When do I pay -- and for what?

While employees can expect to pay a greater share of the (nonpreventive) medical services they receive in 2024, in most cases their office visit experience will be similar. On the day you see your doctor or therapist, you're responsible for a copay, $15 for BlueHMO participants and $25 for BluePPO participants. That copay will cover other services received. If your appointment is for a preventive service, you won't even have a co-pay.

What's changing about office visits in 2024 is that ongoing or short-series appointments, for example, for allergy shots, mental health sessions or physical therapy, will require the copay at each visit, not just the first one.

Other pieces of the cost-sharing structure are a deductible and coinsurance. If one of these applies (typically when a copay is not taken), it will be paid later to your medical provider -- for example, McFarland Clinic -- after the provider has sent the claim to Wellmark and Wellmark has processed it. That usually takes three to four weeks, after which you'll receive a bill from your provider.

Remember, the Explanation of Benefits you receive from Wellmark is not a bill.

Curious about costs?

Wellmark offers an online cost estimator -- but keep in mind it's an estimator, not a quote for services. To use it, on the Wellmark website, log in to your myWellmark.com in the upper right corner. At the bottom of your homepage, locate the section called "what are you searching for today?" Select "find costs" and the link below to be taken to the provider finder tool. Once there, select the "estimate your costs" box and enter a procedure to compare the costs.

Customer service specialists at Wellmark also can help with medical plan questions, for example, comparing how a medical service was actually paid in 2023 and how Wellmark anticipates the same service would be processed in 2024. Wellmark staff also can answer questions about the list of preventive services, which by federal law carry no cost-sharing. Call the number on the back of your Wellmark member ID card for help.

Or, you can request information locally. The business office staff for most providers, including Ames-based McFarland Clinic and Ames' Mary Greeley Medical Center (MGMC), will provide, at no charge, a cost estimate of a procedure before it's scheduled and reflecting the patient's insurance coverage.

And, when you're receiving services it's appropriate to ask questions about what's happening at the appointment and how the health care provider will bill the services.

Payment plans for even small balances

For employees concerned about covering medical expenses in their monthly cash flow, payment plans are common among medical providers. ALEX, the online tool that helps you analyze the costs, pros and cons of your benefits options, has a video and FAQ about using payment plans. Closer to home, MGMC and McFarland Clinic both offer interest-free payment plans. The unpaid balance required to request a payment plan is $50 or less. Here are a few more details shared by the providers:

Mary Greely Medical Center, billing services office, 515-239-2111

• Interest-free payment plan of up to 24 months (minimum balance to request a payment plan is $25). MGMC suggests monthly payments of 10% of the balance, if possible.
• MGMC also offers financial assistance for qualifying individuals and families, based on family size and income (up to 350% of the federal poverty level).

McFarland Clinic, business services office, 515-239-4598

• Interest-free payment plan (minimum balance to request a payment plan is $50).
• The maximum length and minimum monthly payment vary according to the size of the balance (the larger the balance, the longer the terms). McFarland's financial advisor team works with the patient to reach a mutually acceptable payment arrangement.
• McFarland offers financial hardship adjustments on services received. The patient requests and completes an application form to begin this process.

Costing several scenarios

Below are a few common medical claims in the ISU Plan and a comparison of the change in out-of-pocket cost to an employee from this year to next. These scenarios reflect the cost-sharing structure of the BlueHMO option and an early-in-the-year claim date when the deductible is zero.

Simple leg fracture

(emergency room care, x-ray, medical supplies and crutches)

2D or 3D* mammogram

(a preventive service)

*Not on the federal list; ISU Plan also covers 3D mammograms with no cost-share for the patient.

Physical therapy

(six sessions prescribed for a tight shoulder)

Pregnancy and hospital birth

(9 months of prenatal care including office visits, ultrasounds and bloodwork; childbirth service and facility service)

Colonoscopy, not including pharmacy prep kit

(a preventive service)