By Katrina L. Coker, aka "The Scrum Mother," as told to Julie Davis
Professionally, I'm a scrum master within the field of project management. Scrum is a type of framework that breaks down a job into smaller tasks with regular team check-ins to keep things moving. I also have a master's degree in conflict management, and I was trained to find how to have win-win situations for everybody and solve real-world problems in the most efficient way. I've been able to use all these skills to navigate the complex world of health costs.
Having had health concerns since I was a teen, I've needed to access health care in a way that gets me the care I need at cost I can afford (well, most of the time!). I actually come from a family of medical professionals and have worked in medical offices, specifically on health authorizations and insurance verification authorizations – yes, even more complicated than they sound.
Recently, I've been able to apply what I've learned on my own about health care to my work, sharing my knowledge with teams in Human Resources Technology (the software development teams). This included information on benefits and compensation and the processing of selecting and enrolling in health care from an employee's perspective. I've also worked with leaders who were selecting the benefits to include for employees year to year. Here are my cost-saving or cost-conserving tips that will hopefully help you.
How to Evaluate Health Insurance Plans
If you work for a company that offers sponsored health insurance, take the time to investigate the various plans. Often there are two or more tiers with escalating benefits and escalating costs. You also can apply the following advice if you're shopping on the Affordable Care Act Marketplace. Note: If you work for a company that offers health care plans, you may not be eligible for the Marketplace.
The tendency for many people is to automatically choose the option with the lowest premium, but that often has a high deductible. It's impossible to predict the future, but if you're in good health, that could be an option, especially if you can add a health savings plan. But my advice is to be very careful: If you break your leg, for instance, it can end up costing you more than what you saved on the premiums.
Add up all the costs you'll be responsible for. Beyond the premiums, there's also the deductible – what you must spend before insurance kicks in. Even then, some plans pay only a percentage of the costs – such as 80%, with you picking up the other 20%. Though copays don't add up to that much in the scheme of things, note the copay for your primary provider and for any specialists. Another important number to look at is the maximum out-of-pocket cost. That's the worst-case scenario you'd be liable for in a catastrophic situation.
Look at all the benefits. Is there a free wellness visit and a well woman's visit? Are preexisting conditions covered? (They are in the Marketplace, but don't assume that's the case with employer insurance.) Since using in-network providers and facilities costs less, are your existing doctors and your preferred hospital in that network?
Evaluate any bells and whistles. See if the plan covers vision and dental. Some do, and some others have separate options you can buy. Look at the cost: Are dental exams covered? Are eye exams and glasses covered? What are the deductibles, and what providers will you need to see? Another important type of coverage is for mental health. Is there an employee assistance program or benefits like a membership to the Calm or BetterHelp apps?
Next, try to predict what your expenses could be in the coming year by adding up what you spent on health care in each of the last three years. Then think about any new needs. For instance, if you're hoping to become pregnant soon, you'll want maternity benefits. If you know that you're going to need a joint replacement, estimate what your costs will be.
If you don't feel comfortable making choices on your own, reach out to an experienced friend or family member you trust or even to an insurance broker to ask for help.
A note about COBRA: If you find yourself – as I did after a job layoff – with a COBRA plan, compare it to what's available on the Marketplace and do a cost analysis. Compare not just the premiums, but the coverage, deductible, and copays. For the care I needed, staying on the COBRA was less expensive. Compensation plans differ from company to company, so be sure you know how many months it will last and when you'll need to begin the search for new coverage.
Save Money With a Medical Savings Account
If you have a high-deductible health plan through an employer or the Affordable Care Act, you have the option to create a health savings account (HSA) that you fund with pretax dollars. Your money goes further because taxes aren't taken out. An HSA is owned by you, and the funds can even be invested and grow over time.
Another savings option available with many employer plans is a flexible spending account, again funded with pretax dollars. You often need to use it within the calendar year, so you want to put in only what you think you'll need. A wide variety of nonmedical items can be paid for from these accounts, from eyeglasses to humidifiers to sun protection products. Know how to use these funds. Many plans come with a debit card. Read the fine print because you don't want to find that you used funds incorrectly and have to pay the money back.
Because I'm now a self-employed consultant and am still on the insurance plan from my previous employer through COBRA, I can't opt into a formal savings account. So I created my own fund for medical expenses not covered by the plan. I put a certain percentage of each check I get right into a separate checking account. This doesn't decrease my costs but helps ease them: I'm still paying the bills, but I know the money is there when I need it.
Saving on Meds: Generic or Brand-Name?
For many common drugs, you can save money by asking your doctor to prescribe the generic version if it exists. But it's important to talk with them or with your pharmacist about whether it would be better to stick with the brand. Try apps like GoodRx and Mark Cuban's Cost Plus Drugs for discounts. You might also compare costs at pharmacies and ask your local drugstore if they offer a savings card. Drug companies also offer savings programs for people who have a harder time paying for the brand. Unfortunately, these aren't available if you're on Medicare.
Where to Have Testing
For lab and imaging tests, hospitals tend to charge more than freestanding facilities, but sometimes cheaper isn't better. Because of a family history of breast cancer, I started seeing a gynecologist at age 13. (I'm 41 now.) I need to have imaging done every six months and, because I have dense breasts, that needs to be by MRI and, on occasion, ultrasound, too. Even with my current insurance, that's an out-of-pocket of $1,000 each time. But I found that when I went to a generalized imaging facility, mistakes were made. In one instance, the tech didn't position me properly and I had to have the test redone, causing added stress. For my own peace of mind, I go to a dedicated breast center. They have all my records and can easily compare my latest results to results from previous visits.
Negotiate When Possible
Many people are unaware that they can do this, or they may feel awkward about it, but it can pay to negotiate. Medical debt has reached crisis levels in this country. If you have huge bills to pay, ask if you can get on a payment plan with the provider. In some cases, they may even be willing to negotiate a lower amount – a buyout – if you can pay that right away because they'd rather not have it on their books for years.
You can also negotiate up front. If with insurance you'd still have to pay $1,200 for a certain test, ask the provider if they offer a "self-pay rate" that's lower than your health insurance's contracted rate. That could bring the cost down to $1,000. Just keep in mind that the $1,000 may not be applied to your deductible.
A New Mindset
Keep in mind that you're not just a patient, you are a customer and that, hopefully, you get to choose who to give your money to. When you pick insurance, you're signing a contract and are entitled to services that you're paying for, even if it takes negotiating to get them.
I'm passionate about sharing my experiences because I don't want anybody to make their health care choices based on what they can afford rather than what they need. That's why I advocate so we can all get the health care we deserve.
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SOURCE:
Katrina L. Coker, aka The Scrum Mother.
