Anyone out there with a high deductible health insurance plan with coinsurance? tips

[barbarabini]

Does anyone out there have a high deductible insurance plan with coinsurance?
If so, do you have any tips on trying to make it affordable? For children? Are you able to check the prices somehow on your prescriptions? I went to the phartmacy for a child's prescription decongestant and my price was 141.82. Any way to shop around to at least lower these prices? Also, do you find it cheaper to do the flu shots at doctors or at the pharmacies? Any other tips?

Our deductible is 3000. We also pay 40% coinsurance on every claim. So its going to get pricey.

 

[mrsklamc]

You pay %40 AFTER the $3000? What is your maximum OOP?

Prescriptions can be cheaper at Costco; I would also let your dr's know so they can work with you on prescribing generics, etc.

 

[barbarabini]

yes, 40% coinsurance after the deductible is met. maximum oop is 9000 this year coming (Jan 2012) was 7000 last year.

Soo.. any tips...
I will check costco.

 

[dhardawa]

Things like flu shots should be covered 100% now. It was part of the Obama changes. Definitely let your doctor know you have a high deductible and high coinsurance. Often, if doctors know, they can prescribe lower cost drugs or give you samples. Also, for any name brand drugs, check the website. Many have programs that cover all or part of your copay. Places like Wal Mart and Target can be WAY cheaper than drug stores like CVS and Rite Aid. Also, make use of the coupons that are often in the store ads for gift cards with new or transferred prescriptions.

Do you have an HSA? If not, I'd highly recommend one. That will save you money as well since it is pre-tax.

 

[neatokimmo]

If you have a high deductible plan, you really have to bring it to the attention of your doctor. I can remember when they wanted to run a test to see what type of crud I had. I asked, does the antibiotic clear up both types. They said yes. I started at him for awhile and he was like oh - I guess you don't need blood work. I said nope, that would have cost me another $150.

If you rarely take antibiotics and they work well for you, be proactive in your prescriptions. Amox works wonders for me and it is $4. When you get a script, asked them is this on the $4 list?

When you take your kid for their well visit, tell them you have a high deductible plan and this is their ONE checkup for the year. Plan it so you can wipe out the school physical form at the same time.

Take vitamins. Load the kids up on vitamin C so they won't get everything floating around at school.

My plan is 4K ooo with 20% ooo afterwards. One free well child visit (including shots), one female exam for free and that is it. But it is also $10 a month and my company bribed me with 1K for expenses. My one dermo appt chewed most of that up, but I still have last year's 1K. And I didn't pay $250 a month in premiums for three years.

 

[clh2]

We've had a high deductible for years. I love it (mostly). We switched DH into his employers plan about two years ago - since my employer started to charge a ridiculous "spousal surcharge".

We've been contributing about $150 per month into the appropriate health savings plan - don't recall the particular acronym, and now have over $12K. So - while I was a little bit hesitant at first, now we have an appropriate cushion and that money is mine to keep (i.e. isn't a "use it or lose it" plan).

The one thing I would be "uber-particular" about is in-network vs out-of-network. Our annual exams are covered 100% if they are in-network. Anything out of network is on the "you will get screwed" pricing. Plus - for any other visits - we also try to utilize "in-network" pricing, there is still a significant discount, about 50% in our plan, if you go in-network for "sick-visits".

I would also be very specific with the doctor about the use of generics for prescriptions.

 

[neatokimmo]

We've been contributing about $150 per month into the appropriate health savings plan - don't recall the particular acronym, and now have over $12K. So - while I was a little bit hesitant at first, now we have an appropriate cushion and that money is mine to keep (i.e. isn't a "use it or lose it" plan).

I am going to contribute to my plan this year also. From what I understand, if you don't use it for medical reasons, you can pull it out when you are older like a retirement account without penalty. The interest rate is very low on it, but you get the tax break.

 

[LoveBWVVBR]

I'm sure that I'm opening a can of worms here, but I came here for the same advice on finding a reasonable price on prescriptions and I was directed to some online Canadian pharmacies. There are like 3 that have been vetted by a US state (Nevada??). He have high deductable health insurance, but after we paid our $5000 deductable this year everything has been covered 100%. Do you have a max. OOP? That 40% co-insurance could ruin you if you ever had a major illness and there was no cap.

Also, before our deductable was met I had to have a sick visit for a sinus infection. I knew that I needed antibiotics. Instead of going to my doctor and spending like $100, I went to the clinic at Wal-Mart and spent $40. There are "Minute Clinic" type places at Wal-Marts, CVS, Walgreens, etc. all over the place now. They are WAY cheaper than going to your regular doctor for run-of-the-mill sick visits. Just be sure to get your records so you can give them to your doctor in order to maintain continuity of care.

 

[mrsklamc]

I am going to contribute to my plan this year also. From what I understand, if you don't use it for medical reasons, you can pull it out when you are older like a retirement account without penalty. The interest rate is very low on it, but you get the tax break.

This is incorrect. If you ever pull it for non medical expenses, you will be taxed at your normal rate.

 

[livndisney]

I'm sure that I'm opening a can of worms here, but I came here for the same advice on finding a reasonable price on prescriptions and I was directed to some online Canadian pharmacies. There are like 3 that have been vetted by a US state (Nevada??). He have high deductable health insurance, but after we paid our $5000 deductable this year everything has been covered 100%. Do you have a max. OOP? That 40% co-insurance could ruin you if you ever had a major illness and there was no cap.

Also, before our deductable was met I had to have a sick visit for a sinus infection. I knew that I needed antibiotics. Instead of going to my doctor and spending like $100, I went to the clinic at Wal-Mart and spent $40. There are "Minute Clinic" type places at Wal-Marts, CVS, Walgreens, etc. all over the place now. They are WAY cheaper than going to your regular doctor for run-of-the-mill sick visits. Just be sure to get your records so you can give them to your doctor in order to maintain continuity of care.

I wonder if the "cheaper" thing is regional? I was just considering going to a mini clinic type place and just to be seen would have been 70-100 dollars.

 

[LoveBWVVBR]

I wonder if the "cheaper" thing is regional? I was just considering going to a mini clinic type place and just to be seen would have been 70-100 dollars.

It might be. I live in coastal FL and the clinic that I went to was at Wal-Mart. I think that it was right around $40 to be seen/treated for my sinus infection.

 

[livndisney]

It might be. I live in coastal FL and the clinic that I went to was at Wal-Mart. I think that it was right around $40 to be seen/treated for my sinus infection.

Hmm I am in Central Florida and at CVS it was 89.00 just to be seen. I wonder if any of the Walmarts have the clinic.

Looks like all we have is Solantic-if you are under 45 you can get a physical for 50.00 over 45 and it is 100. One medical complaint 99.00 Oh well. Thank you for the info.

 

[LoveBWVVBR]

Hmm I am in Central Florida and at CVS it was 89.00 just to be seen. I wonder if any of the Walmarts have the clinic.

Looks like all we have is Solantic-if you are under 45 you can get a physical for 50.00 over 45 and it is 100. One medical complaint 99.00 Oh well. Thank you for the info.

None of the Wal-Marts around you have clinics? I'm in Brevard County and we have more than one (Merritt Island and Cocoa as far as I know). I'm sure that there are some in the Orlando area. I am surprised that CVS is so expensive, though. I wonder how they compete with Wal-Mart at that price?

 

[Sandy61]

Not about prescription, however my tip is this...

I went in for a mammogram and it was covered by insurance. They called me to come in for more because they thought they saw something. The additional mammogram cost me several hundred dollars because it was submitted to insurance in a different way. The insurance company said to call the hospital or clinic and ask that they re-submit it the same way as the first time.

We have had this happen a couple other times over the years and have had to ask that a charge be re-submitted a different way. It has always worked in our favor to do this. We always call the insurance company first.

 

[erincon23]

We're in a similar situation. With prescriptions -- $4 is good, but Meijer pharmacies (if you have one near you) have a nice list of FREE Rxs. My DS's acne meds are on this list -- but this can be a pain, since you can only get 2 weeks worth at a time (you can keep getting 2 weeks' worth) -- he's away at college, so I got him the first part of the Rx but he's going to transfer it to Target and pay for it -- it's $4 for 20 days, but $10 for 3 months -- so watch out for things like that.

ALWAYS tell your doctor immediately that you don't have prescription insurance. They'll usually try to find something cheaper than they might have prescribed.

If you or your kids need a long-term expensive Rx, think about ordering it from India. My DS takes Singulair, which is $140/mo no matter where we go, has no generic, and nothing else seems to work as well. My mom gets it from India for $10 a month, and orders at least 6 months' worth at a time. DS says it works just fine for him.

If you need physical therapy -- tell the therapist on the first visit that you pay everything out of pocket. Ask if you could go for two or three visits for the evaluation and start the work, then get exercises you can do at home for a while, then come back for a re-evaluation. Sometimes that won't work, but often -- for things like a sprain -- it might be just fine. Also try to pay at least SOMETHING at each visit so you don't get a huge whopping bill in the mail after it goes to your insurance and comes back that you owe 100% (hopefully after they adjust it for discounts). This might work for other types of ongoing care.

Sports physicals, school physicals -- many offices will begin advertising that they'll do sports physicals for $25 or $30. It may not be your regular doctor, but if your child is generally healthy, it shouldn't be a problem to go to someone else for the sports physical. Inoculations -- look for clinics that offer low-price vaccinations. Sometimes the county health department will offer discounted vaccinations.

Read your policy carefully! Ours takes a bigger discount for urgent-care visits than for our regular doctor, so the urgent-care ends up being MUCH cheaper than going the family dr. for things like colds, etc. I wouldn't want to do this for anything chronic, but for sprains, viruses, one-time things, etc., it works just fine. They send a report to our family dr., so he keeps up with all of it. And it's easier to get in.

 

[livndisney]

None of the Wal-Marts around you have clinics? I'm in Brevard County and we have more than one (Merritt Island and Cocoa as far as I know). I'm sure that there are some in the Orlando area. I am surprised that CVS is so expensive, though. I wonder how they compete with Wal-Mart at that price?

I think that is why CVS is so expensive-because the Walmarts don't seem to have the clinics. I found one down in Kissimme, but it is run by Solantic with the prices I mentioned earlier.

 

[MrsPete]

We carried major medical only for 10-12 years, and it worked out great for us:

Our premiums were something like $20 twice a month -- so much less than full-coverage insurance. And, being frugal, we put that savings away and calculated how much we were saving.

Yes, we paid $125 or so out-of-pocket every time our kids had strep throat or similar, and that was rough: It seems that when someone'd get sick, two other family members'd get sick too. But that only tended to happen 2Xs a year, and we were paying much, much less than we would've paid in premiums.

When the doctor gave us a prescription, we'd explain that we didn't have pharmacy coverage and asked for a generic. Sometimes they'd give us samples. Most times they'd prescribe an older, less expensive drug -- those tend to cost less.

We started this type of coverage after our girls were done with all those shots they need early in life, and we "won" financially every year except the year that the oldest broke her arm (on a growth plate -- needed to see the orthopedic specialist). Then came the year that my husband had a serious emergency, and in the process they also discovered that he was diabetic. That cost us over $2000 out-of-pocket. Still, for all the premiums we didn't pay over the years, we were ahead. But we knew it was time to go back to traditional insurance; those premiums every month really hurt.

 

[PrincessSuzanne]

I know my solution to high deductible plans won't work for every one, but DH and I just switched to Tricare Reserve Select, we pay $198 premium per month and have a $50 deductible then 15% co-insurance.

Up until this month, when this new plan kicked in, We had a $4000 deductible, then I think a 20% co-insurance. I was $150 every 2 weeks for the premium, I have no idea what the company paid. The did attach $500 in a HSA, but that can be eaten up quickly. My husbands company wanted even more for the premium than mine did.

It's ridiculous, because DH never goes to the doctor, but I felt like he needed coverage, just in case and that just in case came in May, luckily the deductible had been met, 2 days later and it wouldn't have, because our dedcutible ran from June 1 thru May 31.

I am going to save more than $1700 over a 1 year period by switching, and probably more now, because the premium cost will drop in January I believe.

I only take a couple of meds, one of which I can get OTC and one is on the Target $4 list, the other one, I don't even know the cost of, but now with Tricare it is $5. My doctor would give me samples when she wanted to change something I was on, so if it didn't work, I wasn't out the cost of a prescription. I price shopped, there was even a tracker on our insurance website where you could check prices at different pharmacies before filling it. Before that, I would call around and compare.

 

[johde]

As others have said, my best advice is to shop around for your health care. I'm single and my HDHC plan has a $1,500 deductible, then pays 100%. So far, I've only spent about $150. Just last week I needed lab work done. In town, the hospital (only complete lab in town) wanted $115 for a lipid panel. I went on line and went with a prepaid lab company that works with one of the labs in the town where I work and it cost me $29.00. This company doesn't bill insurance. Had I went to the out of town lab directly it would have been $40 but still less than the Hospital.

 

[bethy]

If you have a high deductible plan, you really have to bring it to the attention of your doctor. I can remember when they wanted to run a test to see what type of crud I had. I asked, does the antibiotic clear up both types. They said yes. I started at him for awhile and he was like oh - I guess you don't need blood work. I said nope, that would have cost me another $150.

If you rarely take antibiotics and they work well for you, be proactive in your prescriptions. Amox works wonders for me and it is $4. When you get a script, asked them is this on the $4 list?

When you take your kid for their well visit, tell them you have a high deductible plan and this is their ONE checkup for the year. Plan it so you can wipe out the school physical form at the same time.

Take vitamins. Load the kids up on vitamin C so they won't get everything floating around at school.

Excellent job being proactive and accountable for your own healthcare!

I honestly think that this is the ticket for putting a dent in our national healthcare crisis - going back to having individuals be responsible for their own care and running the show rather than doctors and insurance companies.

We have a similar plan with a $10k annual dedictible and let me tell you - paying for things out of our personal funds sure makes us stop and at least think things through first. Now we go to the doctor when we really need to rather than just at the drop of a hat or out of habit.

We do also have an HSA which pairs really well with this sort of healthplan.