When it comes to paying for health care, consumers have more skin in the game than they did in the past.
Health-care costs have been on a steady rise and containing these potential budget-busting costs is a top priority among consumers, a survey shows. Americans ages 25-64 spent approximately $1,522 in out-of-pocket medical expenses in 2012, according to a new survey out of Aetna. What’s more, one in three dipped into their investments and savings to cover their health-care needs.
Health reform has sparked changes in plan design that may mean higher premiums, co-pays and deductibles for consumers. On top of that, the new world of consumer-directed health plans means employers are shifting more responsibility for plan and treatment choices—and for staying healthy—to consumers.
Changes can be intimidating, and understanding the current health care landscape may be overwhelming. But tools, information and knowledgeable resources are there for the taking, if you choose to take advantage of them, experts claim, and the only way to get on top of your expenses is to be engaged.
In fact, the survey says 37% of respondents look at their potential out-of-pocket expenses as the primary consideration when choosing a health plan. Plan/coverage options and doctor and hospital networks are now taking a back seat.
Health-care reform has made Americans more sensitized to wallet pressure at the drug store, the doctor’s office and even the gym, claim experts, and point to the early days of private exchanges when seniors’ buying behaviors made cost a key component in their purchasing decisions, and enrollees started buying lower levels of coverage with higher deductibles.
Drug costs, too, became a factor. Ten years ago when the Medical Modernization Act ushered in Medicare Part D prescription coverage, seniors learned that paying close attention to month-over-month drug costs and incorporating generics into their prescription regimens could help cut back on out-of-pocket expenses, an aid in particular when seniors found themselves in the coverage gap or donut hole. Bryce Williams, Towers Watson’s managing director of exchange solutions, says initially traditional formularies inside the firm’s client base allowed 72% to 74% brand to generic substitution. New tiers increased brand substitution to between 82% and 84%. That 10% jump was a big help in eliminating out-of-pocket expenses, Williams says.
Service Costs Vary
But in today’s health-care arena, all components of care factor into cost. Previously, consumers gave little or no thought to the segment costs of a primary care visit (e.g., labs, EKGs or a potential referral to a specialist). “Today, consumers may have some trepidation about understanding the mechanics of how a claim gets paid,” says Susan Kosman, Aetna’s chief nursing officer. But parts of the visit are individually billable and come with a variety of costs.
For example, a 24-hour lab inside a tertiary hospital has high operating costs that are passed through to the consumer, says Williams. The difference could be two to four times more than the smaller, independent lab down the street, he says.
Kosman says consumers need to be more aware of how their choices influence their costs and recommends patients scrutinize their Explanation of Benefits statement like a credit card bill to spot unnecessary overspending.
According to Kosman, using FSAs or HSAs can save consumers money in the longrun. So can online tools which can help provide cost estimates to help patients better budget.
And the proof is in their decisions: Kosman says Aetna’s research shows that after members use the insurer’s Member Payment Estimator and obtained cost estimates on one of more than 30 commonly selected health care services, they chose the provider whose out-of-pocket cost estimate was on average $170 lower than the average of the estimates they received. The Member Payment Estimator provides cost estimates and cost comparisons for more than 650 commonly used, nonemergency in-network health services.
Dr. Keith Davis, CEO/medical director of the Shoshone Family Medical Center suggests patients establish a good relationship with their primary care physician to openly discuss their treatment costs and to keep budget concerns part of the conversation.
For example, if a consumer is not sure of the full scope of a test being ordered, he or she may be blindsided by the cost of the bill. However, there’s a delicate balance between cost sensitivity and necessity.
Admittedly, the focus on cost can work against you, Davis notes. Patients sometimes avoid important preventive screenings and medical tests either because they don’t have insurance or are feeling the pressure of hefty copays. However, even choosing a less comprehensive test option may compromise predictive findings of early disease.
Davis points out the often-cited medical advice that everyone has a colonoscopy after age 50. Discussing family history with your PCP can help you establish risk and make a testing decision, he says.
If you want to take charge of your out-of-pocket health expenses, experts suggest these tips:
Be aware of your options. Some employers reduce premiums or provide discounts for gym memberships, community-based services or exercise equipment, and these options are often available at open enrollment, says Kosman. Look for them.
Buy-up to save money. A lower premium may be enticing, but the plan could bring unexpected costs down the road. “Buying up [from bronze] to silver might be a great deal,” says Williams. “For an extra $400 in premium, you might ‘get back’ $1,000.”
Understand the moving parts. Learn the nuances of deductibles, both for the individual and family on the plan, advises Kosman. Also, having clarity about the workings of your FSA or HSA company offering is imperative to an enrollment decision.
Know your pharmacy benefit. A lot of out-of-pocket expenses are captured in the medication it takes to manage your conditions. Generics save money as do mail orders, so ask your doctor for advice and plan accordingly.
Davis also cautions avoiding polypharmacy exposure and advises that you work with your doctors to limit your prescriptions to avoid redundancy or adverse drug interactions.
Compare delivery models. New delivery models like clinics, urgent care centers and patient-centered medical homes may present less costly alternatives to office or emergency room visits. Virtual visits can save time as well as money, Davis says.
Compare costs. Some facilities offer sliding fee schedules based on your income. And if you’re short on cash the day of the visit, some clinics will honor the discounted price as long as you pay in full prior to the billing date. “You won’t know if you don’t ask,” cautions Davis.
Get on a wellness track. Mental and physical wellbeing can keep you out of the doctor’s office. Job or life stress can be deadly, so forget about any stigmas and seek out counseling when necessary, advises Davis.
Keep talking. Continually ask questions to find cost-cutting alternatives and other treatment plans. “This is not easy stuff,” says Williams. “Be sure you talk to an expert.”