Out-of-pocket medical expenses: Here are 4 ways you can reduce this cost

Out-of-pocket medical expenses typically constitute outpatient department (OPD) expenses, which are not covered by many health insurance policies, resulting in policyholders paying a considerable amount during regular visits to the doctor without exercising their health insurance policy. Normally, the health policies cover only in-patient expenses when you are hospitalised for more than 24 hours. So, how then can you minimise your financial burden when it comes to healthcare and periodic doctor consultation?  

Here are four ways to reduce OPD expenses, and medical expenditure overall: 

1. Healthcare policy with comprehensive OPD coverage: Getting a health policy that covers OPD costs is a smart move to reduce medical expenses. For this, you can research and compare different policies to find one that offers extensive coverage for outpatient services. It will help if you look for policies that include doctor visits, diagnostic tests, and preventive care. It is also essential to pay attention to coverage limits, co-pays, deductibles, and out-of-pocket maximums associated with the policy. By finding a policy that suits your needs, you can minimise your out-of-pocket expenses and maximise the benefits you receive.  

Siddharth Singhal, Business Head–Health Insurance, Policybazaar.com, said, “OPD expenses, including doctor consultations—physical and virtual, pharmacy, diagnostics, etc.,—account for nearly 70 per cent of health spending in India. With rising medical costs, having health insurance that covers such expenses has become imperative.” He adds, “Health insurance with OPD cover enables the insured to file claims for expenses other than those incurred during hospitalisation. This means the patient does not need to be admitted as an in-patient during these visits. The word OPD refers to costs connected with a trip to a clinic, hospital or related facility for a diagnosis or treatment on the recommendation of a medical professional.”

While OPD coverage is available with insuretech firms, you can buy it as a rider along with your basic health policy. Some OPD policies from insurance companies include ICICI Lombard’s BeFit, ManipalCigna Health Insurance’s ProHealth Prime Advantage, Bajaj Allianz General Insurance’s ‘Health Prime’ rider and so on.

However, you must understand the exclusions while opting for OPD coverage. Most of these policies don’t cover maternity OPD expenses, cosmetic treatments, hazardous and adventure sports, non-prescribed dietary supplements, treatment for addictions, etc.

2. OPD subscription plans: As mentioned above, you can opt for health financing provided by new-age healthtech platforms that can help you manage your OPD expenses more efficiently. Once you subscribe to these plans, you get prepaid benefits on regular medical expenses, dental care, mental health, vision care, etc. However, you must know that most of the insuretech firms offering annual, monthly health OPD subscription plans are not under the direct purview of the regulator, the Insurance Regulatory and Development Authority of India (Irdai).

3. Focus on preventive healthcare: This is another effective strategy for reducing OPD expenses. You should leverage the preventive services covered by your existing health policy, such as vaccinations, screenings, and annual check-ups.  

Many insurers provide free medical check-ups if you don’t make claims from your regular or family floater health insurance policy. However, many insurers offer free annual health check-up facilities even if you have filed a claim during the policy term. The frequency of medical health check-ups varies from insurer to insurer and policy to policy.  

For instance, you might have your health policy for ten years,  but you can avail of your free health check-up for only the first five years. Hence, you can contact your insurer and ask them to understand whether your existing policy provides free health check-ups.

“Active preventive care allows you to detect potential health issues early on, hence avoiding the need for costly treatments in the future. By prioritising prevention, you can maintain good health and minimise the need for frequent doctor's visits. Prevention is better than cure rightly applies here,” said Aniruddha Sen, Co-founder of Kenko Health.  

4. Develop a healthy lifestyle: A healthy lifestyle can significantly reduce your overall medical bills and OPD expenses. Sen said, “You can start by adopting habits such as exercising daily, having a balanced diet, following a sleep schedule, and avoiding smoking and alcohol consumption. A healthy lifestyle can help prevent chronic conditions, reduce the frequency of doctor visits, and minimise the need for medical interventions. Self-care practices can help you reduce healthcare costs in the long run.”  

Hence, by combining these strategies with proactive healthcare decision-making, you can take control of your OPD expenses and work towards more affordable healthcare practices.