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Being a savvy Idaho health care consumer: A how-to guide

Chuck Weir, 72, flips through a thick manila folder of Medicare paperwork he has collected over the past seven years. Weir signed up for a Medigap plan at age 65. It was the wrong choice, he says. When his premiums spiked, he started evaluating options and eventually became so enthusiastic that he opened a Medicare-centric brokerage from his home.
Chuck Weir, 72, flips through a thick manila folder of Medicare paperwork he has collected over the past seven years. Weir signed up for a Medigap plan at age 65. It was the wrong choice, he says. When his premiums spiked, he started evaluating options and eventually became so enthusiastic that he opened a Medicare-centric brokerage from his home. kjones@idahostatesman.com

[Editor’s note: This story has been edited to correct the name of Medicare Plan F.]

Chuck Weir was turning 65, a birthday that came with big decisions: Should he enroll in Medicare Advantage, Medigap, Medicare Part D, Medicare Plan F?

Weir wasn’t an expert in health insurance. He spent his adult life working in software for Boise companies. But he did a bit of research and signed up for a Medigap plan through Mutual of Omaha. The next year, his Medigap premiums went up about 50 percent.

“Sweet little surprise, isn’t it?” he said.

That experience made Weir, now 72, so passionate about informed decisions when it comes to senior health insurance that he opened a small insurance brokerage, specializing in Medicare. He spends several hours with each client, explaining the nuances of Medicare and its alphabet soup of options.

The Boise resident is one of several Idahoans who told the Statesman they have found ways to be adept value shoppers in an increasingly complex health care marketplace.

Dennis Buck, a 61-year-old project management consultant, has basic health coverage through the Veterans Administration. But he still has to pay a copay for prescriptions. Buck moved from Southern California to Eagle about two years ago and learned he could shop around.

“The VA hadn’t mentioned that you could get prescriptions outside the VA, but the doctor up here did,” he said.

And shop around he did. Buck looked at the prices, including membership discounts, at Albertsons, Rite-Aid, Shopko, Walgreens, Fred Meyer, Costco, Kmart, Target and Wal-mart.

Fred Meyer came out on top, with no membership requirement and a $7.50 to $10 price for 90 days of medication. Those prices stayed pretty steady — at least, for the past two years. Buck got a case of “sticker shock” last week when he picked up two prescriptions from Fred Meyer. The price for a 90-day supply of the blood-pressure drug Benazepril had gone from $10 to more than $22.

“So I began shopping again when I got home,” he said. “I found the website Good Rx (goodrx.com) to be helpful. Good Rx also has a mobile app. You enter in your location and the drug, select generic or brand, dosage and quantity.”

Here are more tips from Buck, Weir and other shrewd consumers, some tools offered by health insurers and the health care industry, and some basic guidelines on saving money on health care:

IT’S A GAMBLE

When your car needs a new fuel pump, and you don’t have a regular mechanic, you might call a few shops to get price quotes.

When you need a new knee, it’s not that easy.

Many hospitals and physicians’ offices are reluctant to quote a price, partly because insurance plans vary in how much of the cost they’ll cover and what types of services they’ll cover.

Medicare, unlike private insurance, pays only a set amount — what it has determined is a reasonable price. That can make it easier for a Medicare patient to get a ballpark estimate of his out-of-pocket responsibility. Hospital charges vary widely, so it still makes sense to shop around, and ask what the hospital charges for a procedure. (If your coinsurance is 20 percent, multiply the hospital’s charge by 20 percent.)

But the insurance plan you have isn’t the only variable. When you’re under the knife or in recovery, complications or other surprises can drive up your costs significantly.

Even the price of a routine annual visit to your doctor can go from $80 to $130, depending on which code the doctor’s office submits to the health insurance company. There are different codes for new patients versus existing patients; 20-minute checkups versus 40-minute evaluations; and the well-woman visits that insurers are legally required to cover 100 percent, versus the annual checkups that insurers don’t have to cover.

Savvy consumers should check for improper coding and other mistakes on their Explanation of Benefit (often called an EOB) document. That key document usually is either mailed to you or uploaded to your account on your health insurer’s website. It tells you what the health care provider submitted to your insurance company, and it tells you whether the insurer covered it, at what price, and gives you important details such as the reason a claim was denied.

If you spot an error on your EOB, you can ask your doctor’s office to fix the problem, file an appeal with your insurance company or even file a complaint to the Idaho Department of Insurance.

USE YOUR HEALTH INSURER

When you buy a generic drug from the cheapest pharmacy, or you get an MRI in an outpatient imaging center instead of in a hospital-owned facility, it doesn’t just save you money. It saves your health insurance company money.

That’s partly why insurers are now pushing tools that give consumers more control over their out-of-pocket costs. As more Idahoans move to high-deductible plans, they’re using the tools to shop around.

Blue Cross of Idaho built a Cost Advisor website to help its members compare costs for 400 common medical services, from a basic office visit or physical therapy session to a vasectomy or a C-section delivery. The company plans to expand the menu this fall to 1,600 services. Other insurers such as Aetna and Regence BlueShield offer their own tools.

Keep in mind ... ▪  Be skeptical of deals: Coupons or discount cards may actually drive up costs. ▪  High-deductible plan? Use your HSA. ▪  Ask about options. Physical therapy is cheaper than back surgery. ▪  Instead of an office visit, try email, phone or video conference. ▪  Being as healthy as possible is the ultimate money-saving strategy. ▪  Ask for generic instead of brand-name prescriptions.

The website launched in late November 2014, and members use it about 1,200 to 1,500 times a month to compare costs in Idaho.

“We understand that costs continue to rise for our members, and one way they can actively participate in managing health care costs is to understand where health care dollars go and have some consumerism involved,” said Maurine Collins, marketing manager for Blue Cross of Idaho.

In May, the tool found potential savings of $241 per member, across the range of services they searched for, Collins said.

While the website calculates copays and out-of-pocket costs based on the customer’s health plan, it relies on year-old claims data for its dollar amounts.

So, like other health care cost tools available, it’s more anecdotal than encyclopedic.

WHAT ABOUT VALUE?

The holy grail of bargain shopping in health care is the nexus of cost, quality and patient satisfaction.

The Affordable Care Act, or Obamacare, made changes that force the industry to strive for that nexus. Hospitals can now lose money from Medicare if too many of their patients develop infections, for example.

Organizations and websites have popped up over the years, hoping to satisfy or capitalize on patients’ desires to find the best-of-the-best surgeon or avoid that bad-apple clinic. Some of those organizations give out ratings and awards but charge hospitals to market them. The Leapfrog Group charges up to $16,000 for permission to advertise those honors, while Healthgrades has been reported to charge a great deal more than that.

And ratings can be skewed if they aren’t put in context.

For example, patients are more likely to die at a hospital that is a trauma center, such as Saint Alphonsus Regional Medical Center, because more patients are on the verge of death when they come through the hospital’s doors. One St. Luke’s hospital may end up with older or sicker patients than another St. Luke’s hospital. And individual reviews from patients? They are subjective.

Look into quality and safety: Hospital Compare website Nursing Home Compare website Home Health Compare website Dialysis Facility Compare website ProPublica Surgeon Scorecard ProPublica Nursing Home Inspect The Joint Commission Quality Check

Health insurers like Blue Cross of Idaho and Select Health are hoping to offer quality and patient satisfaction ratings in their apps or websites. But both insurers said the tools remain in development phase.

Utah-based Select Health has launched a “customer experience” comparison tool in Utah. It uses a five-star rating system, based on how patients answer 10 questions, such as, “Did you wait longer than 15 minutes?” or “Were you able to get an appointment when you needed it?” But it isn’t coming to Idaho yet.

“It’s very, very expensive,” said Christopher Stalling, who oversees e-business and marketing operations.

The insurer also is piloting a program in which it sends out a report to consumers, pointing out how they use health care and how they could save money — going to an urgent-care clinic instead of the emergency room, for example.

Audrey Dutton: 208-377-6448, @IDS_Audrey

Tell us your experiences

Do you have tips to share? Lessons learned through trial and error? Share your wisdom or warnings on this story at IdahoStatesman.com or at our Facebook page — facebook.com/idahostatesman.

Prices, quality are secret in Idaho

In Idaho, there is very little transparency in health care, which makes hitting that value nexus more difficult.

Unlike states such as Oregon and Colorado, Idaho does not make hospital discharge data or health care provider claims data available to the public. Legislators in Idaho have proposed creating databases, but those efforts have been fruitless so far, and Idaho providers have not voluntarily given their data to the public.

It also does not participate in the Healthcare Cost and Utilization Project, a federal-state-industry project that is sponsored by the federal Agency for Healthcare Research and Quality. The project is the “largest collection” of such data, it says, with databases going back to 1988. Alabama and Delaware are the only other states that do not participate.

One set of quality screening tools that is available to Idahoans is the Hospital Compare website from the federal Centers for Medicare and Medicaid Services and its sister websites for nursing homes, home-health agencies, dialysis facilities and others.

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