KEEP YOUR SHARE OF HEALTH COSTS TO A MINIMUM
Common Ground Healthcare Cooperative pays for most of our members’ health care bills, but our members have responsibilities too. This is called cost-sharing, and it is part of any health insurance plan that you can buy today. Below you’ll find some important tips on saving money.
YOUR PREMIUM: A “premium” is the amount you will pay monthly for your coverage. Plans that cover less will have a lower premium, and higher cost plans will cover more of the costs. You can’t change plans once you start, so it is important that you spend a little time predicting your health needs during the coverage year, and then selecting a plan that fits your needs. You should also think about the worst case scenario, and how much you will be able to afford to pay if an accident or illness hits you or your family. Sometimes a lower premium plan can end up costing you more.
DEDUCTIBLES: A deductible is the amount you will have to pay before coverage kicks in. CGHC small group plans have separate deductibles for in-network and out-of-network care, and you will pay a lot less if you see providers that are in-network. Individual and family plans only have in-network deductibles. Deductibles apply to most, but not all covered services. For example, CGHC covers certain in-network preventive care services up front, before deductibles are met. Also, if you have a plan with copays (see below), you will only have to pay the copay and not the full deductible before CGHC coverage starts.
COPAY VERSUS COINSURANCE PLANS: If you buy a plan with copays, it can help make the cost of healthcare more predictable. That’s because a copay is a set amount you will pay each time you visit your doctor or specialist, visit an urgent care or emergency room, and fill most prescriptions. In some plans, copays apply before you meet your deductible (this can vary by carrier and by plan). The downside is, you’ll pay a little extra for a copay plan versus a coinsurance plan, where you will first have to meet your deductible, and then we will pay a percentage of your care.
CHOOSE THE RIGHT KIND OF CARE: You will pay more or less depending on your care setting. Click here to find out more about the right care in the right place at the right time.
COVERED DRUG LIST: Click here to learn about CGHC’s drug formulary, which is the list of medications we cover. This document also explains which medications are in our generic drug category versus preferred brand, non-preferred brand and specialty. Whether you are in a copay or a coinsurance plan, you will typically pay the least for generic and preferred brand medications and the most for non-preferred brand and specialty medications. Talk to your doctor about prescribing a drug that is in the generic or preferred brand categories but is still approved to treat your condition or injury.
KNOW YOUR COVERAGE: Remember, CGHC covers a lot of health care services, but it doesn’t cover everything. It doesn’t cover cosmetic procedures for example, and it doesn’t cover experimental treatments. The best thing you can do is ask questions before you seek treatment. Be as specific as possible about what care you want and why.