As a self-employed family, we have to buy our health insurance ourselves out-of-pocket. Premiums and deductibles have been skyrocketing over the last few years and we've been working hard to make the most of our health plan and save where we can but it's still hard. I thought I'd share some of things we've learned buying insurance and paying medical bills ourselves over the years. Most of these tips relate to families buying insurance out-of-pocket, but a lot of tips would also benefit those that get insurance through their employer.
| These tips relate to what we've learned in our own experience - please consult your insurance broker, accountant, etc for the best information regarding your own situation |
Shop Around for Insurance
If you're buying insurance yourself (not through your employer) these days, you're pretty much limited to only getting insurance through the Healthcare Marketplace as most insurance carriers have gotten rid of their individual plans and rolled them into the Marketplace Exchange.
While shopping for a plan on the Marketplace, you can compare premiums, deductibles, and coverage but make sure you are VERY thorough. At first glance it may seem you have a lot of options, but many times plans are not widely accepted at doctors and hospitals. Once you find a plan you think will work for you, check with both the Marketplace as well as the insurance company directly to make sure the plan is accepted at all your family's doctors, specialists, and area hospitals. The last thing you want to happen is to head to the ER for a broken ankle and find out afterwards that your insurance won't even touch that bill. Depending on your family size and income, you may also qualify for a discount on the cost of your premiums through the Marketplace.
Consider the High Deductible
If your family has no chronic medical issues, is healthy (knock-on-wood), and you're not planning on having a baby or surgery in the coming year it may be advantageous to go for the sky-high deductible. Yes, this could be risky as you never know when something may come up, but if nothing major comes up you can save a lot on your monthly premiums.
Pay Your Monthly Premium on Your Credit Card (if possible)
If you can't purchase your insurance pre-tax through an employer, see about using your credit card to pay for your monthly premiums. Not all insurance carriers will let you pay your premium on your credit card, but if they will let you - do it! Most credit cards have cash back rewards or bonuses for using your card, so you might as well take advantage of it. My credit card offers 1% cash back, so I earn about $55 back on my premiums each year - it's not much but it's better than nothing, and I know there are cards out there that have much better rewards than mine.
*Obviously only pay your premiums on your credit card if you're good about paying that amount off in full every month - you do not want to go into credit card debit over your health insurance premium.
Health Savings Account (HSA)
A Health Savings Account (HSA) is a savings account that's designated for medical expenses only. Ideally you deposit into the account pre-tax and this money can grow and be saved for future medical bills. This is especially useful if you have a high deductible because then you'll have pre-tax money set aside to help pay for anything that may come up. Many HSAs have monthly fees though, so it's important to do your homework and talk with your accountant to see if an HSA is right in your situation.
Take Advantage of Preventive Care
All preventive care (annual exam, most basic blood work and vaccines, many basic screenings) are covered in full under Health Care Reform. Don't be fooled - these aren't really free (you're already paying for them with your high monthly premiums and deductibles), but it's true that you don't have to pay anything more out of pocket for them. Since they're included in your health plan, make sure to keep up-to-date on all your preventive care and stay healthy - this will hopefully keep expensive health issues from possibly surprising you later on.
Know the Membership Perks of Your Health Plan
A lot of health plans have perks that might not come up when you look at your plan details - make sure to search these out and take advantage of them. These perks can be things like discounts at athletic stores or on prescription eye glasses, gym membership or race fee reimbursements, healthy eating incentives, and more. Take note of what's available to you and use them when you can.
Shop Around for Non-Emergent Care
In the event you need a diagnostic test or minor procedure done, shop around for the best price for your insurance. Prices for things like blood work and x-rays can vary wildly among doctor offices, hospitals, etc so it's important to do your homework.
Shop Around for Prescriptions
What you'll pay out-of-pocket on your prescription medications can also vary greatly from pharmacy to pharmacy. If you have a prescription, make sure to call around to your area pharmacies and ask them to run a price check of your medication against your insurance (you'll need to give them your insurance info, and they'll probably have to call you back with the answer). Also, check with your insurance to see if they have a Mail-Away program - typically you send in a written prescription and they will fill your RX for three months at a time at a discount.
Always Check EOBs and Medical Bills Before You Pay
After you see your doctor, you will get an EOB (Explanation of Benefits) in the mail or available to you online. Double check these to make sure your visit and anything that was done was billed appropriately. For example - if you had a problem visit and then a follow-up visit a week later, the follow-up visit should be billed as a lower-level (cheaper) visit as long as nothing new was addressed at the appointment. If you feel as though something was billed incorrectly, call your doctor's office and ask them to review the claim and resubmit if necessary.
Also, sometimes things that should be covered by insurance aren't, often due to human or computer error when the claim is processed - and you may get a bill from your doctor/hospital for it. If you ever have a question on why something wasn't covered or wasn't covered as much as you thought it should have been, it's definitely worth your time to call and question it.
Ask for a Prompt Payment Discount on Medical Bills
Once you get a bill from your doctor or hospital, call and ask if they have a prompt payment or cash discount if the bill is paid in full. Most places will offer you a discount (it varies, but we've seen discounts range from 5-35%) if you pay your bill in full within 30 days. If you can afford to pay the bill now and take advantage of the discount it's definitely worth it!
Payment Plan or Payment Forgiveness for Larger Bills
If you get a bill that you're not able to pay in full or if they do not offer a prompt payment discount, ask to be put on the minimum payment plan. As long as the doctor/hospital does not charge interest, you might as well take your time paying the bill and not put undue stress on yourself.
And as a last resort - if you have an extenuating circumstance and cannot pay your bill or make a payment plan work, many places will work with you to forgive some or all of your bill. Speak with their billing department for more information on this - but be prepared to provide all your personal financial information (assets, personal savings, records, etc) to prove financial/personal hardship.
Great Record Keeping
Finally, keep great records throughout the year - record all premiums you paid out-of-pocket, all copays, medical and dental bills, prescriptions, and all mileage to appointments. At the end of the year your accountant can help you wade through all the information and determine what you will be able to claim as a tax deduction - but the more information you have to give him, the more you will potentially be able to write off so keeping great records is key.
I hope these tips will help you and your family save money on your health insurance and medical bills. If you have any other tips to share, I would love to hear them!
Please note: These tips relate to what we've learned in our own experience, please consult your insurance broker, accountant, etc for the best information regarding your own situation. Use the information in this post at your own discretion and risk.