Understanding health care terminology can be challenging. It can be difficult to grasp how a health plan operates and potentially hinder cost savings. How can one maximize benefits while minimizing out-of-pocket expenses? Increased knowledge leads to greater savings.
Follow seven steps to reduce health care costs.
Deductibles
The deductible is the amount of up-front, out-of-pocket expenses to be paid before a plan starts paying for covered medical expenses. Deductibles are calculated per person and per family (if covered by the plan), and the yearly deductible calculation begins when the plan starts (usually January 1).
Co-insurance
This cost-sharing agreement with a provider is the percentage of eligible claims to be paid after the deductible is met. For example, if a patient has a $1,000 bill and the co-insurance benefit is 20%, the plan will pay $800, and the patient will pay $200 to satisfy the bill. Co-insurance ratios vary according to plan; for example, some plans have an 80%/20% formula.
Choose a Plan Based on Health Needs
When selecting a health plan, consider how much is typically spent on health costs per year. Then, estimate the cost of any anticipated family or health changes for the following year. Also, factor in the plan’s monthly cost to select a deductible and co-insurance that best fit the budget.
A co-pay is a fixed amount of money paid to receive a health care service, such as a doctor’s visit. These co-pays do not apply toward the deductible and vary depending on the service.
For example, co-pays for specialist visits may be higher than those for routine visits to a primary health care provider. Similarly, co-pays for urgent care visits can be lower than those for emergency room care.
The co-pay is generally paid at the time of the office visit. If a provider performs services or orders tests, the patient may also receive a bill (separate from the co-pay) after the visit. Benefits for those services or tests are calculated according to the deductible and co-insurance mentioned in Step 3.
To budget accordingly, ask questions to understand what’s covered by a co-pay, including prescription medications. If a health care provider orders tests or additional services, ask about the cost and how it’s covered by the plan to prevent being caught off guard by a large bill later.
Health plans include a maximum out-of-pocket amount (MOOP), which limits the total amount to be paid for covered services per plan year. This cap protects user’s finances from the high price of a catastrophic claim by limiting their responsibility.
The MOOP is calculated per individual and per family (if they are covered by the plan). Once the MOOP is met, the health plan begins to pay 100% of covered services.
When budgeting for health care, keep in mind that total out-of-pocket expenses for in-network services are limited.
An in-network provider is a doctor, pharmacy, hospital or other health care provider who has agreed to provide services or supplies at a discounted rate. Using in-network providers can save money, so ask providers if they are in the plan’s network. On the contrary, obtaining services from out-of-network providers can cost more or, in some cases, will not be a covered benefit.
If enrolled in a GuideStone® health plan, you may look up your providers using Highmark® Blue Cross Blue Shield’s online find a doctor or pharmacy tool (login required).
Most health plans are required to provide preventive care services at no additional cost. Utilizing these services increases the likelihood of early issue detection, potentially saving money and promoting optimal health.
If enrolled in a GuideStone health plan, download your Preventive Schedule and arrange preventive care visits accordingly.
Save on prescriptions by requesting generic medications — just as effective and safe as brand-name drugs — but at a lower cost. If taking maintenance medications, switching to a 90-day mail-order prescription may offer savings (plus get the added convenience of shipping straight to home). It also pays to shop around because medication prices vary across pharmacies and retailers. Find more ways to save on prescription drug costs.
Similar to prescription medications, health care service costs can vary across health care providers and facilities — sometimes by thousands of dollars. The time spent comparing costs can help save money.
If enrolled in a GuideStone health plan, members can earn cash rewards for shopping for health care services through SmartShopper®.* This money-saving program helps find competitive medical service prices — without compromising quality — and offers incentive rewards.
Learning how a plan’s basic components work can help people maximize their benefits and be good stewards of their finances. Understanding these components can also aid in choosing the right plan for the budget during enrollment season.
At GuideStone, our vision is for every servant of Christ to finish well. That’s why we advocate for your well-being at every point in your health care journey. If you are not a GuideStone health plan member, we’ve designed plans to protect both individuals and groups — all built on biblical values. For more information, contact us at Insurance@GuideStone.org or 1-844-INS-GUIDE (1-844-467-4843), Monday through Friday, from 7 a.m. to 6 p.m. CT.
GuideStone welcomes the opportunity to share this general information. However, this article is not intended to be relied upon as legal advice, medical advice, diagnosis or treatment.
*SmartShopper is not available with Blue High Performance Network or Medicare-coordinating plans.
Article 