Tips and tricks to save health care dollars

Submitted by the NJEA Health Benefits Committee

How to save the plan money

Use your primary care physician
Use your primary care physician (PCP) for as many services as possible. PCP office visits are much cheaper for your insurance plan than specialist office visits, and often you can get the same services from your PCP without the extra step or the costs of seeing a specialist.

Your PCP can be the key to coordinating your health care. Make sure your PCP knows which specialists you’re seeing and that your PCP receives copies of your records, so they can make the best medical recommendations to ensure the best outcomes. Better outcome means fewer office visits, which saves money. If you are in the School Employees Health Benefits Plan (SEHBP), you have access to the Direct Primary Care Medical Home (DPCMH) program. The two providers are Paladina Health and R-Health. Go to njea.org/heathbenefits to learn more.

Sometimes you can even reach out to your PCP before visiting the emergency room or urgent care center, which can save money. DPCMH gives you 24/7 access to your physician, who will help you determine if emergency care is necessary.

Get wellness visits
Make sure you get your wellness visits in every year. These preventative exams are free for you and provide a yearly check-in with your doctor to make sure you’re healthy and to intervene early if there are causes for concern. Preventative care and early intervention are much cheaper in the long run than neglecting a chronic condition that could have been managed earlier.

In SEHBP, there is the NJ Well Program, which provides monetary incentives to reach health goals. Retirees are also eligible if enrolled in the Aetna Educators Medicare plan. Check with your local association to see if you have a wellness program in your local. If not, consider stepping up and starting one.

Consider medication options
Get the most out of your prescription plan by discussing with your doctor less expensive alternatives to your medications, when applicable. Generic medications are more affordable for you and for your plan compared to name brands. Talk to your physician about other prescription options as well, such as, 90-day vs. 30-day supplies, single dosage vs. multiple dosages, and so forth.

Use in-network providers
Use in-network providers for all visits, especially specialists. In-network providers are doctors who have agreed to reimbursement rates with your insurance company. Out-of-network providers can charge whatever they want and can also “balance bill” you, which is a potentially expensive practice where the provider bills you for the difference between the provider’s charge and the allowed amount.

Do your research for elective surgery
If you are having elective surgery, research prices before you have the procedure. The surgeon’s and the facility’s office can give you a breakdown of the charges to you and your plan. Prices can vary by facility and physician and cost does not always correspond to quality.

How to save yourself money

Do your research during open enrollment
Research your options during open enrollment to make sure that you have coverage that meets your needs. You may want to choose a plan that has lower premiums, which could result in lower insurance deductions from your paycheck. A summary and comparison of your options will help you decide which plan is right for you and your family.

Protect yourself from surprise medicals bills
Particularly when you are in the hospital or having elective surgery, ensure all physicians and providers are in-network to protect yourself from surprise medicals bills and balance billing.

Use mail-order prescription options
If you have a prescription plan that includes a mail-order option, it is often a cheaper copayment than going to your retail pharmacy. This is particularly helpful for maintenance medications that you take every day. For your convenience, opt for automatic refills and have them shipped to your house.

See if you’re eligible for an FSA
If you are eligible through your local association, you can participate in the Flexible Savings Account (FSA) program to contribute pretax dollars into an account to use for out-of-pocket medical expenses. You can use the FSA store to save money on some over-the-counter items as well. Plans can vary, so make sure you understand how yours works. Some FSA funds have use-it-or-lose-it provisions, unless your plan has a carry-over provision.

Check your bills and EOB
Particularly when you are in the hospital or having elective surgery, ensure all physicians and providers are in-network to protect yourself from surprise medicals bills and balance billing.

Plan for when you must go out-of-network
If you must use out-of-network providers, get approval for the procedure in advance and ask for a copy of your bill ahead of time.

When you are an informed consumer, you make better health and financial decisions for you and your family. Health care benefits can be complicated, but as educators you know the importance of advocating for yourselves and your families. 

This article was submitted by the NJEA Health Benefits Committee

Chair Eda Ferrante, Passaic County
Debra Steineder, Atlantic County
Debra Kwapniewski, Bergen County
Kristen Frey, Burlington County
Kelly Rosato, Camden County
Nicole Carminati, Cumberland County
Anthony Rosamilia, Essex County
Carol Ceglia, Gloucester County
Kevin Reed, Hudson County
Joann Gitto, Hunterdon County
Iris Tonti, NJREA, Mercer County
Denise King, Monmouth County
Maryellen McLeod, Morris County
Judith Ruff, NJREA, Burlington County
Lisa Simone, Ocean County
Carrie Odgers Lax, Passaic County
Michael Kydonieus, Somerset County
Guadalupe Ferreiro, Union County

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