By Laura Weiglein, Head of Products
Health care is deeply personal, but it’s also shared. In group health plans like the ELCA Health Plan, everyday health care choices directly affect individual well-being — and they can also help keep benefits sustainable for the whole community. That’s because plan members share a common pool of resources designed to support everyone who participates. So, the way each member uses care affects what will be available for others — today and in the future.
Importantly, using health care wisely doesn’t mean avoiding or putting care off. It’s essential to take care of your physical and emotional well-being when you need it.
Use these five practices to help you choose the right care, at the right time, in the right place — so both the care you receive and the money you spend can go further.
1. Prioritize Preventive Care
Preventive care is one of the most powerful ways to maintain your health before small concerns become larger ones. Regular checkups, recommended screenings, and vaccinations help you avoid and detect issues early — often before symptoms appear — when treatment is simpler, more effective, and less costly.
+ Ask your doctor what age-appropriate screenings/vaccinations are right for you.
ELCA-Primary health benefits cover 100% of the cost for in-network preventive services, including a routine preventive visit, cancer screenings, blood pressure check, depression screening, vision screening, and dental cleanings. If a visit includes evaluation or treatment of existing conditions or concerns outside the scope of preventive care, additional charges may apply.
2. Choose the Right Kind of Care
Not every health concern requires the same level of care. Using on demand care, virtual visits, or same day primary care when appropriate can lead to faster treatment and significantly lower costs than urgent care or an emergency room. Research shows that emergency department visits are among the most expensive types of outpatient care, with insured patients paying around $646 out of pocket on average, and total costs varying widely depending on services provided.1
For similar non emergency conditions, care delivered in lower acuity settings — such as urgent care or a physician’s office — can cost a fraction of what an ER visit costs, sometimes many times less. Choosing the right setting helps avoid unnecessary expenses and keeps emergency resources available for true emergencies, for you and for other plan members.
Many people don’t realize that some facilities labeled “urgent care” are actually hospital affiliated emergency rooms. These sites may look similar but can result in ER level billing, higher copays, and unexpected costs. Knowing what type of care site you’re visiting ahead of time can help prevent surprise costs. If your health plan offers care coordination — such as the ELCA Health Plan’s health care coordination through Quantum — take advantage of it to confirm which sites are in network and appropriate for your needs.
+ Prepare before you need care. If your health plan offers on-demand or virtual care, consider starting there by enrolling in it now so you’re visit-ready. And take a few minutes to identify your nearest true urgent care center and emergency room, so you know where to go when something unexpected happens.
ELCA‑Primary health benefit members have access to 24/7 virtual primary care through the 98point6® by Transcarent app at no additional cost. Sign in to learn more:
3. Lean on Care Coordination
Health care can be complicated, especially when multiple providers or treatments are involved. Care coordination is a service included in many health plans that helps you avoid duplicated tests, unnecessary services, and out of network charges. For example, depending on your coverage, an MRI performed at an in network, freestanding imaging center typically costs $100–$400 out of pocket. That same MRI, performed at an out of network or hospital based facility, can leave a covered member owing $600–$1,500 or more, due to higher billed charges, larger coinsurance, separate deductibles, or balance billed amounts — even though the imaging itself is identical2.
A care coordinator can help guide decisions like which facilities are in network, where to find lower cost options, and whether prior authorization is needed — reducing billing surprises and helping you receive appropriate care at a lower cost. And care coordination helps protect the health plan’s shared resources from unnecessary or avoidable expenses that add up over time.
+ Know what support your plan offers — and if care coordination is available, take advantage of it. Especially during a complex health journey, having help navigating providers, approvals, and next steps can save time, stress, and money.
Quantum Health Care Coordinators can help ELCA-Primary health benefit members compare care options, understand coverage, find in-network providers, create care plans, and resolve claims questions. Sign in to connect with a Care Coordinator, or to use self-guided resources like the search tool or the Quantum Health App.
4. Get the Most Value from Your Prescription Drugs
Prescription medications are essential for managing many conditions. Because many medications are taken for months or even years, over time, small choices can make a big difference in cost. Generic medications often provide the same clinical benefit as brand name drugs at a much lower price. For example, the brand-name drug Lipitor, a commonly prescribed cholesterol medication, can cost well over $100 per month, while its generic equivalent, atorvastatin, may cost $10 or less per month3, depending on dosage and pharmacy. Over time, that difference can add up — for individuals and for the health plan.
Mail-order delivery for ongoing prescriptions can also save time and travel by providing a larger, extended supply delivered to your home. And for people who take specialty medications, specialty pharmacies offer the clinical support and careful handling required for complex drugs — helping manage the cost and handling of these medications that often cost thousands of dollars per year.
+ When a medication is prescribed, ask your doctor or pharmacist whether a generic option is available and whether mail order home delivery could save you time and money.
ELCA-Primary health benefit members pay less when choosing generic medications and mail-order home delivery through Express Scripts. Sign in to learn more or contact Express Scripts.
5. Take Advantage of Tax‑Advantaged Health Accounts
Tax advantaged accounts are one of the most effective ways to save on out-of-pocket health care costs by paying with pretax dollars. For example, if you have a $1,000 medical bill and your combined tax rate is about 30%, you would need to earn roughly $1,430 before taxes to cover that bill with after tax dollars. Using pretax dollars through an HSA or FSA means you only need to earn $1,000, saving more than $400 in taxes.
Health savings accounts (HSAs) and health flexible spending accounts (FSAs) can be used for many eligible health care expenses, including doctor visits, prescription drugs, dental care, glasses or contact lenses, hearing aids, physical therapy, mental health services, and even over-the-counter items like sunscreen and first aid products.
+ Take time to learn which expenses qualify for HSA or FSA use — and consider enrolling in one the next time your health plan allows. Planning ahead can make everyday health care costs more manageable.
Depending on their health benefit option, ELCA Primary health benefit members may have access to a health flexible spending account (FSA) and/or health savings account (HSA). Taking time to understand these account types can help guide your decisions during Annual Enrollment, as they may influence which health benefit option you choose. Sign in to myPortico and select Health Benefits to find more information on each tax-advantaged account type.
Being a savvy steward of one’s health care resources doesn’t require major changes — just informed, intentional choices. When people use health care wisely, they support their own health and financial wellness and strengthen the sustainability of the plan. Over time, that shared stewardship helps promote greater stability and ensures benefits can continue to serve those who rely on them.
About the Author
Laura Weiglein is Head of Products at Portico Benefit Services, where she leads the design and delivery of health and financial benefits for ELCA ministries and other faith-based organizations. With a background in health care strategy and product development, she brings extensive experience creating member-focused solutions that improve access, affordability, and overall well-being. Prior to joining Portico, Laura held leadership roles at Medica, Trustmark Benefits, and HealthPartners.
1 https://www.healthsystemtracker.org/brief/emergency-department-visits-exceed-affordability-thresholds-for-many-consumers-with-private-insurance/; https://www.kff.org/health-costs/emergency-department-visits-exceed-affordability-threshold-for-many-consumers-with-private-insurance/
2 https://scienceinsights.org/mri-cost-with-insurance-what-youll-pay-out-of-pocket/
3 https://medxdrg.com/is-atorvastatin-cheaper-than-lipitor-a-generic-vs-brand-name-cost-breakdown