navigation in choppy seas

The cost of healthcare is rising. Patients are having difficulty affording out-of-pocket costs for recommended drugs and treatments. Retirement savings are being tapped into for the purpose of paying for healthcare costs.

How did we get here?

What can patients do?

90 years ago, the first employer-sponsored hospitalization insurance plan was created by teachers in Dallas, Texas. President Lyndon B. Johnson signed the Medicare and Medicaid programs into law in 1965. Over the next 50+ years, the health insurance industry has become increasingly more expensive, more complex and more difficult for patients to navigate.

Rising monthly premiums, more prior authorization requirements,  increasing medication, procedure and ancillary service denials, and unaffordable out-of-pocket costs are all contributors to this complexity. This creates confusion for patients as they navigate the healthcare system.

Some pointers:

      Understand your healthcare insurance policy as it is a contract between you and the health insurance company. Take the time to learn and understand the following terms: individual deductible, family deductible, co-pay, co-insurance, annual maximum allowable. Remember, your healthcare provider does not know the intricacies of every health insurance policy.

      Understand what is and isn’t covered under your plan.

      If your plan is employer-based, take the time to meet with a Human Resources representative from your company in order to better understand your policy.

      Establish an HSA (health savings account) with deposits from your pre-tax income that can be used to pay out-of-pocket healthcare expenses. The unused balance may be rolled over annually. Understand which out-of-pocket expenses may be paid from an HSA.

      Shop around! There is considerable price variability between imaging centers, medical practices, labs, pharmacies, urgent care centers and hospitals for healthcare services--even within the same zip code. Price transparency exists for almost all consumer goods except healthcare. Ask about prices. If you can’t get an answer, then keep shopping…

      Ask about “care credit” whereby large medical expenses may be paid using a monthly installment linked to your credit/debit card, HSA or bank account.

      Ask about reduced prices for payment with cash rather than filing an insurance claim.

      For non-urgent care, I recommend doing your homework. Shopping for high quality, low cost medical care is worth it.

      And finally, take advantage of annual preventive services covered by your health insurance policy. Most preventive services are $0 co-pay. Be sure to mention any symptoms or concerns to your healthcare provider at the time of your annual exam.

Here’s to calmer seas…