In years past, health plans worked with employers to help manage almost all health benefit decisions, leaving employees relatively unaware of the costs. Today, for example, employers and consumers are more frequently choosing plans with higher deductibles; more than 43 percent of Americans are enrolled in such plans, according to a recent study from the Centers for Disease Control and Prevention.
To help people maximize the value of your health plan and more effectively navigate the health system, here are strategies to consider:
Understand your coverage and go-to resources: Read your health plan’s summary plan description to understand what is covered so you’re aware of potential out-of-pocket costs, including premiums, co-payments, deductibles and co-insurance. If you are unfamiliar with those terms, or others, visit justplainclear.com, an online resource that features a glossary of common health care acronyms and concepts.
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Evaluate different care settings: People who experience a significant or serious medical issue should go to the emergency room (ER), but for those who need non-emergency care, other settings – such as an urgent care center, primary care physician, convenience care clinic and virtual visit – may be a more efficient and affordable option. For instance, visits to the emergency room can cost patients up to 10 times more than a visit to urgent care or other care settings, so making more informed decisions about where to go for care could save $1,500 or more per treatment.
Comparison shop based on quality and cost: More people are accessing online and mobile resources that provide health care quality and cost information, enabling consumers to comparison shop for care as they would other services. Some health plans give people resources to compare quality and cost measures for specific health care providers, with customized estimates based on actual contracted rates. This is important because health care quality and cost can vary significantly across the country and even within the same city, despite the fact that there is often little or no corresponding improvement in health outcomes for services performed by higher-priced care providers.
As people take greater responsibility for their health care decisions, considering this information may help save time and money while making the health system easier to navigate.