Understanding healthcare as a consumer can be overwhelming. There are so many companies, so much industry jargon, and the benefit explanations can be so long. Nearly everybody will find something about healthcare that confuses them—even people with experience in the industry. There’s a lot to learn! While it might be difficult to learn everything, understanding a few key things will help you make smarter choices.
1. Know basic terms
HealthShares and health insurance use different words to describe similar ideas. Whether you’re looking for traditional insurance or a medical cost sharing ministry, you need to understand what a company means when it uses words like “deductible” and “member responsibility.” To help, we’ve made a simple reference for the most common terms. You can also read about cost terms on healthcare.gov.
Other good terms to know are “copay” (how much you pay a provider at the time of service), “PCP” (primary care provider—the person you see for basic care like yearly checkups), and “SCP” (specialist care provider—people like neurologists, rheumatologists, and orthopedic surgeons).
2. Know what you need
If you have ever worked in customer service, you probably can remember at least one customer that wanted help making a choice without being able to give any helpful information: “I’m looking for a book, it had a blue cover” or “I need to buy my nephew a birthday present, what will he like?” That’s a pretty bad way to shop for books or birthday presents, but it’s a truly terrible way to shop for healthcare. Making an uninformed decision about your healthcare could lead to awful consequences, so you must understand what care you need.
Here are some yes/no questions to ask yourself:
- 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 offer help with basic emergency care, so this list of questions can help you choose a specific program. If you answered “yes” to any of those questions, you know what to look for in the plan information.
For example, I answered “yes” to nearly all of these questions. When I look for healthcare, I know I need a plan that will help me pay for regular visits to the doctor, occasional trips to an allergist, my flu shot, and my inhalers. When I look over the benefit guidelines, I always check to see how much I will have to pay to visit my primary care provider and how much I’m going to be charged to visit a specialist. I also find it easier to pay a slightly higher monthly fee in exchange for cheaper copays. Other people might know they don’t need help as often and choose to pay lower monthly fees instead.
You are your own best advocate for your healthcare. Take the time to really think about what you need from it. Which leads us to the final point.
3. Know what you can afford
In healthcare, as in life, you get what you pay for. There are common trends:
- smaller monthly costs -> bigger costs at time of care
- bigger monthly costs -> smaller costs at 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’ve 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. Healthcare is expensive, so really try to get the best plan you can afford. A cheaper monthly plan that pays 50 percent of hospital bills, for example, will save you money until someone in the family needs critical care. Of course, 50 percent of $500,000 is helpful, but perhaps not as helpful as a plan that would have paid 90 percent of those costs.
If possible, try finding a plan that pays for at least 70 percent of major healthcare costs. That will grant some peace of mind should you need help with a medical emergency.
Ask for help
If you are shopping for healthcare and you’re still feeling stuck, you can always call companies you’re interested in. Some representatives might try to upsell, but most understand how confusing this process can be and want to help. If you can give them basic information about your medical needs and what you can afford, they can guide you through the options their company offers to help you choose which program is right for you.