The first question everyone asks when looking at health plans is “How much is this going to cost?” While there is no denying that premium is an important consideration, the true cost of any health plan is more complicated than just the outlay for premiums.
Once you add up the potential out-of-pocket costs associated with any plan, it can change the cost rather dramatically. In addition to deductibles and co-pays, consider potential exposure to out-of-network charges and the possibility of separate deductibles and out-of-pocket maximums before insurance begins to pay. While it is impossible to know what all of your future costs may be, you can look at the past few years’ expenses for maintenance drugs and regular office visits. Consider your financial situation and to what extent you are able to absorb higher out-of-pocket expenses and balance this against potential premium savings.
Consider how prescriptions are covered and take the time to inquire as to formularies so you understand not only the coverage difference between generic, bioidentical and specialty drugs but the real cost difference between them. Inquire as to whether or not there is a separate prescription deductible. Heavily advertised drugs are not necessarily the best or most effective in all cases – ask your physician and pharmacist if there are less expensive options.
If you’re working with a professional health insurance agent they will certainly be willing to walk you through the myriad of offerings and advise you based upon your specific needs. They will also be able to advise you on the important value added features offered by some carriers such as Teledoc®, medical management programs for certain conditions, adherence programs and site of care management. All of which can make your utilization experience more positive.
Lastly, consider the various funding options available: Section 125, premium-only plans, HRAs, HSAs; while these don’t reduce your cost, they provide tax-advantaged methods of setting funds aside for out-of-pocket exposures.
Being a good consumer of anything requires being an educated consumer and seeking advice from knowledgeable professionals.