Health insurance premiums and expenses are rising because medical costs are increasing. In the last few years, we’ve been experiencing surges in prescription drugs and hospital services. But it’s not just utilization driving up the price tag. Reduced competition (from mergers and acquisitions), lower government subsidies, and more administrative overhead all contribute.
The average annual cost has tripled in the last 20 years, far exceeding typical inflation. And incomes aren’t keeping up with these (and other) increasing costs. If you need a way to keep your medical expenses closer to budget, try out some of these tips.
1. Know What You Are Paying For
Most people have health insurance because it, in theory, reduces medical expenses. However, policies vary on which services they cover and which have fees. The single best way to keep your expenses low is to understand your plan.
To predict what your annual medical visit will actually cost, you need to comprehend the “Big Four” of your insurance policy:
- Deductibles are your first paywall. It’s the amount you need to pay before your insurance starts to cover costs. However, most policies will pay for all or part of certain services from day one (see more in the next section).
- Co-pays are the fixed, predetermined amounts you pay for a specific service, and they typically do not count toward your deductible since the policy already covers the remaining portion. Services that have co-pays are usually routine and low-cost. For example, it may cost you $50 to see your primary care physician (PCP).
- Co-insurance is splitting a percentage of the total cost of a bill with your insurer (and typically starts after you’ve met your deductible). These are typically for complex, high-cost services, such as hospital stays, surgeries, medical equipment, and advanced imaging. For instance, your policy may require you to pay 20% of your inpatient hospital stay.
- Out-of-pocket maximums are your safety net. It’s the most you will ever have to pay annually. Once you’ve spent this amount, your insurance company pays 100% of the costs.
2. Know What You Don’t Have to Pay For
Likewise, check out which services are completely covered. The Affordable Care Act (ACA) made certain preventive services free for those insured, meaning your insurance provider will pay all costs (no copay, coinsurance, or deductible) for these. The only catch is that you need to go to a provider who is in your network.
Medical services that are typically free:
- Annual wellness visits
- Screenings for chronic conditions, such as blood pressure, Type 2 diabetes, and cholesterol tests
- Cancer screenings, like mammograms (after the age of 40), colonoscopies (after 45), and cervical cancer swabs
- Essential vaccinations and immunizations, including flu shots, Tdap, and Hepatitis A and B
- Pediatric care (like wellness visits), which include growth tracking, developmental screenings, behavioral assessments, immunizations and vaccines, vision and hearing screenings, blood and lab work, and oral health
However, medical billing is complicated, so you need to be careful about getting a diagnostic code rather than a preventive code. So, if you go in for an annual visit but express a concern about a new lump, bump, or pain, your doctor may charge for the diagnosis rather than the routine preventive exam.
3. Getting the Cheapest Price By Going to the Right Place
Most people know that they need to go to an in-network provider to get the lowest cost. But when you’re sick or injured (and can’t wait for an appointment with your PCP), you might incur a higher-than-necessary bill for going to the wrong immediate provider.
Before going to the first physician who will see you, here are the three tiers to consider:
- The cheapest place to go for non-emergencies is your phone, and I don’t mean Googling your symptoms. Most modern insurance plans have 24/7 telehealth portals for non-emergencies, such as rashes, sinus infections, prescription refills, and mild flu symptoms. A telehealth visit may cost nothing or less than $50, and you don’t even have to leave your bed.
- When you need in-person treatment (such as for a broken bone, high fever, or animal bite), urgent care is far more affordable than the emergency room. Most insurance plans have a fixed co-pay for urgent care that is slightly higher than your primary care (as long as you stay in-network).
- The emergency room (ER) is the highest-cost setting because it is for life-threatening crises. The ER uses high-tech equipment and specialized trauma staff for issues like chest pain, uncontrollable bleeding, severe head injuries, and difficulty breathing. Insurance companies often consider ER visits as out-of-network.
4. Save on Prescription Drugs the Same Way You Save at the Grocery Store
Insurance companies charge prescription co-pays in tiers. Unsurprisingly, name-brand drugs cost more than generics. If there isn’t a generic version of your medication, visit the drug manufacturer’s website and look for a “co-pay savings card” to lower the cost. Also, check for manufacturer coupons.
Similar to shopping at Costco or Sam’s Club, buying in bulk can save you. Ask your doctor about writing your maintenance prescriptions (medication you take all the time) as a 90-day supply instead of 30. Many policies only charge double for a three-month supply, essentially giving you a buy two, get the third free deal.
Your co-pay fee may not be the best price. Platforms like GoodRx, Amazon Pharmacy, and TrumpRx may offer your medication at a lower fee. The catch is that, by not using your insurance, the amount you pay isn’t going toward your deductible.
5. Shop Around for Medical Tests
Facility fees started appearing around 25 years ago to cover the high overhead of hospital-based facilities. But they’ve shot up more than 530% since their origins, and they’re often still a surprise for some of us that were used to just getting one bill from our doctor.
So, if you need bloodwork, an MRI, a CAT scan, or the like, check out the total price at different locations. For instance, going to a LabCorp or Quest Diagnostics can be a third of the cost compared to a hospital lab. An independent imaging center may charge less than half for an MRI.
By Admin –
