US Health Insurance Basics

us-health-insurance-basics

Health insurance in the US is complicated. Whether you are new to selecting and using your own insurance plan or are trying to maximize the benefits from a plan you’ve had for a while,  the tips below can help you get you started. 

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TIP #1: CHOOSE THE HEALTH INSURANCE PLAN THAT MAKES SENSE FOR YOUR HEALTHCARE NEEDS, NOT NECESSARILY THE PLAN WITH THE HIGHEST OR LOWEST MONTHLY PREMIUM. 

Choosing the right healthcare plan at the start of the year can save you thousands annually. Instead of only looking at the monthly premium cost OR the plan benefits, consider the two together.  If you rarely use healthcare, it is almost always cheaper over the year to sign up for the plan with lower monthly premiums. If you expect to have a surgery, or go to the doctor more regularly, you may want to consider a plan with a lower deductible and higher premiums. Remember, premiums are fixed costs you pay every single month, even if you don’t ever go to the doctor. Learn more about the different types of health plans and how to choose the best plan

TIP #2: YOUR HEALTH INSURANCE MAY HAVE MANY HIDDEN DISCOUNTS AND BENEFITS. 

Did you know you can use your health insurance to get discounts on yoga mats, meditation apps, skin care creams, nutrition plans, FITBITs, massage therapy, Lasik vision correction, and more? Did you know you can use your HSA and FSA money to buy tons of great items that you use every day? Check out the links in the paragraph for more details!

TIP #3: THE EMERGENCY ROOM IS MUCH MORE EXPENSIVE THAN AN URGENT CARE.

Emergency rooms (ERs) are the most expensive places to get healthcare. Unless you have a TRUE emergency, it is in most people’s financial best interest to try to see a primary care doctor or go to an urgent care instead. Emergency room visits can easily cost $2,000+ and you will have a longer than necessary wait.

Learn more about the ER here:

TIP #4: IT IS OKAY TO GET A SECOND OPINION, AND IT IS ALMOST ALWAYS COVERED BY YOUR INSURANCE AS ANOTHER DOCTOR VISIT. 

Doctors are highly-educated, very experienced professionals who commit to giving you the best care possible. That being said, not every doctor gets it right all the time and their approach might not jive with what you want out of your healthcare. If you ever feel confused, uncomfortable, or unsure of a diagnosis and next steps, it is appropriate to ask questions and to seek a second opinion. Many people believe that their insurance may not pay for a second opinion, but in reality, the visit is typically just billed to your insurance as another primary or specialist visit. For the best experience, look for a specialist from a different practice, and ask while scheduling if they will see a new patient for a second opinion. 

Learn more about how to be a great patient and how to find a second opinion here.

TIP #5: YOU CAN HAVE YOUR LAB, IMAGING, OR SURGICAL ORDER SENT TO ANY FACILITY, NOT JUST THE ONE THAT YOUR DOCTOR RECOMMENDS. 

Doctors tend to send orders to facilities they know and have established relationships with. That doesn’t mean they are in your insurance’s network, it doesn’t mean they have the best quality, and it certainly doesn’t mean they can do the service for the best price.

Before you go anywhere for a service, make sure they are in-network and call to ask about the pricing. If you don’t like either of the answers, look for a different in-network provider that can perform the service you need. Learn more about how to shop around, and check out these online lab options!

TIP #6: REVIEW YOUR MEDICAL BILLS BEFORE PAYING THEM.

Don’t pay your healthcare bill until you’ve compared it to the Explanation of Benefits (EOB) from your insurance plan. Misbilling is a common problem, and you could potentially save hundreds of dollars by waiting to confirm that the EOB and bill match. Learn more about what to do with an unexpected medical bill

TIP #7: HEALTHCARE IS UNDERSTANDABLE ONCE YOU FIGURE OUT THE BASICS.

Healthcare can be confusing, but so are investments, taxes, the stock market, old literature, Excel formulas, foreign languages, and politics. Once you understand the basics of how your healthcare plan works, you will be able to ask some foundational questions that empower you to be a better healthcare consumer, potentially saving yourself thousands of dollars each year. Start by reading your insurance summary of benefits to understand what your deductible is and what services apply to the deductible vs copays. At each appointment or service, ask your provider’s patient financial specialist to explain how your benefits apply to these services, or call your insurance at the number on the back of the card. You’ll find tons of helpful resources here:                                                   

TIP #8: A PROCEDURE, LAB WORK, IMAGING, OR OFFICE VISIT HAS A DIFFERENT PRICE EVERYWHERE. SHOPPING AROUND IS IN YOUR BEST INTEREST. 

Procedures and imaging can range from less than $50 to several thousands depending where you go. Office visits (for those on a high-deductible plan) usually range from $60-$600. Learn how to shop around here, and check out the options for online lab work here!

TIP #9: EVERYTHING THE DOCTOR OFFERS AT YOUR ANNUAL PHYSICAL MAY NOT BE FREE.

Under the ACA, annual physicals with in-network providers are free to the patient, as they are billed with unique “preventive” codes. However, if you are at your physical and start to tell the doctor about your sore throat, your aching back, or your fatigue, this changes the coding from preventive to diagnostic as the doctor is now diagnosing your ailments.

This applies to labs in the same way. The idea of preventive lab screenings is that the doctor is screening for something that you aren’t already diagnosed with or seeing symptoms for. If you have a documented and known condition (such as diabetes), the doctor cannot run a preventive glucose test for diabetes. If you express concern about several symptoms commonly associated with heart disease, your cholesterol test (included in the lipid panel) will not be billed as preventive. Learn more here. If you are interested in getting lab testing that is not covered by insurance, check out these at-home lab testing options

TIP #10: IT IS IN YOUR BEST FINANCIAL INTEREST TO SEE IN-NETWORK DOCTORS WHEN POSSIBLE. 

Your costs will be much lower if you see an in-network doctor because your insurance company has negotiated a lower rate with them, and any of your costs will be applied to your in-network deductible or copays. This is especially true if you might meet your out-of-pocket maximum. Once you meet your out-of-pocket maximum, the insurance company will cover all medically necessary costs as long as you see in-network providers.