Strategies to Control Your Health Care Costs - Clinical
There are many things that consumers can do to lessen their health care costs from a clinical perspective. Here are some strategies:
- Talk to your provider about options: As an example, from 2004 to 2009 high tech treatments for prostate cancer (intensity modulated radiation therapy and robotic surgery to remove the prostate gland) increased significantly among men unlikely to benefit from the treatment. That is, their cancer’s were not life threatening or they were expected to die from something else. High tech treatments were done anyway that produced questionable benefits. Always explore with your provider other options that are available that may be just as effective without the added cost or clinical risk;
- Discuss the costs of drugs: For drugs, find out if generic’s are available. Also check to see if other types of drugs are equally effective for lower cost. Explore these options with your provider;
- Use your preventive services: An ounce of prevention is worth a pound of cure. Under the Affordable Care Act (ACA) prevention is one of the ten essential benefits. The law instructs insurers to provide all of the 50 preventive services recommended by the U.S. Preventive Services Task Force at no extra cost. For private employer plans and Medicare, read your benefit services and take advantage of the preventive care offered to you;
- Explore with your provider covered services: Covered services are tricky. You would think that if your provider requests a service, then it must be covered. Not so. My wife recently had a physical where a battery of lab tests were ordered. One of them was a calcium test that was not covered as part of her routine physical so we needed to pay for this separately. Check with your provider before tests are done to determine if they are covered. If they are not, then you can have a discussion with your provider as to their benefit and make an informed decision from there.
- Stay in Network: Many plans will charge you more if you use providers outside of their network. Before you pick a plan, review who is in the network and pick a plan that has the providers (like the doctor you currently use) that you want to use;
- Stay Healthy: One of the best ways to reduce the cost of health care is to take care of yourself. Exercise, proper nutrition, not smoking and other positive health habits will pay dividends in reducing the risk you take when you access the health care system.
Health care expenses have already surpassed yearly grocery costs for a typical family and continue to absorb a greater amount of household budgets. They cannot be eliminated but they can be controlled. Here are some financial strategies mainly for those who receive their insurance through their employer or who will buy insurance on the new health care exchanges:
Become knowledgeable about plan benefits: Under the 2010 Affordable Care Act (ACA), there will be four plans (bronze, silver, gold, platinum) for people buying insurance on an exchange. Each must cover 10 essential benefits such as prescription drugs, preventive care, etc. Most employer plans will also include these essential benefits --- take some time to review and understand what is covered.
Become knowledgeable about key insurance terms: A recent Carnegie Mellon study found that only 14% of study respondents could accurately explain four key health insurance concepts, namely: deductibles, copayment, coinsurance and out of pocket maximums. Here’s a link to help you understand these terms: www.bls.gov/ncs/ebs/sp/healthterms.pdf.
Become knowledgeable about your total costs: There are two components:
o The amount you will pay during a year for your plan (premium);
o The amount that you may pay for maximum out of pocket expenditures.
Estimating your premium is easy compared to out of pocket expenditures. For those with insurance, risks should be considerably lower under the new ACA. First, there will be no lifetime limits on essential medical expenses and second, out of pocket maximums for covered services will be limited to $6400 per individual and $12,800 per family per benefit period. To calculate your total cost (worse case scenario) take your premium and add it to the out of pocket maximum. For example, if an individual pays $3600 per year for a premium, then the maximum financial risk for covered services would be $10,000 ($3600 premium +$6400 out of pocket maximums). In general, the less a plan pays up front, the lower your premium. If you don’t need a lot a care, pick a lower premium cost plan but make sure that big ticket items (example, hospitalization, surgery, etc.) are in your covered services.
Explore provider costs: Finding out costs for complex care such as inpatient hospitalization for a surgical procedure may be difficult because the facility cannot accurately estimate all the care that you will receive. For more routine care (like a certain type of MRI, etc.), it will be easier. You can call to find out your cost given the insurance that you have. Comparison shopping is becoming more routine and acceptable in health care. Be sure to get the estimate in writing.