Managing the Costs of Chronic Care

Unlike acute conditions, a chronic condition lasts a long time—sometimes for life. Examples are diabetes, asthma and heart disease. If you have a chronic condition, it makes sense to ask yourself two questions: What care will you need to stay healthy? And, how much will it cost?

Your first concern should be staying healthy. Ask your doctor what you need to do to help you manage the condition, and follow his or her recommendations.

A second important concern will be how much you’ll have to pay. Every patient is different, but here are a few general guidelines to help you plan.

Follow Healthy Habits

Following your doctor’s treatment plan can keep you healthy, and save you money. For example, many people with chronic conditions need regular medication. Sticking to your doctor’s medication schedule can prevent your condition from worsening. So can keeping regular follow-up appointments with your healthcare providers.

In general, adopt a healthy lifestyle, including exercise, a balanced diet and avoiding smoking. That may help keep you away from the hospital.

Budget Your Costs

Get the most complete picture that you can of your yearly costs. That way, you can build a budget and plan ahead.

You might need doctor visits, tests, medical equipment in your home, or other supplies. Ask your doctor to help you make a list of how many services, tests and medications you’ll need each year. Then, budget how much you’ll pay. If you’re insured, make sure to include costs like:

  • Deductibles. The amount of money you need to pay before your health plan starts to pay for your care.
  • Copays. The fixed cost you pay for a doctor’s visit or test.
  • Coinsurance. The percentage of the cost you’ll pay for a medical service.

If your condition is one of the “episodes of care” on our fairhealthconsumer.org website, you can look up the total estimated yearly cost.

Look for a Health Plan That Covers Your Needs

What health plan is best if you need a lot of medical services and medications? It may not be the one with the lowest premium. Premiums are the regular payments (often monthly) that you make to keep your coverage.

Plans with low premiums often have high deductibles. That means you need to spend a lot of money before your plan starts paying its share of the costs. You may be better off paying a higher premium each month to get a lower deductible.

Consider a Flexible Spending Plan

Suppose you do have a high deductible. Or, you just expect to pay a lot of money out of pocket for your condition. Then, consider a flexible spending plan. These plans allow you to set aside money from your paycheck to pay for healthcare for you and your family. The money is saved before being taxed, so you can stretch your dollars. To decide how much to set aside, use the yearly budget you develop for your condition.

Ask Your Healthcare Providers How to Save Money

Your doctors and other healthcare providers have experience treating your condition. So, they may know ways to save money without putting your health at risk. For example, your doctor may prescribe a cheaper medication, like a generic drug. Or, your pharmacist may help you buy a three-month supply of your medication at once to save money. You may also ask your providers about funding from organizations that focus on your condition.

Stay in Your Plan’s Network

If you have a health plan, try to get your care within your network. A network is the group of doctors, hospitals, labs and other healthcare providers that have contracts with your health plan. Getting in-network care is almost always cheaper than going out of network.

If you do choose to go out of network, use our cost lookup tool. That will let you estimate how much services cost in your area. You can compare the estimate to local providers’ prices and use it to negotiate.