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ARTICLE Health Plan Costs

Health Plan Costs/Utilization

Making healthy choices and knowing how employers and insurance companies are dealing with rising health plan costs can help you manage your expenses.

What you can do to help control costs

A simple way to help control your health care costs is to focus on staying healthy. The healthier you are, the less time you'll spend visiting the doctor or taking sick days at work. Reduce your need for medical services and you'll spend less money on health care over time.

Examples of lifestyle choices that can help you save on medical costs include:

  • Getting preventive care, including screenings recommended by age
  • Not smoking
  • Drinking in moderation
  • Managing your stress
  • Eating a healthy diet and exercising

Find tools for managing your health and wellness online at and complete a Family Health History Tree to determine your risk factors for certain diseases that may be common in your family and prevalent the African American community.

Other methods to consider in controlling costs include:

  • Visit your Primary Care Provider (PCP) for regular check-ups and screenings
  • Contact a nurse at the NurseLineSM or chat with them live. To get there, visit: >> Live Nurse Chat
  • Consider using an Urgent Care Center, instead of the Emergency Room, for non-life threatening and less critical conditions
  • Planning ahead for medical expenses. Log in to and click "Estimate Health Care Costs" to calculate what you'll need for a medical procedure in your future.
  • Reduce prescription drug costs. Talk with your doctor about generic drugs and explore ways to save on your prescriptions – mail-order options are generally less expensive than walk-in pharmacies.
  • Take advantage of cost-saving opportunities. Look into discounts or incentives from your health plan or employer for things like gym memberships, weight loss programs, vision care and smoking cessation.

How employers are responding to rising costs

As health care costs continue to rise, employers are finding ways to manage them while still offering employees health insurance benefits. Some of these changes include:

  • Increasing employee contributions to health care premiums
  • Raising copayments and deductibles
  • Switching to health care plans with lower rates
  • Offering a high-deductible health plan option with health savings accounts (HSA)
  • Purchasing health care jointly with other businesses
  • Reducing the amount of coverage offered

In some cases, employers may choose not to offer coverage if insurance costs get too high.

How insurance companies help control costs

One way insurance companies help control costs is by working with hospitals and other providers to create plan networks. By negotiating lower-cost contracts with these provider networks, they can pass on cost savings to you. That's why if you're enrolled in a plan with a network, you'll save money by visiting in-network providers.

Some other ways health plans contain costs include:

  • Same day surgery admission. Health plans may require that surgery patients go to the hospital the day of the procedure instead of the night before, cutting one whole day of hospitalization fees.
  • Outpatient surgery. If a procedure or surgery does not require overnight recovery, your insurance company may require you to have it on an outpatient (non-hospitalized) basis.
  • Prior consent and limitations. Insurance companies may require that you get their permission before they will cover certain treatment or procedures. In addition, some plans may deny hospitalization or charges for a medical procedure if they find it exceeds normal costs or is an unnecessary treatment.
  • Specialized care programs. These services are designed to help you and your family handle specific conditions like cancer, obesity, heart health and pregnancy. Specialized care programs can provide you with information on treatment options.
  • Health and wellness education and services. Check your plan's member website for resources, tools and interactive activities designed to help you stay healthy. In addition, your plan may offer discounts on wellness products and services like fitness club memberships and laser vision correction. Stretch your health care dollars by taking advantage of these resources and programs.