Health care should be a key part of a family budget, but costs are hard to predict. The true cost of health care can change, based on the health conditions of family members, your health care plan and how you use health care resources.
To help manage your health care budget in 2017, use these tips:
Don't forget deductibles and copays
Most health plans have deductibles you must pay, along with copays for health care services. A deductible is the amount you owe for certain covered medical services before your health plan begins to pay for them. A copay is just a fixed payment for covered health care. Most often, it’s the amount you owe each time you visit your primary care physician, a specialist, the emergency room or urgent care. Your copay amounts are specific to your plan. To determine your copay amounts, log in at hap.org and click “My Benefits.” From there, you can estimate how many times you might need to visit your PCP or a specialist and budget accordingly.
Generally, there are two types of plans:
• Low-deductible: These have higher premiums, (the amount you pay for your health plan each month) but, because the deductible is low, you’ll likely meet it earlier in the year.
• High-deductible: These have lower premiums, but, because the deductible is high, it may take longer to meet it.
Consider which type of plan best meets your needs. Also, keep in mind some plans cover office visits before you meet your deductible.
Choose generic drugs when available
Many drugs have generic versions with the same active ingredients and therapeutic effects as brand-name drugs that cost much more. Many popular but expensive drugs are now available as generics.
If family members are taking long-term medications, generics can significantly lower your health care budget. Also, make sure your prescriptions are on your health plan’s drug list. You don’t want to learn after signing up for a plan that a much-needed drug isn’t covered.
More prescription drug tips:
Research your drug copays
Drugs are categorized in tiers that determine copays. These tiers can vary, but many plans have the following categories:
- Tier 1: Generic – Non-brand name drugs with the lowest copay.
- Tier 2: Preferred brand – Brand name drugs with the lowest copay.
- Tier 3: Non-preferred brand – Brand name drugs with a higher copay.
- Tier 4: Specialty drugs – Biologics or prescription drugs used to treat complex or chronic illnesses, which require special handling, provider coordination and patient education for safe and effective use.
- Preventive: Generic preventive prescription drugs used to prevent illnesses, diseases or other health problems.
- Medical drugs: Drugs infused or administered in a doctor’s office or facility that are covered under your medical benefit.
Find out where your drugs fall in your plan’s drug list. This will help you know their costs and allow you to ask the right questions. You can find HAP’s drug lists here.
Talk to your health care providers about cost
If you find a drug is too expensive, tell your doctor and pharmacist that you prefer lower copay drugs and generics. We all want to pay less for health care. Your doctor or pharmacist will work with you to find an affordable treatment with a lower-tiered drug.
Consider mail order with a 90-day supply, when available
Using mail order with a 90-day supply will reduce your copay or coinsurance in many prescription drug plans. Most plans offer this option at only two or two-and-a-half times the 30-day copay. That’s less than paying for three 30-day supplies.
HAP members may have their prescriptions home-delivered by Pharmacy Advantage's convenient mail order service. You can refill or renew your prescriptions by phone or on the Pharmacy Advantage website. For more information, visit PharmacyAdvantageRx.com or call (800) 456-2112.
Look for patient assistance programs
These programs provide free or lower-cost medications to people who can’t afford them. You may qualify based on income. Extra Help, the Medicare drug-cost assistance program, and many pharmaceutical companies list patient assistance programs on their websites.
By asking the right questions and collaborating with providers, you can help control prescription costs.
Check to make sure your health care providers are in your network
Many health plans offer lower costs for physicians, hospitals, pharmacies and other providers that are in the plan’s network. If you go out-of-network for care, you may pay a lot more for these services, or they may not be covered at all. Be sure to check whether your providers are included in your 2017 health plan’s network.
You can use HAP’s provider lookup tool to find out which doctors are in your network and compare doctors, their backgrounds and affiliations. You can also call your provider directly to verify this information.
Take advantage of free preventive services
Health plans like HAP offer a long list of free health screening services and treatments to keep you healthy. These include yearly physicals, vaccinations for children, non-diagnostic mammograms and many other screening tests that can save money through preventive care.
Log in at hap.org and select “Member Resources” from the “My Plan” tab for our Preventive Service Guide. If you’re wondering if something is considered preventive, call your personal service coordinator or Customer Service. For more info on preventive services, check out our Preventive vs. Diagnostic post.
Consider how your family's circumstances may change this year
Will one of your children play sports? Think about copays for possible sports injuries. Covering a child on your plan? If you’re a Personal Alliance member, your coverage ends at the end of the year in which your child turns 26. If you have a plan through your employer, you’ll need to check when your child’s coverage ends.
Consider how your personal health budget needs may change in the coming year. Budget for them realistically. These tips should give you a healthy start.
If you have questions, contact your personal service coordinator or call Customer Service at the number on your ID card.