Before working in the employee benefits industry in Augusta, I was like many employees — I didn’t fully understand how health insurance actually worked.
I remember seeing my monthly payroll deduction for health insurance and then hearing that our rates were going up again the following year. Like many people, I assumed insurance companies were simply raising prices because they could. (Which is not completely wrong.)
At one point, after reaching my maximum out-of-pocket for the year, I remember thinking, “Well, if everything is free now, I might as well get everything done before the end of the plan year.”
In my mind, I thought I was maximizing my benefits and maybe even “sticking it to the big insurance company.”
What I didn’t understand at the time was that the claims generated by me and my coworkers were directly influencing the cost of our company’s health plan.
In the employee benefits world, there’s a simple saying: “So goes your claims, so goes your rates.”
The more claims a group generates, the more likely the plan will experience higher renewal increases. Once I understood that connection, it completely changed how I thought about healthcare utilization.
Tips for Employees to Become Better Healthcare Consumers
Healthcare costs continue to rise for businesses across the country, and employers feel the impact directly through higher insurance premiums and unpredictable renewals. While plan design and carrier negotiations often receive the most attention, one of the biggest factors influencing healthcare costs is something much simpler: how employees actually use their healthcare benefits.
In many organizations, healthcare is treated as a passive benefit. Employees receive an insurance card, but very little guidance on how to use it effectively. The result is often confusion, inefficient utilization, and higher overall costs.
Forward-thinking employers are beginning to recognize an important opportunity: creating a workplace culture where employees are empowered to become smarter healthcare consumers.
When employees understand how the healthcare system works and how to make informed decisions, they can play an active role in managing costs while still receiving high-quality care.
Changing the Culture of Healthcare Consumption
Just like companies promote cultures of safety, productivity, or wellness, healthcare utilization can also become part of the workplace culture.
Employees often want to make cost-conscious decisions, but they need the right tools and information to do so. Employers can support this by helping employees understand the basic principles of navigating healthcare and by making smarter options easier to access.
This shift benefits both the employee and the employer. When healthcare is used efficiently, employees often experience less stress and fewer surprise bills, while companies see more stable healthcare spending over time.
Practical Ways Employees Can Make Smarter Healthcare Decisions
Becoming a better healthcare consumer doesn’t require medical expertise. Often, it simply involves understanding a few key options available within most employer health plans.
Start with telemedicine when appropriate.
For common illnesses, prescription refills, or follow-up questions, telemedicine visits are often faster and significantly less expensive than in-person appointments. Many plans offer virtual visits with little or no copay.
Choose the right level of care.
Emergency rooms provide critical care, but they are also one of the most expensive healthcare settings. Many non-emergency issues can be handled at urgent care clinics or through telehealth at a fraction of the cost.
Stay within the provider network.
Using in-network providers helps employees avoid surprise billing and keeps costs lower for both the employee and the health plan.
Take advantage of preventive care.
Most employer-sponsored health plans cover annual physicals and preventive screenings at 100 percent. Preventive care can detect health concerns early and often prevents more serious — and more expensive — medical issues down the road.
Employers Play an Important Role
While employees can take steps to become smarter healthcare consumers, employers play a critical role in making those decisions easier.
One of the most effective tools is education. Simple benefit education sessions, short guides, or Q&A meetings can dramatically improve employees’ understanding of how to use their coverage.
Many companies are also working with brokers and carriers to create incentives that guide employees toward smarter healthcare choices.
For example, some plans offer zero-cost copays for telemedicine or primary care visits, encouraging employees to seek care early and avoid unnecessary emergency room visits.
Other employers partner with carriers that provide nurse navigators or care coordinators. These professionals help employees identify high-quality, cost-effective providers and simplify the process of comparing options when services like MRIs, complex imaging, or infusion treatments are needed.
Instead of employees feeling overwhelmed by the healthcare system, these resources help guide them through the process and make “shopping around” far more manageable.
A Shared Responsibility
Managing healthcare costs is not solely the responsibility of employers or insurance carriers. It works best when employees are equipped to make informed choices and employers actively support that process.
When companies create a culture that encourages smarter healthcare decisions — supported by education, guidance, and incentives — the results can be significant.
Employees gain confidence navigating their healthcare options, employers experience more predictable healthcare spending, and the entire workforce benefits from a system that is easier to understand and use.
Healthcare may always be complex, but empowering employees to become better healthcare consumers is one of the most practical steps organizations can take toward building a more sustainable benefits strategy.
About the Author
Jamie Gose is an Employee Benefits Consultant with The Pennant Group in Augusta. He works with businesses across the CSRA to design cost-effective employee benefits strategies and help employees better understand how to use their healthcare benefits.
Questions? E-mail jamie@thepennantgroup.com or call 706.723.8429
