5 Ways to Be a Wise Healthcare Consumer

by Sherri Oliver

Most of us enjoy shopping, and doing it online makes the experience easy. A click here, some scrolling there; before you know it, exactly what you want shows up at your front door. Well, being a healthcare consumer isn’t necessarily that effortless. How to find health insurance? How to find a doctor? How to find a life insurance policy? We’ve all asked these questions at one time or another. Choosing the right insurance at the right price; crossing your fingers in hopes that you’ve picked the perfect doctors; and trying to figure out which supplemental insurance is best can leave you feeling unsure about, and questioning your decisions.

As consumers, we’re often conscious about the things we buy. For example, we may prefer one brand over another because of price, business practices, or ingredients. However, it can be harder to make these informed decisions when it comes to healthcare. But it doesn’t have to be that way. Being a wise healthcare consumer makes all the difference.

It means implementing useful research information and tips when searching for and selecting quality healthcare insurance, providers, and services for you and your family. As you navigate the healthcare space, here are 5 ways you can become a wise healthcare consumer.

1. Understanding Your Insurance Policy

Health insurance offers a level of financial security that could protect you and your family when a health crisis arises; and understanding what a policy covers can help you make the necessary decisions when it comes to care. In order to fully understand policy coverage, you should first understand its terms. A recent Consumer Sentiment survey states, only 9% of Americans showed an understanding of these four basic health insurance terms – health plan premium, health plan deductible, out-of-pocket maximum, and co-insurance.¹ 62% recognized the correct definition of the term “in-network healthcare provider.”² All of us want our healthcare dollars to go further and having knowledge about the policy details can give you a feeling of confidence when trying to figure out how to find affordable health insurance.

Terms to Know:
Co-insurance – the shared cost between the insured and insurance company for specific coverage
Co-payments – the required payment due at the time of medical service
Deductible – amount paid by the insured prior to the benefits covering costs
Out-of-pocket – money paid by the insured (e.g. deductible, co-pays, etc.)
Dual Coverage – coverage from two health insurance plans (e.g. major medical and supplemental)
Coordinated Benefits – designated benefits paid from an insurance policy that is primarily responsible for claim coverage, in conjunction with other policies paying out additional amounts (NOTE: sometimes one policy will not pay because the loss was covered under another policy) 
In-network – doctors and healthcare facilities that are part of your plan’s network of providers
Out-of-network – doctors and healthcare facilities that are not part of your plan’s provider group
Grace Period – amount of time or number of days given to pay a premium after its due date
Waiting Period – the wait-time after the policy is issued before specific benefits are payable
Exclusions – items the policy will not cover
Lifetime Maximum – amount of money the policy pays for the duration of an individual’s policy
Family Lifetime Maximums – amount of money the policy pays for the duration of a family plan policy

2. Choose the Right Healthcare Providers

There are several reasons to look for a healthcare professional… a recent move to a new town; you’re in need of a second opinion or a specialist; your doctor may be ill or retiring; or you’re just not happy with your current provider. When wondering how to find a good doctor, consider asking friends, a nurse you may know, or even a pharmacist for referrals then do your research. 47% of internet users search for information about doctors or other healthcare professionals.³ You can check out local and suggested providers just by doing a quick online search. Find out whether they are in- or out-of-network, read reviews, visit their social media pages, and look into the medical facility where they practice. It’s important to do your investigative homework when finding a primary care doctor, or any provider.

3. Consider Supplemental Insurance

Supplemental insurance is additional insurance that can help pay for out-of-pocket expenses and services that your major medical doesn’t cover like co-payments, co-insurance, and deductibles. This type of insurance can also provide additional benefit coverage for various specific healthcare-related issues such as cancer; short-term disability; and hospital confinement expenses, just to name a few. When contemplating how to find an insurance policy, know that supplemental policies can offer smart coverage with specific financial guarantees.

In 2018, 67.3% of the population had private healthcare insurance, while 34.4% were covered by public (state or federal) coverage.⁴ When choosing a health insurance plan, or plans, shop around. The average annual health insurance deductible for a U.S. employee is $1,655.⁵

Making sure you and your family’s healthcare needs are covered at an affordable cost is key. Find the type of plan that best fits your needs – HMO (Health Maintenance organization, PPO (Preferred Provider Organization), EPO (Exclusive Provider Organization, and POS (Point of Service). Once you’ve made this decision, do cost comparisons. The Health Insurance Marketplace Calculator, created by the Affordable Care Act (ACA), gives estimates and eligibility for health insurance premiums and subsidies. Enter basic information like family size, income, and age then the calculator formulates options.

It’s your body and your wallet. Your decisions matter. Doctors are busy and at times, very stressed. 80% of U.S. physicians said that their workload is at capacity or overextended.⁶ Also, 55% said moral was very or somewhat negative.⁷ This is not the time to leave your healthcare choices and plan up to anyone other than you.