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Focus has shifted from “quality” coverage to “affordable” coverage and the definition of each is very fluid.

To some, quality means low copays, to others it means inclusion of all of their prescriptions, and to others it means inclusion of all of their providers. “Affordable” is equally varied ranging from low premiums to low access costs to low maximum limits.

The problem is that market forces and government intervention are shaping this area of our lives to a point where we cannot find the balance that many of us seek. If we are willing to accept benefits that are less rich in order to continue to access our providers, we often discover that provider networks are very fluid and those who once participated may no longer be included.

If we select a plan based on prescription inclusion we are often surprised when the drugs we researched move from one cost level to another, and sometimes even fall completely off the approved list.

Sometimes we select a plan based on the benefits and cannot clearly see that charges for services which were once covered as copays now apply to the deductible. One of the most painful surprises in the past few years has been the “unbundling” of services performed in our physicians’ offices which appear as separate bills for lab work and x-rays. Also surprising is the set of bills that appear from providers we never met who read our x-rays and imaging after we have paid for the folks who performed the actual procedures.

And throughout all of this the rates continue to increase while the benefits which we can afford get leaner, provider lists are suspect and prescriptions can move off the approved list at any moment.

What can we do?

  1. Ask what the cost of our services will be before our visit. “Are you a participating provider and what will my cost be after the discount has been applied?” is a question we should all be asking.
  2. Access telemedicine options whenever they are available to reduce our costs and make best use of our precious time.
  3. Shop resources for services like mammograms, MRIs and other imaging needs. Costs vary greatly and are often very high.
  4. Check with online resources like www.goodrx.com to find the most cost-efficient places to fill prescriptions.
  5. Shop our coverage options each year and keep close track of how we actually use healthcare services. We should weigh carefully if we should enroll in a rich plan if we are rare users of services. Alternately, we should carefully research the coverage for the services we use on a regular basis to see what our expected costs will be.
  6. Most importantly, we should STAY HEALTHY!!! We should make a conscious commitment to eat right, exercise and relax. Prevention is our best course of action during this most difficult time of transition in healthcare.
  7. Contact us anytime at Czajkowski Dumpel & Associates, Inc. – We are here to help!