CO-PAYS. DEDUCTIBLES. OUT-OF-POCKET EXPENSES. It may feel like you need to empty your savings account to stay healthy. You’re not alone: One in six Americans spends at least 10 percent of his or her annual income on prescriptions, premiums, and medical care.
Here, learn why you’re paying too much—and how you can put that money back in your own pocket.
1. Choose a plan carefully. When it comes time to re-enroll this year, don’t blindly check the box next to your current policy. Re-evaluate your plan annually to ensure it meets your current needs.
The first question you should ask is whether you have a favorite doctor or a medical condition that requires a specialist’s care. If you answered yes to either, your best bet may be one of the pricier preferredprovider organization (PPO) or pointof- service (POS) plans, which give you the freedom to visit any physician, says Lankford. Generally, an in-network doctor will charge $10 to $25 per visit; out-of-network M.D.’s bill you for 30 percent of their fees. But if you only see your physician a few times a year, a health-maintenance organization (HMO) may be a better fit. These offer a limited selection of doctors for cheaper premiums and co-pays.
If you’re self-employed or your employer doesn’t offer medical insurance, check out Web sites that offer price and coverage comparisons by state. Take into account your prescriptions, regular care needs, and mental health and vision expenses. Also consider if you’re planning on becoming pregnant within the year, because not all plans cover those costs.
2. Question your tests. Doctors aren’t necessarily aware of what screens and exams are covered by your insurance. To avoid pricey surprises, bring a list of approved labs to your first appointment with a new physician. Also check with your insurance provider before you schedule any treatments or tests, such as X-rays, MRIs, and breast ultrasounds; you may need to get written or verbal approval beforehand. Write down everyone you talk to and the time and date you spoke.
3. Bargain with your doctor. If you’re paying your bills out of pocket, don’t be shy or embarrassed to ask your doctor for a discount. Explain your situationand say you’re not in my network, but I wouldn’t trust anyone else to handle this. Is there any way you can adjust your fee for me? The key is establishing a personal relationship with your doctor and the staff.
4. Know what to do in an emergency. When a crisis occurs, hospital and doctors’ fees are probably the last thing you’re thinking about. That’s why it’s crucial to review your policy in advance. Check to see if you need preapproval before going to the emergency room and note which hospitals in your area are considered innetwork and what constitutes an emergency. You’ll protect yourself from an unexpected bill: Health insurance companies deny 20 percent of all emergency care payment requests that require prior authorization, according to a recent study published in the Annals of Emergency Medicine.
If it’s urgent, don’t hesitate to call an ambulance. But for non-life-threatening situations, such as a broken bone or a fever below 103°F (unless you have stomach pain, which could signal appendicitis), ask a friend or family member to give you a ride to the hospital.
5. Review your hospital bill. Experts estimate up to 90 percent of hospital bills contain errors. Before you check out, request an itemized bill. Each treatment you receive is assigned a numerical code. So somebody accidentally typing in the wrong code could mean a difference of hundreds or even thousands of dollars. Before leaving, scan your bill for any unusual charges. Then, at your next appointment, ask your physician or someone on her staff to go over anything you don’t recognize.
6. Be drugstore-savvy. You can save up to 30 percent on your prescription costs by going generic,. Ask your doctor if there’s a proven generic version of the medication she’s prescribing. They have the same quality and safety records as brand-name medicines. If there’s not one on the market yet, ask your M.D. if there’s a less expensive but equally effective alternative to the drug they’re prescribing. Even if your physician offers you free samples of a drug, still request the generic prescription: Once the complimentary packets run out, it’s likely you’ll have to fork over more money. In fact, a study from the University of Chicago found that patients who received at least one free sample of a brand-name drug spent 40 percent more for medication over six months than those who didn’t get them, possibly because they continued to buy the pricier pills.
7. Split your pills. Some drugs cost the same in high and low dosages. If you’re on medication, such as one for high cholesterol, ask your doctor if she can write you a prescription for a highdose pill you can cut in half at home.
8. Find a discount pharmacy. Big chains like Target and Wal-Mart sell some generic drugs, such as antibiotics and cholesterol-lowering pills, for as little as $4 for a 30-day supply. Costco also fills prescriptions at a discount (you don’t have to be a member to use their pharmacy). You might also ask your M.D. to write you a three-month prescription, then order it through an online pharmacy associated with your insurance plan or an independent one, such as walgreens.com , drugstore.com, or cvs.com. But be sure to comparison-shop: Researchers from the Creighton University School of Pharmacy found brand-name Rx’s are cheaper when purchased by mail, but generic drugs can actually cost more.
9. Take advantage of hidden perks in your plan. Your health insurance policy may cover all sorts of nontraditional services for free or at a discount. Check to see if yours offers discounts on or pays for smoking-cessation programs, weight-loss or nutrition counseling, or gym memberships. A handful of insurance companies, including Aetna and Kaiser Permanente, are also starting to cover alternative treatments, such as acupuncture, massage therapy, and chiropractic care.