As a local health insurance consultant with more than 12 years in the industry, 80 employer clients, and 1000+ lives on the individual and Medicare market, I have seen a dramatic shift in the healthcare space over the last few years. Our local healthcare market and industry are changing. We, as consumers and consultants, need to make some adjustments in order to keep up.
When people buy a TV, they research features, compare prices, and look for reviews. When they buy a car, they negotiate, shop around, and rarely pay the sticker price. Yet when it comes to healthcare—often one of the largest expenses people face—most consumers are expected to agree to the purchase without knowing the price until weeks later.
That is not normal. And it’s one of the biggest reasons healthcare costs continue to rise.
Today, healthcare is no longer passive. It is an active sport, and the people who participate—by asking questions and doing basic research—consistently spend less and get better results.
Healthcare Is the Only Industry That Works Backwards
In almost every other part of the economy, consumers know the price before they buy. Healthcare is the exception. Patients are scheduled for tests, imaging, procedures, and prescriptions without ever being told what they will cost.
That doesn’t mean consumers can’t ask. It means they usually don’t.
Before agreeing to care, individuals should ask:
• What will this cost me?
• Are there lower-cost alternatives?
• Is this urgent, or can it wait?
• Do I have to get the procedure/test done at a certain facility?
Asking these questions isn’t delaying care—it’s practicing smart consumption.
Research Is No Longer Optional
No one would buy a car without doing some homework. Healthcare should be no different.
Tools now exist to help consumers research costs and options, but they only work if people use them. FAIR Health Consumer provides typical pricing data based on real claims. Insurance carrier member portals show deductibles, out-of-pocket limits, networks, and cost estimators.
Prescription drugs are a prime example. Many consumers assume their insurance copay is the best price—often it isn’t.
Smart consumers compare options using GoodRx, Mark Cuban Cost Plus Drug Company, Amazon Pharmacy, and myfreemeds.com, which offers a flat monthly fee for access to a defined list of generic medications.
Access Has Improved, but Strategy Matters
Consumers today have more access points than ever before—but choosing the wrong one can be expensive.
Direct Primary Care (DPC) is one growing option. For a flat monthly fee, patients get direct access to primary care without insurance billing. In Augusta, practices such as Flex Health, Welcome Health, and Direct Health Primary Care offer DPC models focused on access, longer visits, and proactive care.
Not all DPC practices are the same. Services and capabilities vary. Choosing a provider should be based on personal health needs, not just price.
There Is No One-Size-Fits-All Solution
The most successful healthcare consumers use a combination of tools:
• Insurance for catastrophic risk
• Primary care for prevention and coordination
• Telehealth and urgent care for convenience
• Transparent cash-pay options when appropriate
• Prescription pricing tools to manage ongoing costs
Participate—or Pay More
Doctors provide guidance. Insurance processes claims. Consumers pay the bill.
Healthcare should not be the only purchase you make without knowing the price.
The Bottom Line
Healthcare is no longer something that happens to you—it’s something you must actively manage. Consumers who research, compare, and engage spend less and make better decisions. Passive consumers don’t.
Questions? Email tom@thepennantgroup.com
