039 - Direct Primary Care - What Is It?  What Can It Do For Me? explains a (sort of) new way to receive care from your doctor.

As many doctors move away from so-called networks and health systems to open independent private practice, they have structured their new practices to operate under a subscription model for their patients.

Patients pay a monthly, quarterly or annual fee and in return have complete access to a doctors services, as needed.

The American Academy of Family Physicians describes the model on their website.

038 When It Comes To Health Insurance, Don’t Listen To Your Doctor explains why your health insurance remains valid even though your doctor states that they no longer “take insurance”.

Your health insurance contract has absolutely nothing to do with your doctor or the hospital or the pharmacy.....even though they will explain to you that it is the insurance company at fault for all kinds of issues that affect how and when you can receive treatment.

Scott explains that the contract that the doctor, hospital and pharmacy are constrained by is a Provider Contract or Provider Agreement.  The Provider Agreement may state that it is by and between the doctor/hospital/pharmacy and a named insurance company and its affiliates, but it is completely separate and distinct from the contract you or your employer has that provides your insurance/health plan that pays you as the beneficiary of your policy.

#037 How You Can Control Your Healthcare Costs explains how your premium costs are a direct reflection of the amounts paid to doctors, hospitals and pharma and what you can do to help yourself lower your costs by comparing.

It’s Open Enrollment season.  Confused?

You can only control what you can control.  If you need help, ring me up at [email protected]

Help yourself by checking healthcare prices.  Two great spots to look and keep your doctor and hospital honest:

Surgery Center of Oklahoma

Mark Cuban Cost Plus Drugs

Watch Dr. Keith Smith and Mark Cuban testify before Senate Committee on Aging

Is your HSA set up correctly?  If you don’t know and want to get ready for 2026, keep an eye out for my upcoming workshop.  Check your balances now and what your plan’s maximum out of pocket is for next calendar year.  Don’t miss out on saving the most you can with your HSA!  Workshop coming up in late November and early December.

Follow me on X: @scottwdowling and @doxcost

#036 Power To The Patients - Why You Need To See Prices explains why Hip Hop artists Fat Joe, Rick  Ross, Busta Rhymes, Method Man, French Montana and Chuck D are spot on in the public service announcement demanding price transparency in health care.

Watch the PSA here

#034 Is Your HSA Ready For Next Year explains the steps you need to take now to be prepared for January 1st so that your HSA has you 100% covered for the entire year.

#035 - Why You Need To Tell Your CEO You Want Fountain Health explains why you need to speak up so that you and your family can be healthy and well with the proactive and preventative benefits from Fountain Health compared to what you only have now.

#033 - If you don't know about Fountain Health, you are missing out on the most revolutionary idea to hit health insurance since 1965 and the advent of Medicare.   Scott W. Dowling explains how Fountain Health is better than your traditional plan - saving lives while saving money.  Learn what makes Fountain Health different and how it helps your company, your employees and their loved ones.

#032 - So How's Your HSA Look In The Middle Of The Year helps you to determine if you are short of dollars needed to cover an accident or sickness right now and the rest of the year, how you can fix that now and whether or not you need a new strategy for 2023.

Scott W. Dowling explains the calculation needed to figure out if you are short of HSA funds in the middle of the year.  You may need to contribute to your HSA out of your own pocket now, he explains.

And, if your employer is contributing based on the number of payroll periods during the year, you may wish to rethink your strategy for 2023 so that you are 100% covered next year and every year thereafter.

Maximum Out of Pocket Cost - Current HSA Balance = (Deficit or Surplus)

A Surplus means that you have enough in your HSA to cover the Maximum that you have to pay for any and all health insurance claims you are responsible for in your health plan.

A Deficit means that you will be short of dollars needed to cover the Maximum Out Of Pocket costs that you are responsible for in your health plan.  Further, you'll want to determine how much you will receive from your employer towards your HSA over the remaining pay periods of the year.  If the combined total of Deficit + Remaining Employer Contribution is still less than the maximum you can contribute for the year, then you should contribute that amount immediately, using your personal savings, which can be deducted from your tax return next spring.

HSA Annual Contribution - (Deficit + Remaining Employer Contribution) = Amount You Should Contribute Now From Personal Funds

#031 - HSA - How To Start Your New Year illustrates what you need to do at the start of 2022 to be 100% covered and have peace of mind no matter what health insurance claims you may incur during the year.

#030  - Why Your High Deductible Health Plan Is Not As High As You Think exposes the misperception that an HDHP is too expensive.  Scott W. Dowling provides a real world example - from close to home - that illustrates why there is no advantage to having a traditional low deductible plan and how it ultimately costs you more compared to a High Deductible Health Plan.

Focus on Out Of Pocket Maximum - Not Deductible

The total amount you may spend on an insurance claim includes the amount you pay for the insurance premium plus the total amount you pay Out Of Pocket.  Out of Pocket includes deductibles and coinsurance amounts.  The maximum Out Of Pocket cost is expressly stated in the plan description.  Make certain to locate the maximum Out Of Pocket amount in the plan description when you are comparing your options.  Even plans with $250 or $500 deductibles can have maximum Out Of Pocket amounts over $10,000 and even $15,000 annually.

The Goal:  Pay the least amount of premium AND the least amount in claims

Your goal is to pay the least amount of money while ensuring you are 100% covered.  The money you pay for premium is part of the total you need to consider when comparing your options.  Lower deductible plans cost more in premium than higher deductible plans.  Out Of Pocket costs are capped at a certain amount as stated in the plan design.  The maximum Out Of Pocket states the limit that insurance plan will start to cover all of your remaining annual expenses at 100% - meaning you have nothing further to pay for claims during that annual period.  Know your Out Of Pocket maximum.

A High Deductible Health Plan with a Health Savings Account costs less overall

A High Deductible Health Plan (HDHP) with a Health Savings Account (HSA) costs less in annual premium than a traditional PPO or HMO plan.  Depending on your tax bracket, a traditional PPO or HMO plan can cost 20% to 30% or more for Out Of Pocket costs compared to an HDHP with an HSA.  When you pay your Out Of Pocket costs with your HSA, the money you spend has not been taxed.  When you pay your Out Of Pocket costs for a traditional PPO or HMO plan, the money you spend has already been taxed.  For example, an individual in the second lowest marginal tax bracket, 22%, will spend 28% MORE on Out Of Pocket expenses.  $10,000 paid from your HSA is the same as $12,820 if you have a traditional PPO or HMO.   A PPO or HMO costs a lot more money!

I prefer Lively HSA (full disclosure, I receive a nominal fee from Lively...at no cost to you)

Surprise!  Blowing Through Your Out Of Pocket Maximum On One Claim Is Very Easy To Do

This example may be relatable for many of you who either participate or are parents of those who participate in competitive athletics.  All of the kids in the family have been competitive athletes into college.  Our rugby player had an unfortunate accident that required surgery - on his thumb!  A broken thumb doesn't sound that bad, but after 3 days of visiting a clinic, getting an x-ray, a second opinion and then surgery including 9 screws and a plate, the total claim came in at over $15,000.  And that's at the network discount!  We're easily through the annual Out Of Pocket maximum......for a broken thumb!!!!

Thanks, as always, for listening to Doxcost.  We appreciate you very much!  Please tell your family, friends, coworkers, boss, office manager and/or firm administrator about Doxcost.  Listen wherever you get your podcasts.

www.doxcost.com

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