Bringing greater clarity to employee health care costs
Employers who offer health plans with clearer coverage and cost visibility may have an edge in today’s competitive job market.
It’s clear that consumers are wanting — rather demanding — greater transparency in health care costs. They want to understand what their plan covers, how much a procedure or provider visit will cost and whether lower-cost alternatives are available.
Yet nearly half of insured adults when surveyed reported challenges in understanding at least one aspect of their health insurance, with:1
- 36% feeling unsure about what their insurance would cover
- 30% wondering what they would owe out-of-pocket for care
- 30% reporting that they didn’t understand their Explanation of Benefits (EOB) statement
This confusion may lead employees to delay or skip necessary care.1 It may also cause them to pay more for their care because they lack the information needed to make more informed decisions.2 On the other hand, those with a better understanding of their benefits may be more likely to effectively manage their health.3
That’s why the health care industry is working to improve the member experience with:
- Health plan designs that reduce cost confusion
- Tools that provide upfront cost estimates to support cost-effective care decisions
- Proactive alerts when lower-cost alternatives are available
Health plan designs that reduce cost confusion
A survey conducted by UnitedHealthcare found that 3 in 5 respondents could not correctly define key health care terms like “coinsurance” or “out-of-pocket maximum”.4 When employees don’t understand their health plan, they’re more likely to feel confused and frustrated when they receive a bill.
50%
average lower out-of-pocket costs for Surest members5
Health plans that eliminate some of the cost complexities may help. One example is the Surest® health plan. With no deductibles or coinsurance, members can see actual prices for care in the form of a copay. Within the digital experience, they can also see the included care services that are covered as part their visit. Plus, members receive one bill for their service, which may help eliminate surprise bills.
Providing health plans that include services or medications with no out-of-pocket costs for members can make a significant difference by eliminating financial barriers and potentially increasing the perceived value of employer-provided benefits.
Tools that provide upfront cost estimates to support cost-effective care decisions
Searching for a health care provider shouldn’t be a difficult experience. While many carriers offer provider search tools, these tools may not always deliver accurate information or may be limited in the details they provide. Inaccurate contact information, network status and incomplete specialty listings can lead to member frustration and may even delay access to care.6 Tools that lack cost information or don’t offer the ability to compare costs in advance may add to that frustration.
UnitedHealthcare continues to reimagine how members access cost and coverage information — aiming to make it easier, clearer and more comprehensive. In 2025, we’re making strides to improve our member experience by offering:
19K
The number of common medical services included in the UnitedHealthcare cost estimation tool7
- A better understanding of what’s included in members’ plans
- More detailed guidance on how to best utilize members’ benefits
- Greater visibility into out-of-pocket costs for covered services
This level of transparency — regarding what’s covered and how much a visit, service or treatment may cost — can help employees and their families better budget for nonemergent care and make more cost-effective health care choices.
“We know health care quality and cost can vary significantly even within the same city, which is why we provide millions of our members with tools to help them review quality information and cost estimates for more than 19,000 common medical services,” says Samantha Baker, chief consumer officer for UnitedHealthcare Employer & Individual. “Members can access this information online, via our mobile app and through our customer care Advocates, making it easier for them to make more informed decisions.”
This commitment to empowering more-informed decisions also inspired the recent launch of Smart Choice. Available through the UnitedHealthcare® app or myuhc.com®, Smart Choice helps members compare providers by prioritizing search results and offering a dynamic score based on quality and how well a provider aligns with a member’s care needs, specific benefit plan coverage and personal preferences (such as distance, in-person vs. virtual offerings, gender and language).
Recognizing that providers play a key role in guiding care decisions, UnitedHealthcare is also working to ensure they have the information they need. That includes integrating patient-specific benefit details into providers’ existing electronic medical records (EMRs). This gives providers a more complete view of their patients’ care needs, prior authorization requirements and anticipated costs — enabling more personalized and informed recommendations that take into account what that care or treatment may cost the patient. In some cases, providers can even run trial pharmacy claims to get a better sense of a member’s cost-share.
Proactive alerts when lower-cost alternatives are available
While having access to eligibility and cost information before seeking care can help employees feel more confident in their care decisions, nobody wants to feel like they’ve made a mistake if they choose a less-than-optimal option. Adding precautions to alert members and providers when a lower-cost or perhaps more appropriate alternative exists can help further protect employees’ wallets.
At UnitedHealthcare, members receive alerts via text and email within 4 hours of an eligibility check being performed by a potential out-of-network provider or facility. This advance notice may give the member an opportunity to explore network options and potentially lower their costs by making a more informed decision before care is received.
Additionally, through the Proactive Savings Alert program, UnitedHealthcare members are notified of potential savings on medications — before they refill a prescription. The program uses advanced analytics to compare prices in real time. Alerts are accessible anytime, anywhere, through a link that shows all eligible savings opportunities.
On the provider side, PreCheck MyScript from Optum can also flag when lower-cost alternatives based on a member’s benefits and coverage may be available. In fact, PreCheck MyScript has been found to save members an average of $110 per prescription when switching to a lower-cost alternative,8 such as going from a brand name drug to a generic equivalent. Employers can also benefit, saving an average of $295 per prescription switch.8
Federal regulations offer further cost protections
To help address the impact of health care confusion in the U.S., the No Surprises Act went into effect on January 1, 2022. This law provides federal protection against unexpected medical bills that can occur when consumers:9
- Receive emergency care, including emergency mental health services
- Use out-of-network air ambulance services
- Receive nonemergency care from out-of-network providers at certain network facilities
These protections — along with the Transparency in Coverage rule, which requires insurers to create online, personalized pricing tools for consumers — have been a catalyst for carriers and providers to develop new tools that aim to help employees, employers and providers better understand the total cost of care.
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