How to Cut Your Health-Care Costs
Avery Johnson
For many Americans, the health-care news this year is more of the same: rising insurance premiums—and for some, reduced coverage—at a time of continued economic malaise.
Health care remains one of the largest line items in any family’s budget, and finding ways to save is more important than ever. But people out of work are learning that coverage sold on the so-called individual market is typically not as robust as their work-based insurance was. And those still covered through employers are seeing more high-deductible plans, according to a November survey from human-resource consultant Mercer.
Whatever your situation, here are seven tips to help you save on medications, health insurance, doctors’ bills and more.
1. Understand New Legislation
Many people think that the Affordable Care Act doesn’t take effect until 2014, but that’s not entirely true. For instance, the law already allows young adults to stay on their parents’ policies until age 26. While this might mean more in premiums for a family, it could cut down on costs should your recent college graduate need care.
Insurer rebates are a possibility for some as well. The law requires that 80% of the premiums insurers collect from individuals be spent on health-care costs. If that threshold isn’t met, the insurer has to send its customers rebates.
Rebate checks are expected to start coming to customers this summer, according to the Department of Health and Human Services. The department says consumers will be able to see if insurers owe rebates at www.healthcare.gov, a government website about the health-care law and insurance.
2. Use Preventive Services
Under the new law, many plans are required to cover preventive care without cost sharing such as co-pay or deductible requirement. Mammograms, well-baby visits, breast-feeding support and immunizations are covered, among other things.
“Use it so you save money in the long run,” advises Cheryl Fish-Parcham, deputy director of health policy at Families USA, a health-care consumer group based in Washington, D.C.
Plans designed before 2010 aren’t required to comply with all of the new rules. But follow up with your provider if you think a bill is not right.
“Mistakes happen all the time, and if you just say ‘Oh well,’ you could owe a lot of money,” says Karen Pollitz, senior fellow at the Kaiser Family Foundation.
3. Get Consumer Assistance
The health law funds new programs that help consumers resolve disputes and find information about insurance.
Healthcare.gov lists programs and resources available state by state. “These are a big help when you have hassles,” says Ms. Pollitz, who says you can also call your state’s insurance department or attorney general’s office.
If you are seeking coverage, healthcare.gov has a plan finder where you can browse available options. The site also reports on health plans that have requested premium increases and why. Starting in September, it plans to offer a summary of plan benefits and coverage for various scenarios.
4. Look for Cheaper Drugs
A number of big-name branded drugs lost patent protection in 2011, including Lipitor,Pfizer Inc.’s bestselling cholesterol drug. Until the end of May, Lipitor is being sold by Pfizer and two generics makers. After that, other generics companies will flood the market, driving the price down further, according to Pfizer.
For people who want to continue taking branded Lipitor, Pfizer is working with some health plans and pharmacy benefits managers to offer the drug at the generic price, sometimes resulting in an average co-pay of $10, down from around $25 before the patent expired, says a company spokesman.
Whether you choose a generic or brand medicine, it makes sense to find out how your pharmacy benefits work and to choose drugs at the lowest price possible. Tracy Watts, a partner in the health-benefits practice at Mercer, says if your doctor prescribes a medication that your plan doesn’t have at a preferred price, ask the doctor if there is an equivalent medicine for less.
If you are a senior on Medicare, you can count on a 50% discount on brand-name drugs and a 14% price cut on generics if you find yourself in the so-called doughnut hole—when the cost of a medicine exceeds the initial coverage limit but isn’t high enough to qualify for catastrophic coverage.
5. Be Smart About High-Deductible Plans
Plans that offer you a reduced premium in exchange for higher initial out-of- pocket expenses are on the rise. Often these are paired with a tax-preferred savings account or linked to preventive-care programs.
“I’m increasingly convinced that until 2014 a high-deductible plan is the only way to safely save money on premiums,” says Nancy Metcalf, senior program editor at Consumer Reports. Ms. Metcalf adds that these make sense financially because they still typically cover 100% of costs should something catastrophic occur, and don’t cost as much in premiums. The downside: You’re on the hook for your initial health spending until you hit the deductible, at which point the plan picks up the rest.
The Mercer survey found that 32% of large employers last year offered a consumer-directed high-deductible health plan, up from 23% the year before— the biggest such increase the firm had ever recorded.
Take advantage of wellness programs and incentives your employer offers that encourage preventive care. If you get a break on premiums for participating in a health-risk assessment, do it, says Ms. Watts. “That gives you free money, and good information on your health,” she says.
A few caveats: Make sure you can actually afford a high deductible. And before switching plans, make sure your doctor participates.
6. Stay in Network
“Stay in network whenever possible,” says Ms. Pollitz.
In-network doctors and hospitals contract with the insurance company for a reasonable agreed-upon amount; out-of-network providers don’t have to put a limit on what is “reasonable,” she says.
One exception: Insurers are required to cover emergency services whether the hospital you are taken to is in network or not. That’s a health-law provision, but, as with all these new rules, sometimes it takes following through if you get a bill that you think is wrong.
Another thing to check out is whether all the health-care providers you will be seeing during a hospital stay are covered by your plan’s network. Often hospitalizations include nurses, anesthesiologists and even doctors you may never see in person. It pays to check out in advance if they are in network, and to challenge bills you get from them if they are not.
7. Challenge Doctors and Insurers
Ask your doctor why a test is necessary, whether you can wait to have the procedure, and if treatment will change depending on the results, says Consumer Reports’ Ms. Metcalf.
She points to EKGs, bone-density scans for osteoporosis and MRIs for back pain as a few big-ticket tests that not everyone needs.
If you talk to your doctor ahead of time about costs and explain that a procedure is more than you can afford, the physician can often modify treatment, says Ms. Fish-Parcham of Families USA, the health-care consumer group.Don’t be docile about billing, either. In the event that a doctor sends you a bill that you think your plan should have paid, make calls to the insurer and your doctor. Have an upfront conversation with the doctor’s office.
“If you get a bill, call them immediately and say ‘I’ve got an issue with my health plan and I’m working on it,’” says Ms. Pollitz. “That’s important because medical bills that aren’t paid promptly go straight to collections.”
From The Wall Street Journal
http://online.wsj.com/article/SB10001424052970203646004577215394166155830.html?mod=googlenews_wsj
Posted: 3/12/2012
