Managing Costs of Chronic Conditions

Summary

If you’ve been diagnosed with a chronic condition, this article will give you some guidelines to help manage your care and costs. In it you will learn how you can get help to:


  • Follow healthy habits.

  • Know and budget for your costs for a year of care.

  • Look for a health plan that pays a bigger share of your costs. This might mean choosing a plan with a higher premium, but a lower deductible.

  • Consider a flexible spending plan to help you pay your out-of-pocket costs with pre-tax income.

  • Get help from your providers to save money.

  • Avoid extra costs by choosing providers who are in you plan’s network – meaning they have agreements with your health plan.

  • Use resources like our cost lookup tool to estimate the cost of your care, and negotiate prices with providers in your area.


If you are diagnosed with an ongoing, chronic condition, you need answers to two important questions:

What care will you need to stay healthy?
And, how much will it cost?

Your first concern should be staying healthy. That’s true no matter your health condition—whether it is diabetes, asthma, heart disease, depression or something else. Ask your doctor what you need to do to help you manage the condition, and follow his or her recommendations.

A second important concern will be how much you’ll have to pay. By definition, chronic conditions last for a long time, or get better and come back. Every patient is different, but here are a few general guidelines to help you plan.

Follow Healthy Habits



Following your doctor’s treatment plan can keep you healthy, and save you money. For example, many people with chronic conditions need regular medication. Sticking to your doctor’s medication schedule can prevent your condition from worsening.


Keep regular follow-up appointments with your healthcare providers, such as doctors or other types of healthcare professionals. That way, they can track your condition and treat any complications before you need to go to the hospital.


In general, adopt a healthy lifestyle, including exercise, a balanced diet and avoiding smoking. That may help keep you away from the hospital.



 

Budget Your Costs



Get the most complete picture that you can of your yearly costs. That way, you can build a budget and plan ahead.


You might need doctor visits, tests, medical equipment in your home, or other supplies. Ask your doctor to help you make a list of how many services, tests and medications you’ll need each year. Then, budget out how much you will pay. If you are insured, make sure to include costs like:


Deductibles: The amount of money you need to pay before your health plan starts to pay for your care. You might have separate deductibles for medical services and prescription drugs.


Co-pays: The fixed cost you pay for a doctor’s visit or test.


Co-insurance: The percentage of the cost you will pay for a medical service. If you don’t know how much the service will cost, ask your doctor.


If your condition is one of the “episodes of care” on our website, you can look up the total estimated yearly cost.

Look for a Health Plan That Covers Your Needs

What health plan is best if you need a lot of medical services and medications? It may not be the one with the lowest premium. Premiums are the regular payments (often monthly) that you make to keep your coverage.


Plans with low premiums often have high deductibles. That means you need to spend a lot of money before your plan starts paying its share of the costs. You might also have higher co-pays when you visit the doctor or seek other services. If you visit the doctor often, those co-pays can add up.


You may be better off paying a higher premium each month to get a lower deductible, and spend less on doctors’ visits, tests, and medications.

Consider a Flexible Spending Plan



Suppose you do have a high deductible. Or, you just expect to pay a lot of money out of pocket for your condition. Then, consider a flexible spending plan if your employer offers one. These plans allow you to set aside money from your paycheck to pay for healthcare for you and your family. You can use the money for certain medical and dental expenses, including prescription and over-the-counter medications. You can also use it for medical equipment like crutches, and diagnostic devices like blood sugar test kits.

The money is saved before tax is taken out, so you can stretch your dollars. To decide how much to set aside, use the yearly budget you develop for your condition.

Your employer may offer a Flexible Savings Account (FSA), as part of the employer’s health plan. Budgeting in advance is especially important if you have an FSA, because you will lose any money you don’t spend by the end of the year. (Your employer can give you a two and a half month “grace period” but is not required to.)

If you have a high deductible health plan, you may be able to open a Health Savings Account (HSA) through your bank. Unlike an FSA, the money you save in an HSA will “roll over” year to year if you don’t spend it, and you can take it with you if you change jobs or stop working.


Ask Your Healthcare Providers How to Save Money


Your doctors and other healthcare providers have experience treating your condition. So, they may know ways to save money without putting your health at risk. For example, your doctor may prescribe a cheaper medication, like a generic drug. Or, your pharmacist may help you buy a 3-month supply of your medication at once to save money. You may also ask your providers about funding from organizations that focus on your condition.


Stay in Your Plan’s Network



If you have a health plan, try to get your care within your network. A network is the group of doctors, hospitals, labs and other healthcare providers that have contracts with your health plan. Getting in-network care is almost always cheaper than going out-of-network. If you’re having surgery or another procedure done, make sure that all the providers involved are in your network. That includes your doctor as well as the surgeon and anesthesiologist. If you need a lab test, ask your doctor to use a lab that is in your network.


If you do choose to go out of network, use our cost lookup tool. That will let you estimate how much services cost in your area. You can compare the estimate to local providers’ prices and use it to negotiate.


If your condition is rare, or you need care that not many doctors can give, you may need to go out of network to find a provider with the right skills and experience to treat your condition. If you live in certain states like New York, you might be entitled to have your insurer let you go out of network for the in-network price.



Your Action Plan: Managing the Costs of Your Chronic Condition


To keep the costs of your chronic condition under control:


  • Follow healthy habits, including taking your medications as prescribed.
  • Make a budget of your yearly costs, and how you plan to pay for them.
  • Look for a health plan that pays a bigger share of the deductibles and co-pays, even if the premium is higher than other plans.
  • Consider a flexible spending plan, which lets you set aside pretax money from your paycheck to pay for healthcare.
  • Ask your providers, such as pharmacists and doctors, how you can stay healthy while saving money.
  • Try to use providers in your plan’s network. Use resources like our cost lookup to estimate how much out-of-network care might cost.
 

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