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Use these tips and tricks to get the most out of your health plan and save out-of-pocket costs

Sep 25, 2023
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Your Community Health Options plan offers access to the benefits that help you reduce out-of-pocket costs while ensuring you and your family can meet your health needs. Learn how you can save here.

 

Some people become so overwhelmed with their health insurance that they often don’t take advantage of the benefits they pay for. Of course, insurance is there for emergencies, but did you know you can use it to lower your out-of-pocket healthcare costs, often for everyday services?

You’d be surprised at how many benefits go unused. And if you’re in an employer-sponsored plan, you’re leaving money on the table. According to the U.S. Bureau of Labor Statistics, health benefits can amount to up to 10% of your total compensation.

Don’t let your plan go to waste: Be sure to know your benefits by reading through your Member guide and Summary of Benefits found within your Member portal at healthoptions.org. Even if you checked at the beginning of the year, it’s never a bad idea to look again so you don’t miss out on health and wellness benefits.

Importantly, Community Health Options plans offer access to benefits that help you reduce out-of-pocket costs while helping you meet your health needs. Here are some ways you can save:

 

  • Urgent Care: When you’re hurt or sick, sometimes you need care right away. Of course, head to the emergency room or call 911 if your condition is serious or life-threatening, but save time and money with Amwell® for 24/7 urgent care telehealth from the comfort of your home—at $0 cost share on non-HSA plans, and $67 on HSA plans ($0 after deductible).

Need an office visit? Find a local in-network urgent care here. If you don’t have an urgent care near you, a primary care walk-in clinic is usually less expensive than an ER visit.

 

  • Lab Tests: When your provider recommends lab work, you could save hundreds of dollars by choosing an in-network lab that’s not affiliated with a hospital. You may need to ask your provider for a written order or to send it to the lab of your choice. Quest, Nordx and Affiliated Labs are among labs designated as eligible freestanding unaffiliated labs. Check the Provider Directory at healthoptions.org for more information.

 

  • Prescriptions: Ask for generic options for you and your family to take advantage of a $5 copay for a 30-day supply of Tier 1 preferred generics. You’ll also pay only two 30-day copays for a 90-day supply through Express Scripts (ESI) mail order for most maintenance prescriptions (Download the ESI app or register with ESI here). Additionally, when using an in-network pharmacy that accepts GoodRx, with Price Assure you’ll automatically pay our generic price or the GoodRx price—whichever is lower. (Note: HSA plans have a deductible before copay or coinsurance for prescriptions, while HSA Plus plans provide access to specific medications before the deductible (noted by H.S.A. on our formulary).

 

  • Chronic Illness Care: If you have asthma, coronary heart disease, chronic obstructive pulmonary disease, diabetes and hypertension, save on routine care at in-network providers with no deductible and on certain medications with our Chronic Illness Support Program, available on all non-HSA plans*. You pay $0 for ESI mail-order preferred generics and have a 50% reduction in copay for preferred brand maintenance medications. You’ll also find CISP-eligible maintenance medications in the formulary on our website.

 

Read your Schedule of Benefits and Summary of Benefits and Coverage in your Member Portal for more information. Still have questions? Call our Maine-based Member Services team at (855) 624-6463 between 8 a.m. and 6 p.m., Monday to Friday.

*Not available on catastrophic plans

 

SEE ALSO

When it comes to healthcare, Maine gets high marks for its quality of care. The trouble is, it’s getting harder for Mainers to access that care.

Recently, a Community Health Options Member needed a new primary care provider after her doctor retired. After a long search, she finally found someone accepting new patients, but faced an eight-month wait for an appointment. Unfortunately, her story has become commonplace. Access to care is no longer a struggle for just the uninsured but has become a universal issue that hits everyone.