How Utahns can get the most from health insurance
As more Utahns enroll in health coverage via the federal portal HealthCare.gov the question becomes: Now that I have insurance, how do I milk it for all it's worth?
It's a new challenge for the chronically uninsured, for fresh-faced college students who banked on never getting sick and for working poor families who couldn't previously afford a health plan.
"Our focus is trying to educate them on how to use the health care system," said Jack Winn, an outreach and enrollment specialist for the Association for Utah Community Health (AUCH).
"For a lot of our clients, the entry point has been the emergency room or free clinics with long wait times and no systems for managing their care," Winn said. "They don't necessarily understand the importance of having a primary care doctor."
For these new enrollees it's important to find a "medical home," and the sooner, the better. Don't wait until you're sick, and take advantage of preventive services, such as cancer screenings and immunizations, which are free, said Winn.
And if you're going to schedule a mammogram or colonoscopy, do it early in the year.
Then, if a health problem turns up, you can start working through your deductible the annual amount policyholders often must pay before qualifying for some elements of coverage.
The sooner you pay, or meet, your deductible, the sooner your full benefits kick in, said Melissa Christian, a vice president at Regence BlueCross BlueShield.
Christian has worked in insurance for 22 years, but she notes, "I'm also a consumer."
Her No. 1 tip for navigating health care: "Be engaged. This is your insurance, your health care."
Here are some others:
Doctor shop • Look for a clinic that has extended hours and is open on evenings and weekends. Schedule an introductory appointment and interview the physician. How friendly is the clerical staff? Does the office have a helpful website? How quickly do they respond to patient phone calls and emails? Check to see if a doctor is board certified at CertificationMatters.org and see if they've ever been disciplined by state regulators at www.dopl.utah.gov">http://www.dopl.utah.gov.
Compare costs, quality • Not all hospitals and physicians are alike, and there's a growing number of "transparency" tools available to help patients compare them on cost and quality. Most insurer websites have members-only widgets for calculating out-of-pocket costs for procedures. States grade hospitals on quality. And hospitals have started publishing their doctors' patient satisfaction scores. There are also websites such as HealthGrades.com and RateMDs.com
Stay healthy • Because consumers are having to shoulder more of their own health costs in the form of rising deductibles and co-payments for care, the best way to avoid unexpected costs is to stay healthy. Employers and insurance companies are offering discounts on monthly premiums for consumers who undergo physicals, shun tobacco, have their body fat measured or agree to wear a pedometer.
Use generic drugs • Generic drugs are much cheaper than their pharmaceutically equivalent brand-name predecessors.
Reserve the ER for emergencies • If your injury or illness is life-threatening, rush to the nearest hospital emergency room. But if it can wait a day or two, call your doctor or the nearest urgent care clinic. Free-standing clinics can also be less expensive options for lab and imaging tests and outpatient procedures.
Know before you go • Make sure the procedure you need is covered before you have it done. And make sure the doctor and hospital you pick is in your insurance plan's network. Otherwise you could get hit with a larger bill, or more of the tab.
Extended shopping deadline
The Obama administration is feverishly working to fix problems with its online insurance portal healthcare.gov and has pushed back the application deadline.
Shoppers now have until Dec. 23 to purchase coverage effective in January.
Under the Affordable Care Act, virtually all Americans must have health coverage by January or pay a penalty.