Get discounts on prescriptions, negotiate with your doctor, bargain-shop for a health plan—and take more control over your family's medical bills.
Find the Best Plan
1. Shop for the Best Plan
When selecting a health plan, don't just choose the one with the lowest monthly premium or the one you used before. Benefits can change significantly every year—as can your family's health needs. The best way to bargain shop: Jot down your family's average number of doctor visits per year, routine prescriptions, dental cleanings, and other services. Compare what you'd pay over an entire year for these items on each plan. Don't forget to include monthly premiums and deductibles. “The most common mistake is buying insurance based on the lowest monthly premium,” says Sally Poblete, CEO of Wellthie, a healthcare technology company that helps people understand their health insurance options. “This works best for people with no medical issues. It is helpful to add up the monthly premium and deductible to evaluate the plans.”
2. Consider an HD Plan
If your family is healthy and doesn't visit the doctor too often, a high-deductible (HD) health plan can save you hundreds of dollars per month in lower premiums.
Another benefit: Most HD plans qualify you to open a health savings account (HSA), where you can sock away (on a pretax basis) money to pay your insurance premiums and out-of-pocket health expenses. Better yet, unused HSA money continues to grow tax-deferred, year after year. An HD plan might not be right for you, though, if family members have chronic (and costly) health conditions, you're not disciplined about saving money in your HSA, or if having such a high deductible makes you uneasy.
3. Join a Discount Club
If you don't have dental insurance, look into plans like AmeriPlan Careington International, or HealthInsurance.com's dental-discount cards. Participants in these plans agree to give members up to a 60 percent discount. You'll pay a monthly membership fee starting as low as $8.95, and you'll probably need to pay cash at the time of service. Check each plan's coverage in your area before you sign up—some regions have fewer participating providers than others.
4. Join the Farm Bureau
Believe it or not, you don't need to be a farmer to join your state's farm bureau. Simply by paying an annual membership fee (usually less than $50) you're eligible for all sorts of benefits -- including discounted group health insurance in some states. If you or your spouse are self-employed, this might work for you. For more information, type "farm bureau" and your state's name into your Internet search engine.
5. See if you have any subsidies available
Depending on your income level, the government may be able to pay a portion of your health insurance coverage under the Affordable Care Act. “While discussions in Washington continue regarding the Affordable Care Act, individuals and families can continue to purchase individual insurance starting next month—they can do so from Healthcare.gov, local broker, direct to the carrier, or through a number of online websites,” Poblete says. “Families who need financial assistance can continue to qualify for advanced premium tax credits and cost-sharing subsidies.”
Maximize Your Coverage
6. Take Advantage of Extras
Your health plan may offer valuable services you don't hear much about, so poke around its Web site to learn what's available, says reader Kimberly Hoody, of Phoenix. Some carriers, for example, have nurses on call 24/7. They can tell you how to safely remove a splinter or whether or not your child's cold symptoms warrant an immediate doctor visit (and another co-pay, ka-ching!). Some plans also offer discounts on acupuncture, gym memberships, massage treatments, and weight-loss programs.
7. Look for Special Services
Many health plans have programs for patients with ongoing conditions like asthma or allergies, including discounts on preventive care, helpful newsletters, and more. Reader Jaimee Starr's son Austin, has asthma and gets chronic bronchitis in the winter months. After talking with her health-plan representatives, the Springfield, Ohio, mom learned she could buy a home nebulizer from them for just $55 instead of renting one from her pharmacy for $180. Health-plan reps also steered her to a drugstore that offered lower prices on her son's asthma medication. See if your insurer offers advocate programs, like UnitedHealthcare’s Advocate4Me, to help you navigate your health insurance and get the treatment you need at a lower cost.
8. Flex Your Spending
If your employer offers a flexible spending account (FSA), you'd be nuts not to use it. FSAs are tax-sheltered accounts that you can use to pay for out-of-pocket medical costs such as office and prescription co-pays. Reader Lisa Chavez-Melo, a human-resources professional in Albuquerque, New Mexico, suggests "guesstimating" what you'll spend on medical expenses each year and putting about 20 percent less into your account so you don't have to worry about scrambling to find last-minute ways to spend it before it disappears. (FSAs are a "use it or lose it" plan and the money must be used within the year.) Some good ways to spend that last bit of FSA money: replacement glasses or contacts and dental cleanings.
9. Read Bills Carefully
Up to 50 percent of your doctor or hospital bills may contain mistakes that end up costing you money, says Jane Cooper, president of Patient Care, a consumer-advocacy group in Milwaukee. Something as simple as an incorrect billing code could prompt your insurance to pay less than expected or even reject your claim. Other common errors: mistakes in an account number, claims with incomplete information—even claims sent to the wrong insurance-company address by a doctor. Read your benefits booklet carefully to make sure your plan is paying all it should. If you catch an error, send a certified letter to your insurer. Follow up in a few weeks to make sure the mistake is corrected.
10. Don't Accept "No"
If your insurance company won't pay for a service you think you deserve, don't just give up. Appeal the decision. If you're denied again, contact your state insurance commission. That agency can mediate a dispute between you and your insurance company. If you win, you could save yourself hundreds, or even thousands, of dollars.
11. Remember to Network
When making an appointment, always double-check that the doctor is still in your insurance plan's network. (Many come and go.) And ask to see in-network providers when you go to the hospital or an urgent-care center. Just because a facility participates in your plan doesn't mean every professional (the nurse-practitioner or radiologist, for instance) does. Also, if you need to see a doctor when you're out of town, call your insurance provider's toll-free phone number to find out the best way to get services that will be covered.
12. Split the Cost
If you need extensive dental services, ask your dentist about starting the work in December and finishing it in January. Depending on your dental-plan benefits, you may get better coverage by splitting the cost of the treatment between the two plan years.
Discuss Options with Your Doctor
13. Have Your Doctor Help You
Get a copy of your insurance company's list of covered prescription medications (a "formulary") and share it with your doctor. Many insurers separate drugs into several pricing "tiers," so some medicines cost you more than others. If your doctor knows what's on your insurer's list, he can select the best medication for you at the lowest price. Also, if your plan requires you to get a referral to a specialist, take your insurance plan's preferred-provider list to your primary-care appointment. Your doctor can easily pick out the best specialist who participates in your plan.
14. Be Up Front About Finances
Are you short on cash? Do you have a high insurance deductible? Don't be embarrassed to tell your doctor or dentist. He may be able to suggest less-costly treatment options or even agree to lower fees. “Try to negotiate the fee you pay before or at the time you make your appointment and/or offer to pay cash,” suggests Ruth Linden of Tree of Life Health Advocates. “Some physicians will agree to accept a reduced rate, if you inform them you are experiencing difficult financial circumstances.” In fact, a Wall Street Journal/Harris Interactive poll found that three out of five people who negotiated with their doctors received discounts.
15. Slice Your Pills
Believe it or not, many high-dose prescription pills, from allergy meds to antidepressants, require exactly the same co-pay as their lower-dose counterparts. Ask your doctor whether you can safely split a higher-dosage pill in half, so you can cut your costs too. (You can't do this with controlled-release medications.)
16. Ask for Samples
Your doctor's cupboards are full of free drug samples, courtesy of the pharmaceutical industry. If your child is getting shots, ask for a trial-size pain reliever in case he needs it later. If you're trying a new antibiotic or rash cream, your physician may even have enough samples to cover your course of treatment. Also, check out the drug company's Web site, which sometimes offers coupons or free samples.
17. Look for Help to Lower Prescription Costs
“Find out if your medication is available through a patient assistance program (PAP),” Linden says. “PAPs help lower-income patients receive free or low-cost medication, even patients who may already have prescription drug coverage. Eligibility for a PAP may depend on several factors, including your income and the amount of your copay for the drug in question, if you have prescription drug coverage.”
Take Preventative Measures
18. Get Regular Checkups
Don't skimp on checkups! Under the Affordable Care Act, all preventative care visits are free, allowing you to keep tabs on your family’s health and potentially head off any underlying health issues. “Annual physical and annual OB-GYN checkups are included, and your annual mammograms too,” Poblete says. “For the kids, your annual checkups are all included in the plan with no additional out-of-pocket costs.”
19. Stay Up to Date on Vaccinations
Getting vaccines on time will also lower your child's risk of illness—and your risk of facing high medical bills.
20. Watch Your Head
Make sure you and your kids wear helmets when you ride a bike, a scooter, or a skateboard, since most serious injuries are the result of falls.
21. Get in a Lather
Americans plunk down big bucks every year on cold remedies and flu treatments when the best preventive medicine is plain old soap and water. Teach everyone in the family to scrub their hands for about 20 seconds before eating, after playing outside, or after being in contact with someone who's already sick.
22. Prevent Tooth Traumas
Starting around their first birthday, kids should get twice-yearly checkups from the dentist, says Keith Morley, DMD, president of the American Academy of Pediatric Dentistry. Preventive care nips problems in the bud before they become more costly. You should also talk to your dentist about getting sealants for your child's molars. (Sealants are a liquid plastic material applied to your child's back teeth to prevent them from decaying.) Many insurance companies cover the cost, but even if they don't, get them anyway: They'll probably save you money in the long run.
23. Steer Clear of the ER
Never use the emergency room as a substitute for your regular doctor. You'll pay much more, and you'll probably wait longer to be seen, says Parents advisor Alice Domar, PhD. If your child feels lousy on a Friday morning, make an appointment with the doctor for that day so you don't end up in the ER over the weekend.
If it’s not a life-threatening issue, an urgent care facility may also be able to help you at a reduced cost and wait time. "Check if your health insurance plan covers services at urgent care clinic," suggests Edgard Baquiero, a health insurance agent with Seguros B&C. "Those are great to receive care for non life-threatening conditions. And prices are a lot cheaper than the ones hospitals charge for emergency rooms."
24. Skimp on Supplements
Don't spend your hard-earned money on vitamins, mineral supplements, and herbs since there's not enough data to support their effectiveness, says Dr. Domar. Most vitamins and supplements will pass right through you, which means money down the toilet—literally! The notable exceptions: calcium and vitamin D supplements, which have been proven effective.
25. Pay Less for Prescriptions
Go generic, for starters. In almost every case, generics are just as good as name brands and are much cheaper, says Catherine Tom-Revzon, a pharmacist at The Children's Hospital at Montefiore, in New York City. Second, compare costs since prices vary significantly from store to store. Your best bet may be a warehouse club like Costco or Sam's Club. (You don't even need to be a member.) Another option: If your plan has a mail-order pharmacy, you might be able to get 90 days' worth of prescriptions mailed to you for two co-pays.
26. Keep an Eye on Discounts
Remember that you don't have to buy glasses or contact lenses from your optometrist or ophthalmologist. Federal law requires them to give you a copy of your prescription so you can buy lenses anywhere you like. Even if you don't have vision coverage, insurance providers may offer discounts on glasses or contact lenses. If not, look elsewhere: Some Automobile Association of America policies include eyewear discounts. Warehouse clubs and online retailers also offer deals.
27. Go to Dental School
If you need expensive dental care, consider a clinic at a local dental school. Well-supervised students staff these clinics and charge between 20 and 50 percent less than what you'd pay at a professional dental office—big bucks if you need a costly crown or implant. Search for dental-school programs in your area at ada.org.