Question: What is a “deductible” and how does it affect me?

Sprague: A “deductible” is a fixed amount of money that you must pay out for your health care each year before your insurance company begins to pay the bills. In many cases, the deductible is a few hundred dollars. However, it is possible to reduce the cost of premiums by setting a higher deductible. These policies are most appropriate for individuals who feel comfortable taking greater financial risks. Our agents can help you forecast and compare the premiums and your direct medical costs of several different deductible levels.

Question: What is a co-payment?

Sprague: A co-payment is a small fee – usually in the range of $5 to $20 – that you pay each time you visit your doctor, use some other healthcare service, or get a prescription filled. The insurance company then pays the rest of the cost. Co-payments help to keep insurance costs lower than they otherwise might be for two reasons. First, you are paying part of the cost. Second, requiring patients to pay something tends to discourage the over-use of unnecessary services or medicines.

Question: How can I save money on healthcare?

Sprague: The most important thing you can do is to find the right healthcare insurance policy for your needs. It is never a good idea to avoid seeing your doctor when you have a medical problem or to fail to take medicines you really need in order to save money.

There are many ways to save money on healthcare, however. Here are some of them:

• Keep accurate, thorough records of your deductible expenses. Often, health insurance policies are written with a deductible for each person in the family and a larger deductible for the entire family. If several family members receive medical care or buy prescriptions, you may reach your family level of deductible before all of the individual deductibles have been met. Be sure to let your insurance company know when you have met your family deductible, since their system may track only individual amounts
• Do not repeat medical tests unless necessary. If you change doctors or dentists, or are referred to a specialist, make sure that copies of your records are sent to the new provider.
• Buy generic drugs and shop for the best price. Ask your doctor to prescribe generics whenever they are available and will meet your medical needs. Also compare prices of over-the-counter medicines, since there are considerable differences among brands and stores. Look into mail-order pharmacies; the costs may be lower. But since they take more time to fill prescriptions, do not jeopardize your health by letting your prescriptions lapse and not taking pills on time.
• Avoid emergency rooms except for true emergencies. Emergency room care is some of the most expensive available, simply because they are staffed and equipped to deal with medical crises 24/7. If you have a problem that your doctor can treat during office hours, choose that option instead of going to the emergency room.
• Keep vaccinations up to date, and keep records of them. Although not all insurance policies cover the cost of vaccinations, they prevent a number of critical illnesses that could seriously jeopardize your health and require expensive treatment.
• If you need surgery, ask whether it can be performed on an outpatient basis or on the day you are admitted to the hospital. Have all of the pre-operative testing done before you are admitted. If your surgery is likely to require less than a week’s stay in the hospital, try to schedule it early in the week to avoid spending the weekend.
• Find out ahead of time how much your insurance company will pay your doctor for a major medical procedure (such as surgery). Then ask your doctor whether he or she is willing to charge only the amount covered by insurance.

Question: Once I’m on Medicare, I won’t need health insurance, will I?

Sprague: Alas, if that were only true…! A guide to understanding Medicare Supplemental Insurance and choosing among the 12 different insurance options is available at the U.S. Department of Health & Human Services website. While that’s a good place to begin, we expect you’ll have plenty of questions. We’re here to help.

Question: I worry about whether I’ll be able to afford long-term care for myself or my spouse.

Sprague: You’re not alone – many people share your concern. There are no simple answers, but like other big life issues, individual needs vary widely. Fortunately, there is an ever-increasing variety of options to meet differing situations. The U.S. Department of Health & Human Services website offers a good, current overview of what long-term care means and includes some planning tools that may begin to give you a sense of your options. But since there are likely to be many other factors that may influence your individual circumstances, you’ll probably benefit by discussing your options with a knowledgeable insurance agent.