor would certify your health status for disability claims.

To learn more about what your health insurance is doing, visit their website, call them directly or contact your Human Resources/Benefits Department. Here are links to several of the major national health insurance companies and their public positions on COVID-19.

Cigna

UnitedHealthcare

Aetna

Blue Cross Blue Shield

Kaiser Permanente

Medicare