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Spring is in full swing!
 
Some welcome the season with open arms - Hooray for longer days, butterflies, and cute baby ducks - while others greet the change with less enthusiasm (think allergy sufferers).
 
No matter your perspective, we can all agree that this time of year embodies 3 things: growth, renewal, and rebirth. When we think about it in this way, we can’t help but embrace the optimism and hope this brings.
 
With the transition to warmer weather, we soon find ourselves shifting our focus away from marveling at nature’s beauty towards the reality summer is just weeks away and our swimsuit body is still in sleep mode. The aesthetics of achieving our ideal weight and fitness is not all bad - who doesn’t want to be ‘summertime fine.’ But it is fair to challenge our thinking to get to the core of the matter: healthful living.
 
The art of living healthfully is centered around establishing the deliberate habit of practicing wellness. According to SAMHSA (Substance Abuse and Mental Health Services Administration) wellness is “not the absence of illness or stress”, but it is “being in good physical and mental health”[1].
 
A key factor as we strive to achieve optimal wellness is our access to health care. This concept is also an integral part of the framework that guides the mission and goals of Healthy people 2020, the United States strategy to achieve optimal health for all Americans. According to Healthy People, “access to comprehensive, quality health care services is important for promoting and maintaining health, preventing and managing disease, reducing unnecessary disability and premature death, and achieving health equity for all[2].”  

Access to health care “impacts one's overall physical, social, and mental health status and quality of life and can be broken down into three main components: health insurance coverage, timeliness that care is received, and consistent and reliable delivery of health services[2].
 
In an ideal world everyone would get the high-quality care they need in a timely manner regardless of insurance coverage status, but the reality we face is a far from perfect health system. 

Many people face difficulties in navigating health care access. The reasons for this varies but impact is felt the same across socioeconomic groups. Regardless of race, education level, or sexual orientation we all may at some point face difficulty in getting needed health care. Barriers to accessing healthcare, (literal and perceived), are real and can be very frustrating if you don’t have a plan of action. So, what do you do when you encounter a health care barrier?  Great question! 
Today we are going to provide you with a few useful healthcare hacks so you can overcome barriers to health care. We will address options to access primary care, women’s health services, mental health, dental, vision, and prescription services.
Before we go any further, allow me to introduce myself. I am Danita King and hold my Master of Public Health and have worked within health benefits for one of the nation’s largest workplace benefits administrators for the past four years. I also act as program coordinator for an HIV Awareness program which serves my entire county. I have roughly 10 years of professional experience in the health benefits field and on a personal level, have navigated health choices for my own family for the past 16 years.

Believe me when I tell you, I have seen it all from people who are insured and face sudden layoff, to divorcees and survivors of deceased family members that lose benefits eligibility and those who are insured but the cost is so significant they must choose between paying for health coverage or groceries. The one thing they all have in common is the need to understand how to get access to basic care needs.

Fact is most insured individuals have access to health benefits due to private employer sponsored group coverage while those who lack insurance historically have worse access to care than those with private coverage[3]. Kaiser Family Foundation reports, “One in five uninsured adults in 2016 went without needed medical care due to cost[3]."
  
In recent years due to the passage of the Affordable Care Act not only have we witnessed the creation of avenues where people who at one point were considered ineligible for health insurance now have options to choose from, but it has set minimum health insurance requirements. I’ll spare you all the details but in short, this means the insurance carriers must now cover 10 essential services by at least 60% and some at 100% (think annual physical)[4].

What that means my good people is if you are offered health coverage through your employer even if you get the least expensive plan, it is worth considering enrollment as it must abide by these minimum coverage rules as well. Can we say winning? What are the 10 essential services all health insurance must cover[5]?
  • Preventive & wellness services and chronic disease management
  • Prescription drugs
  • Pregnancy, maternity, and newborn care
  • Emergency services
  • Ambulatory patient services
  • Laboratory services
  • Pediatric services, including oral and vision care
  • Hospitalization
  • Rehabilitative and habilitative services and devices
  • Mental health and substance use disorder services

Now let’s get down to the nitty gritty with these long-awaited healthcare hacks!

Hack #1: Find a Primary Care Physician (PCP) You Trust  
Why is this important? It’s about way more than just the ease to get a prescription filled when you run out, a PCP is familiar with your health needs—they know what questions to ask and can better help you manage a chronic disease as compared to having a new person each time you go.

As a rule of thumb, “seek primary care for non-emergent needs, including check ups, screenings, care for common illnesses and immunizations. Primary care should always be your first stop if possible — but not in an emergency.6” Remember preventive care office visits in most cases are covered 100% by insurance, which means no out of pocket cost to you if you have this visit with your regular primary care doctor, so you save money and get better personalized care at the same time.

Healthcare Hack #2: Most women’s health services have zero out of pocket cost.
Another benefit of the ACA is a great number of health screenings and services important for women’s health are required to be covered as part of preventive care. Key to having these services charged at no cost is to be sure to follow the rules of your health plan by making sure your provider is in-network and paying attention to your final bill.

When your visit is for a service considered preventive, if you have an out of pocket cost always question why and challenge the validity of the charges. Examples of preventive services for women include the following[7]:
  • Breast cancer screening (mammography)
  • Cervical cancer screening (Pap test)
  • Contraception
  • HIV and STD screening and counseling
  • Osteoporosis screening (bone density)
  • Well-woman visits

For those who may be uninsured, depending on your individual financial situation and the state you live, your family may qualify for programs such as Medicaid or the Child Health Insurance Program (CHIP) which “provide free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities8. Even if you don’t qualify for these programs there are low cost community health centers nationwide that operate on a sliding fee scale to provide these same services at a reduced cost based on your income[9].

Hack #3: Short-term Mental Health Counseling is Often FREE
Most employees underuse the phenomenal benefit known as the Employee Assistance Program (EAP). This is a mental health counseling benefit to help you and eligible family members receive anywhere from three to eight visits per person, per issue to cope with short-term counseling needs (such as stress, anxiety, depression, marital, death, etc.)

Hack #4: Dental Schools Need Real-Live Subjects for Students to Practice On
Most dental schools have clinics which provide dental care at a reduced cost. These clinics allow students to gain experience treating patients, while being closely supervised by licensed dentists. If you’re not feeling adventurous enough to try out one of these clinics, many community health centers also offer low cost dental options.

Hack #5: Seek out Vision and Prescription Discount Programs
Preventive care for children usually includes an eye exam but requires a stand alone plan for eyewear. Many organizations offer discounts or fully cover the cost for both children and adults if you can't afford routine eye exams and prescription eyeglasses[10]. Pharmacies and primary care providers may also have discount cards, free samples, and coupons available if we ask. Another cost saving tip, if there are no health reasons not to, consider taking the generic version of a drug[11].

Let’s take these tips and continue the mission to live our best lives without fear.


Resources:
  1. Eight Dimensions of Wellness (2017 October 24). Retrieved from https://www.samhsa.gov/wellness-initiative/eight-dimensions-wellness
  2. Access to Health Services (2018 May 30). Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services
  3. Key Facts About the Uninsured Population (2017 November 29). Retrieved from https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/
  4. Minimum Essential Coverage & 10 Essential Benefits (2018 February 26). Retrieved from https://resources.ehealthinsurance.com/affordable-care-act/minimum-essential-coverage-10-essential-benefits
  5. What Marketplace health insurance plans cover Retrieved from https://www.healthcare.gov/coverage/what-marketplace-plans-cover/
  6. The Importance of a Primary Care Provider (2015 April 07). Retrieved from https://mayoclinichealthsystem.org/hometown-health/speaking-of-health/the-importance-of-a-primary-care-provider
  7. Centers for Disease Control and Prevention. Meeting Women’s Needs Through the Health Insurance Marketplace: What You Need to Know (2017 September 8). Retrieved from https://www.cdc.gov/women/healthcare/index.htm
  8. Medicaid and CHIP Coverage. Retrieved from https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/
  9. How to Find Low-Cost Healthcare in Your Community. Retrieved from https://www.healthcare.gov/community-health-centers/
  10. Heiting, Gary. (2018 March) Free Exams and Eyeglasses. Retrieved from https://www.allaboutvision.com/eye-exam/free-exam.htm
  11. Scutti, Susan. (2016 August 25). How to Pay Less for Your Prescription Drugs, Legally. Retrieved from https://www.cnn.com/2016/08/25/health/where-to-get-cheap-drugs/index.html
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