Every January, individuals should review the details of their health insurance plan. This is particularly important for those who’ve made changes or switched carriers from the previous year. Understanding new deductible requirements and prescription drug coverage can help reduce or eliminate unnecessary costs. Here’s how to navigate a health plan and keep care affordable. Choose an HMO: Certain plans, specifically health maintenance organizations (HMOs), allow members to minimize out-of-pocket costs by meeting with their primary care physician and completing a health assessment early in the year. For example the Healthy Blue Living HMO requires patients to visit their primary care provider within the first 90 days of coverage. Learn the difference between high/low deductible plans: A deductible is the amount an individual will pay out-of-pocket for health care before insurance begins contributing to the bill. Understanding this helps members to better anticipate expenses throughout the year.
- A high deductible plan has a low monthly premium but higher out-of-pocket costs. These members have the option of opening a health savings account (HSA) to supplement medical, dental, vision and pharmacy expenses. Online contribution calculators are available to explain how HSAs work in different situations.
- A low deductible plan has a higher monthly premium but lower out-of-pocket costs. Paying more upfront offers expansive coverage with predictable pricing.
Research prescription drug options: Even if a health plan includes prescription drug coverage, there are still ways to receive additional savings. Here are some tips on managing pharmaceutical costs:
- Bill the correct insurance: Make sure medications are billed and covered under the right plan. Check what drug tiers are included to determine potential copay or coinsurance. If available, some out-of-pocket costs may be paid using secondary coverage.
- Buy in bulk: Individuals with ongoing prescriptions should opt for a 60- or 90-day supply of medications. This limits pharmacy visits and minimizes copays.
- Buy generic: These drugs aren’t name-brand but can deliver the same results at a fraction of the price.
- Combine doses: It’s much less expensive to take one pill instead of two. If possible, ask a primary care physician to prescribe a stronger dosage that can be taken less frequently.
- Review the drug list: Each insurance plan has a list or formulary consisting of drugs approved by the U.S. Food and Drug Administration (FDA). It informs patients of any special requirements or limitations such as quantity restrictions or a need for prior authorization.
Use price transparency tools: Due to federal health care reforms, individuals have more access to information about the cost of health care services. When planning for a major medical expense, like an MRI or surgery, the service location can affect the pricing. Consult with the insurance company and prospective institutions to gain cost estimates. Certain organizations have online tools available for members to compare doctors and facilities. If you found this post helpful, check these out:
- Surprising Perks Your Health Plan Covers
- Are Your Health Care Choices Costing You?
- Adulting 101: Figuring Out Health Insurance
About the Author: Rick Notter is the vice president of individual business at Blue Cross Blue Shield of Michigan. Photo credit: SDI Productions