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This product was prepared with support provided through a grant from the
Robert Wood Johnson Foundation’s State Health and Value Strategies program.
Take charge of your
long-term health conditions!
Webinar 4 for Oklahoma employees November 15, 2016
Tips to get the most out of your
health insurance and health care
Diane Webb, MPH, CHES Health Literacy Program Manager
Meet
Laura and Mika
A
B
C
D
E
Finding trusted information about your condition
Understanding what your health insurance plan covers
Keeping costs under control
Finding a doctor you trust
Other – Type in your chat box
Poll: What’s the hardest part of taking care of
a long-term health condition?
“Take care of your body. It’s the only place you will have to live in.”
- Jim Rohn
Agenda
Learn about your long-term health condition
Get the most out of your health care
Understand your health insurance options
Agenda
Learn about your long-term health condition
Get the most out of your health care
Understand your health insurance options
Keep track of your health
Find trustworthy health information
Learn about your long-term health condition
Ask your doctor about your condition
What do I need to do to take care of my health?
Ask your doctor about your
health condition
1
2
3
How do I do it?
Why do I need to do this?
Good questions to ask your doctor:
National Patient Safety Foundation, 2016
To better understand type 2 diabetes, Laura asks:
o What is type 2 diabetes?
• Diabetes is a disease where you have too much sugar in your blood
o How can I take care of my diabetes?
• Check the sugar in your blood
• Take medicine
• Follow the food and exercise plan
Laura asks her doctor about diabetes
To better understand his blood pressure medicine, Mika asks his doctor:
o When should I take this medicine?
• Take 1 pill each morning when you wake up
o What are the side effects?
• Blurred vision
• Confusion
• Urinating (peeing) less often
• Feeling dizzy
• Sweating
o What do I do if the medicine causes problems or doesn’t work?
• Call the doctor’s office if you notice any side effects
Mika’s doctor prescribes medicine
Find trustworthy health information
1
2
3
4
Who wrote the information?
o Look for articles written by credible health experts
When was this written?
o Look for information from the last 5 years
Does the source refer to other credible sources? o Such as National Institutes of Health (NIH), Centers for
Disease Control and Prevention (CDC), or university sources
Where is the information from?
o Look for websites that end in .edu, .gov, and .org
o Look for materials by organizations with good reputations
Ask yourself these questions:
American Diabetes
Association (ADA) www.diabetes.org
Useful information about:
o Diabetes basics
o Living with diabetes
o Food and fitness
o Events and programs in your community
American Heart
Association (AHA) www.heart.org
Useful information about:
o Basics about high blood pressure
o Treatment for high blood pressure
o Healthy living tips
o Support groups
There are many ways to track your health
o On paper, such as a diary or a worksheet from your doctor
o Websites online
o Apps on your mobile phone
Don’t forget to track your family history, too!
Keep track of your health
Create your family health portrait at familyhistory.hhs.gov
Laura uses a worksheet to track:
o Foods she eats at each meal
o Blood sugar levels before and after meals
This helps Laura learn:
o How different foods change her blood sugar levels
o How medicine changes her blood sugar levels
o When her blood sugar levels are too high or too low
Laura tracks her diabetes
Find this record at www.niddk.nih.gov
Glucose Buddy BG Monitor Diabetes BlueLoop
Mika uses a worksheet to track:
o Blood pressure readings
o Where he took the reading
o Date and time of the reading
This helps Mika learn:
o How his readings change during the day and at different places
o How medicine changes his blood pressure
o If he’s meeting the goal he created with his doctor
Mika tracks his high blood pressure
Find this log at www.heart.org
Health
Smart Blood Pressure Tracker (Smart BP)
Tracking your health helps you:
o Share information with your doctor so you can create goals together
o Record and see progress toward your health goals
o Take care of your health condition between doctor visits
o Get organized
Why should I keep track of my
health information?
CDC.gov, 2016; HHS.gov, 2016
Agenda
Learn about your long-term health condition
Get the most out of your health care
Understand your health insurance options
When you have a long-term health condition, it’s important to plan ahead.
Understand your health insurance options
Check that your doctors are in-network
Check that your medicines are on your plan’s formulary
Pick a plan that gives you the most for your money
Take advantage of savings accounts
If you need a lot of health care, you may save money by choosing a plan that costs more out of your paycheck.
Pick a plan that gives you the
most for your money
The more money you pay for your insurance premium, the less you will pay for health care services:
The less money you pay for your insurance premium, the more you will pay for health care services:
Laura picks a plan with a higher premium
HealthChoice HDHP
Premium: $372.60
HealthChoice High
Premium: $571.04 vs.
Take advantage of health savings accounts
IRS.gov, 2016; OPM.gov, 2016
What are health savings accounts? o Accounts that let you set aside pre-tax money
to pay for qualified medical expenses: • Flexible Spending Account (FSA) • Health Savings Account (HSA)
How do I enroll in a health savings account? o During the Option Period, you have the
chance to enroll in one
What can I buy with my FSA or HSA?
IRS.gov, 2016; OPM.gov, 2016
Find a list of what you can buy at www.ebd.ok.gov/flexible-spending
Why should I enroll?
o You pay less money in taxes
o Vision care, such as glasses, contacts, and lasik
o Transportation to medical appointments
o Diagnostic care
What can I buy?
o Over-the-counter medicines with a doctor’s prescription
o Copays, co-insurance, and deductibles
o Prescriptions, such as insulin
Mika picks an HDHP because:
o He’ll pay a lower premium
o He doesn’t have any planned medical expenses besides his routine doctor appointments
o He’ll enroll in an HSA to pay for out-of-pocket costs, such as his medicine
Mika picks the HealthChoice High
Deductible Health Plan (HDHP)
Without an HSA With HSA
Yearly salary $40,000 $40,000
Yearly HSA savings $ 0 $ 1,200
Taxable income
Estimated taxes
Take home pay
Mika saves money with his HSA
Mika’s take home pay was $360 more with an HSA!
$40,000
$12,000
$38,800 ($40,000 – $1,200)
$11,640
$28,000 $28,360
Savings calculator www.ebd.ok.gov/flexible-
spending/Pages/FSA-
Calculator.aspx
Use this to help you:
o Calculate how much money you should save in your account based on your family’s expected health care costs
o See how much money you can save in taxes
EBD.OK.gov, 2016
Check that your doctors are in-network
In-network
$
Out-of-network
You will pay more
$
$
$
$
$
In-network providers Health care providers who contract with your insurance plan to give you health care services at a lower cost.
To find a list of in-network doctors and other health care providers:
o Visit your plan website
o Call your insurance company
o Ask family members or friends
Find providers in your plan’s network
Employees Group
Insurance www.ebd.ok.gov/Benefits/Provid
er-Directory/Pages/Default.asp
Search for in-network providers by your zip code:
o HMO providers
o Hospitals
o Urgent care
HealthChoice Select https://gateway.sib.ok.gov/
providersearch/SelectProgr
am.aspx
Useful information about in-network:
o Providers
o Medical facilities
Search by:
o Provider name
o Specialty
o Zip code
A primary care doctor is a doctor who gives you care for common health problems and preventing illness. They’ll also help you get access to specialists and special care services.
A primary care doctor helps you take care of your long-term condition:
o Schedule regular visits and tests
o Build a relationship with you
o Find health issues early
o Make referrals to other doctors
Find a primary care doctor
True or False?
Mika’s doctor gives a referral
True or False?
The cardiologist orders a heart test at a hospital.
True
Mika’s doctor gives him a referral to see a cardiologist, a heart doctor.
Before Mika sees the cardiologist, Mika needs to make sure the cardiologist is in his plan network.
True Before Mika gets the heart test, Mika needs to check that the hospital facility is in-network.
To find out costs for your medicines, find your plan’s drug formulary online:
o Check if your medicine is on the formulary
Check that your medicines
are on your plan’s formulary
Drug formulary tiers
Tier Drug Copay
Tier 1 Generic $15
Tier 2 Preferred brand $40
Tier 3 Non-preferred brand Pay 100% until deductible is met
o Ask your doctor or pharmacist for a generic version or a different medicine
o Use mail order for long-term medicines if your insurance company allows
o Ask your doctor or pharmacist for samples or coupons
Save money on your medicine
Laura’s doctor prescribed:
o Metformin
o Lantus, a type of insulin
Laura found the list of diabetes medicines on her formulary.
Are her medicines covered?
Laura checks her formulary
Mika saves money on his medicine
Mika’s doctor gave him a prescription for a medicine to treat high blood pressure called Zestril®.
To lower the cost:
o He asks his doctor for a generic version
o He asks his insurance company about mail order
30-day supply at his local pharmacy costs $10
90-day mail order costs $15
1 2
Zestril® costs $484 Lisinopril costs $10
Agenda
Learn about your long-term health condition
Get the most out of your health care
Understand your health insurance options
You are the most important member of your health care team.
Get the most out of your health care
Follow your doctor’s instructions
Make sure you understand your doctor
Be honest with your doctor
Get what you need from your insurance company
Your doctor may have you:
o Fill a prescription and take medicine
o Make another appointment for tests
o Get lab work
o Schedule a follow-up visit and preventive care, such as:
• Tests
• Screenings
• Shots
Follow your doctor’s instructions
Every 3 to 6 months
o See her doctor
o A1c test to see her blood sugar levels over 3 months
o See her dentist
Every day
o Test her blood sugar
o Take her medicine
Once a year
o Wellness checkup
o Eye exam
o Urine (pee) and blood tests to check her kidneys and cholesterol
Laura’s schedule of tests and
checkups for diabetes
o Ask your doctor to explain or re-explain anything you don’t understand
o Take notes during your appointment
o Review your medicines with your doctor
o Repeat back what your doctor says. You can say:
Make sure you understand your doctor
“I think what you are saying is…”
“I just want to make sure I understand…”
“So you’re telling me that I need to…”
Mika’s doctor tells him to follow the DASH diet for his meal plan. Mika is unsure what this means, so he asks his doctor to explain.
Mika’s unsure of his meal plan
Dietary D
S
A
H
Approaches to
Stop
High blood pressure
Find the DASH eating plan at http://www.nhlbi.nih.gov/files/docs/public/heart/hbp_low.pdf
Laura’s doctor changes her medicine to:
o Raise the amount of insulin from 10 to 15 units
o Take insulin when she goes to bed instead of when she wakes up
Laura checks that she understands
Laura wants to repeat back the instructions to make sure she understands.
A
B
C
D
Sounds good!
So you’re telling me that I need to take 15 units at night.
Poll: What can Laura say to repeat back her medicine changes?
I guess that makes sense, I think I get it.
I think you’re saying my blood sugar levels are too high.
Communication is key to building a strong relationship with your doctor.
o Tell your doctor if you: • Smoke and how much
• Don’t always take your medicine when you should
• Drink and how much
• Use herbal remedies or supplements
• Exercise and how much
• Forgot to follow the instructions for a medical test
Be honest with your doctor
Laura has diarrhea after taking metformin. She’s feels embarrassed about telling her doctor and instead decides to take it only with dinner.
At her next doctor visit, her blood sugar levels are higher than they should be. Her doctor reviews her medicines with her. He asks “How do you take metformin?”
What should she do?
Laura’s medicine side effect
A
B
C
D
E
Tell her doctor about her side effect
Tell her doctor she stopped taking it in the morning
Tell her doctor she takes it 2 times a day, as prescribed
Change the subject
Ask her doctor to re-explain how to take her medicine
Poll: What should Laura do?
Mika’s has been struggling to stop smoking and drink less. At his next doctor visit, he fills out a form that asks the number of:
o Cigarettes he smokes a day
o Alcoholic drinks he has a day
Why is it important for Mika to answer honestly?
Mika’s doctor asks about
drinking and smoking
A
B
C
D
Alcohol raises your blood pressure
His doctor may need to change his medicine dose
Why is it important for Mika to answer honestly?
His doctor could suggest a quit smoking program
All of the above
Get what you need from your
insurance company
When you call your insurance company:
o Write down your questions ahead of time
o Have your insurance card and any supporting papers or bills with you
o Take notes about the phone call, including the date and name of the person you talk to
o Afterwards, file the notes with your other insurance papers
Best time to call is before 11:00 am and after 3:00 pm
Laura’s doctor prescribes her an insulin pump. Laura wants to make sure her insurance will cover the cost, but is unsure after reading her plan policy.
She calls her insurance company to ask and finds out: o An insulin pump is durable medical
equipment
o She needs to ask her doctor to send a note that it’s medically necessary
o The name of the in-network supplier to order it from
Laura gets an insulin pump
Tip 1: Learn about your long-term health conditions
o Ask your doctor about your condition
o Find trustworthy health information
o Keep track of your health
Review
Tip 2: Understand your health insurance options
o Pick a plan that gives you the most for your money
o Take advantage of savings accounts
o Check that your doctors are in-network
o Check that your medicines are on your plan’s formulary
Review
Tip 3: Get the most out of your health care
o Follow your doctor’s instructions
o Make sure you understand your doctor
o Be honest with your doctor
o Get what you need from your insurance company
Review
What questions do you have?
Please take our survey!
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This product was prepared with support provided through a grant from the
Robert Wood Johnson Foundation’s State Health and Value Strategies program.
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