Managing a chronic health condition can take a financial toll on you and your family. Costs add up quickly from medicines, testing, copays, travel, and more. But help is available from your doctor and from programs specially designed to lower healthcare costs.
Understanding health insurance terms
As you navigate your way through the healthcare system, it is helpful first to understand some common terms related to health insurance.
Primary care provider
Someone who helps manage general health needs and chronic conditions. They may be a doctor, nurse practitioner, clinical nurse specialist, or physician assistant.1
Deductible
The amount you pay for healthcare services before your insurance kicks in. For example, if your deductible is $500, your insurance provider will pay for covered services only once you have paid $500 of your own money.1
Co-insurance
Co-insurance is a type of insurance coverage in which people share the cost of covered services with their insurance company. This means you will pay a certain percent of the cost of covered services, and your health insurance covers the rest. You pay the coinsurance amount plus any deductible amount.1
For example, you may pay 20 percent of an amount allowed by your insurance. If your insurance company allows $150 for an office visit, your insurance plan will cover 80 percent of that ($120). You will then be billed for your 20 percent co-insurance amount, or $30.1
Copay (copayment)
A set amount that you pay for a service covered by your health insurance plan. You usually pay the copay at the time of service. This amount can change, depending on what health services you receive.1
Network
The providers, facilities, and suppliers your insurer partners with to offer healthcare services. If your insurance company partners with your doctor, then that doctor is considered “in-network.” Otherwise, the doctor is considered “out of network.”1
Options for lower-cost healthcare
Private companies, nonprofits, and the state and federal government all offer free or low-cost programs to help pay for healthcare expenses. Here is a look at a few.
Copay/prescription assistance programs
These programs offer financial help for medical treatment. They can help you pay copays, co-insurance, and insurance deductibles for prescription drugs, equipment, and supplies.2
People qualify for these programs by proving they cannot afford their medicine or other healthcare costs. How you qualify for help varies with each program. Search online for “copay assistance” or “prescription assistance” to find help.2
Note that some insurance companies use copay accumulator programs, which stop copay assistance coupons from counting toward deductibles and maximum out-of-pocket spending.3
Medicaid
Medicaid is a joint federal and state health coverage program for low-income adults, children, pregnant women, older adults, and people with disabilities. Some states have additional options for coverage. To find out if you qualify for Medicaid, contact your state Medicaid agency or fill out an application through the Health Insurance Marketplace.4,5
Learn more at Medicaid.gov or Healthcare.gov.
Children’s Health Insurance Program (CHIP)
CHIP is a joint federal and state health coverage program for uninsured, low-income children and pregnant women. Eligibility varies by state. To find out if you qualify for CHIP, contact your state CHIP agency or fill out an application through the Health Insurance Marketplace.5,6
Learn more at Medicaid.gov or Healthcare.gov.
Community health centers
These clinics offer low- or no-cost healthcare services and referrals to specialized care. Search online for the center nearest you or go to Findahealthcenter.hrsa.gov.7
Veterans Affairs (VA)
The VA offers healthcare for US military veterans and people on active duty. Family members may also qualify for healthcare through the VA. You may apply online, in person at the nearest VA medical center or clinic, by phone, or by mail.8
Learn more at VA.gov.
More tips for lowering costs
Here are some extra tips for lowering your healthcare costs.
Nonprofit groups
National and local charities can help you save money on prescription drugs and healthcare services.9
Drug samples
Some doctors give out free samples of brand-name drugs to help ease costs. Samples also allow you to check out a drug’s side effects and how well it works before buying it. Plus, samples act as a stop-gap until you can sign up for a patient assistance program (PAP).10
Generic medicines
Ask your doctor, pharmacist, or insurance company if your medicine is available in a generic form or under a less expensive brand name. Mail-order pharmacies are another option to lower drug costs.9
Price shopping
Check with different pharmacies in your area for the best price on prescription drugs. Also, ask your healthcare provider about how to access discounted prescription lists.10
Referrals
Your doctor can also refer you to state-sponsored services and community assistance programs.10
Drug makers
Drug companies offer 2 types of help. They have programs that allow you to use a discount drug card at the pharmacy. There are also PAPs, which offer free or low-cost medicines to people who cannot afford them. You can also check the website of the drug maker to see if there are available discounts offered to patients.10
Clinical trials
Clinical research is a way to access medical care and new treatments before they are widely available. Keep in mind that the trial’s sponsor covers costs related to taking part in the clinical trial. However, you or your insurance company may pay for care costs such as hospital stays, lab tests, and doctor visits.11-13
To learn more about coverage options and your rights as a healthcare consumer, visit the CoverageRights.org and HealthCare.gov websites.
For more information and help, check out:
Health Resources
Resources for Veterans, LGBTQ+ People, and Other Special Groups
Workplace Considerations
Disability Benefits
Applying for Social Security Disability Benefits (SSDI)