Managing health care costs
Understand what your health plan covers
Before receiving care, review your health plan benefits to understand what services are covered and what costs may apply.
Coverage can vary depending on the type of care. For example, many health plans cover certain preventive services at no additional cost when specific requirements are met. However, services that fall outside preventive care — like evaluating a new symptom or medical condition during a routine visit — may result in additional charges.
For planned procedures or treatments, it is also helpful to confirm whether any prior authorization or other plan requirements apply.
Use in-network providers whenever possible
Many health plans offer the highest level of coverage when care is received from in-network providers.
Before scheduling care, verify that the healthcare provider, facility, and any related services participate in your plan's network. For procedures or surgeries, it may also be helpful to ask whether other providers involved in your care, like anesthesiologists or specialists, are in-network.
Using in-network providers can help reduce out-of-pocket costs and limit unexpected bills.
Estimate costs prior to receiving care
The cost of the same medical procedure may differ substantially from one facility to another. This can be true for a wide range of non-emergency services, including:
- Imaging tests such as MRIs or CT scans
- Laboratory services
- Outpatient procedures
- Joint replacement surgeries
- Hernia repairs and other elective surgeries
Comparing costs before scheduling care may help you identify lower-cost options that meet your health care needs.
Many health insurance carriers, healthcare systems, and third-party organizations provide cost estimation tools that offer price information for common healthcare services.
These tools can help you:
- Compare estimated costs across healthcare providers
- Identify in-network doctors, hospitals, and facilities
- Understand how insurance coverage may affect costs
- Review quality ratings or performance measures when available
While estimates are not guarantees of final costs, they can provide a useful starting point when planning for care.
Choosing healthcare providers based solely on price may not always be the best approach. Quality, experience, outcomes, and convenience are also important considerations.
When researching care options, you may want to review:
- Provider credentials and experience
- Quality ratings and patient outcomes
- Network participation
- Location and accessibility
- Estimated out-of-pocket costs
Considering both quality and cost can help patients make well-informed decisions about their care.
Even when insurance covers a procedure, members may still be responsible for certain expenses.
Potential out-of-pocket costs can include:
- Deductibles
- Copayments
- Coinsurance
- Charges for out-of-network care
- Services not covered by the health plan
Before scheduling a procedure, consider contacting the health insurance carrier or provider's billing office to better understand what costs may apply.
Ask questions before a procedure
Review bills and insurance documents carefully
After receiving care, compare your provider bill with your Explanation of Benefits (EOB) from your health insurance carrier. The EOB explains how a claim was processed, what the health plan paid, and what portion of the costs may be your responsibility.
Review bills carefully to ensure the services listed match the care you received. If something appears incorrect or unexpected, contact the provider's billing office or your health insurance carrier for clarification.
Look for opportunities to save on prescriptions
Prescription costs can add up over time, especially for medications taken on a regular basis.
To help manage expenses:
- Ask whether a lower-cost alternative or generic medication is available.
- Discuss whether a 90-day supply is appropriate for ongoing medications.
- Take medications as prescribed to help avoid complications that could lead to additional healthcare costs.
- Keep an updated list of medications and share it with your healthcare providers to help prevent duplicate therapies and potential drug interactions.
