As coronavirus and the encouragement for social isolation continue, stress is taking its toll with job-loss, loneliness and worry are surging. As reported in in a post in the Wall Street Journal on May 25, 2020, Andrea Peterson reports that more are turning to medications; like anti-anxiety anti-depressant medications and sleep aids which have risen during the pandemic.
Tina Fey’s wisdom on the impact from stress was highlighted in her book Bossypants,
“I was a little excited but mostly blorft. "Blorft" is an adjective I just made up that means 'Completely overwhelmed but proceeding as if everything is fine and reacting to the stress with the torpor of a possum.' I have been blorft every day for the past seven years.”
Peterson, continues, prescriptions for anti-anxiety medications, like Klonopin and Ativan, rose 10.2% in March 2020 and prescriptions for antidepressants, like Prozac and Lexapro, rose 9.2% in the same period.
Circumstances including health concerns, social isolation, childcare, at home schooling and job losses are eroding the sense of calm and taking a toll on people’s well-being. In fact, the American Psychological Association shared that was parents with children under 18, 46% rated their average stress level related to the pandemic as 8, 9 or 10 on a 10-point scale, according to a survey the released May 21.
As reported in the Washington Post on May 26, 2020, the Census bureau recently released a study suggesting 1/3 of all Americans now show signs of anxiety depression or both. Most would think the most of those experiencing these symptoms of fear would be the most at risk, those over the age of 80. Not true, this study found that younger people, specifically younger Americans under the age of 30, are more upset and challenged by the Coronavirus Anxiety and Depression.
What can we do, you and me, to address the anxiety and depression and the fears that seem to be our new normal.
Here’s some thoughts
ONE - pay attention to what you are listening to ... turn off the news and turn on your favorite Pandora playlist. If you need an example, I listen to a soft jazz and a reggae playlist. Both help me to exhale and that feels much better than the churn of my stomach after a daily dose of the news.
TWO - smile ... yes smile. My kundalini teacher Jae Dev Sing suggests when our body is engaged our mind will follow. So, take some time each day to smile ... especially with those you love and care for, be it on a phone call or in person, even if you are socially distanced.
Until then, I am Doc Frank your friendly psychologist.
Frank Wood, PHD
Dr. Frank Wood is a Licensed Psychologist and the creator of Thriving with Stress, an innovative training program designed to leverage stress – in the workplace, in relationships and with life.
As a speaker, author and trainer on stress, Dr. Frank has applied all of his expertise and experience in developing The Thriving with Stress program; a program that clients refer to as a "game changer" and a “program that is turning the tables on stress.”
Uncovered, in partnership with HealthSherpa, is committed to keeping you up-to -date on what your health insurance covers for COVD19, and what to do if you lose your health insurance. We wanted you to see what HealthSherpa has published on questions you may have – as well as a question direct from our community.
Right now, many Americans are practicing
social distancing to help “flatten the curve” of the transmission of
coronavirus. But at the same time, they are also seeking information on what to
do should they contract COVID-19.
If you are concerned you may have COVID-19,
here’s what to know about how your insurance works when it comes to testing in
light of the expanded Centers for Disease Control (CDC) testing
If you don’t have health insurance, enter your
zip code below to search for plans and prices below. If you lost your insurance
recently, you may qualify for a Special Enrollment Period (SEP), and several
states have announced SEPs for all residents due to COVID-19.
Per the CDC, testing for coronavirus—the novel
virus that causes COVID-19—is now available in all 50 states. There are
currently a total of 75,000 lab kits “cumulatively” available for public labs
and more are hoped to be available soon. Private companies like Lab Corp and
Quest Diagnostics will be providing the majority of testing, though. And many
Americans may be wondering what this means in terms of what their insurance may
The Trump administration has announced that
testing for COVID-19 has been designated as an Essential Health Benefit (EHB),
meaning that testing must be covered by all ACA- compliant plans. This means if
you are enrolled in a Marketplace plan, your insurance company will cover
COVID-19 testing is also covered by Medicare
and in most cases by Medicaid.
If you have coverage through an employer,
whether COVID-19 testing is covered depends on the size of your employer. If
you are employed by a company with fewer than 50 full time employees, COVID-19
testing will in most cases be covered. If you are employed by a larger company,
whether COVID-19 testing is covered is determined by your employer; you should
contact your benefits department for more information.
In addition, many health insurance companies
have announced that the test will come with a $0 co-pay, at no cost to the
Many insurance plans will also be covering
telemedicine services should Americans wish to speak with a doctor at home
through web-based conferencing, thus allowing them to continue to socially
distance. Contact your health plan to learn about their telemedicine
Any treatment you need for COVID-19 will
be covered by your insurance in the same way as any other similar treatment or
hospitalization, although some insurance companies are waiving certain copays
you may have to pay for COVID-19 treatment. Once again, you can consult this list from America’s Health Insurance Plans
(AHIP) to learn more about the details of coverage.
Depending on the type of plan you have, the
kind of coverage it provides, and your specific insurance carrier, the
specifics of cost-sharing and benefits can vary when it comes to costs you
may need to incur as a result of testing and treatment. Important to keep in
mind is that while co-pays may be waived or COVID-19 testing, this may not
apply for all other tests, treatments, or doctor’s visits associated with the
virus, including hospitalization. Which means depending on the kind of health
insurance plan you have, you may need to meet your deductible before full
coverage kicks in for your treatment, including whatever benefits you may have
for in-patient hospital care.
What are the risks of
being uninsured during the coronavirus outbreak?
If you are uninsured, then you will need to
pay for the cost of coronavirus testing and any treatment associated with
COVID-19 yourself. The out-of-pocket costs for testing without insurance can range from approximately
$500 at a doctor’s office to approximately $1000+ in a hospital setting.
In 2018, 27.9 million nonelderly Americans were uninsured in
the United States. Most uninsured people are in low-income families, with
families of color disproportionately represented among uninsured
Outside of Open Enrollment, you can typically
only enroll in health coverage if you have a qualifying life event—for example,
losing your health coverage within the last 60 days.
From our Uncovered community: What if I lose my employer-based coverage? What if my income changes and I can’t afford coverage? What if I don’t currently have coverage?
If you’re concerned about losing your health insurance due to job status change (full time to part-time or job loss), consider these options:If your employer has over 20 employees ask your employer about your COBRA option. You can continue under your current plan for up to 18 months but will be required to pay the full monthly premium. Currently your employer contributes between 75-80% of the monthly cost. Loss of health insurance due to a job status change within the last 60 days is deemed a qualifying life event which entitles you to enroll in any ACA health plan. If this is you (you have lost your insurance and you want to enroll in an ACA plan) – and you live in California, Colorado, Connecticut, DC, Massachusetts, Maryland, Minnesota, Nevada, New York, Rhode Island, Vermont or Washington – click on your state link listed below and you can see how to enroll now.If this is you (you have lost your insurance and you want to enroll in an ACA plan) – and you live in a state other than those listed in the point above, CLICK HERE and we will connect you to enrollment options. The resulting reduction in earnings from a job loss may qualify you for government health insurance subsidies on qualified ACA plans or for Medicaid coverage which varies by state but requires minimal premium contributions.If you don’t currently have health insurance and haven’t experienced a job status change, many states—currently California, Colorado, Connecticut, DC, Massachusetts, Maryland, Nevada, New York, and Rhode Island—have opened up Special Enrollment Periods to help people without health coverage get insured during the coronavirus pandemic. The federal government has not yet BUT is considering opening a Special Enrollment Period as well. So if you live in one of the states not listed in the point above, stay tuned – you may have a chance to enroll at a future date before the October, 2020 open enrollment period. We will keep you apprised of if and when that happens.
If you have lost your health insurance and want to enroll in a new ACA healthcare plan, and you live in one of the states below, click on the state in which you live. Otherwise, CLICK HERE.
If you are currently uninsured, don’t forget
that you can apply to
see if you or anyone in your family may qualify for Medicaid or CHIP at any
time—you don’t need a qualifying event to apply.
How does ACA insurance
compare to short-term insurance during the coronavirus outbreak?
While coronavirus testing is now an Essential
Health Benefit (EHB) and thus qualified for no co-pay coverage, EHBs only apply
to ACA-regulated plans. Which means that EHBs do not apply to short-term health insurance.
Short-term plans typically do not cover
pre-existing conditions, preventive care, emergency services, mental health
care, prescription drugs and maternity care. If you have a short-term health
insurance plan, know that you may need to pay out-of-pocket for any coronavirus
testing or coronavirus-related hospitalization you may need for
Only plans that are regulated by the
Affordable Care Act, such as those available on the Health Insurance
Marketplace, contain no-cost Essential Health Benefits.
Enter your zipcode to search for marketplace plans and prices.
Medicaid is a program jointly funded by the
federal government and the states to provide health insurance to low-income
Americans. Medicaid eligibility is determined based on income level. Adults,
children, pregnant women, the elderly, and people with disabilities can all
become Medicaid recipients. Medicaid covers one in four children, 21 percent of
all low-income adults, and 60 percent of nursing home residents in the United
States at this time.
While details of Medicaid programs and
benefits vary by states, federal law does require that all Medicaid programs
cover a certain set of “mandatory benefits.” These include inpatient and outpatient
hospital services, nursing facility services, home health services, physician
services, and laboratory and x-ray services.
What is CHIP?
The Children’s Health Insurance Program (CHIP)
provides low-cost health insurance to children up to age 19 to children whose
families earn too much to qualify for Medicaid in their state, but do not earn
enough to be able to afford private insurance. In some states, CHIP also covers
pregnant women. Every state runs and offers their own CHIP insurance program
While you can apply for CHIP at any time, and
do not have to wait for the annual Open Enrollment Period (OEP), in 15 states,
children may have to be uninsured for up to 90 days before becoming eligible to
enroll in CHIP.
Each state has different guidelines in terms
of income eligibility and eligibility standards. 46 states plus the District of
Columbia make CHIP eligible for children whose families earn up to or above
200% of the Federal Poverty Level (FPL). That translates to $50,200 for a
family of four. 24 of these states offer CHIP eligibility to children in
families who earn 250% or more of the Federal Poverty Level, or $64,750 for a
family of four.
While details of CHIP benefits vary slightly
by state, federal law guarantees that CHIP programs everywhere must provide
comprehensive coverage, including:
If the patient does NOT meet the criteria, the doctor treats whatever they believe the illness to be. For example, patients with flu-like symptoms typically receive Tamiflu if they contact FSH within 72 hours of the onset of illness.
If a patient DOES meet the criteria
Doctor advises to self-quarantine for 14 days
Doctors do NOT advise patients to seek in-person care for mild symptoms (this reduces the risk of unnecessary exposure to MORE illness and contains the spread of the germs)
If the patient is having difficulty breathing or is in respiratory distress, doctors advise patients to dial 911 and let them know that they may have COVID-19.
The First Stop Health team will follow-up with the patient to coordinate communication to public health authorities.
I think I might have COVID-19. What should I do?
Experiencing mild symptoms such as cough and/or fever or believe you may have been exposed to the virus? DO NOT GO to the emergency room. Instead, if you suspect you may have COVID-19, you should call your doctor or use telemedicine.
Experiencing severe symptoms such as shortness of breath or difficulty breathing? Call 911 and advise the dispatch of your symptoms. DO NOT CALL emergency rooms prior to going (many are not set up to handle the volume of calls). Remember to use emergency departments for emergencies only.
What should I do before contacting First Stop Health Online Doctors?
First Stop Health is experiencing an increase in volume as a result of COVID-19. While wait times remain low, and First Stop Health expects to continue to deliver speedy service, please be patient as they work to care for customers and keep up with the evolving protocols.
Before contacting First Stop Health about COVID-19, please:
Ensure you are a First Stop Health customer. First Stop Health telemedicine service is provided through Uncovered.
Take your temperature.
Download the First Stop Health mobile app or login by clicking in the upper right-hand corner. You can call 888-691-7867, too, but requesting a doctor visit via app or web is the fastest way to talk to a doctor.
Can First Stop Health doctors order COVID-19 lab tests?
No telemedicine providers can currently order a COVID-19 test. As of March 9, there were 79 labs in the U.S.with COVID-19 testing available (it’s currently in very short supply).
How can I get tested?
Only people who meetspecific criteria outlined by the CDC should be tested. If a First Stop Health doctor determines that you do meet the criteria, their customer services team will follow up with you to coordinate communication with public health authorities. Like most other doctors (including those who practice telemedicine), First Stop Health doctors cannot simply order a lab test for COVID-19.
As of March 9, there were79 labs in the U.S. with COVID-19 testing available (it’s currently in very short supply). For most people with mild symptoms, testing is not necessary because the course of treatment for COVID-19 doesn’t vary with a positive test result.
Click here to review current travel recommendations.
Should I wear a face mask?
If you are NOT sick, no. The average face mask does not protect you from getting this type of illness.
If you are sick, yes. A face mask may help you from spreading your illness.
Should I keep social distance?
If possible, yes. According to the CDC, social distancing means as remaining out of congregate settings, avoiding mass gatherings, and maintaining distance (approximately 6 feet or 2 meters) from others when possible. This helps protect you from exposure and helps slow the spread of the virus.
The virus is airborne, which means it spreads from person to person through coughing and sneezing. It can be spread through infected surfaces or objects, as well.
How do I prevent it from spreading?
Avoid sick people. Wash your hands for at least 20 seconds, and wash them often. Stay updated with recommendations here.
What are the symptoms?
The most common symptoms are fever, cough, and shortness of breath. Symptoms can be more severe.
How long before symptoms appear?
After exposure, symptoms typically appear within 2 to 14 days after exposure.
How severe is COVID-19?
Most people who are infected recover. Some don’t show any symptoms. An estimated2.3% of those that contract COVID-19 die (this number is the “case fatality rate” or “death rate”). The best outcomes are reported for those under 50 years old, where the death rate has been reported at 0.4% or less.
Is there a vaccine available?
There is currently no vaccine to protect against COVID-19. The best way to prevent infection is to take everyday preventive actions, like avoiding close contact with people who are sick and washing your hands often.
Can COVID-19 live on surfaces?
Yes. The best way to kill germs is by cleaning and disinfecting surfaces with household cleaning sprays or wipes.
Coronavirus, or COVID-19 (“novel coronavirus”), has made its way into the United States and each day there are more confirmed cases. While you’re still relatively unlikely to contract COVID-19, now is the time to start getting prepared, and telemedicine should be an item on your prep list.
Check out the CDC’s Coronavirus homepagefor up-to-the-minute information and advice. If you’re looking for a doctor’s opinion on your symptoms, click the button below:
Because the threat of illness is so high, telemedicine can help you make the right decision about getting tested. While virtual doctors cannot test for or treat coronavirus, they can help assess risk based on your travel history and symptoms.
While telemedicine services cannot virtually test you for Coronavirus, a telehealth doctor can give you their professional opinion about your symptoms and how to reduce your risk of contracting the virus.
2. Telemedicine Gives You Back Up Medical Care
Telemedicine puts a doctor within arm’s reach at all times—which can also be important if the disease continues to spread. New reports are indicating that this outbreak will stress the U.S. health system, especially access to Primary Care Providers. Telemedicine gives you access to doctors for non-virus related healthcare needs, taking stress out of the system while ensuring that you have access to the care you need.
With doctors available 24/7 via mobile app, website or phone, telemedicine is the best choice for many minor illnesses or injuries.
3. Get Prescriptions And Refills
Telemedicine provider, First Stop Health, will prescribe medication and refill prescriptions over the phone or via video chat. Experts recommendpreparing for coronavirus by having an additional supply of the prescription medications you need in case of a broader quarantine. If you are someone who regularly takes medication or vitamins, make sure you have a supply of the prescriptions you need ahead of time.
4. Limit Your Exposure To The Outside World
It’s no secret that limiting your exposure to the outside world is one of the best ways to reduce the chances you’ll contract coronavirus. The more you can avoid sick patients in crowded waiting rooms, the safer you are from getting a new illness.
Why First Stop Health
If you’re considering telemedicine as a prep step for coronavirus, we highly recommend First Stop Health’s service. First Stop Health provides prescriptions, 24/7 access to board certified doctors and the ability to call over the phone or video chat.
Unlike other telemedicine providers, you can subscribe to First Stop Health for a flat fee—which means you get unlimited virtual visits every month and up to seven family members are covered by the same subscription.
Megan Weddle works for First Stop Health, a company that specializes in bringing telemedicine to consumers, so it’s no surprise she’s a fan of technology itself. Her reason, though, is beyond professional—it’s personal.
Telemedicine helped Megan discover her twelve-year-old-son Brady—whom she thought was dealing with a simple stomach flu—was actually facing appendicitis.
Not the Stomach Flu
It all started when Megan decided to take her eleven and twelve year old children on a flight to the west coast to visit relatives. It was the first long flight for the kids, and her son Brady complained a little about his stomach hurting on the flight. They thought it was just upset from the cookies on the plane.
“The number one thing the kids wanted to do when we got to California was go to In-N-Out Burger,” Megan says. “After visiting the Hollywood sign, my son looked at me and said, ‘I need to find a bathroom NOW.’”
The flight, the burger, the time difference . . . Megan knew it could have been anything.
They hopped in the car on the way to Santa Monica, and Megan wondered several times if she’d need to pull over for Brady, who was still struggling with stomach issues in the back seat.
An hour later, as she was handing her card over to the receptionist at the hotel, Brady ran straight for the bathroom. He came out a few minutes later, saying he’d gotten sick.
As the rest of the family went to the pool—with everyone agreeing it was best to stay away from what was surely the stomach flu—Megan considered her options.
Where Megan Turned Instead Of Racing To Urgent Care
“It was close to the time an urgent care would be closing. Then, I thought to myself, I am going to call First Stop Health. I work for a telemedicine company. This is what it’s for: avoiding unnecessary visits to the ER or the doctor.’”
Megan picked up the phone and dialed. Although she could have opted for a video visit, she chose the phone option that time. Even though Brady wasn’t registered with First Stop Health, she was able to use her info and give his age, medical history, and presenting symptoms. She told the nurse that she thought it was the stomach flu and likely needed some anti-vomiting medication.
The Doctor’s Time Saving Diagnosis
When the doctor got on the line, he indicated he wanted her son to do a balance test, just to rule out anything more serious than the stomach flu.
“He told me to have Brady jump on one foot. I thought it was ridiculous—he’d been jumping all day, running around, before he started to feel bad. Brady refused to jump, though. Then the doctor said he hated to be the bearer of bad news, but my son was presenting with appendicitis.”
The doctor gave her information for two hospitals near where they were staying. They went immediately to the ER, where the doctor gave the same balancing test—which Brady failed.
His appendix was about to burst, and he needed emergency surgery.
Brady made it through the surgery just fine, but if his appendix had burst, there could have been serious complications. Megan credits First Stop for being a big reason why she got Brady to the hospital in time.
“The best part of this service is having access to a doctor 24/7. As a parent, sometimes you think you know it all. But, to be fair, we don’t. If Brady’s appendix would have ruptured, we would have been in California longer. Because we caught it and did the surgery right away, we only had to spend one night in the hospital. He bounced back.”
What’s Different About First Stop
On top of being a quick way to talk to board certified doctors, First Stop has other benefits, too. The service costs just a couple of dollars every month for individuals, unlike other telemedicine services that charge up to $75 per call.
First Stop can also be used by up to seven other family members, meaning the whole family can have instant access to care.
A Good Call For Moms With Kids
In addition, using telemedicine can be uber-convenient and less risky to other members of the family who are not sick.
“Sometimes, you don’t want to drag your non-sick kids into a waiting room, which is a petri dish. There’s only so many times you can say, ‘don’t touch that.’ I know. I am a mom of four!”
In the end, telemedicine not only made the trip easier on Megan and her family, but it also could have saved Brady’s life. That’s a call that’s always worth it.
“It never occurred to me to shop around before then,” Kelly said. “It’s kind of a one-pony show up here. You go to the place that’s available.”
Kelly said she considered paying cash to get a lower rate, but because she knew she’d need surgery and thus meet her deductible for the year, it was more cost-effective to find the cheapest route through her health insurance.
How To Find The Best MRI Cost
Kelly followed a step by step approach to research and shop for the best, most affordable care. Here’s how to do what Kelly did:
Call the physician and ask for the procedure code. Note that there can be multiple codes for each type of procedure. For an MRI, for example, there are different codes for “with contrast” and “without contrast.” Be sure your doctor provides you with the code for the precise procedure you’re getting.
Call different facilities you’d like to price shop, ask for their facility code (or ICD10), and ask the medical billing department for their price based on the procedure code from your physician. See our list of healthcare transparency sitesfor resources to help you find and compare providers.
Call the insurance company and give them the information: the procedure code, the facility code, and the quoted price—and have your insurance company confirm what you’ll owe.
Make the decision that is most in line with what you want and need for your healthcare—and your bank account. You should also remember that most outpatient facilities offer payment programs, which can be a great fall back option.
Kelly’s Shopping Success Story
Ultimately, by using a simple online search to find facilities and then calling around to get the lowest price, Kelly found a facility that would do the MRI through her existing insurance for a price of $341—a savings of over $1,600. She scheduled the test for the exact day her six-week waiting period was up.
“Through this experience, I learned to shop around because the medical care that’s available to you isn’t always the cheapest. It pays to look for some competition,” Kelly said.
It’s important to note that the MRI Kelly received—the one that was $1,600 cheaper at another location—was a 2D MRI, not a 3D MRI. Both of these types of MRIs can generally be used to diagnose a meniscal tear with similar accuracy.
IMPORTANT NOTE: It’s critical to check with your doctor to see what kind of MRI you need in your situation, rather than go with the one that’s most convenient or cheapest.
“Here [at the local facility] I would’ve been paying for a fancier machine that I didn’t really need. My doctor didn’t care if the MRI was 2D or 3D. It definitely makes sense to do your research .”
Ultimately, the MRI confirmed what Kelly and her doctor had suspected, and she got the care she needed for her injured knee. She reports she is very glad to be back up and running!
If you have a planned hospital need, you aren’t at the mercy of the billing department: if it makes sense for you, you can pay cash and save—sometimes up to 75 percent! In this article, we’ll look at how.
Here at Uncovered, we get it. All those tests, procedures, and surgeries are stressful enough in premise alone. Then, you factor in the cost, the fear of medical debt (and the fact that it can feel impossible to know how much you’ll owe ahead of time), and your stress level goes through the roof, right?
It doesn’t have to be like that. With a few calls and by asking the right questions, you can learn your all-in price. What was Eric’s big trick?
Paying upfront, in cash.
When it doesn’t make sense to pay in cash
Look at what kind of plan you have. If you have a full plan that covers preventative care, you’re safe. Or, if it’s early in the year and you have a low deductible that you know you will hit—and need to hit to account for more upcoming expenses during that calendar year—you’re also safe. Nothing to do. (Just make sure you stay in network!)
When it does make sense to pay in cash
If you have short-term insurance, it almost never covers preventative care, so it makes sense to find out the cash price. If you have a deductible you know you will not meet during the calendar year and are having a non-preventative procedure, it also makes sense to find out the cash price. You’ll be paying it in cash anyway, so why not pay less?
Here’s how to find out the cash price:
Step One: Call the surgery center or physician and say you’d like to negotiate.
Step Two: Ask who is involved in the procedure, what services you will receive, and get a breakdown of those costs. For example, for Eric’s colonoscopy, they broke it down for him all the way to the cost per polyp removal.
Step Three: Tell them you’d like to negotiate an all-in price to pay on the day of service.
Step Four: Save big money!
These Tips in Action
Eric Neuville is the perfect example of what to do when it comes to negotiating hospital bills. When his doctor referred him for a colonoscopy, he knew it wouldn’t be covered under his short-term medical insurance because his plan didn’t pay for preventative care at all. He also knew his deductible was high–$8,000—and that he wasn’t going to meet it.
Eric’s doctor told him he wasn’t sure how much the colonoscopy would cost. What he refers to as his “sort-of” insurance carrier also told him they didn’t know (and wouldn’t until the surgery center billed them). The common refrain was that the procedure had to be done for them to know—which, according to Eric, was ridiculous. And he would know, as a twenty-five year veteran of the insurance industry who ran product development for Anthem Blue Cross and Blue Shield.
Eric’s wife called the surgery center and asked for the all-in cash price on a colonoscopy. They broke it down for her: if they paid in full on the day of service, it would be $1000 cash, a savings of almost 70 percent.
The day of the surgery, Eric walked in and told the receptionist he was quoted a cash price of $1,000. He gave them two cards: his insurance card and his payment.
When the couple later got a bill with a “discounted” price of over $3,000 for the surgery, Eric had to remind them that he’d already paid—and that he hasn’t paid nearly that much.
It wasn’t the couple’s first time using the cash method to save. When Eric’s wife had a hip and knee replacement due to arthritis, they got another 75 percent discount by paying a quoted all-in price up front.
What Eric Has To Say About Negotiating
Eric is an advocate for healthcare consumerism not just when it involves his bank account.
“We need to be as active in our healthcare choices as we are when we make a choice about what television to buy next,” he says. “We have to challenge ourselves. I have zero patience for the ‘I have insurance, so I don’t have to worry about it’ mindset. That drives up costs for us all.”
I spoke with M.C. Laubscher on his podcast, Cash Flow Ninja, recently about the things everyone should be thinking about when they’re making decisions about their healthcare. His listeners come to him all the time with questions about healthcare…”What should I do? How much should I be paying? How do I find better information to make smarter decisions?”
M.C.’s audience is filled with entrepreneurs and investors and the advice I have for them is perfect for anyone who is looking for individual insurance during open enrollment this fall. We talk through:
The difference between healthcare and insurance
What everyone should be doing during open enrollment to find the best insurance plan
Picking your health insurance plan for 2020 is an important decision you’ll be stuck with for the entire year. Which means it’s worth taking the time to do a little homework and make the pick that’s right for you.
Follow these seven steps to make sure your insurance plan fits your health needs and your budget.
1. Start With Your Health History
Make a list of how much you used your health insurance last year. The list needs to include physician office visits, prescriptions, diagnostic and lab work, and medical procedures.
2. Find Out What Plans Are Available To You
Identify the plans available to you, the amount of cov- erage they offer, and the amount of upfront dollars you will need to pay.
Use a chart like this to help you organize:
Premium (cost per month)
Deductible (amount you pay before insurance kicks in)
Out of pocket charges
3. See How Each Plan Stacks Up Compared To Your Expected Medical Costs
Compare the costs of every health plan available to you. Don’t automatically exclude any, even those with a high deductible. Which plan costs you the least in total?
4. Find Out What Can You Afford Monthly
Can you handle your healthcare costs in one payment or, if not, how much you can afford monthly. For example, can your pocketbook sustain $694 in monthly costs, or $8,365 annually? Be realistic.
5. See If Your Current Doctors And Hospitals Are In Network
If you go to an out-of-network provider, your copay, deductible, coinsurance, and out-of-pocket maximums will generally double. You’ll have to decide if that doctor/provider is worth it or be forced to find another doctor.
6. See What’s Covered
7. List the tax deferred mechanisms of each plan
Ask for and study all tax deferring or saving mechanisms available like premium-only plans, flexible spending accounts, health reimbursement accounts, and health savings accounts. These plans all allow you to save and use your dollars before income tax is applied, kind of like a 401K. These options are no brainers when they’re available to you since they increase the amount of money you have to pay for your health expenses.
Remember, don’t overinsure by selecting the plan with the lowest out-of-pocket fea- tures, because it will have the highest premiums, which are non refundable. This checklist will give you a clear idea of the most cost-effective plan that meets your specific needs.
You only have one chance a year to make the best choice, so do your homework!
Healthcare transparency sites give you access to information that could help you make smarter decisions and save you thousands of dollars. But not all healthcare transparency sites are created equal. Below is our list of the top healthcare transparency websites for 2019.
Be Careful Who You Trust
Healthcare transparency sites are usually built on access to real, anonymized healthcare records that allow them to analyze cost, effectiveness and provide reviews. The only problem is, sometimes this data isn’t accurate, or the site just isn’t pulling from a large enough population to provide accurate information.
The Sites That Made Our List
We’ve reviewed each an every one of these sites to make sure they’re helpful and user friendly—but most importantly, that you can trust them. They’ve earned our stamp of approval as insiders and we think you should use them.
Healthcare price transparency is a growing trend—more and more people want to know what they’re going to pay when they visit the doctor or hospital. Everyday new sites are started to help people better understand the cost of healthcare.
Bookmark this page. We’ll continue to update this guide as new sites become available. But most importantly, use these sites! The information they give you could save you hundreds or thousands of dollars.
“It’s not technically insurance—even though it is. And I can’t speak for everyone, but from my experience, there are no downsides.”
That is the way Nat Comisar describes the HealthShare program he and his wife switched to after finding the traditional route—searching on the Healthcare Marketplace (Obamacare)—to be far too pricey.
Nat was no stranger to the world of insurance, either. In the past, he was the employer who provided healthcare to his employees. When he became self-employed, he figured he’d have no problem securing insurance. After all, he was a healthy 55-year old man with no preexisting conditions and on no medications.
To the best of his memory, the best deal he could find was going to cost him $680 a month with a $7200 deductible. Because he rarely had any reason to go to the doctor in the first place, that could have amounted to almost $16,000 annually for something he didn’t even use.
So, what was next for Nat? He made the same decision a lot of people in that situation do: he went without insurance for five years, finding it far cheaper to simply pay the fine when tax time came around.
When Nat’s wife went to search in the Healthcare Marketplace, her premium was more reasonable—at first. It started at around $270 per month. Then, it started steadily increasing, all for the exact same coverage. When it approached $500 per month, Nat’s wife made the same decision as her husband: she went without insurance for about a 18 months.
While out to lunch with a friend—a friend who had just happened to be writing a book at the time about how to take control of your healthcare and save money along the way—Nat learned of an option he had no idea was out there: HealthShare.
“The way I understand it, the HealthShare Market is the way insurance is supposed to be,” Nat says. “It’s a pool of individuals who are funding a contingency for one another for health concerns.”
HealthShare programs are religion-based. Many don’t require you to be a member of that particular religion, just that you are a person of faith. Remember—each program is different, so do your research wisely.
Nat did just that, focusing on three major HealthShare companies. He ultimately chose the one that seemed easiest to join and most organized—Solidarity HealthShare, a Catholic Organization.
Practically, Nat now pays $300 a month to cover both him and his wife. Collectively, they have a $1000 deductible.
“We still don’t use any of our insurance dollars,” Nat says. “In this last year that we’ve been a part of this, I bet we’ve only spent about $400 towards our deductible. Still, it’s so worth it. A plus is that with this company, if I do get to a place where I need assistance, I can see who it comes from. I can also see where my contribution is being sent and send a message to them, if I want.”
To be eligible for this program, Nat had to pledge a few things: that he was a nonsmoker, did not use illicit drugs, and was a moderate drinker, if he drank at all. If he had any preexisting conditions (he didn’t), he’d have to declare them up front—but that would not make him ineligible for coverage. Instead, it would mean he could not be reimbursed in the first year of being in the pool, and only up to $25,000 annually the second and third years. For everyone—preexisting condition or not—there is a $1 million lifetime cap.*
Nat’s plan sends him and his wife to annual checkups, both of which are covered. There is no pharmaceutical component to his plan, but that’s okay—there are discount cards to help with that.
Sometimes, when Nat does need to use his HealthShare—which, by the way, satisfies the legal requirement for having health coverage, saving him that annual tax penalty—receptionists give him a funny look. He says he’s used to explaining from there.
“I tell them, ‘It’s HealthShare, not insurance. You should be able to file it. If you can’t, just consider us a self-pay, and we’ll file it.’”
The Bigger Picture
Nat says in the beginning, he was curious about the extent of the religious component.
“In the end, I’ve found it to be a Christian organization that is a big group of people supporting one another,” he says. “There’s not a profit motive.”
In retrospect, Nat says he wishes he would have known about HealthShare sooner.
“Before, I had 350 employees in the restaurant business. Had something like this existed—or had I known it existed—I could’ve covered everyone at 100 percent, purchased supplemental insurance, and still not have to ask for their financial participation.”
If someone who was in the business of providing health insurance didn’t know about this option, odds are that this is your first time learning about HealthShare, too. We want to be clear: this option is not for everyone, but if it turns out to be for you, you could be on the receiving end of some big savings.
*Remember that not all HealthShare programs are the same. For more information the company Nat and his wife decided to use, visit Solidaryhealthshare.org. To find the right option for you, visit HealthSharingPlans.com.
Prescriptions are expensive, but you have more resources available to help you cut those costs down than you think. Here, we’ll look at how one man saved $422 a month on his medication by leveraging a Patient Assistance Program (PAP)–and how you can get similar results.
(Yes, you did read that correctly: $422 a month!)
No one is immune to the high prices and feeling of bureaucracy that can sometimes shroud the world of healthcare and big pharma—not even Scott Heiser, who literally wrote the book on the subject.
The difference is that Scott knew what to do—and, by being here, that means you can, too.
In the past, Scott was hospitalized with deep vein thrombosis (DVT) and subsequent pulmonary embolism—i.e., a blood clot in the lungs. Scott recalls that the whole thing was a shock, kind of a “freak incident.” He talked with the physicians, who said he needed to be on a blood thinner for a year.
Together, they discussed options: there was Warfarin, an older and relatively inexpensive prescription, or Eliquis, a newer-generation drug that was more costly. Each drug—as is true for them all*—had pros and cons: Scott learned it was easier to control bleeding and coagulate more quickly with Warfarin, but he’d also to test his blood often. With Eliquis, he wouldn’t have to test his blood, and he’d have the convenience of only taking one pill a day. Although an uncontrolled bleed was not likely in his case, if he faced one, it would take him longer to coagulate.
Because Scott’s risk factors were low for needing quick coagulation—and taking into account he only needed to be on the precautionary medication for a year—he and his doctor decided Eliquis was the best choice.
The problem? It was $432 a month. Because Scott knew about PAPs to reduce consumer costs, though, he was able to get that cost down to $10 a month.
That’s that mega monthly savings we’re talking about! Hardly chump-change.
Let’s take a closer look at PAPs.
PAPs: What You Need to Know
PAPs are offered by pharmacy manufacturers to provide financial assistance to those taking a particular drug and who meet certain requirements. While each PAP is different, they generally provide assistance to those who meet one or a combination of the following criteria:
Have a high deductible health plan
Have an income of at or below a certain point
Do not have health coverage
Just as qualifications for each PAP are different, so are their means of providing assistance and reducing consumer costs. Some will cover your copay. When this happens, the pharmaceutical company still bills your employer (if they provide your insurance) the full amount—that’s just business.
“Our whole philosophy is that you, as a consumer, should understand the cost being borne by the system and be aware so you can try to minimize that cost. Why? Easy: it will pay dividends to you in the long run by keeping your premiums low,” Scott says. “If your employer’s premiums don’t go up, they don’t raise them for you, either.”
How Scott Saved Over $5,000
In the short game, though, Scott knows that money talks. And $10 is a whole lot more digestible than the alternative—which is an example of what makes PAPs so attractive.
Here’s how Scott secured the reduced rate:
He searched for the phone number of the manufacturer and called to ask if they offered any type of assistance program. (Spoiler alert: they did.)
He talked with the representative to see if he met the program requirements due to his high-deductible health plan. (Spoiler again: he did.)
The representative said he’d notify Scott’s pharmacy of his discount, which was good for 24-months. (That’s all, folks. Discount received.)
It took all of twenty minutes—for the online search and the phone call combined—for Scott to save more than $5,000 for the year he was on the drug (that, due to the timing of his hospitalization, he would’ve paid 100 percent out-of-pocket).
Today, it’s not even necessary to do your own online investigation. Instead, you can simply visit RXHope.com. This free, reference-based website lists over 330 drugs for which PAPs are available; it’s all right there for you.
Note that your drug may or may not be on the list—and if it is, you may or may not qualify for the PAP—but isn’t taking a few minutes to check worth the effort?
Discount Cards: Save $5, $50, or More!
Sometimes, a PAP may not be available for a drug you’ve been prescribed. In that case—and, really, in any case—Scott says he recommends utilizing a prescription drug coupon card.
He recalls having a prescription for Fluorouracil, a mild chemotherapy topical. He brought his coupon card (SingleCare, in this case) to the pharmacy, knowing what discount he was eligible for. The pharmacist (from a big chain store) said the cream would be $200, but—good news!—the store offered a $50 coupon.
Scott knew that with his coupon—one the pharmacist said he may not be able to accept because he couldn’t file it electronically through the store’s system—could save him $100. Ultimately, Scott requested the paperwork to file on his own, saving himself the extra $50.
The pharmacist wasn’t trying to pull a fast one; he was simply dispensing drugs and offering discounts in the manner in which he was trained. In fact, Scott even had a brief chat with him—to the benefit of others within earshot who were obviously listening—about the way the card worked as well as other ways to save on prescriptions (like visiting RXHope).
Had Scott not had the discount card and the pharmacy not offered its coupon, he would have had to pay the full $200 for the cream—in essence, meaning there was $100 that nobody would have known about that the insurance company was keeping. This shows that insurance companies aren’t passing down all the rebates to pharmacists—all the more reason to be an engaged consumer of healthcare.
Scott had a similar situation in which his wife went in to pick up a prescription for Estradiol, a hormone replacement patch. The brand name was $140, and the generic was $80. With the drug discount card, they were able to drop that price to $45—a substantial savings on any long-term medication.
At the end of the day, you want to save money on prescriptions, right? Rebates go on in the pharma world to employers and insurance carriers all the time. How do you get your own rebate? The true examples above are here to show you that it is possible to get in on that game.
As we’ve illustrated, with certain specialty or single-sourced drugs, manufactures will deal directly with you in the form of PAPs (if you meet their requirements). With other, more generic drugs, a discount card might be the way to go.
The bottom line? There is no downside to looking at your savings options—a little time could go a long way to the bank.
How much could you be saving? Once you get your prescription costs down, tell a friend. Help them. The more we speak up as consumers of healthcare, the more premiums will come down, and the more we can be a part of changing this industry.
Are you happy paying thousands of dollars in healthcare costs you don’t use? Are you angry at the medical bills you incur for services that should cost a fraction of that amount? Are you looking for answers?
This week we interview a healthcare industry insider, Scott Heiser. He spills the secrets on what is actually causing the problems in our system. He also gives us some simple tips and tricks to save yourself thousands of dollars with only a few minutes of your time...
Listen to the entire episode to learn insider negotiation techniques on The Money Tree Podcast!
Now, more than ever, prescription drug prices are expensive—especially if you have high out of pocket costs.
Specialty drugs, single source branded drugs, and repack- aged generic drugs are all escalating in cost (7 percent per year, two times the Consumer Price Index). Remember the EpiPen story? A low-cost generic solution was repurchased and repackaged by Mylan. Then, the drug manufacturer increased it from $70 to $600 without offering any product enhancements—just price increases!
If you aren’t aware of how to mitigate those costs, you might be needlessly throwing away thousands of dollars a year. Even if your insurance plan offers drug coverage, you can still use these tips to save even more money. The first step is to understand how drug manufacturers price their drugs and why they’re being prescribed.
The Questions To Ask Your Doctor To Save Money
If you’ve been to the doctor recently, you know that most visits end with you getting a prescription.
Why is that?
If you stop and think about it for a second, it makes sense. You go into the doctor expecting to be cured, and you want to walk away with something tangible that tells you you’ll get better. There are other things you could be doing to feel better, but that’s a topic for another post.
So when it comes to prescriptions, what can you do to save money?
Where To Start: Ask Your Doctor These Questions
How much does it cost?
Can the pharmacist substitute a cheaper, generic form of the medicine?
Are there cost-effective alternatives to this medication?
Does the drug company offer any discount or rebate programs?
Does the drug company provide a prescription drug assistance program?
Can you prescribe a half-year or year supply so I can buy in bulk?
Insider Tricks To Save Money On Prescriptions
So, how can you get the best price on your prescriptions? Think about it like anything else you would buy and SHOP! Here are some insider tips and tricks to save money:
Turn to big box stores.
Wal-Mart,Kroger,Costco,and even Amazon are getting into the drug business. Their goal is to get you in the door (or on the website) by any means necessary. For example, about a decade ago, Wal-Mart accomplished this by selling generic amoxicillin for just $4. Consumers came for the dirt-cheap drugs and, while they were there, bought orange juice, milk, and chicken noodle soup. It’s a straightforward model, and it still works today; you can find good deals on basic drugs at big box stores.
Use Price comparison tools
Check with your insurance plan for comparison tools. If you don’t have one with your plan or are uninsured, check with the following: GoodRx, One RX, or use our partner SingleCare’s tool on our How to Save page. They all will provide pricing for prescriptions at their negotiated prices. Compare them all. You’ll be surprised to find they are different. Also, compare one pharmacy location with one in another area of town. Sometimes there is different pricing, so it pays to look.
Note: When using one of the discount cards with your health plan, make sure the drug is on your formulary (approved drug list). Research the discount programs for the exact drug. Ask you pharmacist what the cost of the drug is through your health plan. If the discount card is lower, use it instead of your health plan. Then file that drug as a claim. You can access claims through your health insurance carriers’ web portal. It’s worth the extra effort. Check it out.
Use Over-the-Counter (OTC) First, Then Generic, Then Compare Brand vs. Brand
Generics are generally cheaper than brands. Unfortunately, you need to be aware of the industry’s trend to “patent stack” generics, significantly increasing their price (EpiPen). Therefore, check the over-the-counter alternative. Many times, the prescription for a generic scripted drug is about convenience (for instance, take one pill a day instead of two or four). Remember, you pay for that!
Also, check multi-source brand drugs (where there are multiple branded drugs, no generics, treat- ing the same symptom) and determine which has the highest efficacy: best price, similar medical outcome.
Get Your Prescriptions Through Mail Order
If you’re on a maintenance drug and your plan offers a mail order program, you may be able to save some money. If your plan has copays for a thirty- day supply, check what the copay is for the mail order at ninety days. It could be less, so it’s worth trying.
Also, the mail-order pricing may be more attractive than the retail.
Buy In Bulk. Get Your Doctor To Prescribe For Longer Periods
Did you know your doctor can prescribe a years’ worth of maintenance medication versus a thirty- or ninety-day supply? They can, and it can save you a lot. Use the highlighted shopping tools for a twelve-month supply. Currently, you can buy a year’s supply of atorvastatin, a generic statin heart medicine, for 20 percent less than buying a thirty-day supply each month for a year.
Buy In Higher Dosage And Split The Pills
Getting a higher dosage and splitting the pill may be less expensive. Ask your doctor, pharmacist, or insurance company if higher dosage and pill splitting would work in your situation.
Use Patient Assistance Programs (PAP)
RX HOPE is a website that lists over two hundred single source drugs that offer patient assistance programs based on income or for those participating in a high-deductible plan—i.e., 50 percent of the country in 2017.
These plans will offer coupons with sometimes dramatic price reductions for a set period of time. I previously highlighted the Eliquis savings, which was through a PAP ($4,440 savings/year). You can also contact the manufacturer of the drug directly and ask for avail- able coupon plans.
These are real techniques that can save you hundreds, even thousands of dollars on your prescription drugs. If you’re worried about talking about costs with your doctor—don’t be. It’s a conversation that is non threatening to them, it’s not like you’re challenging their diagnosis or treatment. Plus, they want to provide you with the best service possible, and if that means facilitating you saving on prescriptions they absolutely want to do it!
Navigating the health care system isn’t always easy, but this checklist gives you the tools you need to start saving.
The following is an excerpt from a Q&A session I had with Authority Magazine’s Christina D. Warner…
As a part of my interview series with leaders in healthcare, I had the pleasure to interview Scott Heiser. Scott has more than twenty years’ experience as a consultant for clients in the insurance and healthcare system. Scott was a partner and owner of a commercial insurance brokerage, in which he led and developed an employee benefit practice that managed more than half a billion dollars in health benefits. Scott is a strategic innovator who knows the ins and outs of what can feel like the overwhelming world of healthcare and insurance. Today, he is dedicated to sharing his knowledge to help educate and empower his readers. His goal is to improve your health outcomes while lowering your costs.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
Afew years ago, I was meeting with a large multi-state client representing 16,000 employees. We were discussing ways to reduce costs for their prescription benefit program…
Check out Authority Magazine’s Medium Page to read the full article!