For many people, the start of a new year is a customary time to assess their health and finances. And for most Texans, new health plan benefits begin in January, so now is an ideal time to learn how your health plan works.
Here are five tips that may lead you to better health and even help save you money this year and beyond.
Understand your health plan
It sounds basic, but understanding your health plan before you need to use your benefits can save you a lot of time, stress and money. Learn what your health plan covers – including medical, pharmacy and preventive benefits. When in doubt, call the number on your health plan ID card to get the most up-to-date information.
Also, it’s a good time to make sure you understand health plan terms such as deductible, copay, coinsurance and out-of-pocket limit. If you need a refresher, there are resources online such as the Just Plain Clear Glossary to help you learn and understand these terms.
Ask about lower-cost prescriptions
If you’re worried about the cost of a medication, mention your price concerns to your doctor who can help find the most appropriate and affordable option for you. Many doctors are now using technology that enables them to view precise medication costs in real time before leaving the exam room. You may be surprised to learn that generic medications often are more affordable, and just as safe and effective as their brand-name equivalents.
In addition, some pharmacy benefit plans now offer discounts at the point of sale by providing savings from pharmacy manufacturer rebates directly to consumers. These discounts could potentially lower your out-of-pocket costs on select medications.
Stay “in network”
One way to help keep costs down is to stay in your health plan’s care provider network, which consists of the doctors, specialists, hospitals and other care facilities with whom your health plan has contracted to provide health care services. Your insurance company has agreed to pay those health care providers a certain amount of money for your visits – usually a discounted rate. Because of those discounts, you usually pay less when you see a health care provider in the network vs. one who’s outside the network.
For out-of-network care providers, your insurance may cover only a fraction of the cost of care – or none at all – depending on your plan. Before you make your next appointment, check with your health plan to make sure the provider or facility is “in network.”
Know your care options before you go
If your health issue isn’t an emergency, visit your primary care doctor for care first. Your doctor knows you and your health history, can easily access your medical records, and can take care of many health needs, provide follow-up care or refer you to specialists.
If it’s not possible to visit your regular doctor, you may be able to receive fast, professional and lower-cost care at an urgent care center, a convenience care clinic or an online doctor visit. Online doctor visits are a great option for treating conditions such as colds, migraines and allergies. Online visits often can cost as low as $40 or $50 per visit, much less than a trip to urgent care or an emergency room.
Take advantage of wellness discounts and incentives
Many health plans now offer financial incentives that reward you for taking healthier actions such as completing a health survey, exercising, or meeting nationally recommended health benchmarks for cholesterol, blood pressure, body mass index, and no nicotine.
An increasing number of employers are offering wellness discounts and incentive-based wellness programs to support their employees’ efforts to help improve their health. These initiatives may also lead to increased employee satisfaction, productivity and reduced costs.