Lower your out-of-pocket healthcare costs

You can take several steps to lower the amount of money you pay out of your pocket for healthcare.

Updated: September 1, 2021

Work with your PCP

Work with your Primary Care Provider (PCP) to navigate the healthcare system and coordinate your care. Remember to obtain referrals to specialty care if you’re in a plan that requires referrals, such as:

  • Fallon Health Direct and Select
  • Harvard Pilgrim Independence and Primary Choice
  • Neighborhood Health Plan
  • Tufts Health Plan Navigator

Look for Tier 1 and 2 specialists

If you get care from Tier 1 and Tier 2 specialists, you pay the lowest copay for the highest performing doctors.

  • Tier 1 specialists have excellent quality and cost-efficiency scores.
  • Tier 2 have good scores.
  • Tier 3 have standard scores.

Contact your health plan or visit their website to find specialist tier designations.

Use Tier 1 hospitals for planned hospital admissions

Use Tier 1 hospitals for planned hospital admissions. Some of the GIC’s health plans tier hospitals based on their quality and/or cost. If you have a planned admission, talk with your doctor about whether Tier 1 hospitals in your plan are good choices for you.

Bring your plan’s prescription drug formulary to doctor visits

Bring your plan’s prescription drug formulary with you to doctor visits so you can discuss which tier your prescriptions fall under and see whether there are lower cost alternatives. Abbreviated drug formularies that show you alternatives to Tier 3 copay drugs and drugs subject to prior authorization or step therapy are posted on the GIC section of your plan’s website.

If you're a member of the UniCare State Indemnity Plans, remember that more drugs will be subject to prior authorization as of July 1, so be sure to print the new formulary and bring it to any doctor visits. You can also request that CVS/caremark mail it to you.

Use urgent care facilities and retail clinics

Consider using urgent care facilities and retail clinics for urgent (non-emergency) care. With a retail clinic - also called convenience or limited service medical clinics - you only pay the PCP office visit copay instead of the $100 emergency room copay.

Depending on your plan, you’ll pay as little as the PCP office visit copay up to the specialist copay for most urgent care facility visits. Some hospital-owned urgent care facilities have higher copays.

Search for urgent care and retail clinics on your plan’s website so you know where they are when you need them. Your plan handbook lists urgent care copays.

Compare health plan costs

Your health plan has a cost comparison tool that can help you shop for health care services in advance. Plan websites such as Unicare and Allways Health Partners let you search by area and service, and lower cost options are highlighted. Fallon Health will even send you a check if you use their website and visit a cost-effective facility or provider.

Consider enrolling in a Flexible Spending Account (FSA)

By enrolling in an FSA, you can save $300, on average, in state and federal taxes for every $1,000 you contribute to a FSA.

Open enrollment for state employees will take place April 4 – May 2, 2018 for benefits effective July 1, 2018. Most municipalities also offer FSA benefits.

Retirees are not eligible for FSA benefits.

Practice healthy lifestyle habits

The best way to reduce your health care costs is to take care of yourself by adopting healthy habits such as:

  • Eating healthy
  • Exercising regularly
  • Quitting smoking
  • Finding better ways to manage stress

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