Are You Paying More to Stay Healthy?

40551961 - model isolated puzzled

If you are hoping to buy health care under the old model of “fix it when broke” and praying you still have the old $500 deductible or 80/20 plans – that ship sailed five years ago. High-deductible insurance plans are here to stay; in fact they’ve tripled in the last four years. These controversial plans are advertised to save money to the average consumer when in reality the cost is being passed to the consumer.  Your premium goes up and you get to pay the first $3K to $15K, what a deal!

The high-deductible plans have deductibles that range from $1000 to $15,000. The average in Minnesota is $3000 to $7000. The premiums for these plans are enticing as there is definitely a savings compared to the current lower deductible plans, however, the out-of-pocket expenses can balloon quickly.

There are several things to think about when considering a high-deductible plan or any plans for 2017:

  • High co-payments
  • Caps on hospitalization costs
  • Out-of-pocket costs can be hidden within high deductible plans. One of the biggest considerations is: what is your clinic and network availability!
  • Statistics show that consumers on high-deductible plans are less likely to get care at emergency rooms and tend to skip preventative services or lower cost intervention like massage.
  • Chiropractic and other wellness services may be limited. We see the “Sticker Shock” in your eyes every day where you, the patient, stops when your insurance finally tells you what the REAL COVERAGE is.

Metro Area Insurance Options

All health insurance plans are not the same, nor do they offer the same “in-network options.  Right now in the metro area you basically have four plan options; Blue Cross Blue Shield (BCBS), Health Partners (HP), Medica and Preferred One to work with. It is our opinion as an independent clinic that BCBS and Preferred one still offer the best products in a crazy market. A few details are listed below:

  • Health Partners in which you are only allowed to go to their clinics they own and control.
  • Blue Cross Blue Shield (BCBS) is still fairly open but certain managed care plans for individuals will only allow you access to Allina clinics.
  • Medica is similar to HP, in only allowing you to be seen at Allina or Medica/Fairview clinics. Basically Medica and HP are considered “closed business systems” which means you will only get care in clinics they control be aware that neither will contract or work with smaller independent clinics, which have been forced to be assimilated into larger clinic systems or lose their contracts.
  • Many of these plans also cut services with Mayo so you really need to watch this.

There is a strong push to squeeze out good doctors in private practice which forces you to go to large specialty clinics and practices. Just this December about 60% of all Orthopedic and Neurosurgeons across the state got the “Pink Slip” from BCBS as “in- network” providers. They are choosing to contract with more regional clinics and cutting costs. However, many great doctors got the axe not based on skill levels, but just because they were in solo or small practices.

Medicaid, Medical Assistance and Medicare
Medicaid or Medical Assistance (MA) is another situation entirely, as is Medicare. The plans that give you the best coverage under MA really depend on which county you live in. In Hennepin County its Hennepin Health and then BCBS. In any other county I would still look to BCBS. If you have HP you are locked into their clinics systems, basically you lose choice. Ucare is better than HP but they really limit services with prior authorizations the others don’t do. Medica is dropping out of the MA market in 2017 which I feel is a good thing. They were also a closed network like HP.

For those of you on Medicare, the best plan option with the best coverage is still getting good old “Plain Jane” Medicare from UNCLE SAM and supplement. Many people, due to the marketing from the big 4, think they can only get advantage plans or supplements from the BIG 4: Ucare, HP, Medica and BCBS. There are actually over 350 supplemental plans offered, much cheaper and all work the same.  If you are retired, this gives you the best coverage.

Smart Healthcare “Cents”

As a healthcare consumer you need to know your options and have a plan in order to make informed decisions and stretch your healthcare dollars and cents:

  • Put aside funds to meet your deductible.
  • Do your homework on what office visits, procedures and treatments will cost. Often cash prices (such as AdvaCare offers) is cost effective.
  • Prevention and wellness care saves money in the long run.  Prevention and wellness care. Health care that is more preventative to keep you healthier is still the most cost effective way to go.

AdvaCare Strides with the Times

We realize your healthcare decisions will be built upon a foundation of patient preference, experience, effectiveness and value.  Let us help you by making available our pricing information.  We’ll consult to assist you in the best preventative treatments, such as IV therapies for your wellness and to help deal with pain and inflammation or our Class 4 K laser which is very effective for pain, swelling, scar tissue and Neuralgia.

Advacare is getting our family practice providers contracted with all the plans that will work with us, which is all plans except Medica and HP. This should be completed by the end of January.  We are also adding more times for Prolo and pain management injections with our additions staff.

Great news for Aetna plans, which tend to be for groups that have a national foot print, you are now using the Preferred One network for MD, PT and DC care, so in our clinic you are now in network!!

Contact us today for you or any of your family members to set up a free consult to find out how we could be helping you today! 952-835-6653