Understanding healthcare as a consumer can be overwhelming. There are so many companies, so much industry jargon, and the benefit explanations can be quite long. Nearly everyone will find something about healthcare that confuses them—even people with experience in the industry. However, understanding a few key aspects of the industry can contribute to making informed choices.
1. Know basic terms
HealthShares and health insurance use different words to describe similar ideas. Whether an individual is looking for traditional insurance or a medical cost sharing organization, they need to understand what a company means when it uses words like “deductible” and “member responsibility.”
Other essential terms include “co-pay/copay” the amount payable to a provider at the time of service), “PCP” (primary care provider—the individual providing basic care, such as yearly checkups), and “SCP” (specialist care provider—professionals like neurologists, rheumatologists, and orthopedic surgeons).
Here is a reference for understanding the most common HealthShare terms, and more information about health insurance terms is available on healthcare.gov.
2. Identify personal needs
Choosing healthcare coverage without understanding individual needs can lead to undesirable outcomes. A set of personal yes/no questions can aid consumers in the process of determining their needs:
- Do I have any chronic or pre-existing conditions?
- Will I need medications to help me manage these conditions?
- Do I need access to mental health resources like counseling?
- Will I want preventive care like yearly checkups, vaccines, mammograms, and eye exams?
- Could I need maternity care in the future?
- Do I think I might need healthcare for a serious need, like a major injury or cancer?
Health insurance and HealthShares both provide support with basic emergency care, so these questions can help consumers choose a specific program. Affirmative responses to any of these questions should guide members on what they look for in HealthShare membership or health insurance information.
For example, an affirmative response to most of these questions would indicate the need for a plan that supports regular visits to the doctor, occasional allergist appointments, flu shots, and inhalers. When reviewing benefit guidelines, it would be important to check the costs for visiting a primary care provider and a specialist. Some consumers might prefer to pay a slightly higher monthly fee in exchange for cheaper copays, while others might know they don’t need help as often and choose to pay lower monthly fees instead.
When it comes to healthcare, consumers can be their own best advocates and should feel encouraged to analyze their needs.
3. Understand affordability
When it comes to healthcare management costs:
- Lower monthly costs leading to higher costs at the time of care.
- Higher monthly costs leading to lower costs at the time of care.
People who rarely get sick and have no major chronic conditions usually prefer health plans that charge lower monthly fees. They will probably have to pay more for a doctor visit and will definitely have to pay more out of pocket before their health plan starts helping with medical bills. On the other hand, if nothing major happens during the year, they will have saved money.
People who do have chronic conditions or expect to need a doctor several times in a year usually like plans that charge higher monthly fees in exchange for smaller costs at the time of service and more help paying medical bills. While healthcare can be expensive, it is important to use a budget in planning. For example, a cheaper monthly plan that pays 50% of hospital bills will save a patient money until a family member needs critical care. A plan that shares 90% of such costs may prove more beneficial in the long run.
Ask for help
For those feeling overwhelmed by the process of shopping for healthcare, reaching out to companies of interest is always an option. Although some representatives may attempt to upsell callers, most will want to help. Before calling, consumers should be prepared with basic information about their medical needs and budget. This will allow company representatives to provide the most useful information.
