Co-pays, prescriptions, and all those documents: yes, it's a puzzle out there. We're here to help—feel better yet?

By Jessica Migala
September 23, 2019
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Health care is practically a language of its own. In fact, it’s so complex that more than half of U.S. consumers don’t understand the basics, according to a 2017 survey from the research firm Accenture. For those folks, it’s a struggle to manage doctor’s appointments, decode bills, choose insurance, and maximize benefits.

“There’s definitely a skill set to managing our health care. Problem is, it’s something we’re never taught how to do,” says Sana Goldberg, RN, author of How to Be a Patient ($12; amazon.com). The system has grown increasingly complicated and overburdened. Most of the time, she adds, we interact with doctors and insurance companies when there’s a problem—even an emergency—which can lead to making rushed decisions. Add kids or loved ones you’re caring for and it’s enough to make your head spin.

“Dedicating time and head space to organizing and planning can set you up to approach health care as preventive rather than reactive,” says Goldberg. That can pay off for your well-being and peace of mind. Here are a few ideas to simplify your health this fall.

RELATED: How to Cut Waiting Room Time in Half—Plus Other Doctors’ Office Shortcuts You’ll Wish You Knew Earlier

1. Create a healthbook.

Everyone needs what Goldberg dubs a “healthbook,” a notebook devoted to controlling the chaos of your health info. Take notes during doctor’s appointments, list questions for your provider, and write down the plan of action discussed with your doc, she recommends. Depending on how much info you need to track, you can also do this in the notes app on your smartphone. What’s most important is that it’s all in one convenient spot. If you manage other family members’ health care, use a notebook with a separate section for each person.

2. Review your insurance.

If you’re buying a plan on the Health Insurance Marketplace, note that open enrollment for 2020 starts November 1 and, in most states, ends December 15. Take time to compare available plans: Read the summary of benefits and call providers (both existing ones and potential new ones) to make sure they’ll be in-network next year, says Cheryl Fish-Parcham, director of access initiatives at Families USA, a nonprofit dedicated to improving health care access and affordability. Always find your plan through healthcare.gov, she says. Unfortunately, there are many unofficial websites that look legit but sell plans that don’t comply with the Affordable Care Act, meaning the coverage may be abysmal, she explains. Plus, if you need help, healthcare.gov links to agents, brokers, and personnel trained in helping people with enrollment decisions. The “Find Local Help” page will direct you to the right place.

3. Compare costs.

Did you know that many insurers offer tools online (or via an app) to sort out prices for treatments and procedures? Few people do. “Most folks don’t use the cost-comparison tools available to them,” says Adam Beck, vice president of employer health policy at the advocacy organization America’s Health Insurance Plans. You can compare the cost of services from several doctors or facilities on your plan to score the best deal. These tools can also help estimate out-of-pocket costs.

4. Flex your FSA.

If your coverage includes a flexible spending account, you put money into a tax-free account. That money can be used for out-of-pocket costs like co-pays, prescriptions, and deductibles. Because FSAs are use-it-or-lose-it accounts, find out now how much you have saved, and check with your FSA administrator about when and how the funds need to be used. (Some plans require you to use the money by the end of the year, others give a grace period, and some let you roll funds over to the next year.) Arrange treatments with out-of-pocket costs (orthodontia, for instance) or go to fsastore.com, which sells FSA-eligible products. It’s packed with surprising finds, including sunscreen, insoles, baby monitors, acne treatments, and reading glasses.

5. Collect your medical records.

“These are as much your property as the suit you dropped off at the dry cleaner,” says Leslie D. Michelson, founder, chair, and CEO of the health care navigation firm Private Health Management and author of The Patient’s Playbook ($13; amazon.com). After filling out a HIPAA release at the doctor’s office (and possibly paying a fee, depending on the practice’s rules), you’ll receive a stack of papers. Go through them and create a summary of these important pieces of info, he says: dates of vaccinations and surgeries, ongoing treatments, and hospitalizations. Scan the document to your phone. Next time someone at the doctor’s office requests your medical history, take out your phone and ask if you can email this document so they can print it out. “Having this info in your possession and all in one place will give you the confidence to access health care and give doctors the critical info they need to best treat you,” he says.

6. Bag up your meds.

The reality of seeing multiple doctors and specialists is that your care may not be coordinated. Meaning, your primary care provider may not know the name and dosage of the thyroid medication your endocrinologist prescribed. And you may not remember off the top of your head. For any appointment, round up the bottles of the medications and supplements (including vitamins) you take, toss them into a bag, and bring the bag with you. “As a physician, I find that’s easiest. Sometimes what’s listed in your file is different from what you’re taking,” says Danielle Ofri, MD, PhD, a faculty member at NYU School of Medicine and Bellevue Hospital in New York City and author of What Patients Say, What Doctors Hear ($13; amazon.com). Your doctors might also consider streamlining your medications if anything is redundant or causing interactions or side effects.

7. Tap into the power of the portal.

Many doctor’s offices use a medical portal, such as MyChart, to aggregate data on your past visits, test results, and upcoming appointments. If yours uses this or a similar system, you’re in luck. That’s because it typically has a handy messaging feature for nonurgent medical questions and requests: You can clarify something after an appointment, ask a question you forgot when face-to-face with your doctor, get more info about a blood test result, request a referral, or note that your prescription needs a refill. It can be an efficient way to get the help you need, says Goldberg.

8. Ask for help in advance.

Switching insurers on an employer plan? Ask your HR department if your company has a patient health advocate to answer questions about the transition, says Beck. Or call the insurer’s hotline and speak with a customer service rep. Ask how to transfer prescriptions, find doctors, or make sure ongoing treatment continues without interruption. “There’s a misconception that health plans want to steer you away from care,” says Beck, “but they’d much rather you take care of things in advance than have problems later on.”

9. 411 your fam.

Each member of your household should have an instruction sheet, a 411 on their health. Write down conditions (asthma, diabetes, high blood pressure), meds, doctors’ numbers, and releases (for example, permission to administer an epinephrine autoinjector if necessary). Laminate the sheets and stick them on your fridge. Stash copies in your car and kids’ backpacks too. It’s for other caregivers, emergency personnel—and you. “In an emergency, you think you’ll be totally capable of delivering that information, but why trust your memory in that moment?” says Michelson. “This makes sure everyone gets the care they need.”

Learn the Lingo

People who understand basic health care terms tend to make better financial and medical decisions, and they also save time by making fewer calls to insurers’ customer service departments, says Jean-Pierre Stephan, managing director of health front office and consumer insight and growth at Accenture. Brush up on the five terms below—or even save them in a note on your phone.

  • Premium: The amount you pay for your health insurance every month.
  • Deductible: The amount you pay for covered health care services before your insurance plan kicks in.
  • Co-payment: A fixed amount you pay for a covered health care service (say, $25 a visit).
  • Coinsurance: The portion of the cost of a covered health care service you pay after you’ve paid your deductible (e.g., 20 percent of charges).
  • Out-of-pocket maximum: The most you have to pay for covered services in a plan year.

Make Sense of Medicare

If you or a family member is eligible for Medicare, make it a habit to review plans annually during Medicare open enrollment (this year, it’s October 15 to December 7), suggests Seema Verma, an administrator at the Centers for Medicare & Medicaid Services. These tools will help.

What’s Covered app (free; iOS and Android)
You can look up whether Medicare covers a service, which may eliminate the need to dial the 800 number. You can even use it at the doctor’s office for a quick check while planning care, says Verma.

Procedure Price Lookup
This tool tells you whether it’s less expensive to have a procedure done at a hospital outpatient department or an ambulatory surgical center, based on national average prices.

Plan Finder
If Mom wants to change plans or you’re not sure she has the right coverage, look for the Plan Finder tool, launching this fall. It compares plans based on location and shows extra benefits and pricing. One cool feature: When you sign in, the tool gathers your claims data and offers suggestions for an Rx list. Once you click on the prescriptions you want to add, you get options for a prescription drug plan (Part D), says Verma.

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