31 Ways to Cut Your Health-Care Costs
By Kimberly Lankford
Your out-of-pocket costs could rise significantly unless you learn some key strategies to become a better health care shopper. The following moves can help you save hundreds or even thousands of dollars.
Many insurers are shrinking their networks and including fewer doctors and hospitals. "The most expensive health care mistake you can make is to go out of your health plan's network," says
The out-of-network base price may also be higher because the network's providers agree to the insurer's negotiated rate, but outside providers can charge more. You may also have a higher deductible for out-of-network care and a higher annual limit on your out-of-pocket expenses.
Before you visit a doctor or have a procedure, ask both your insurer and the providers if they're included in your plan's network. If you're having surgery, check on the surgeon, anesthesiologist and facility.
Your health plan may provide extra incentives for you to use certain in-network providers or facilities. The UnitedHealth Premium designation program, for example, recognizes physicians that meet guidelines for providing high-quality, cost-efficient care, and you may pay lower co-payments or coinsurance rates if you use those doctors. Most health plans' search tools can help you find providers who participate in these special programs.
Different facilities charge vastly different prices for x-rays and tests. The average outpatient hospital cost for MRIs and CAT scans is
Your doctor may work at several hospitals or outpatient surgery centers. While the surgeon's charge will be the same, "the hospital's fees can vary by thousands of dollars," says Aube. The cost may be even less at an outpatient surgery center, even though the same doctor is performing the procedure. For example, the average cost nationwide for a colonoscopy, GI endoscopy or arthroscopy in a hospital is
Sometimes you can't avoid a trip to the emergency room. But you may be able to go to a much less expensive urgent care center or convenience care clinic for some types of care. Visit an urgent care center for conditions such as minor cuts, burns and sprains, fever and flu symptoms, joint or lower back pain, and urinary tract infections, says Aube. You may pay even less at a convenience care clinic at a supermarket, pharmacy or other retail store, where a clinician can treat you for sinus infections, rashes, earaches, minor burns and other routine medical conditions, she says. The cost varies by type of facility: The average cost nationwide of an emergency room visit is
Many health plans now offer 24-hour help lines staffed by doctors or nurses who can treat you by phone or online video chat. You can use this service for nonemergency conditions, such as cold and flu symptoms, nausea and vomiting, sore throat, earache, and sinus pain. A doctor will prescribe medications, if appropriate. The average telehealth consultation costs
Generic drugs can cost as much as 80% less than their brand-name alternatives, says Aube. The lower list price makes a huge difference when you're in the plan's deductible period and paying the full price out of your pocket. And the coinsurance rates are usually lower, too -- often 10% to 15% of the cost for generics, 25% for preferred brand-name drugs, and 50% for nonpreferred brand-name drugs.
Some plans no longer cover certain brand-name drugs. For example, one popular health plan doesn't cover Lipitor, which costs
The patents for several popular brand-name drugs -- Celebrex, Copaxone, Nexium, Actonel and Exforge -- are scheduled to expire soon, which will open the door for drug companies to manufacture generic alternatives. "It takes some time after patents expire for manufacturers of generics to receive approval from the
Some brand-name drugs don't have a generic equivalent but may have a "therapeutic alternative." That means a medicine that is in the same class of drugs but is chemically a little different. For example, Diovan is a blood-pressure drug with no direct generic substitute. In one popular plan, the monthly cost for a 30-day supply of 80 mg tablets is
More health plans are introducing preferred pharmacies, which cost even less than regular in-network pharmacies. For example, the Humana Walmart Rx plan for
Mail-order pharmacies may provide a three-month supply of drugs for the same price as a one-month supply at a local pharmacy. Some plans require you to use mail order for maintenance drugs.
Ask your doctor if you can save money by cutting your pills. Your physician will have to write a new prescription for twice the strength and half the quantity, noting your intent to split the tablets, says
Many health plans are adding new hurdles that you must clear before you can get certain medications. For example, you might have to try step therapy (which requires you to try other medications first, if possible) or seek prior authorization (the insurer asks your doctor a detailed list of questions about your condition and your treatment before it will cover the drug). Understand the rules for getting your drugs covered, and get your doctor involved to help explain to the insurer why you need the medication or to file an appeal if it is denied.
You can no longer use tax-free money from a flexible spending account or health savings account for over-the-counter drugs without a prescription (except insulin). To get reimbursed from your FSA or HSA, ask your doctor for a prescription for any medications you use regularly, such as pain relievers, allergy medications, anti-fungals and cough-and-cold medicines, says
The Affordable Care Act requires all insurers to provide several kinds of preventive care without any cost-sharing from you, regardless of your deductible. Depending on your age, this rule may apply to blood-pressure, diabetes and cholesterol tests, mammograms and colonoscopies, flu shots, routine vaccines, well-baby and well-child visits, and other preventive services (see the preventive-care page at Healthcare.gov for details).
The cost-free preventive care rule applies only to in-network services (it's not unusual for an anesthesiologist involved in a colonoscopy to be out-of-network, for example), and you may be charged extra if something comes up in the test that requires more investigation. Ask if all of the providers involved in a procedure are in your insurer's network. See Loopholes in Free Preventive Health Care for details.
Many employers who offered wellness benefits that weren't worth the effort have been beefing up their incentives recently. More than one-fourth of the large employers surveyed by the
You may get extra cash or discounts on your premiums for taking a health-risk assessment or participating in a tobacco-cessation program. Or your employer may offer free weight-loss or stress-reduction programs. More than half the employers surveyed by the
If you have a high-deductible plan, make sure you're getting credit toward the deductible for all of your care. Even if you're paying from your own pocket during the deductible period, file the claim so that you'll get the rate the insurer negotiated with the provider. Check your explanation of benefits to make sure you received credit toward meeting your deductible and your annual maximum out-of-pocket spending limit. And time your procedures carefully -- you may want to schedule them near the end of the year, after you've met your deductible, rather than in the new year, when the deductible resets.
If your health insurance policy has a deductible of at least
You may be able to collect extra money from your employer if you sign up for an HSA. Some match your contributions, but others seed your account just for signing up. It isn't unusual for employers to contribute
Because HSAs do not have a use-it-or-lose-it rule, you can keep the money growing in the account for the future and use it tax-free to pay for many medical expenses down the road, even in retirement. You can't contribute to an HSA after you sign up for
If you use your HSA to pay out-of-pocket medical bills right away, look for an administrator with low fees, low minimum requirements, and maybe a debit card that makes it easy to use the money at the doctor's office. If you use other cash for current medical expenses and keep the money growing in your HSA for longer-term costs, look for an administrator that offers good investment choices (many let you invest in mutual funds or sometimes even stocks), and see if you can minimize fees by maintaining a minimum balance in the account. Compare HSA administrators' investing options and fees at www.hsasearch.com. See Contributing to a Health Savings Account in 2014 for more information.
If you don't have an HSA-eligible high-deductible health insurance policy, contribute to a flexible spending account, if your employer offers one. You can contribute up to
If your modified adjusted gross income is less than 400% of the federal poverty level (
Notify the exchange if your income changes during the year. You can qualify for a bigger subsidy if your income drops or, if your income rises, you'll avoid a surprise at tax time. Be careful about moves that could boost your income above the cut-off for the subsidy, such as converting a traditional IRA to a Roth or withdrawing money from a traditional IRA or 401(k). See Beware Pitfalls of Health Care Subsidy for more information.
Open enrollment for individual insurance is closed for 2014, whether you buy coverage on the exchanges or from an insurer (it re-opens on
Always get an itemized bill when you have a hospital stay or major procedure -- and question unexpected charges. Then match your bill with your explanation of benefits. Coverage may be denied if the procedure wasn't coded properly, says
If you're still in the deductible period, see if you can get a discount for paying cash. Make sure you're getting the insurer's negotiated rate and submit the claim yourself so that it counts toward your deductible.
Many insurers have improved their health care shopping tools over the past few years, using the insurer's negotiated rates with providers in your area to show how much you'll pay under your policy. Aetna's Member Payment Estimator, for example, shows up to ten cost estimates for a procedure in your area, including a variety of options (stand-alone centers, hospitals, convenience-care clinics, ERs). You can also compare prices for your drugs at several pharmacies in the area, search for lower-cost medications, and find in-network providers.
Some employers and insurers even offer alerts to let you know when the price of your drug has dropped, if a generic alternative becomes available, or if you could save money by getting x-rays at a stand-alone facility, says
Review your insurer's rules regarding emergency care and find out if you need to contact the insurer for approval before you can receive certain kinds of care. Familiarize yourself with the appeals process in case a procedure or drug is denied, or if you need permission to go to an out-of-network provider. You may also get help with appeals from your state insurance department (see www.naic.org for links).
Sign up for the daily JWR update. It's free. Just click here.
All contents copyright 2013