We're smack-dab in the middle of annual open enrollment for the Affordable Healthcare Act. Even if you are not signing onto “Obamacare”, you likely are in, or just went through, your company's open enrollment period where you can change your healthcare plan to (hopefully) better suit your needs in the coming year.
We definitely switched healthcare plans, coming off of a high-deductible one that offers no coverage or coinsurance until we meet the $5,000/person deductibles, and going into a higher-monthly premium plan through Paul's new employer. This plan will be effective January 1st, and will offer us much better coverage. Hurrah!
Coming off of a year with a high-deductible plan, I'd like to talk about ways for you to not lose the family farm if you're on one. Because let's face it, those medical costs can add up quickly, leaving you in no-man's land where you are not close to meeting your deductible yet–and still see hope that you won't by the end of the year–so you're on the hook for all of your medical bills.
Make Strategic Use of Urgent Care Locations
This crazy thing happened while we were on the high-deductible healthcare plan: my poor cat was attacked by a huge dog. I chased the dog off, and in an instinctive act of protection, I grabbed for Lyla Bear. But I should have let her compose herself, because she was lodged in attack mode and bit me deeply.
The four incisions, at first, looked fine. I immediately cleaned them off and used Neosporin on them. But within two days they became warm, inflamed, and infected (I later learned that cat bites are very dangerous).
Fortunately, I did what an insurance rep had advised me to when I asked him for ways to save money off our healthcare costs on a high deductible plan: I went to an urgent care facility instead of to my doctor's. A nurse practitioner saw me, did all the normal stuff, and prescribed me a generic antibiotic. The whole thing cost less than $150.
Leverage Free Elements of the Affordable Care Act
One of the best ways to keep your high deductible plan affordable is by taking advantage of some of the great elements of the Affordable Care Act. Since you have an insurance plan, you can get the following for free (you won't even owe a co-pay):
- Free Annual Physical Exam
- Free Annual Well Woman Exam
- Free Immunizations
- Free Screenings
On our plan, I still got to see my OB/GYN for the year without co-pay or a bill, and Paul went for an annual physical. We leveraged these offerings by scheduling appointments around when we had questions or concerns to ask a doctor anyway. While you shouldn't expect a doctor to offer outside of what is required for these free appointments, there is normally a small conference in the beginning where they ask if you have any issues or want to discuss something. Take advantage of this free time!
For more specific information about what benefits are free, even if you haven't met your deductible yet, check this link out.
Get One of You Off the High Deductible Plan
From talking with insurance reps, I found out some interesting info that could save you + yours some money. If there is one of you that tends to cost more — more prescriptions, more health needs, more at risk, chronic illnesses, etc. — then it could pay to shell out a higher monthly premium for that person to have a lower deductible.
Yes, members of a family can have more than one healthcare plan!Members of a family can have more than one healthcare plan! Click To Tweet
You can keep yourself and the other family members on the high deductible plan and hope that these tips + some luck help you to not pay the entire deductible out of pocket.
Save Up Enough to Cover the Deductible
This is great prevention for losing the family farm…even if you're rolling your eyes because you're wondering who on earth has their entire deductible amount in savings (we did, for the record).
When you sign up for your high deductible plan, you should choose one that you can cover the full deductible on for the people on the plan. So if the annual deductible is $5,000 per person, and there are two of you, technically you should have $10,000 set aside just for potential healthcare problems. Who knows if you might end up in the hospital, in an accident, or with some other surprise health problem that could easily eat up this amount. If you were liable for it, would you be able to cover it, and how?
Having these funds set aside is your cleanest option.
Ask for Lower-Costing Options at the Doc's Office
My husband needed to see a dermatologist for a skin issue that we thought could be serious. Fortunately for us, it wasn't. Still, it needed to be taken cared of with medication.
When he initially went to fill his prescription, Paul's mouth dropped at the staggering cost: $400+.
So you know what he did? He called up his dermatologist and explained the situation–that we have a high deductible and have to pay for all of this out of our pocket. The doctor willingly rewrote a prescription for a generic drug and sent it to our pharmacy. This was a huge savings to us!
If you find yourself in the same position (or before you find yourself in it, like when your doctor is grabbing his script), then don't be afraid to ask for the lowest-costing medication that will get the job done.
For Maternity, Ask for Specific Billing Options
Something else I learned while talking to the insurance rep could help those of you who are pregnant or are looking to become pregnant during the time you're on a high deductible plan.
Yes, through the Affordable Healthcare Act, all health insurance plans must now include maternity. However, some states have extended the time that people can keep their old, non-Affordable Healthcare Act abiding plans for another year — such as our state, Texas — and also, your are still liable to pay for all costs until you reach that deductible.Through the Affordable Healthcare Act, all health insurance plans must now include maternity. Click To Tweet
It turns out that some maternity appointments are considered preventative care. Hurrah! However, lots of doctors like to bundle all of the costs together into one lump sum when you deliver. So you may want to work with your doctor's office to see if they can bill the appointments considered preventative by your insurance company, separately. Otherwise, these appointments might get lost in the shuffle and you could end up paying for them yourself.
FYI: our insurance company mentioned that they have a list of which appointments are considered preventative, and that it depends on how the doctor's office codes the visits. So ask your health insurance company for a similar list to make things easier on your doctor's office (and ultimately to make it easier for them to save you money).
A final thought: I hope that you do not meet your entire deductible for the year, because that means your out-of-pocket costs were high (not to mention the fact that you had some health issues you're dealing with). But if you do happen to meet your entire deductible in a year and there's still at least a few weeks left, then take advantage of the situation. Are there appointments you can schedule in between the holidays instead of next year so that your insurance company can foot the bill instead of you starting at the deductible $0-reset in January? Is there a procedure you've been putting off, but can schedule in this calendar year to save yourself money now that your coinsurance has kicked in?
What kind of insurance plan do you have? Please share in the comments below, along with your experiences in saving yourself money. Who knows, you might really help someone else out!