The Affordable Care Act is almost certainly set for repeal, but that doesn’t mean consumers’ healthcare woes are going away. Republicans are years away from implementing a replacement plan, and though leading proposals may lower premiums for some individual consumers, they likely aren’t going to put a dent in other trends affecting our wallets.
Consumers have a bitter pill to swallow—healthcare in the United States is abnormally expensive. The Affordable Care Act was unsuccessful in lowering the overall cost of healthcare, and Republicans generally don’t believe it’s the government’s role to do so. Conservatives want more free-market principles in healthcare, but many consumers don’t truly understand what that means.
What is free-market healthcare? In general, it means giving consumers more insight into how much their care costs and how much they’re spending, and more control over where their healthcare dollars go. Policymakers on both sides of the aisle agree that this will be necessary to restrain skyrocketing costs.
Sounds great, right? So what’s the downside? Accomplishing the above means pushing more healthcare costs onto consumers, and less on employers and insurers. This is already happening, and consumers do not like it. Even those who want a free-market healthcare system often balk when their deductible goes up or their insurer forces them to pay for care out-of-pocket. This approach is even more challenging for people who have a lot of healthcare expenses—people with chronic conditions, for example.
So as 2016 winds down, Americans face yet another year of healthcare debate in 2017. Republicans will have to decide on a replacement for the ACA, and it likely will include more of these “free-market” principles. In preparation, here are three healthcare resolutions for consumers.
1. Study up
According to a UnitedHealthcare survey, just 7 percent of adults could define the four basic health insurance concepts—premium, deductible, coinsurance, and out-of-pocket maximum. Can you? This is critical information in determining which plan to choose. The reality is, health insurance plans do not cover everything. Many of them cover very little, in fact, until you hit your deductible—the amount of medical bills you must pay in full before your insurer begins contributing.
Jargon they may be, but the above terms tell you how much your plan covers. If you don’t understand them, it is almost guaranteed you will be surprised—and probably not pleasantly so—at what your plan covers.
Some plans have “high” deductibles, meaning you could be liable for thousands of dollars. A broken bone, an infection, a bad case of the flu—any acute healthcare need could easily result in $5,000 in bills that you will be expected to pay.
Don’t just sign up for the cheapest plan you find. Read the fine print. Ask a trusted advisor to help you understand insurance terms, and carefully consider your potential financial risk under a given plan.
2. Learn to price-shop
Consumers already know how to price-shop, but many don’t do it when it comes to healthcare. Think about it—you would never buy a car or television without comparing a few prices. Yet, consumers have close to no idea what healthcare services cost, or that some providers are more expensive than others.
Let’s say you need an MRI. Do you know how much an average MRI costs? Are you comfortable asking your doctor or her billing department what you can expect to pay? Are you okay with having it done by a nurse at a different facility to save a few hundred bucks if your doctor’s prices are above average?
These are the questions you need to start asking yourself and your healthcare providers. This isn’t easy—though patients often trust their doctors intimately, many are intimidated by them, too. Experiencing healthcare needs can be stressful and confusing, and patients sometimes don’t want to ask too many questions. Consumers often also believe that their doctor will consider the financial implication of tests or medications, but that isn’t always the case.
Additionally, many doctors just don’t know how much that MRI costs, either. They don’t know which insurance plan you have, and they don’t know what agreement that carrier worked out with the facility. The reality is that pricing in healthcare is very opaque. Price-shopping requires a little digging, a few hard questions, and the possibility that you may have to change doctors if you want to save money.
This is an issue that isn’t going away, regardless of what happens to the ACA. Many consumers believe the ACA is the reason their doctor is out-of-network, but your doctor and your insurance company make those decisions. The bottom line is some doctors and hospitals charge more for the same services than others. You and your insurer both want to pay the least expensive price, all else equal, and your carrier can choose to include less expensive doctors instead of more expensive ones. These are the dynamics at play when it comes to who is in-network, not government regulations.
3. Take care of yourself
Hey, this might be one of your New Year’s Resolutions anyway! But in all seriousness, consumers have to accept personal responsibility for their health. Of course, accidents happen. Serious illnesses strike. That’s why we have health coverage. But for a long time, consumers were able to turn a blind eye to how expensive it is to have poor health. When employers picked up the bulk of the tab, some employees might have not paid a dime for healthcare, regardless of how much care they used.
That has changed, and the U.S. isn’t going back to “zero deductible” employer healthcare. Consumers will continue to bear larger financial shares of their health insurance. They will continue to pay out-of-pocket for doctors’ visits and prescriptions.
With that in mind, it is harder to ignore the financial impact of preventable conditions associated with poor diet and lack of exercise. Whether your doctor has already recommended you improve your health, or you hope to avoid developing these conditions, 2017 is the year to take that resolution seriously.
Healthcare is expensive. The way it’s looking, consumers are only going to spend more of their own money paying for it, not less. You may want to think very seriously about how you can avoid spending more than you have to. Vowing to be a better healthcare consumer in 2017, and educating yourself on what that means, could benefit you for life.