fbpx

Proven Health Insurance Advice For Open Enrollment

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
  • How to manage healthcare costs

Listen to the full episode below

How To Choose The Best Health Insurance For 2020

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:

Plan 1Plan 2Plan 3
Premium (cost per month)


Deductible (amount you pay before
insurance kicks in)



Co-pays


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.

Tip: check out the Kaiser Foundation’s calculator for help with this.

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

  • Pregnancy
  • Hospitalization
  • Emergency services
  • Outpatient care
  • Mental health
  • Prescription drugs
  • Rehabilitation services
  • Lab services
  • Pediatric services
  • Preventative services

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!

Check out Health Sherpa to find and compare the best insurance plans for you.

Uncovered’s Top Healthcare Transparency Services | 2019

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.

Reviews, Affiliation & Scheduling | Qualitative Sites

Reviews & Comparison

Reviews & Scheduling

Procedure Cost Predictors | Quantitative Sites

Cost estimator tools

Carrier cost estimator tools

Coupons And Saving Sites

Patient assistance programs

Rx Coupon Codes

EHR vendors

Even More Sites Are Coming

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.

From No Coverage to Affordable Coverage, with HealthShare

“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.

Easy, right? 

Wrong.

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.

Discovering HealthShare

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.

Overpaying for Your Prescriptions? Here’s Proof You Don’t Have To

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.

What’s Next?

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.

Healthcare Is Making Me Sick | Author Hour Podcast

I had a great conversation recently with Nikki Van Noy on her Author Hour podcast. We talked through the book and my background, but more importantly I walked her through the same actionable, plain-spoken tips that anyone can use to better empower themselves when dealing with the healthcare system.

All of us can make better choices in selecting our healthcare insurance plans, how we can maximize our coverage, how we can lower costs for treatment and prescriptions, and how we can generally make better choices that render better health results.

Listen below to hear the conversation.

Drug Patents Expiring in 2020 | Ken’s Capsule

It’s almost always cheaper to opt for a generic medication instead of a brand medication. However, generic medications aren’t always an option for drugs whose patent hasn’t expired yet. Pharmaceutical companies use patents to protect their R&D investment and try to maintain the exclusivity period as long as possible.

But that doesn’t mean you’re trapped with a brand drug. Patent terms for brand drugs expire every year, which means a more affordable option might be right around the corner.

First Ask: Does Your Brand Drug Have A Generic Equivalent or Alternative?  

When a patent expires, generic drug makers can enter the market with an equivalent generic alternative. These medications must meet strict FDA guidelines and must have the identical active ingredients and strengths as the originator drug. 

So how do you know if your brand prescription’s patent is on the verge of expiring?

The easiest way to do this is to search for your brand name medication patent expiration date.

Why take the time to search? After a generic equivalent comes out, you can expect the price of the generic to be 15-25% less than the brand drug. After 6 months and multiple generics makers have launched equivalent generics, the price should drop another 20-50%!

Biggest Brand Name Patents Expiring Next Year

When it comes to the biggest patent expirations in 2020, we’ve already done the hard work for you. Below are the most popular drugs that will be receiving a generic alternative in 2020.

Afinitor tablets

Brand prescription name: Afinitor 
Generic name: Everolimus
What it treats: Cancer
Expected savings per month: $3,000
When the generic gets released: Early 2020

Omnaris nasal spray

Brand prescription name: Omnaris
Generic name: Ciclesonide
What it treats: Nasal allergy
Expected savings per month: $185
When the generic gets released: Early 2020

Absorica capsule

Brand prescription name: Absorica
Generic name: Isotretinoin
What it treats: Acne
Expected savings per month: $1,600
When the generic gets released: Late 2020

Atripla tablet

Brand prescription name: Atripla
Generic name(s): Efavirenz; Emtricitabine; Tenofovir Disoproxil Fumarate
What it treats: Antiretroviral
Expected savings per month: $800
When the generic gets released: Late 2020

Chantix tablet

Brand prescription name: Chantix
Generic name(s): Varenicline Tartrate
What it treats: Helps you quit smoking
Expected savings per month: $225
When the generic gets released: Late 2020

Ciprodex ear drops

Brand prescription name: Ciprodex
Generic name(s): Ciprofloxacin; Dexamethasone
What it treats: Ear infections, swimmers ear
Expected savings per month: $180
When the generic gets released: In 2020

Dulera Inhaler

Brand prescription name: Dulera
Generic name(s): Formoterol Fumarate; Mometasone Furoate
What it treats: Asthma
Expected savings per month: $240
When the generic gets released: Late 2020

Noxafil tablets/ susp

Brand prescription name: Noxafil
Generic name(s): Posaconazole
What it treats: Anti fungal
Expected savings per month: Unknown
When the generic gets released: Early 2020

Thalomid capsule

Brand prescription name: Thalomid
Generic name(s): Thalidomide
What it treats: Cancer
Expected savings per month: Unknown
When the generic gets released: In 2020

Zortress tablets

Brand prescription name: Zortress
Generic name(s): Everolimus
What it treats: Transplant
Expected savings per month: $600
When the generic gets released: Early 2020

Other Ways To Save On Your Prescriptions

Check out our article 7 Insider Tips To Save Big On Prescription Drugs for some easy, quick techniques you can use the next time you go to fill a prescription. 

Generic Alternatives

If your brand name drug doesn’t have an exact match generic, look for generic “alternatives” within your medication drug class. A drug class is the broader category your prescription falls into. For example, Beta Blockers which treat heart disease, ACE Inhibitors which treat high blood pressure, or Lipid Regulators which treat high cholesterol. This can be a potential savings discussion with your physician with regards to a therapeutic alternative. 

Ask Your Doctor or Pharmacist

Ask your pharmacist about alternative medications or any potential savings that they may know of for a particular medication or class of drugs.

Remember, don’t be afraid to actually discuss your physician’s medication choice for you. It can be a great savings to you, and enjoy your new collaborative relationship with your physician. Every time you ask questions, you take another step closer to being in control of your health care. 

How To Save $10,000+ On Your Healthcare Bills

The following is an excerpt from a conversation I had with Kirk Chisholm on The Money Tree Podcast

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!

7 Insider Tricks To Save Big On Prescription Drugs

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.

Authority Magazine Feature: The Future of Healthcare

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!

How Much Should You Pay For Health Insurance?

When it comes to health insurance, one of the most common questions I hear is, “Who pays for that?” At the risk of sounding like a smart aleck, the simple answer is: you do.

When it comes to health insurance, one of the most common questions I hear is, “Who pays for that?” At the risk of sounding like a smart aleck, the simple answer is: you do.

But that does not necessarily mean you’re responsible for 100% of the cost of health insurance. There are three basic categories of health insurance sources: employers, individuals buying health insurance, and government programs. In this article, we’ll examine each category in greater detail to more fully answer the question, “Who pays for that?”

Coverage Through Your Employer

Employer coverage is pretty straightforward: you work for somebody, they offer coverage, they pay for a majority of the premium, and you enroll. Employers with over fifty employees are required by the ACA to offer healthcare coverage to their full-time employees (those working over thirty hours per week) or pay a $2,000 penalty for each full-time employee every year. Most elect to offer the coverage.

They must offer at least one plan that complies with all ACA guidelines, including the essential coverage, the minimum plan design, and maximum employee monthly contribution of 9.86 percent of household monthly income for 2019 single coverage. Employers with fewer than fifty employees have the option to offer coverage or not; it depends on their financial situation. If you work for an employer who does not offer coverage, you will need to investigate options: purchasing directly or, depending on your financial situation, looking into government-sponsored plans.

Plan Options

Most employers offer multiple options for their employees. The range of options addresses plan designs that impact how much is covered and what you’ll have to spend if and when you use the healthcare system. Your premium cost impacts how much of your paycheck is paid monthly for your selected coverage. The options you are presented will be from the coverages we discussed PPO (Preferred Provider Organization), HMO (Health Maintenance Organization), or High Deductible Health Plan, usually with a Health Savings Account. Many offer tax-deferred savings vehicles to help offset the cost of healthcare.

Individuals Buying Directly

Buying health insurance directly under Obamacare has been like trading one nightmare for another. Before Obamacare, people with existing conditions were denied coverage. With Obamacare, those people can now buy coverage, but more and more often they can’t afford the monthly health insurance premiums or even find coverage.

Many of the national health insurance companies (Anthem, Cigna, Aetna, United Healthcare) have reduced the number of states to which they offer individual health insurance to the point that a number of counties had only one health insurance carrier option in 2019. And increasingly, the options offered have smaller provider networks.

Bottom line: if you are buying directly, you will probably need to consider increasing your deductibles and out-of-pocket costs to offset premium increases.

The Kaiser Family Foundation, www.kff.org, does an excellent job of tracking health insurance carriers offering coverage by state and the premium rate increases or decreases filed by health plans in each state. They are already compiling 2019 health insurance carrier offerings by carrier by state. Please review their site for updates under the heading Tracking Premium Changes on ACA Exchanges.

Doesn’t Obamacare provide premium subsidies for non-government health insurance to offset the cost? Yes, it does. Obamacare provides premium tax credits and cost sharing subsidies. A portion of the monthly health premiums may be offset for individuals earning less than 400 percent of the federal poverty level (FPL).

Interestingly, 84 percent of the people who signed up for individual health insurance since 2014 received subsidies. Luckily, because of inflation protection in the ACA subsidies, inflation increases are not passed on to those with subsidies. Their subsidies increased as the premium increased, keeping them whole. The people who bore the brunt of the increases were those without subsidies, and not all of them are rich.

The most efficient way to find out what plans, pricing, and subsidies are available to you is to access healthcare.gov or your state-sponsored healthcare exchange. The federal government’s website covers thirty-seven states and the District of Columbia, and will direct you to state-sponsored exchanges. They will start the session by asking basic financial questions that will determine whether you qualify for a subsidy.

In 2019, persons earning up to $48,560 may qualify for an individual’s health insurance subsidy while individuals earning up to $83,120 may qualify for a family health insurance subsidy. The dollar amounts are adjusted annually.

An alternative is Healthsherpa.com, which covers all states and all available health plans. They are a private company whose mission statement is “to help every American feel the comfort and security of having health coverage. [They] use design, technology, and customer service by real people to make insurance easier to understand, faster to sign up, and simpler to use.” The major differences are an easier and faster system, and real-time help. They provide counselors via chat rooms who walk through your enrollment and continue the chat room assistance throughout the year.

Government Programs

Note that the following information is true as I write this article, but—as we all know—nothing stays the same, especially in the government and in the world of healthcare. Visit www.healthcare.gov for the most up-to-date information about the status of the healthcare system in the US and what it means to you.

Medicaid

Medicaid is a joint federal and state program that, together with the Children’s Health Insurance Program, makes up the single largest source of health coverage in the United States. Its goal is to provide low-income individuals, families, and children health insurance with little or no premiums, and little or no out-of-pocket medical expenses.

The Affordable Care Act of 2010 created the opportunity for states to expand Medicaid to cover nearly all low-income Americans under age sixty-five. Eligibility for children was extended to at least 133 percent of the federal poverty level (FPL) in every state (most states cover children to higher income levels), and states were given the option to extend eligibility to adults with income at or below 133 percent of the FPL.

The majority of states have chosen to expand coverage to adults, and those that have not yet expanded may choose to do so at any time. Eighteen states have not expanded coverage as of 2019. They are Alabama, Florida, Georgia, Idaho, Kansas, Mississippi, Missouri, Nebraska, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.

The 2019 federal poverty level (FPL) income numbers are used to calculate eligibility for Medicaid and the Children’s Health Insurance Program (CHIP).

Medicaid Benefits

States establish and administer their own Medicaid programs and determine the type, amount, duration, and scope of services within broad federal guidelines. Federal law requires states to provide certain mandatory benefits and allows states the choice of covering other optional benefits. Mandatory benefits include services like inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and home health services, among others. Optional benefits include services like prescription drugs, case management, physical therapy, and occupational therapy.

You can enroll through healthcare.gov. Additional state-by-state information is on medicaid.gov. Or, you can try the American Council on Aging’s Medicaid Assistance site at medicaidplanningassistance.org/state-medicaid-resources. They provide state-by-state names and contact info, and free planning advisor services.

Children’s Health Insurance Program (CHIP)

Children’s Health Insurance Program (CHIP) is a federal/state health program managed by the states. It provides medical coverage for individuals under age nineteen whose parents earn too much income to qualify for Medicaid, but not enough to pay for private coverage. Program coverage varies from state to state, but all states’ CHIP plans cover routine checkups, immunizations, doctor visits, prescriptions, dental care, vision care, hospital care, laboratory services, x-rays, and emergency services. Some states also cover parents and pregnant women. Its goal, like Medicaid, is to provide health insurance with inexpensive or no premiums or out-of-pocket medical expenses.

It’s cumbersome to get coverage through CHIP, but it could be a huge winner for your family if you qualify. If you make up to $40,000 for, say, a family of three, you can still get Medicaid coverage. CHIP, on the other hand, is for people who make more than that but still have a tough time affording coverage. We run into plenty of people who keep their employer’s coverage for themselves but carve off their kids and put them on CHIP. To sign up, you can call 1-800-318-2596, or you can begin the process by completing an insurance application on healthcare.gov. The application will determine if you qualify for the program and will notify your state agency. Your state agency will contact you about enrollment. My advice is to do both and follow up.

Medicare

Medicare is the guaranteed-issue, government health insurance program for individuals over sixty-five, certain younger people with disabilities, and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). It does not have income requirements to join. Its goal is similar to Medicaid in providing affordable healthcare insurance to seniors. All four components of Medicare (Parts A, B, C, and D) require monthly premiums, deductibles, and out-of-pocket costs for services.

Different parts of Medicare help cover specific services:

Part A: Hospital Insurance. It covers inpatient hospital stays, some home healthcare, stays in skilled nursing facilities, and hospice care.

Part B: Medical Insurance. It covers outpatient care, preventive services, medical supplies, and some doctors’ services.

Part C: Medicare Advantage Plans. Offered by private companies that contract with Medicare. They provide Part A and Part B coverage, and most cover Part D benefits.

Part D: Prescription Drug Coverage. This is provided by private insurance companies and adds drug coverage to the other parts of Medicare.

Additional information is available at medicare.gov, or for supplemental assistance and supplemental policies, consult the American Association of Retired Persons (AARP).

But that does not necessarily mean you pay 100 percent of the cost. There are three basic categories of health insurance sources: employers, individuals buying health insurance, and government programs. In this article, we’ll examine each category in greater detail to more fully answer the question, “Who pays for that?”

Coverage Through Your Employer

Employer coverage is pretty straightforward: you work for somebody, they offer coverage, they pay for a majority of the premium, and you enroll. Employers with over fifty employees are required by the ACA to offer healthcare coverage to their full-time employees (those working over thirty hours per week) or pay a $2,000 penalty for each full-time employee every year. Most elect to offer the coverage.

They must offer at least one plan that complies with all ACA guidelines, including the essential coverage, the minimum plan design, and maximum employee monthly contribution of 9.86 percent of household monthly income for 2019 single coverage. Employers with fewer than fifty employees have the option to offer coverage or not; it depends on their financial situation. If you work for an employer who does not offer coverage, you will need to investigate options: purchasing directly or, depending on your financial situation, looking into government-sponsored plans.

Plan Options

Most employers offer multiple options for their employees. The range of options addresses plan designs that impact how much is covered and what you’ll have to spend if and when you use the healthcare system. Your premium contributions impact how much of your paycheck is paid monthly for your selected coverage. The options you are presented will be from the coverages we discussed (PPO, HMO, HDHP/ HSA). Many offer tax-deferred savings vehicles to help offset the cost of healthcare.

Individuals Buying Directly

Buying health insurance directly under Obamacare has been like trading one nightmare for another. Before Obamacare, people with existing conditions were denied coverage. With Obamacare, those people can now buy coverage, but more and more often they can’t pay for the insurance coverage or find coverage.

Many of the national health carriers (Anthem, Cigna, Aetna, United Healthcare) have reduced the number of states to which they offer individual health insurance to the point that a number of counties had only one health insurance carrier option in 2019. And increasingly, the options offered have smaller provider networks.

Bottom line: if you are buying directly, you will probably need to consider increasing your deductibles and out-of-pocket costs to offset premium increases.

The Kaiser Family Foundation, www.kff.org, does an excellent job of tracking health insurance carriers offering coverage by state and the premium rate increases or decreases filed by health plans in each state. They are already compiling 2019 health insurance carrier offerings by carrier by state. Please review their site for updates under the heading Tracking Premium Changes on ACA Exchanges.

Doesn’t Obamacare provide premium subsidies for non-government health insurance to offset the cost? Yes, it does. Obamacare provides premium tax credits and cost sharing subsidies. A portion of the monthly health premiums may be offset for individuals earning less than 400 percent of the federal poverty level (FPL).

Interestingly, 84 percent of the people who signed up for individual health insurance since 2014 received subsidies. Luckily, because of inflation protection in the ACA subsidies, inflation increases are not passed on to those with subsidies. Their subsidies increased as the premium increased, keeping them whole. The people who bore the brunt of the increases were those without subsidies, and not all of them are rich.

The most efficient way to find out what plans, pricing, and subsidies are available to you is to access healthcare.gov or your state-sponsored healthcare exchange. The federal government’s website covers thirty-seven states and the District of Columbia, and will direct you to state-sponsored exchanges. They will start the session by asking basic financial questions that will determine whether you qualify for a subsidy.

In 2019, persons earning up to $48,560 may qualify for an individual’s health insurance subsidy while individuals earning up to $83,120 may qualify for a family health insurance subsidy. The dollar amounts are adjusted annually.

An alternative is Healthsherpa.com, which covers all states and all available health plans. They are a private company whose mission statement is “to help every American feel the comfort and security of having health coverage. [They] use design, technology, and customer service by real people to make insurance easier to understand, faster to sign up, and simpler to use.” The major differences are an easier and faster system, and real-time help. They provide counselors via chat rooms who walk through your enrollment and continue the chat room assistance throughout the year.

Government Programs

Note that the following information is true as I write this article, but—as we all know—nothing stays the same, especially in the government and in the world of healthcare. Visit www.healthcare.gov for the most up-to-date information about the status of the healthcare system in the US and what it means to you.

Medicaid

Medicaid is a joint federal and state program that, together with the Children’s Health Insurance Program, makes up the single largest source of health coverage in the United States. Its goal is to provide low-income individuals, families, and children health insurance with little or no premiums, and little or no out-of-pocket medical expenses.

The Affordable Care Act of 2010 created the opportunity for states to expand Medicaid to cover nearly all low-income Americans under age sixty-five. Eligibility for children was extended to at least 133 percent of the federal poverty level (FPL) in every state (most states cover children to higher income levels), and states were given the option to extend eligibility to adults with income at or below 133 percent of the FPL.

The majority of states have chosen to expand coverage to adults, and those that have not yet expanded may choose to do so at any time. Eighteen states have not expanded coverage as of 2019. They are Alabama, Florida, Georgia, Idaho, Kansas, Mississippi, Missouri, Nebraska, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.

The 2019 federal poverty level (FPL) income numbers are used to calculate eligibility for Medicaid and the Children’s Health Insurance Program (CHIP).

Medicaid Benefits

States establish and administer their own Medicaid programs and determine the type, amount, duration, and scope of services within broad federal guidelines. Federal law requires states to provide certain mandatory benefits and allows states the choice of covering other optional benefits. Mandatory benefits include services like inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and home health services, among others. Optional benefits include services like prescription drugs, case management, physical therapy, and occupational therapy.

You can enroll through healthcare.gov. Additional state-by-state information is on medicaid.gov. Or, you can try the American Council on Aging’s Medicaid Assistance site at medicaidplanningassistance.org/state-medicaid-resources. They provide state-by-state names and contact info, and free planning advisor services.

Children’s Health Insurance Program (CHIP)

Children’s Health Insurance Program (CHIP) is a federal/state health program managed by the states. It provides medical coverage for individuals under age nineteen whose parents earn too much income to qualify for Medicaid, but not enough to pay for private coverage. Program coverage varies from state to state, but all states’ CHIP plans cover routine checkups, immunizations, doctor visits, prescriptions, dental care, vision care, hospital care, laboratory services, x-rays, and emergency services. Some states also cover parents and pregnant women. Its goal, like Medicaid, is to provide health insurance with inexpensive or no premiums or out-of-pocket medical expenses.

It’s cumbersome to get coverage through CHIP, but it could be a huge winner for your family if you qualify. If you make up to $40,000 for, say, a family of three, you can still get Medicaid coverage. CHIP, on the other hand, is for people who make more than that but still have a tough time affording coverage. We run into plenty of people who keep their employer’s coverage for themselves but carve off their kids and put them on CHIP. To sign up, you can call 1-800-318-2596, or you can begin the process by completing an insurance application on healthcare.gov. The application will determine if you qualify for the program and will notify your state agency. Your state agency will contact you about enrollment. My advice is to do both and follow up.

Medicare

Medicare is the guaranteed-issue, government health insurance program for individuals over sixty-five, certain younger people with disabilities, and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). It does not have income requirements to join. Its goal is similar to Medicaid in providing affordable healthcare insurance to seniors. All four components of Medicare (Parts A, B, C, and D) require monthly premiums, deductibles, and out-of-pocket costs for services.

Different parts of Medicare help cover specific services:

Part A: Hospital Insurance. It covers inpatient hospital stays, some home healthcare, stays in skilled nursing facilities, and hospice care.

Part B: Medical Insurance. It covers outpatient care, preventive services, medical supplies, and some doctors’ services.

Part C: Medicare Advantage Plans. Offered by private companies that contract with Medicare. They provide Part A and Part B coverage, and most cover Part D benefits.

Part D: Prescription Drug Coverage. This is provided by private insurance companies and adds drug coverage to the other parts of Medicare.

Additional information is available at medicare.gov, or for supplemental assistance and supplemental policies, consult the American Association of Retired Persons (AARP).

Why You Must Demand Transparency with Your Healthcare Costs

I wrote Healthcare Is Making Me Sick to help people learn the rules of healthcare so they can regain control of how they experience the system. A friend of mine asked me: What made me feel that I had to write it?

The answer is two-pronged—partly from the financial side, and partly from the quality of life side. The common denominator between them, though, is that it comes down to maximizing your coverage and experience when it comes to insurance.

Allow me to explain both sides of this equation in more detail.

Medical Providers Are in Business

Let’s start with finances: if you get service from a doctor and don’t inquire about the course of treatment, the appropriateness of the treatment, and the cost, you’ll more than likely have a less than optimal experience. Physicians and hospitals are in BUSINESS. One of their goals is to grow their business as profitably as they can. If you’re a passive healthcare consumer, the number of tests, where the tests are performed, and who performs them will affect the financial outcome of your treatment—it’ll cost you more!

Now, consider if everyone else with that same policy takes the same approach; they simply keep paying whatever the bill says and, while they may grumble, they don’t give it a second thought. What, then, are those expenses going to do? They’ll go up.

If those expenses go up, the insurance company’s expenses go up. What is the insurance company (that’s in business like the hospitals and physicians) going to do to your premiums? They are going to go up, too. And this dynamic does not change if you’re on your employer’s sponsored health plan, buying from the public exchange, or buying insurance directly. There’s no incentive for providers or insurance companies to change if they’re not challenged. They both make more money as the costs go up and are, in effect, negotiating with each other over their goals versus yours. I know learning the ins and outs of the industry is time consuming, but the benefits are long term.

Do the Work to Find the Best Doctor

The other side of the equation is life quality. It seems obvious that you’d want the best doctors, right? Why wouldn’t you? Yet, in our society, we haven’t adopted the mentality that we should scrutinize doctors the way we would other service providers, as they’re all not created equal. After all, the last to graduate medical school is still a doctor.

To overcome this hurdle, we must start insisting on transparency by any means available to us, and that includes referrals. Referrals can come from anybody close to us, such as friends, other doctors, and even the carriers themselves. Use any tool at your disposal in order to find the best doctor for you. If you do, you’ll have a better outcome, which means you save money long-term and have a better quality of life.

By allowing the status quo to continue—which means not questioning our doctors and paying whatever they tell us to—we are all complicit. At the end of the day, when my friend asks me why I wrote my book, I tell him it’s because I can make a difference—and so can you. You can change the definition of an industry, even if it’s something as big as healthcare. Doing the same thing over and over and expecting a different outcome hasn’t worked, so why not try something new? That question begs another: How do you tackle two giant industries representing one-sixth of the economy?

Information is Key to Transparency

Information! Information will lead to knowledge, and as Sir Francis Bacon stated, “Knowledge is power.” One piece of information you need to know is the mark ups on common medical services versus the cost and the range of prices for that service.

A quick look at information out there on hospital markups provides some staggering numbers. According to a report from John Hopkins University, on average, hospitals mark up their cost 4.32 times and, in some cases, over six times.

That’s right—for a service that costs them $100, they are charging you between $432–$600. The study also found that “certain types of hospitals had higher markups. In government-run hospitals, the ratio was 3.47; in nonprofit hospitals, 3.79; and in for-profit hospitals, 6.31. System-affiliated hospitals had an average ratio of 4.76, versus 3.54 for independent hospitals, and hospitals with regional market power had an average ratio of 4.56, versus 4.16 for hospitals that lacked such clout—supporting the researchers’ finding that hospitals that can mark up prices will do so.”

This can also be found in medicines within hospitals. Hospitals mark up medicines an average 500 percent of their cost—and have a markup of 250 percent even after negotiations with insurance carriers. The confusion does not stop there. HCCI’s 2015 report, “National Chartbook on Health Care Prices” found there’s a wide range of prices for the same services at different hospitals. Prices vary by state and within states too.

Transparency Tools You Can Use

So, what are you to do? Healthcare prices are crazy! Fortunately, the world is changing. There are a growing number of transparency tools for every healthcare industry sector (doctors, hospitals, and drugs) that you can access. This will help you pull the curtain back on the Great Wizard of Oz of healthcare.

There are categories of transparency sites. The first is what I call qualitative sites. They provide useful information such as: areas of specialty, college education, hospital affiliation, ease of scheduling, staff responsiveness, patient level of trust, and amount of time spent with patient. These sites are useful in helping determine the type of relationship you might have with your doctor. Here are some popular options:

The second set of sites focus more on the quantitative, or outcome-based, aspects of the doctor’s care. For example, they examine items such as costs and how the doctor ranks against his/her peer set for a procedure. Does the doctor you’re reviewing perform more or fewer procedures than their peers? This is important. Remember Malcolm Gladwell’s position that the more you practice the better you are.

The following websites provide you access to healthcare transparency.

For Hospitals

  • Leapfroggroup.org: Leapfrog Hospital Safety Grade
  • Hospital Patient Price List Information: (Look up each hospital’s published pricing list. Your pricing will vary based on your insurance.)

For Doctors

For Prescriptions

The Transparency Genie is Out of the Bottle

I haven’t found one single resource that has provided every answer or covered every area of the country yet, but these resources are growing, becoming more robust, and currently providing us more access to the real costs than we have ever had before. USE them. When comparing costs, look outside your area and see if your situation turns out like the knee replacement from Sacramento to Tucson or if your hospital has substandard records on the services you need covered.

If you’re on your employer’s health plan, ask to see if the health insurance carrier provides a price calculator and quality evaluation tool. If not, ask your employer to investigate offering one. Companies like Castlight, Amino Health, or Grand Rounds can be added, offering access to transparency. Remember, if you save yourself money, you save your employer money, too. They will direct you to the most cost-effective provider based on that carrier’s network and negotiated discounts.

When it comes to transparency, the genie is out of the bottle. If we seek it, demand it, and use it, there’s no way they (the industry) can put it back in.

The First Step to Retaking Your Health is Figuring Out Who You Are

I read an Aetna success story about a man named John who was two steps from a heart attack. In 2010, he took a Health Risk Assessment through his employer. His cholesterol and blood pressure were both off the charts. The news of his high cholesterol was particularly alarming, since he’d been on medication for it the previous two years. He couldn’t argue with the facts: he was forty-seven years old, 300 pounds, and had already had two knee surgeries because of his weight.

Armed with the results from the Health Risk Assessment, he knew he needed to change. He got a health coach who helped him create a game plan to lose some weight. Eventually, he lost 125 pounds. He’s even off cholesterol medicine now.

In short, he changed his life. John’s story is not unique.

There are many stories out there of people like John—people who see a health problem in their life and take steps to fix it. The percentage who actually follow through, though, is small—in my experience, it’s about 6 percent. You need something personal to motivate you. There has to be a catalyst that kicks you in the rear end. For John, he should’ve realized something was wrong when he had those two knee surgeries because of his weight. He knew he wasn’t feeling his best. It wasn’t until the report told him, “Be ready. You’re a walking heart attack,” that something clicked in him.

Don’t wait for a report to tell you you’re dying to take control of your health. Start your healthcare journey earlier than you think you should. It will be uncomfortable, and you’ll encounter a lot of questions. For example, you know you need health insurance, but how much should you get and why? What will it cost? What should it cover? When selecting a doctor or hospital, which ones are experts in the areas I need addressed? How much do they charge? What are their patient outcomes after treatment?

In order to answer those questions, you must know who you are first. You do this by taking a look at what your needs are, what your resources are, then going to the market and seeing who matches them. In this article, I’ll help you figure out your needs.

A Health Risk Assessment is the First Step

Knowing your needs as a healthcare consumer comes down to defining who you are, identifying your risks, and identifying your costs. You start with defining who you are because without that understanding, you won’t know what to buy. You could over-buy or under-buy insurance, and both of those are outcomes you want to avoid.

The first step to becoming familiar with who you are as a healthcare consumer is taking a Health Risk Assessment. What John did by taking that Health Risk Assessment was smart, even if he waited too long to do it. This assessment has a standard set of questions that helps develop your health profile. It assesses your health status, estimates your level of health risk, and provides feedback to guide your behaviors.

Information collected includes your demographic information (age and sex), lifestyle information (alcohol intake, exercise habits, whether or not you smoke, etc.), personal and family medical history, physiological data (weight, height, blood pressure, etc.), and your attitudes and willingness to change your behavior in order to improve your health.

The HRA analyzes your information and produces your health risk profile, which ranks your health in seven key health areas: heart, cancer, diabetes, obesity, nutrition, fitness, and mental and emotional health through color-coding, graphs, icons, and a number based scoring system that tells you if you are doing well, need to be cautious, or need to take immediate action. It recommends key ways to improve your scores and health.

How to Take a Health Risk Assessment

How can you get your own health risk profile? About 33 percent of employers offer these HRAs (Health Risk Assessments) through their employee health plan. For companies with over 200 employees, that number goes up to 51 percent. Many of them even have an app you can use to securely give and receive information for your health risk profile. Medicare and Medicaid both offer HRAs as well, as do some hospitals. Check with your local hospital to see if they have one.

Not too long ago, you had to do these HRAs on paper. Now, you can complete them on your phone through an app or on your computer through a website. It’s so easy that there’s no excuse not to do it, especially because much of the information required can be gathered at a basic physical (which is totally covered if you have an ACA plan.)

Be sure the information is taken within a six-month window, especially for test results. Why is this so important? Understanding your basic health status is the first step in identifying what your objectives need to be. Your objectives clarify and direct you to which tools and options are right for you. A health risk profile is a perfect way to discover what type of insurance and providers you should be pursuing.

Compiling Your Health Record

After completing an HRA, you need to compile all your medical history to complete your total health profile. At first, it will feel laborious. It’s like setting up Quicken, the personal budgeting software, for the first time, or transferring all of your files to a new computer—not a joyous experience, but you’ve got to do it! It entails gathering all of your health records, including documentation of conditions, biometrics, physicals, immunizations, surgeries, imaging, diagnostic test results, and medications.

It should include a thorough understanding of family conditions. Interview your parents about your family health history. If you discover a family history of a genetic condition, after consulting with your doctor, you want to weigh the pros and cons of genetic testing to determine if you are at risk of developing the condition. For example, certain types of tests may be useful in identifying your risk of certain types of colorectal cancer.

So, how do you access your information? With the exception of your family history, all of your data is moving to electronic data interchange (EDI) and storage, so you can call your hospital, doctor, or specialist and ask to download your records (lab work, diagnostic imaging, doctor’s notes). If you are unable to pursue the electronic route, paper records are just as effective. At the very least, keep a list of doctors or hospitals where you have received or are receiving care, what conditions you have been or are being treated for, and what medications you are taking and for what purpose.

Now You’re Ready for the Next Steps

These records complete your in-depth health profile. Having full access to your records, electronically or via hard copy, will help you communicate effectively with your doctor in an efficient manner. That way, they can more accurately assess your conditions and prescribe effective courses of treatment. These records also set you up to find a health insurance option that’s right for you and select a doctor who best fits your needs.

Examining 3 Popular Options for Nontraditional Medical Care

The following is adapted from Healthcare is Making Me Sick: Learn the Rules to Regain Control and Fight for Your Healthcare.

Not everyone approaches healthcare the same way. Cost of care, higher out-of-pocket costs, technology, and transparency are all causing the medical field to evolve.

The evolution is producing nontraditional provider options. So, instead of visiting a traditional primary care provider, millions of people are opting to pursue a different path when it comes to the care they receive. Let’s look at three of the most popular options.

#1: Telemedicine

Telemedicine offers medical consultations over the phone, Skype, or FaceTime, and it’s a piece of the healthcare industry that is constantly growing. In fact, the global telehealth market is projected to reach 12.1 billion by 2023, with a compound annual growth rate of 23 percent between 2018 and 2023.

With fewer doctors able to give significant time to patients, telemedicine can serve as the front line of medicine. In addition, rural areas yearn for good medical care, so teledoctors are a great way to serve people who can’t easily get into a doctor.

One of the advancements in services that is propelling telemedicine is the ability to prescribe medicine through their service. Some services can refer to specialists and facilitate the scheduling of the specialist’s appointment.

Another plus: teledoctor visits are usually discounted compared to traditional in-office visits. If a doctor visit costs $100 on your plan, a telemedicine “visit” might only be $49. If your carrier doesn’t offer a telemedicine service, you can buy it directly from some hospitals such as the Cleveland Clinic and Premier Hospital in Dayton, Ohio, or from Teladoc. You don’t even have to be in their area to use the service.

In addition, Walgreens recently cut a deal with New York Presbyterian to provide telemedicine in the greater New York area. There’s a movement to give people quality, non-emergency healthcare through flexible, timesaving access to doctors.

Telemedicine is the private market responding to the market needs. Using technology, we are reinstating the doctor “house calls.” It’s worth considering twenty-four-hour care in your home with qualified practitioners at a fraction of the cost!

#2: Clinics

What do Wal-Mart, Safeway, Kroger, Target, Walgreens, and CVS all have in common?

They all offer health clinics within their select stores.

More and more, traditional retailers are bringing their retail expertise to medicine to provide easier-access, lower-cost alternatives to healthcare.

The clinics provide services similar to a primary care doctor and are staffed by registered nurses (RNs), nurse practitioners (NPs), and physician assistants (PAs). Services include treating minor illnesses; screening for and monitoring minor injuries, handling skin conditions, conducting wellness exams and physicals, performing women’s services, and giving vaccinations and injections. They diagnose, treat, and prescribe medicines at a lower cost. Fees range from $49–$99 and are accepted by most insurance carriers. Check on their websites for locations that have a clinic and for insurance carriers that accept their services.

Here’s a tip: if prescribed medicine at one of the pharmacy companies’ clinics, make sure you are getting the best price on the prescription before filling it.

#3: Concierge Services

Most primary care practices are inundated with patients, ranging from 2,000 to 3,000 per physician. They typically see twenty to twenty-four patients a day—or about eight minutes with each patient (after you take into account paperwork, lunch, and breaks).

Does eight minutes seem like enough time to you? No, it doesn’t, and many physicians don’t think so either. As a result, they have been morphing their practices into concierge service providers; in fact, there were over 12,000 in 2014.

A concierge practice charges an annual retainer, generally $1,500 per year, waives your insurance copay or deductible for office visits, and submits claims for services to your carrier. Most concierge practices are primary care or general internist doctors.

They limit their practice to 400–600 patients per year, allowing them to extend their time with each patient. You may be wondering why you would want to spend an additional $1,500 per year on top of your insurance to see your doctor?

The answer is simple: enhanced service and access. Concierge practices offer immediate access to their doctors via cell phone, email, and same-day appointments.

Visits are, on average, thirty minutes, granting time to cover all issues. Additional attention is provided with referrals to specialists or hospitals, and some services offer home or hospital visits as well as access to top specialists. In short, they’re the clinical advocates they once were, but at an additional cost. Most practices are located in or near large cities and on the coasts. Two national practices are MDVIP and Pinnacle.

Nontraditional Care is Worth Consideration

Depending on your insurance plan, the care options available to you, and your medical needs, one of these three nontraditional options might work for you.

For more advice on nontraditional care options, you can find Healthcare is Making Me Sick on Amazon.

Scott Heiser 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. To get started, visit www.UncoveredHC.com. 

How Tax-Savings Healthcare Plans Can Save You Serious Money

Health insurance and healthcare expenses can cost a fortune. If the IRS offers tax-incentivized plans, you need to take advantage of them. If not, it’s like throwing money away. In this article, we’ll look at three of the most popular tax-savings plans.

Employer-Offered Tax-Savings Plans

Your employer may elect to offer two additional tax-advantaged or pre-tax programs where you can deduct money from your paycheck before taxes, thus increasing your purchasing power and reducing your taxes. They are:

The premium-only plan (POP) that lets you pay for your monthly portion of the premiums pre-tax; and the Flexible Spending Account (FSA) that allows you to save money from your paycheck on a pre-tax basis toward medical expenses for the year.

You can consult tasconline.com, a company for employers providing flexible spending account administrative services, and search for eligible expenses for a complete list of eligible charges. Your employer will decide the amount you may save, up to a max of $2,650/year in 2018. Eligible expenses include your healthcare plan’s copays, deductibles, and coinsurance. Medications are covered as long as they are prescribed by your doctor. The catch with FSAs is that you have to either use the funds in the plan year or lose them to your employer. That sounds unfair, right? Well, maybe not.

The FSA rules allow you to access 100 percent of what you committed to save for the year at any time during the year, meaning you can access the full year before you have saved for it. Therefore, you need to accurately assess what your expenses will be to ensure you don’t waste your money. There has been a slight loosening of the “lose it” provision, and at this time, you can carry $500 forward into future years.

There is no reason for you not to take the POP plan and reduce your cost of the monthly premium. You should be aware, though, that if you elect to take the POP, you cannot drop the health coverage until the next open enrollment unless you have a qualifying life event (QLE). The FSA, likewise, is an excellent way to reduce your costs if you know which medical expenses you will be incurring in the coming year. Why pay more for the services or more to the government in taxes?

Employer/Individual Tax Incentive Plans—Health Savings Account

Health Savings Accounts (HSAs) are available in both the individual and employer markets if you have elected a High-Deductible Health Plan. High-deductible health plans with HSAs do have minimum deductible and maximum out-of-pocket expense requirements for individual-only and family coverage. The 2019 levels are as follows: $1,350 for individual coverage and $2,700 for family coverage, in terms of the minimum annual deductible. The maximum annual deductible and other out-of-pocket expense limits are $6,750 for individual coverage and $13,500 for family coverage.

The following are the benefits of an HSA:

You can claim a tax deduction for contributions you, or a party besides your employer, make to your HSA even if you don’t itemize deductions on a Schedule A (Form 1040).

Contributions to your HSA made by your employer (including contributions made through a cafeteria plan) may be excluded from your gross income.

The contributions remain in your account until you use them. The interest or other earnings on the assets in the account are tax free. You can save tax free and distributions may be tax free if used to pay qualified medical expenses.

An HSA is “portable.” It stays with you if you change employers or leave the workforce.

HSA Contribution Limits

For individuals buying insurance directly, HSA regulations allow you to legally reduce federal income tax up to $3,500 a year for individuals, or $7,000 for families, into a health savings account for tax year 2019, as long as you’re covered by an HSA-qualified HDHP. There’s no minimum deposit, but whatever you put into your account is an “above the line” tax deduction that reduces your adjusted gross income. Just like IRAs, HSA contributions can be made until April 15 of the following year.

Account holders who are fifty-five or older are allowed to deposit an additional $1,000 in catch-up contributions (this amount is not adjusted for inflation; it’s always $1,000).

For people with employer-sponsored HDHP/HSA accounts, they can deduct up to the same amounts from their payroll before taxes are taken out.

Using Your HSA Funds

You can use the tax-free savings in your HSA to pay for doctor visits, hospital costs, deductibles, copays, prescription drugs, or any other qualified medical expenses. Once the out-of-pocket maximum on your health insurance policy is met, your health insurance plan will pay for your remaining covered medical expenses.

If you switch to a health insurance policy that’s not HSA-qualified, you’ll no longer be able to contribute to your HSA, but you’ll still be able to take money out of your HSA at any time to pay for qualified medical expenses, with no taxes or penalties assessed.

If you don’t use the money for medical expenses and still have funds available after age sixty-five, you can withdraw them for non-medical purposes with no penalties, although income tax would be assessed at that point, with the HSA functioning much like a traditional IRA or 401(k). A list of qualified medical expenses is available on the IRS website, www.irs.gov, in IRS Publication 502, “Medical and Dental Expenses.”

Where Is My Account?

HSA bank accounts can be offered by your employer with easy payroll automatic deposit features, or you can set up an HSA account at one of the many participating banks throughout the country.

They are a great way to offset medical expenses on a pre-tax basis, and save tax-free for future medical or retirement expenses.

Individual Premium Tax Deduction

Additionally, if you’re not on an employer plan, you don’t qualify for subsidies under individual insurance and you itemize deductions on your tax returns, you can deduct qualified medical expenses that exceed 7.5 percent of your adjusted gross income for 2018. Beginning January 1, 2019, all taxpayers may deduct only the amount of the total unreimbursed allowable medical care expenses for the year that exceed 10 percent of their adjusted gross income. This includes health insurance premiums.

If you’re self-employed and have a net profit for the year, you may be eligible for the self-employed health insurance deduction. This is an adjustment to income, rather than an itemized deduction, for premiums you paid on a health insurance policy covering medical care, including a qualified long-term care insurance policy covering medical care for yourself, your spouse, and dependents.

In addition, you may be eligible for this deduction for your child who is under the age of twenty-seven at the end of 2017 even if the child wasn’t your dependent. See chapter 6 of Publication 535, Business Expenses, for eligibility information. If you don’t claim 100 percent of your paid premiums, you can include the remainder with your other medical expenses as an itemized deduction on Form 1040, Schedule A.pdf.

Remember, you need to get professional tax advice on your specific situation.

What You Need to Know About Supplemental Health Plans

The following is adapted from Healthcare is Making Me Sick: Learn the Rules to Regain Control and Fight for Your Healthcare.

You’ve just purchased a health policy and had to increase the deductibles and out-of-pocket costs to afford the monthly premium. You’re not sure where you’re going to come up with the money, but you felt like you had no alternative based on the costs of the lower-deductible plans. Sure, your insurance will kick in after you meet that deductible, but what do you do if you can’t meet your deductible in the first place?

When shopping for insurance, it’s easy to overlook that deductibles represent real money out of your pocket. Your grocery bills, mortgages, and car payments don’t stop just because you have a medical expense you need to cover. In this article, we’ll talk about filling in those gaps in coverage with supplemental policies.

Why Consider a Supplemental Policy?

These are not healthcare policies and should not be considered as a replacement for one. They may make sense, depending on your budget and health concerns, to offset the effects of a catastrophic illness on your finances. You’ll wonder, “Where do I get the money to cover the deductibles and out-of-pocket costs of my insurance plan caused by medical expenses? If I’m not working because I’m sick, how do I cover those costs?”

Supplemental policies offer you direct cash payment in the event you have a critical illness, hospital stay, or accident. They can be purchased directly from the insurance carriers or agents and are often offered through your employer.

Programs can be designed to meet your specific needs and affordability, and they can provide peace of mind. They are not reduced or coordinated with other health insurance you own and are generally extremely affordable—usually under $50 a month.

Supplemental policies have become increasingly popular due to the escalating premium costs that have driven most of us to higher-deductible plans.

Different Types of Coverage

If you have a lower out-of-pocket healthcare plan, you likely don’t need a supplemental plan. In other words, if your deductible is $500, why buy a $5,000 cancer policy?

The direct payments can be purchased at different levels, allowing you to fit them to your specific needs. Underwriting requirements are nominal for basic levels of coverage. Pre-existing exclusions do apply to individuals with an existing condition. There are basically three types of coverage: critical illness, accident and hospital, and medical indemnity plans. Let’s look at each type of coverage in more detail.

Critical Illness

Critical illness covers expenses resulting from specific diseases. The benefit amount is paid in a lump-sum payment when you are diagnosed with that named disease. The most common illnesses covered in this category are as follows:

  • Heart Attack
  • Cancer
  • Stroke
  • Organ Transplant
  • Heart Transplant
  • Kidney Failure
  • Coronary Bypass Surgery
  • Paralysis
  • And more

You can purchase coverage as low as $5,000 per disease up to $50,000 by answering basic health questions. Amounts over $50,000 require full medical underwriting. Costs range from $50 to $150/month depending on your age and the coverage amount.

Accident Coverage

Accident and health coverage simply means plans that pay covered expenses related to accidents. They’re paid in a lump-sum payment to you to use as you deem appropriate and are not limited to, or coordinated with, other medical coverage you have. Covered conditions can include the following as long as they are due to an accident:

  • Fractures
  • Dislocations
  • Concussions
  • Lacerations
  • Second- and Third-Degree Burns
  • Ruptured Discs
  • Torn Knee Cartilage
  • And more

Hospital Indemnity

Hospital indemnity covers expenses for hospital admissions, allowing a daily rate up to a maximum number of days and dollars. You can purchase daily benefits of $100–$1,000 per day for a period of up to 180 consecutive days.

Coverage for the following is included under this type of plan:

  • Intensive Care Units
  • Emergency Room Visits
  • Qualifying Outpatient Visits
  • And more

Major Players in the Supplemental Market

Plans like those I’ve described are becoming more popular as deductibles and out-of-pocket costs rise. So, more insurance companies are now offering those plans. Newcomers in the field are the major health carriers—Aetna, Cigna, Humana, Blue Cross Blue Shield, and United Healthcare—which are now offering the coverages in addition to their comprehensive, ACA-compliant health insurance offerings.

The following companies, alternately, have been offering these coverages for decades: Aflac, Mutual of Omaha, Colonial Life Insurance Company, Principal Financial Group, Assurity Life Insurance, Co-American Fidelity, Assurance, Guardian Life Insurance Company of America, Assurant Health Company, Combined Insurance, and AIG.

Critical illness, accident and hospital, and medical indemnity coverages should be considered when creating your total healthcare insurance package. You may be able to select a higher-deductible health plan at a lower premium and purchase one of these programs for less than the cost of buying a lower-deductible health plan.

Don’t Overinsure Yourself

Only buy the amount of coverage that covers your deductible and out-of-pocket expenses before your health insurance plan pays 100 percent. Only purchase the plan if one of these plans and your health insurance plan combined is less than a lower-deductible health insurance plan. Otherwise, you are overinsured.

For more advice on supplemental policies, you can find Healthcare is Making Me Sick on Amazon.

Scott Heiser 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. To get started, visit www.UncoveredHC.com. 

Is Christian Healthcare Right for You? Here’s What You Should Know.

With the reduced carrier selections, increasing and sometimes unattainable premiums, and increased deductibles and coinsurance, people are aggressively looking for alternatives to traditional health insurance. Some are turning to nonprofit, religious-based plans, known as Christian healthcare plans, due to their significant reduction in premium costs and their exclusion from ACA penalties and requirements.

These plans have seen tremendous growth over the past three years, paying close to two-thirds of a billion dollars in medical expenses and covering over 600,000 members in 2016. Their explosive growth is eliciting greater interest and greater scrutiny.

Both are warranted. Who are they? What do they offer? What don’t they offer? What are their costs? Are they legitimate? Are they regulated? Let’s take a closer look at Christian healthcare plans to see if they might be right for your needs.

What is Christian Healthcare?

Christian health plans are healthcare-sharing ministries oriented toward practicing Christians. They are aligned with biblical teachings that believers have a responsibility to assist each other’s needs. They have been in existence for over twenty years and are growing rapidly due to their philosophy and low initial costs for healthcare solutions.

They are not insurance companies. They are excluded from ACA mandates like pre-existing coverage exclusion, underwriting, and unlimited payments, due to their religious conviction. Members literally share in certain expenses covering one another’s costs. Interestingly, this is the basic definition of insurance to aggregate expenses.

What Are the Requirements?

The major membership qualifications require: Christian testimony (live by biblical standards, bear one another’s burdens, and regularly attend a fellowship of believers); healthy lifestyle (no smoking or illegal drugs); application review (underwriting—you can be denied for pre-existing conditions); and health partners (be willing to participate with health coaches to work toward a healthier lifestyle).

Interestingly again, this shared commitment to health produces solid aspects of the program that work in improving the members’ lives and keeping health costs in control, thereby leading to better quality of life for the individual.

How Does Payment Work? What’s Covered?

Some Christian health plans have PPO network providers, and some don’t. All encourage you to negotiate fees with providers and have provider counselors to assist with negotiations if providers refuse. By paying cash, the members are generally successfully receiving significant discounts off of the published provider charges.

The programs have annual contributions that grant you “sharing” amounts per qualified illness. Each illness will require a deductible from you before the illness is submitted for sharing. Non-qualified or preexisting condition bills can be submitted as financial prayer requests that may or may not be met by the membership. Each individual is assessed on the annual contribution level and then will also receive financial prayer requests from others throughout the year. Entry-level plans usually don’t cover prescription drugs.

When considering these plans, or any other plan for that matter, do not just read the covered procedures. Find the exclusion section, generally in the appendix of their coverage guide, and scrutinize those features. Make sure your health profile, which includes your family health history, does not include those features. Common exclusions with these plans are pre-existing illnesses, prescription medicine, chiropractic treatments, diagnostic services, birth control, and illegal drug-related services.

Who Are the Biggest Players?

The healthcare-sharing ministry landscape is dominated by five major players with the largest memberships and highest revenue spread across the country and across Christian denominations. Samaritan Ministries (Illinois), Christian Healthcare Ministries (Ohio), and Medishare (Florida) are the three large evangelical operations.

Dozens of similar ministries exist across the country, mostly smaller and more localized. Ohio’s Liberty HealthShare is Mennonite, a denomination traditionally committed to pacifism and dialogue. Solidarity HealthShare, founded in 2015, is Catholic, and partnered with another Mennonite aid group in Ohio to be grandfathered into the ACA exemption for sharing ministries, which required that they exist before 1999. There is also a Jewish-based health plan found at unitedrefuahhs.org.

Who Should I Talk to?

If you’re interested in one of these plans, analyze the plan designs, rules, and regulations. Seek out current participants who have had large claims. Find out what worked for them and what didn’t, and go from there. 

How to Develop a Winning Relationship with Your Healthcare Provider

Once you’ve gathered referrals, done your research, and scheduled an appointment with a new primary care physician, how do you get the most out of this relationship? Remember, your doctor is the clinician who should know you best and holistically.

They make the primary diagnosis. They are the ones who will cut through the healthcare system clutter and ease your way into the best appropriate specialties and hospitals. They will even help you save money. Developing a good, solid relationship with this person is the best start or foundation of your healthcare experience.

Your doctor is your teammate and advocate. And no, this isn’t a fantasy; it can be a reality, and one you can achieve without bribing your physician with candy, flowers, or a bottle of Maker’s Mark. If you’re educating yourself, being proactive about your health, and providing the right information, you can establish the kind of relationship that is healthy for you both physically and financially.

The process is like any other valuable relationship: simple if you approach it with the right mindset and effort, but not necessarily what we’ve typically done with healthcare professionals. The keys to success are preparation, clear two-way communication, and clear goals. On average, you’ve got eight minutes per visit with the doctor. Your goal is to efficiently communicate your ailments and expectations. Let’s review some tips on how to maximize that experience and develop a relationship with your doctor.

How to Prepare for an Appointment

Be organized. Studies have shown that patients who filled out a detailed checklist asked more questions during their doctor visit and got more satisfaction with the visit. The checklist should include accurate information, dates, times, and circumstances about your symptoms, your health record (including any and all medications you are taking), and a list of questions you wish to cover. Prioritize the questions by their importance.

Use SBAR to Communicate Confidently

Read this sentence twice to truly get it in your head: it’s your responsibility to communicate effectively with your doctor. You have to be organized when it comes to your own health. Stephen Covey wrote that to effectively communicate, both parties have to “seek first to understand and then to be understood.” Understanding the doctor’s environment sets you up to further prepare your discussion with them.

What better way to prepare is there than understanding how they are trained to communicate with themselves? Many physician practices and hospitals use a technique called SBAR (Situation Background Assessment Recommendation). It was developed by the Navy for use in nuclear submarines to enhance efficient communication. Staff and physicians use SBAR to share patient information in a clear, complete, concise, and structured format and to improve communication, efficiency, and accuracy.

Here’s the framework and how it relates to you:

  • Situation: Take ten seconds to explain (your reason for the appointment)
  • Background: Provide context and data (your medical health record)
  • Assessment: Describe the specific problem/situation (doctor’s diagnosis)
  • Recommendation: Explain what you want to do and when (course of treatment)

Try not to get emotional or engage in non-essential stories. Stick with the facts! Also, don’t withhold information on embarrassing symptoms, issues, or cost concerns that are causing fear. Without that information, the doctor can’t help you.

By being prepared and fact-based, the two of you will have more time to focus on your issues and questions. You have to be concise, organized, objective, and precise.

Here’s a tip: take an advocate with you to the appointment who can make sure you cover your situation and key questions. They can also be another set of ears to listen to the doctor’s diagnosis and course of treatment. Take notes during the appointment and ask for a summary of the appointment from your doctor outlining their diagnosis and treatment plan. This can often be accessed online as well.

Good Questions to Ask

Looking for some assistance in developing good questions to ask your doctor? The US Agency for Healthcare Research and Quality (AHRQ), a division of the Department of Health and Human Services, has included on its website a “tips and tools” section on what to do before during and after your appointment. Sample questions are:

  • What is the test for?
  • How many times have you done this procedure?
  • When will I get the results?
  • Why do I need this treatment?
  • Are there any alternatives?
  • What are the possible complications?
  • Which hospital is best for my needs?
  • How do you spell the name of that drug?
  • Are there any side effects?
  • Will this medicine interact with medicines that I’m already taking?
  • What is my diagnosis?
  • What are my treatment options?
  • What are the benefits of each option? What are the side effects?
  • Will I need a test? What is the test for? What will the results tell me?
  • What will the medicine you are prescribing do? How do I take it?
  • Are there any side effects to this medication?
  • Why do I need surgery? Are there other ways to treat my condition?
  • How often do you perform this surgery?
  • Do I need to change my daily routine?

The Bottom Line

Your healthcare is not a game. Instead of approaching visits with a chip on your shoulder or with confusion, go in confident and prepared. Build a mutually respectful relationship with them, one in which you communicate openly and concisely.

And don’t just get to know your doctor; establish relationships with their nurses and their administrative staff, too, because they’re the gatekeepers.