Your Money and the ACA

Budgeting for increased healthcare costs
Author: January W. Payne

People with bleeding disorders have long faced high medical bills and challenges in getting and maintaining health insurance coverage. The continued implementation of the Affordable Care Act (ACA) should help alleviate some of these problems, but it may also mean increased out-of-pocket costs for you. Now is the time to think about how best to plan ahead.

“The goal of ACA is that all costs are to remain reasonable and affordable for everyone,” says Marla Feinstein, medical information and policy coordinator at the National Hemophilia Foundation (NHF). Above all, the ACA is meant to provide access to affordable care for all US citizens—a fact that is sometimes misunderstood. “It’s about balancing access and costs,” she says. Still, the costs, in some cases, can be unreasonable. Here’s a primer on how to prepare for changes to your out-of-pocket expenses.

Check out NHF’s personal health insurance toolkit. This comprehensive document on NHF’s Web site can help you determine your current out-of-pocket costs. It offers a stat sheet to record your family’s annual health expenses, a health plan comparison guide, a healthcare term glossary, fact sheets and other consumer resources. “The selection of an appropriate insurance plan can affect the health and finances of both the bleeding disorder patient and his/her family,” the kit states. Created to help people in the community navigate their health insurance options, the document is about 30 pages long and is updated annually. 

Select doctors in-network. Health plans maintain lists of “in-network” and “out-of-­network” doctors and healthcare facilities. Investigate whether your family’s current doctors are in-network, which can make a big difference in the out-of-pocket costs you face when you see a particular doctor. If you or anyone on your policy is seeing doctors who are outside the network, consider switching to an in-network provider might be worthwhile to ease the stress on your wallet.

Get preventive care. Under the ACA, many types of preventive care are required to be covered 100% by health plans, with no copayment. This includes screenings for aneurysms, alcohol abuse, blood pressure, ­depression, type 2 diabetes and ­cholesterol. Well-baby and well-child visits, along with routine ­immunizations, are also covered. However, you may still face some costs for an office visit if the doctor charges for services above and beyond preventive care, according to healthcare.gov, a Web site managed by the US Department of Health & Human Services. That’s why it is important to talk to your doctor at the beginning of the appointment about what your care will entail. Ask which preventive services you need and whether they are included as part of your annual visit.

Investigate your medications. Now is a good time to ask your doctor if any of the medicines you or your family members are taking can be substituted with generic alternatives­. (Note: There is no generic for some newer, specialized medications, such as factor product used by people with bleeding dis­orders.) Also, many health plans offer long-term maintenance medications by mail order, which may save money in the long run.

Find out if your employer offers a flexible spending account (FSA), or flexible spending arrangement. An FSA allows you to put pre-tax dollars—up to $2,500 per year—into an account that can be used only for certain types of medical expenses. These include insurance deductibles and copayments, prescriptions, medical devices or dental services. But FSAs require some advance planning. At the beginning of the year you’ll have to estimate how much you expect to spend on qualified expenses during the upcoming year. NHF’s personal health insurance toolkit can help you with this. Because unused money is forfeited, estimate as accurately as you can. The only exception is if your employer’s FSA plan permits a 2.5-month grace period in the new year, allowing you to use the prior year’s funds during that time period.

If you have kids, put some money into a dependent-care flexible spending account. Like healthcare FSAs, dependent-care accounts allow you to put pre-tax dollars into an account for childcare-related expenses. If your employer offers this type of account, you may be required to pay for your child’s care out of pocket, then be reimbursed from this tax-free account. Married couples filing jointly, unmarried couples and singles can contribute $5,000 annually to dependent-care accounts. Those who are married but filing separately can contribute $2,500 yearly.

All of these options can help you budget for increased costs that may come after full implementation of the ACA. “Out-of-pocket healthcare costs are rising overall,” says Feinstein. Allocating your resources to meet your copays may take planning, she says. “It’s about being a better consumer of your healthcare.”