Understanding Costs

The cost of medical care—hospital services, doctor’s visits, prescription drugs, and more—is rising faster than inflation. Insurance companies are trying to find ways to control costs and improve quality, and there are things consumers can do to lower their healthcare expenses, too.

 

What Insurers Are Doing to Control Healthcare Costs

Here are a few of the ways insurers are working to reduce healthcare costs while making high-quality care more accessible and affordable:

  • Negotiating with hospitals to limit increases in service costs, to be more in line with inflation.
  • Paying doctors and hospitals based on quality of care and improved health outcome, instead of on the quantity of services provided.
  • Establishing patient-centered medical homes, where members receive coordinated care across all of their doctors, to provide quality health outcomes and lower claims costs.
  • Lowering operational expenses to reduce the amount of members’ premiums being spent on administrative costs.

What You Can Do to Lower Your Own Healthcare Costs

  • Use generic drugs – Because all generic drugs must pass the same FDA approval process and have the same active ingredients, strength, and form as their brand-name versions, you can purchase the same medication at a lower cost. Many health plans have lower copayments for generic drugs.
  • Go to in-network doctors – The doctors, hospitals, and other healthcare providers in your insurer’s network have agreed to charge lower rates, so in-network services cost less and most health plans have lower out-of-pocket costs within the network.
  • Seek the right level of care – In a true medical emergency, always go to the emergency room. But if you need immediate care for a medical condition that is not life threatening, contact your primary care doctor, or if your doctor is not available, head to an urgent care center. Urgent care centers and primary care office visits cost significantly less than emergency room visits, and most health plans have lower copayments for these services.
  • Focus on staying healthy – Use all of the wellness resources your insurer offers—many of them at no extra cost—to help you stay healthy. Examples include discounts on weight loss programs or exercise equipment, wellness programs, online tools, and more.