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reducing health care costs

Reducing Health Care Costs



Healthcare costs in America are twice as high as other wealthy countries.

That’s the takeaway from recently-released research from the nonpartisan organization Peter G. Foundation. The average American pays $13,500 on healthcare each year.[1]

As medical service prices have increased, so have health insurance costs that cover those expenses.

The average health insurance premium for families has increased 47% over the last decade, says the Kaiser Family Foundation’s latest “Employer Health Benefits Survey.” The health policy research nonprofit has conducted the survey since 1999.[2] Its latest findings show health insurance premium rates are climbing slightly higher than wage increases. But premium rates have trended far more disproportionately in recent years.[3]

More people face growing out-of-pocket expenses beyond the monthly payments. These include deductibles, co-pays, and fees for out-of-network service providers.

It’s easy to feel sick about having to pay so much to stay well. Here are some strategies for minimizing your healthcare costs.

Select the best health plan for your situation

If you and your dependents tend to be fairly healthy, then you might want to consider a health plan with a higher deductible. These insurance plans often come with a much lower monthly premium.

Search for high-deductible health plans at eHealthInsurance, a national health insurance agency created in partnership with the National Federation of Independent Businesses. You can get online health insurance quotes and compare health plans. Also, within your state, you can visit your health insurance marketplace, such as Covered California.

In addition to cost and deductible amount, consider the basic types of plans before you commit. Know whether an HMO, PPO, EPO, or POS plan fits your medical needs and budget. Then look at what is covered across the levels within those plans. This includes considering the type of services covered and the percentage you’ll end up paying out-of-pocket. Think about who you need to cover, existing or chronic health issues, and potential future medical needs.

All of these factors go into selecting a health plan where you’ll get the most coverage at the best price so you don’t end up paying for options you don’t need.

Tap into employer wellness programs

Whether you are a full-time employee or a remote employee with benefits, look for opportunities such as specific wellness programs that promote good health while reducing your own outlay for those services.

Some of these employer wellness programs might include disease management services for free flu shots, smoking cessation, cancer screenings, and access to physicians for physicals and health queries.

If your company offers on-site gyms, massages, and physical therapy, explore these benefits. Anything that helps you feel better and cuts those costs will ease the pressure on your budget

If you are considering switching jobs or are currently looking for a full-time position, then you may want to pay more attention to employer benefits packages. Often, these additional benefits are worth their weight in gold and can be a deciding factor, especially if salary and other options are similar.

Start and contribute to a Health Savings Account (HSA)

An HSA is a tax-exempt account that is made available through high-deductible health insurance plans. It offers many benefits that make it an ideal strategy for saving money as a small business owner or employee.

The funds you put into the account are tax-free, and when you withdraw money to pay for medical expenses, this is also considered tax-free.

It’s an ideal strategy if you don’t regularly visit a doctor. Moreover, the funds can be used for all types of things, including illnesses, accidents, and even dental or vision care. While HSAs don’t help you avoid out-of-pocket medical expenses altogether, they do help alleviate some of the financial burdens.

Each year, the annual contribution limits for HSA tend to change. Currently, individual HSA holders can contribute up to $4,150 to their accounts, while families have a contribution limit of $8,300.[4]

Leverage health discount cards

Depending on your personal need, you may be able to forego dental or vision insurance and just opt for a discount card for those services instead, These health discount costs mean no monthly premiums to pay for coverage that you aren’t actually using. You’ll just pay an annual membership fee to keep your health discount card active.

For example, there are dental savings plans from providers like Careington and Carefree Dental that give you between 10 and 60 percent off the cost of certain dental procedures. Other discount services offer similar savings for things like glasses and contacts, hearing aids, prescriptions, and more. 

These health discount cards don’t interfere with your health insurance. That means you can use your insurance first and then turn to the health discount card to cover what the insurance does not.

Save money on prescription drugs

Prescription drugs cost more in America than any other economically developed country in the world.

How much does that add up to? Roughly $1,376 annually per person, says the latest available data from the Organization for Economic Cooperation. And that number is only predicted to rise in the near future.[5]

The Centers for Medicare and Medicaid Services, National Health Expenditure Projections, reports prescription drug costs will increase by more than 6 percent per year from 2020 to 2027.[6]

With script costs trending upward, it’d be great to know how to save money on prescriptions.

Ask for generic drugs

Pharmaceutical companies often financially reward doctors if they prescribe their expensive drugs. For this reason, your doctor may try to prescribe you an expensive name-brand medication before offering a cheaper solution.

Ask your doctor if the prescribed medication has a generic version to save big bucks. “Generic drugs have exactly the same active ingredients and effects as brand-name drugs, but they can cost 30 percent to 80 percent less,” according to the Food & Drug Administration.[7]

You can also just be honest with your doctor and explain your financial situation. This way, they can help you get the best treatment while working with your budget.

Comparison shop

Just because you’ve filled your prescriptions at CVS for the last 10 years doesn’t mean that pharmacy is the only game in town. Check prices at other local pharmacies, including your grocery store. If you can save enough to make the switch worthwhile, dole out your prescriptions among more than one pharmacy.

Shop online pharmacies

Save money by comparing prices at online pharmacies that deliver prescription drugs right to your doorstep. You may save a lot by ordering online. Plus, you’ll save on gas and time by not having to drive to the pharmacy and wait in line.

Get medications by mail

When you order medications through the mail, you often get a few months of meds at a time with a discount. It’s convenient for you, and cheaper. Win-win! Some insurance companies have their own prescription mail services, as does Medicare. There are also plenty of independent companies that can help you get your medications through the mail.

Find a preferred pharmacy

Ask your insurance company for a list of preferred pharmacies. Insurance companies often partner with certain pharmacy chains to get lower prices for the people they cover.

Sign up for drugstore discount programs

Check with local pharmacies for any discount programs they offer. For example, when you pay $20 (or $35 for a family plan) to join Walgreens’ Prescription Savings Club, you can get discounts on more than 8,000 medications. Plus, you can fill 90-day prescriptions on select generic drugs for the price you’d pay for two 30-day prescriptions.

Bonus: Walgreens’ program also provides discounts on prescriptions for your pets.

Use prescription drug discount apps and cards

Prescription drug discount apps enable you to save big on your medications. The creators of apps like GoodRx, Blink Health, and WellRx set out to create solutions for the high healthcare costs that plague Americans. Read our reviews to discover the pros and cons of each and decide which one is best for you.

Drug discount cards have been saving consumers money on prescriptions for decades. If your insurance doesn’t cover a prescribed drug or you’re saddled with a high copay, check the price on these drug discount sites to see how much you can save.

Not up to the research? Ask your pharmacist if they have information on how much you can save with certain prescription discount cards.

Order a 90-day supply

Ordering a 90-day vs. a 30-day supply may save money on certain drugs. Check prices for both quantities before you fill a prescription. You’ll pay more upfront but the savings over three months may be worth it.

See if you can split the pills

If it’s safe to do so with your specific medication, get a higher dosage and cut the pills in half. Buy a real pill cutter instead of attempting the cut with a knife, though. You don’t want your meds to fly all over the kitchen.

Ask your doctor for prescription drug coupons

Occasionally, pharmaceutical companies will offer coupons for their name brands. Ask your doctor if they can give you any. You could also find some prescription discounts by searching online.

Find a prescription assistance program

There are a few different nonprofit organizations that assist people with their medication costs. The Partnership for Prescription AssistancePatient Advocate Foundation, and NeedyMeds are all great options.

Check into manufacturer programs

Many drug manufacturers offer patient assistance programs if you meet income eligibility requirements. Contact the manufacturer for that pricey drug to find out if you’re eligible for deep discounts on medication. To get an idea of how patient assistance programs work, visit RxAssist, which lists a comprehensive directory of patient assistance programs.

Call your insurance company

Different plans cover different medications. Talk to your insurance company and get an idea of the level of drugs you can afford. When in doubt about your coverage, call and ask – they might tell you how you can save money on your prescriptions. It’s always better to be safe than sorry.

Choose health insurance wisely

It is important to choose your health insurance wisely.  Brokers are trained professionals that can assist you in finding the best plans for your unique needs. If possible, find a broker that is familiar with plans in your area and that is certified to sell ACA plans.

“The least expensive plan is not always the best or the most cost-effective option.  Sometimes, a silver or gold plan may cost you less due to lower copays on brand name prescriptions. For those on Medicare, always have a broker review your part D (drug) coverage annually. Even if your monthly premium is not set to increase, there is no way to know that your prescriptions are still covered the same way for the next year unless you do an analysis of this plan,” says Analisa Cleland, an insurance and financial advisor at Coto Insurance.

If you are on a Medicare Advantage plan, have a certified broker review your coverage annually to ensure that your plan is still a good fit for your individual needs.

Focus on your personal health and wellness

It may sound obvious that taking care of yourself means spending less on co-pays for doctor visits or hospital stays, as well as lower costs for prescriptions. Yet many people still fail to prioritize their personal health and wellness.

Consider the fact that if you take care of yourself, you’ll miss fewer days of work. To a self-employed person who doesn’t get paid sick days, this can mean more money in the bank on top of lower medical costs that get paid out-of-pocket.

Besides eating right, getting ample sleep, maintaining healthy behaviors, and exercising, you can also be proactive by getting immunizations for things like the flu, pneumonia, and shingles.

Compare and review

Whether you’re self-employed or work for a company, and whether you’re single or married with children, personal situations change each year. That’s why it’s important to regularly review your health insurance and budget for medical costs.

Additionally, the healthcare and insurance environment is forever changing. You’ll want to see what’s different and how you can adjust your approach to limit what you spend while maximizing your health coverage.

Not overpaying on medical bills

Up to 80 percent of medical bills contain at least one error. So, if you think you’ve overpaid at least once or twice on a doctor or hospital bill, chances are you’re probably right.

The good news is that you can avoid paying too much on medical bills by taking certain steps to make sure you’re covered for certain medical services, choosing health care providers wisely and knowing how to read the explanation of benefits (EOB) your health insurance company sends after receiving the claim from a health care provider.

Before you take out your credit card to pay a medical bill you want out of your life, here are four tips for making sure you don’t pay more than you owe.

1. Review health insurance coverage

When you know what your health insurance covers, you can choose services accordingly so that claims are less likely to be denied by your health insurance provider. Reviewing your health plan can help you avoid surprise medical bills, unexpected copays or out-of-pocket expenses and expensive prescriptions for medications that aren’t covered by your plan.

If you renewed last year’s health plan, don’t assume that all overage remains the same. Health plans can change from year-to-year, so look over your health insurance policy online or in the handbook your insurance carrier sent in the mail before scheduling medical care.

2. Use in-network providers

Health insurance plans typically have a network of hospitals, doctors and other health care providers included in the health insurance carrier’s network. When you use your insurance carrier’s in-network providers, you’ll typically receive negotiated rates or partial or full coverage of the service, depending on your health plan.

On the other hand, when you use an out-of-network provider, health care costs and services received aren’t usually covered. That means you’ll pay full price for all health care services received from an out-of-network provider. To save money, stick with in-network providers if possible. Find your health plan’s in-network health care providers by login into your health insurance account online.

3. Check the explanation of benefits (EOB)

When your health care provider sends a claim to your health insurance, the insurance company will send you what’s known as an explanation of benefits (EOB). Even though the EOB may look like a bill, it’s not. Instead, the EOB shows the service description, how much your health care provider bills and the medical billing code. The EOB also shows the amount your insurance company reimburses and the amount you owe the doctor or hospital under “patient responsibility.”

If a health care provider sends a bill for an amount owed before you receive the EOB from your health insurance provider, hold off on payment until you receive the EOB so you can compare the amount billed to the patient responsibility amount, which is typically less.

4. Request an itemized bill

If a health care provider sends you a bill with only a lump sum and minimal information other than the date of service and the amount owed, ask for an itemized bill. That way, you’ll know  the cost of each service for which you’re being billed and the billing code so you can compare the itemized bill to the EOB.

When reviewing the itemized bill, also watch for services billed that you may not have received. For example, if your doctor ordered a test and then canceled the order, you may have gotten accidentally charged for services you didn’t receive.

What can I do if I overpaid?

When a doctor’s office or hospital bills for more than the patient responsibility amount on your EOB, it’s probably an unintentional mistake caused by sending the bill before receiving the amount owed under your health insurance plan.

If you’ve already paid the doctor or hospital bill and see on the EOB that you actually owed a lower amount, contact your health care provider’s billing department and ask for a refund. The billing office should process the refund by crediting your credit card or bank account.

How Much Could You Save?

Just tell us how much you owe, in total, and we’ll estimate your new consolidated monthly payment.