Health insurance choices that could save you money

Health insurance can feel complicated, and in today’s economy, every opportunity to budget, save and better understand your benefits matters. In this episode of Money Talks, our hosts sit down with Blue Cross and Blue Shield of Texas Account Manager Claire York, who not only understands health insurance but also understands your state health plan. Tune in to learn how your health insurance works, how premiums are determined, ways to make the most of your coverage and Claire’s tips for getting the most value from your benefits.

Helpful links

• Learn how to earn rewards with HealthSelectShoppERS
• Keep these options in mind when deciding where to get care.
• Don't forget, many preventative services are at no cost to you!
• Listen to our previous episode about the TexFlex Flexible Spending Account program
• More about choosing the right care
• Subscribe to ERS' award-winning financial newsletter: Money MattERS 
• Follow us on Instagram @ERSofTexas

Transcript

Copy

Erika Perez: I did want to ask you a juicy question.

Claire York: I love juicy questions.

Erika Perez: What's one piece of healthcare advice you give friends and family most often? 

Claire York: Um, okay. One piece of advice. I mean, I don't know. Can I give my top three?

Erika Perez: Please?

Claire York: Okay. All right. So, number one. 

INTRO

Crystal Olvera: Hi, everyone, and welcome to a new episode of the ERS Money Talks podcast. I'm Crystal.

Erika Perez: And I'm Erika.

Crystal Olvera: And today, we'll break down how your state health insurance works for you. We'll talk about what kind of plan you, as a state employee, are provided and how to make smart decisions that can save you money.

Erika Perez: Lots of great information for you on this episode. We know understanding your health insurance can be daunting, and that's why we invited an expert to help explain the ins and outs of how your health insurance plan works. Today's guest leads sales and account management for government and public sector business at Blue Cross and Blue Shield of Texas.

Crystal Olvera: So whether you're enrolled in the HealthSelect of Texas Plan or the Consumer Directed HealthSelect Plan, you're going to want to listen closely to learn how you can use your benefits to save you money. So, welcome, Claire. Thanks for joining us.

Claire York: Thank you so much for having me. I'm thrilled to be here.

Erika Perez: Claire, can you tell us a little about your role at Blue Cross and Blue Shield and what drew you to the health care benefits industry?

Claire York: Oh, that's a good question. How is anyone drawn to the health care benefits industry? My role, as you mentioned, is running the sales and account management teams for all of our public sector and state-funded business here in the state of Texas. One of the things, truly, that I love the most is to connect and support all the people that serve us day to day as Texans.

So, what I do is essentially work on your benefit plans with all of the teams that are supporting you, processing your claims, answering your calls, and working on our networks to ensure that they're solid and that you're getting the care that you need at the most affordable price that you can. So that's really our goal at Blue Cross and Blue Shield of Texas, and one that I'm deeply committed to supporting.

Erika Perez: In preparation for today's episode, you kind of expressed your passion, and it really comes across. Could you come up with the simplest way to explain how it all works for members' health care—all that?

Claire York: Okay. So, I think health care is extremely confusing, and after 26 years, I think there's always something new and confusing to learn. But one of the things that is at the core of this is that this is our money that we're spending all day, every day. It's our money, and we should pay attention to how we're spending it. It's not free money. My husband gives me a really hard time for some shopping habits that I may or may not have developed over the years.

Erika Perez: What do they call it—"girl math?"

Claire York: Girl math. I like to call it "shopping math." I know there's a few guys out there with shopping math problems, but, you know, we always see things that we want to get. And then, amazingly, after you've talked about it, right, you get notified on your phone that something has gone on sale or that, if you register, you can get 10% off. And in our minds, we're like, "Oh my gosh, it's 10%, 20%, 30% off. We should go buy it immediately."

So if it's $100 and it's 20% off, then you're only paying $80, and you get, you know, you have $20 you can spend on something else. But in reality, you haven't made any money. You've actually just spent $100 that maybe you should or shouldn't have spent. And I think that's a lot how health care works. Because ultimately, what happens is, through your benefit plan, you're getting about 85% to 90% of the cost paid for. So you're only really paying the 10% when you go in through your copays and your coinsurance, and even with your premiums included. And you tend to forget that it's actually your money and that the cost really isn't $20. The cost could be $2,000. And that other giant portion, that other $1,980, is actually being paid for by someone else. And in the case of ERS, it's being paid for by the State of Texas.

Erika Perez: I certainly hadn't thought of it that way. Which leads me into the next question. When people think about health care costs, what do they often misunderstand?

Claire York: That portion that's being paid by your health plan. And in the case of ERS, it is truly the state's money. You pay a premium every month, which we can talk about more, kind of how that's made up. If you pay some copays and coinsurance when you get services, but the big chunk of your health care dollars are being paid for by the state. And you get confused because it says Blue Cross and Blue Shield on your card. But behind that, while Blue Cross and Blue Shield is helping you find the right providers, use providers that are in the network, propping up those benefits, you know, processing your claims, taking your calls, it ultimately, when it comes down to the financial responsibility for that claim, it's your employer's responsibility, and they're the ones paying it. And they're paying it through money that they contribute to you, as well as the premiums you contribute to the plan.

Crystal Olvera: Claire, you mentioned premium. I'd like for you to maybe talk a little bit about what that means for someone, you know, getting their benefits from ERS because it doesn't quite work the same. And also, just maybe elaborate on some of the jargon that we use, some of the lingo, because health insurance can get really complicated, especially if you don't know the terms that are being used in your benefits enrollment statement and things like that, or your guides.

Claire York: Yeah, I'll do my best to make it make sense because it's health care. But health care, insurance, and insurance in general isn't a concept we don't understand, right? All of us have car insurance. We all, and many of us, have renters or homeowners insurance. You know, we are paying insurance premiums, which is a dollar amount you pay every month or twice a year to have coverage in an event, right? And that's really what health insurance is. You're paying, or your group is paying—and I'll touch on ERS—every month for you to cover you in the case of an event, right? And in health care, it's a health care event.

So there's a premium. That's your monthly charge. I also know that, as part of that, I have a deductible. So, in the event of an incident or that I need health care, if I have a deductible, that's... I have to pay that first before I get support from my insurance. So the same thing happens if you get in a car wreck. You pay your deductible before you can get your car fixed. And then, after that happens, you have to pay either a percentage or, essentially, a copay to get that coverage. So, to receive that medical service, you're either paying a copay or coinsurance, depending on what it is.

In the case of ERS, though, you guys are very, very fortunate. You have an amazing plan. From a premium perspective, employees aren't paying a premium at all. Right? The state is actually paying your monthly premium for you. And they're paying 50% of that premium for your dependents. And that's pretty exciting as well. Yeah.

Erika Perez: Just a personal anecdote. I got my personal benefits statement. Yeah. And yes, I saw how much is covered, that ERS is covering me for, and how much is coming out of my pocket. And I got $0. And so I'm looking at my boyfriend like, "You see that? You see that right there?"

Claire York: And if he's a keeper, then, you know, the further enticement—and, dare I say, some shopping math—for you to use if you're interested.

Crystal Olvera: ERS pays 50%.

Claire York: ERS pays 50%. So, you know, I can't wait for us to catch up in a few months.

Crystal Olvera: I know, guys, I'm single.

Claire York: But I have an amazing health plan.

Crystal Olvera: Yeah, an amazing plan, and that's what I bring to the table.

Erika Perez: Claire, I've noticed that, especially in today's economy, people tend to be savvy shoppers in most parts of their lives, but not when it comes to health care. Why do you think that is?

Claire York: Oh my gosh, I have so many theories. I don't know if any of you out there listening have a husband like mine who legitimately will read every review for a $10 Amazon item before he purchases it, even though he can just return it if he doesn't like it. But he'll always ask me, "Did I check the score? Did I check the reviews?" You know, I don't know why we don't do that when it comes to one of the most important things in our life, which is our health.

And I have some theories. I think, first, it's complicated. Second, I think most of us, and hopefully now you have a little bit of a better flavor, don't understand that it's your money. Whether you're paying that full, you know, $1,000 for a service or you're only paying a $20 copay, it's still your money at the end of the day. And it's really difficult to see as a consumer because you're not seeing that dollar amount go out of your pocket. But it's going to come out of your pocket maybe next year or later in this year. And so I would say that's probably the biggest thing.

Erika Perez: So what are some of the easiest ways people can lower their health care costs?

Claire York: Well, you guys have HealthSelectShoppERS. So that's, of course, one of the easiest ways that you can help lower your costs. But really, I would say, first and foremost, understanding your benefit plan before you need it. Right? So read your booklet. I know it's confusing sometimes. Call. Ask a friend. But read your booklet, understand your benefits, and then, based on your benefits, that's how you start making some smart choices.

So I think easy ways is shopping. There are services that we all get, particularly once you, you know, crest over that 40-year mark. You've got to do some things that maybe you hadn't been doing. And those types of preventive services are very common. There's a lot of different places to get them. And depending on where you go, it will cost you less money and, ultimately, ERS less money, which will mean next year, when your premiums get set, hopefully they'll be lower if everyone is making a good choice.

Erika Perez: Thank you. Yeah. So why can the price of the same health care service vary so dramatically? And when should you compare prices?

Claire York: Well, so a lot of it has to do with location. I feel like a real estate agent sometimes. Location. Location. Location.

A lot of it has to do with that. So if you're looking to get your standard annual preventive mammogram, if you go to a hospital to get that service, you're going to, by and large, pay more. And the reason you're going to pay more is there's, you know, more stuff happening in that space. Is more stuff happening to you or in the scope of that mammogram? Not necessarily. But there's, you know, other stuff. So, in general, it costs more. And we see that pretty pervasive throughout the entire industry across the United States, especially here in Texas.

But there's a lot of freestanding places that you can go that might be right next to your favorite coffee shop to get that preventive mammogram. That could be half or a third of the price of getting it in a hospital. And so not only then do you pay less—well, in the case of preventive, you're not paying at all—but you're not paying it all in the moment. That's the thing to remember, right? There's still a... Just because it's zero for a preventive mammogram—zero? What do you mean it's free?

What it means is that, in that moment, you're not paying anything. But you did pay your premium this month, so you did pay something. And the provider will still bill the insurance company. They will still bill us. We'll still process that claim, and ERS will still pay for that service. You're just not paying out of pocket for that service in the moment.

So then next year, if every year you get the Ritz-Carlton of services, then you're going to pay the Ritz-Carlton of premiums, right, every year. And that's something that I think it's really important that we think about.

I, you know, personally have a great place that I go. They're open on Saturdays, so I don't miss any work. My favorite coffee shop is right next door, and I'm in and out very quickly. I'm not having to deal with hospital parking or anything like that. But really, paying attention to where you're getting services is one of the most important things you can do to save money.

But the best way that you at ERS can find the most affordable health care for things like MRIs, mammograms, any type of imaging, labs, those sorts of things, is to use your HealthSelectShoppERS. Not only can you find a better price, but you also can get rewards for doing that.

Crystal Olvera: And for those of you who don't know about the HealthSelectShoppERS program, it's a fairly new program, and we encourage everyone to enroll because, based on where you go, you can earn rewards. And you earn them in the form of an FSA, which is a flexible spending account with TexFlex. When you earn those rewards, you can actually earn up to $500. You can use that money to pay for eligible medical expenses. Not only does it help with the cost of the procedure, but also by earning you those rewards that you can probably use to buy, you know, prescription drugs or whatever.

Claire York: Any of your... You can use it for your copays. You can use it for prescription drugs. I think you can even use your FSA for over-the-counter ibuprofen and Advil, right? I mean, yeah. So there are a lot of ways to use it, right?

Crystal Olvera: Feminine products. Pimple patches. We've talked about it.

Claire York: If you're ever in the drugstore checking out and you're paying attention as they're ringing it up, it'll pop up if things are FSA eligible. And I really love that feature now, you know, that the drugstores have. So I think... Tissues. I mean, things that you wouldn't even imagine. ChapStick.

Crystal Olvera: Oh yeah. I know.

Claire York: It goes on and on.

Erika Perez: It does. It really does. And, listener, we have a whole episode on some of these fun things, so we'll leave that in the show notes if you're interested in revisiting that one.

Crystal Olvera: All right. So we talked about how it really does matter where you go for health care. I think a lot of people make mistakes when they are seeking emergency care. Can you talk a little bit about when you should choose one or the other?

Claire York: Yeah. I mean, we're convenience culture. I mean, one of the reasons everyone loves Amazon is because you might get your item later today, right? Immediate gratification. Convenience culture.

You can still have that in health care and be planful. And that starts with really thinking about, "Where should I go?" Now, I'm not suggesting that you can be perfect. I am not suggesting that when your newborn has a fever and is crying in the middle of the night that you should make the absolute most perfect choice, because we're all going to make the choice that makes us feel most comfortable in those really scary moments.

But being planful in advance. So there are things like a respiratory infection, a UTI, you know, a migraine headache, that you can use your PCP that you have a relationship with. You can do virtual visits. You can even use online telemedicine choices. So you guys have Doctor On Demand and MDLIVE. Be a little bit planful. Go ahead and register now. Don't wait to have to register in that moment. You can get on a call with a physician almost immediately. You don't have to go sit in an urgent care and, you know, put on a mask and hope you were the first one there and all those types of things.

Now, if you're in a position where you've had an injury, or maybe you have a severe headache, or you've been sick for many days and you haven't been able to eat or drink, you know, that's when it might be an appropriate time to consider something more, and what I would say maybe be a higher level of care, like an urgent care facility.

I highly recommend that you stay out of an ER unless it's 100% an emergent situation that, you know, you think needs significant intervention. And in those situations, you know, find your way to a hospital ER and not to one of these amazing facilities that advertises themselves as an ER.

Crystal Olvera: Those freestanding emergency rooms.

Claire York: And the reason for that is your goal is to get the most appropriate care for you, right, at the right setting. I mean, I personally have a life goal of trying to stay out of the hospital as much as possible. And so I think that's where, you know, managing your health, looking up front at what's the right thing to do. But certainly utilize your PCP. Utilize virtual care. Step up to urgent care when it's really necessary, when it's the weekend and you can't get in touch with your PCP and you can't get your fever down. You know, those types of things are something that... And everyone, again, you know, I'm not a physician. Everyone needs to make the best choice for them in the moment.

But being planful in advance and kind of knowing where to go for particular things. And, you know, if you're using Blue Access for Members or any other tools, you can look online and see, "Where's the closest urgent care?" Right? Urgent care is cheaper than the ER. A lot of times they get you in and out quicker. It's less costly for you. It's less costly for your plan. So know where they are. Know their hours of operation. These are the types of things you do in advance.

I mean, we all know if we search through enough products on Amazon, we might find the one that's delivered by tomorrow morning or later today. It's the same kind of thing with health care. Find the places around you that are open and, of course, always utilize your relationship with your PCP.

Erika Perez: I did want to ask you a juicy question.

Claire York: I love juicy questions.

Erika Perez: What's one piece of advice you give friends and family most often? 

Claire York: Um, okay. One piece of advice. I mean, I don't know. Can I give my top three?

Erika Perez: Please?

Claire York: Okay. All right. So, number one, read your benefit plan. Number two, as one of my favorite high school teachers said, "The only dumb question is the one unasked." And ask questions. Don't be afraid to ask questions of your employer, of your physician. Most importantly, they're human, just like us. So ask them questions. Use the chat function on our portal for Blue Cross, or call if you prefer that method. Ask questions about your benefit plan. Understand how it works. And then the third piece of advice is get a relationship with a PCP. See them annually. Make sure you have that relationship. It's one of the most important ones you'll develop outside of your family.

Erika Perez: Ooh, that PCP one actually does come as a surprise to me. I've been very... Well, you know, I'm just part of a group of folks that think I'm just so healthy and untouchable. 

Claire York: Well, I love my PCP. She's fantastic, and I've had such great experience with her. I get my annual physical. I know everyone says, "Oh, it takes months to get your annual physical." Well, just know that in advance because they plan to have more time with you. So don't call when you need it the next day. Call two months out and make your appointment. Block your work calendar, your home calendar, whatever you need to do.

I mean, my PCP was able to give me a lot of... I'm aging a little bit at this point, and I've got a few creaks and cracks. I think it's really important that she is able to help advise me and give me kind of alternate opinions about things, what I should do, things I can consider. And I can spend that time asking her all those questions about things that maybe I don't understand. Right? 

Erika Perez: Yeah. Thank you for sharing that with us.

Crystal Olvera: That's great advice. Thank you so much for joining us, Claire. We're so happy to have you as an expert today. If you are a State of Texas employee and you aren't subscribed to our monthly newsletter, Money Matters, what are you waiting for? We'll put the details on how to subscribe in the show notes. If you have an idea for a podcast topic, please email us at storyideas@ers.texas.gov or leave a comment on our Facebook page or Instagram page.

Erika Perez: That's right. We officially launched Instagram last month, which—I know what you're thinking. "What do you mean you just launched it?" The answer is yes. We are here. We're in the future. Um, and that handle is @ersoftexas. So make sure you follow us. You'll get more information there. And also, actually, feel free to send us your ideas through a direct message on there as well.

All right. We'd love to hear your thoughts on Money Talks.

Claire York: Thanks for having me.

Erika Perez: Thank you.

Disclaimer: This information is for informational purposes only and is not intended to provide investment, legal, or tax recommendations or advice.