Consumer Driven Healthcare

Choose and use your health benefits wisely

Whether you have a consumer-driven health plan or a regular ol' health plan, chances are you have more choices - and more responsibility - than you had a decade ago.

Spend some time choosing your health plan

If you have health coverage through your employer, you probably have at least a few plans from which to choose. That means you need to invest some time to make an informed choice. It may take an hour or more to find the right balance of features and cost - but it's worth the time. After all, your health plan choice affects you, your family, and your cash flow for a long time.

To decide which plan works for you, first consider the two main types of costs:

  • Premiums - This is how you pay for your health coverage. For most employees, the premium is taken out of your regular paychecks. Your employer may pay the rest of the premium. Premiums stay the same whether you use healthcare or not.
  • Out-of-pocket costs - You pay these amounts when you go to a doctor, hospital, or pharmacy. They include copayments, deductibles, coinsurance, and any amount over and above a given allowance or benefit the plan may pay. Out-of-pocket costs vary depending on your healthcare usage. For more details, visit How do deductibles and copays work?

With many types of plans, if your premium is higher, you have lower out-of-pocket costs when you receive care... and vice versa.

So, how do you choose? Knowing what you spent in the past makes it easier. So gather your medical expense records - your calendar, checkbook, receipts, and Explanation of Benefits (EOB) statements - to see the services you received and how much you paid for copayments, deductibles, and coinsurance. Also, consider what you'll need in the future. In addition to routine healthcare, think about whether you or anyone your plan covers is expecting something this year, like surgery or pregnancy.

Take advantage of network savings

Most health plans have a network - a group of doctors, hospitals, and other providers in your area that have agreed to certain rates for plan members. If you use an out-of-network provider, it's likely your plan will cover less of your costs. Plus, if you go to an out-of-network provider, any amount above what an in-network provider would charge comes out of your pocket.

Plan for emergencies

It's easy to be a good healthcare consumer when you have the time. But in the real world, you don't always have a lot of time to make decisions. Some ways to plan now so you have less to worry about if an emergency happens:

  • Identify which doctor to call in an emergency and find out if the doctor has after-hours care
  • Look up the nearest in-network urgent care center and emergency room and post maps where all family members have easy access
  • Read your plan document for guidance on what constitutes an emergency versus urgent care

If you need non-emergency medical care, think about going to an urgent care center or your regular doctor instead of the emergency room (ER). Sometimes it's a tough call. But for something like a cold or a minor sprain, avoiding the ER will probably save you money for two reasons: the copayment is usually lower for a doctor's visit or urgent care, and your insurer may make you pay for the full cost of care if you use an emergency room for a non-emergency.

Watch Healthcare Video: What is consumer-driven healthcare?