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.
High-deductible and other consumer-driven plans may encourage people to become more engaged in making health care decisions, as they now have a greater, more direct financial obligation for their care. And health plans and employers are providing employees access to information that may enable for a more seamless, coordinated health care experience.
To help people maximize the value of their 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, copayments, 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. Knowing this information can help prepare you to ask questions and avoid any potential surprises in your medical bills. In addition, some health plans offer 24/7 access to a nurse line for information about care options, to help locate the nearest in-network care provider, and to determine what support programs may be available, such as smoking cessation, diabetes management, and incentive-based well-being initiatives.
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. In fact, families could save $4.4 billion annually by choosing an urgent care, a doctor’s office or an online virtual visit – depending on the medical issue – instead of an ER when seeking non-emergency care, according to the National Institutes of Health.
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.
* The information provided is for general information purposes only and is not intended to be nor should be construed as medical advice or a substitute for your doctor’s care. You should consult with an appropriate health care professional to determine what may be right for you. In an emergency, call 911 or go to the nearest emergency room.
 Families USA report, Price Transparency in Health Care, 2014