What Steps Can You Take To Bring Down Out-Of-Pocket Expenses In Healthcare?

Rupa Mehta, 45, a working mother of two, based out of Mumbai, receives an unexpected bill after her sudden gall bladder surgery at a nearby hospital. Though she had health insurance, the out-of-pocket expenses piled up quickly, adding stress to the already challenging situation. And this is not a lone incident. Such stories are common. A lot of individuals and families face significant out-of-pocket costs when accessing healthcare. However, you could always take some proactive steps to reduce and manage such expenses.

One of the major costs troubling a lot of Indians when it comes to healthcare is OoPEs. This imposes a considerable burden on the patient’s family. A lot of people take loans, whether through credit cards or personal loans or even sell assets (mutual funds, provident funds, gold) to pay for medical expenses. More often, rich people can afford to pay for expensive medical treatments, whereas poor people have to manage with low-quality services.

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According to the latest National Health Accounts (NHA) estimates (2019-20), the share of OoPE in total health expenditure declined from 62.6 per cent in 2014-15 to 47.1 per cent in 2019-20. The continuous decline in the OoPE in the overall health spending shows progress towards ensuring financial protection and Universal Health Coverage for citizens.

Here are some ways to bring down OoPE expenses:

Get Familiar With Your Insurance Policy: You must understand your health insurance coverage thoroughly. Get acquainted with your deductibles, co-payments, coinsurance rates, and other services. Once you get very acquainted with your healthcare decisions, it will help you anticipate potential costs.

Select In-Network Providers: You must try to stick to healthcare providers within your insurance network as much as possible. Typically, out-of-network care comes with higher costs as insurers may cover less or none of the expenses.

Go For A Comprehensive Health Policy: “The first and the most important thing you can do to bring down your OoPE is to buy a comprehensive health policy with a minimum Rs 10 lakh of the sum insured. Your policy should include OPD consultations, ambulance, no claim bonuses, restoration benefits, and some not-so-rare critical illnesses. In addition to this, you can consider a non-consumables cover through a rider as these are not covered by a health plan but can amount to a decent amount of OoPE,” says Naval Goel, founder and CEO, PolicyX.com.

Regular Preventive Medical Checkups: You must take preventive care benefits covered by your insurance plan. By regular check-ups and screenings, you can ensure your health issues get detected early on, thereby reducing the costs of treatments later. “Undergoing regular preventative medical checkups helps in keeping your health in check. Some policies offer preventative health check-ups, this benefit too can save you from paying from your pocket,” says Goel.

Maternity Benefit Inclusive Plan: “If you plan pregnancy in the future then purchasing a maternity benefit-inclusive plan can be a very good idea. These covers include all maternity-related expenses such as surgery, newborn, post-maternity expenses, etc,” adds Goel.

Compare Costs: You must research and compare costs for medical services and procedures. While different providers may charge varying prices for the same treatment, you must look for transparent pricing information to make informed choices.

Healthcare Credit Line: You must access a no-cost healthcare credit line for quick funding. This would allow you to borrow and repay money at no expense and cover costs paid by your health insurance.

Negotiate Medical Bills: You must not hesitate to negotiate with the healthcare provider or hospital if you are faced with substantial medical bills. If you explain your financial situation, they may offer payment plans or discounts.

Healthy Lifestyle: You must adopt a healthy lifestyle that can prevent chronic illness and minimize future healthcare expenses, while not directly reducing immediate costs.

By taking these proactive steps, you can sail through any situation of high medical costs and lessen financial stress. It’s very important to be alert, and informed, explore cost-saving options, and advocate for yourself when dealing with OoPEs.