This story was produced in collaboration with

Parents, mark your calendars. Starting Sept. 23, adult children will no longer be left to fend for themselves in their search for health insurance. The new federal health law requires that insurers give parents the option of  covered until they’re 26 years old.ÌýIt becomes effective for the health policy at the beginning of the plan year.Ìý 

New individual and group health plans that provide family benefits are required to extend coverage to young adult children, including those who had previously fallen off their parents’ plans. However, if a child has an offer of insurance through a job, some group plans that were in existence when the law was enacted on March 23 the young adults from their parents’ coverage. That exemption expires in 2014.

Married children and financially independent children are eligible for the coverage, but their spouses or children are not.

About 30 percent of young adults do not have health insurance, according to the Department of Health and Human Services. HHS that the new law could provide coverage to about 1.2 million people ages of 19 to 25 who are currently uninsured.

Cost and access are a problem for many of these people. Only 25 percent of young adults are offered insurance through their employers, says Aaron Smith, co-founder of Young Invincibles, a national organization representing the interests of 18-34 year-olds. The organization provides information on this provision at .

Some questions and answers about the change:

Will my benefits change if I add my adult child to my plan? 

The majority of employees won’t see significant changes to their benefits packages, according to Steve Raetzman, a partner in consulting firm Mercer’s health and benefits consulting practice. However, some employers are expected to alter the way they share costs with employees as a direct response to this provision.

What’s the likely charge for adding an adult child?

That will vary. But under the new law, young adults cannot be charged more than any other dependent. In a recent Mercer of nearly 800 employers, 20 percent said they’ll account for any additional costs by offering four or more rates based on how many dependents an employee chooses to cover, instead of the traditional two-tiered rates for employee-only and family coverage. Under such a system, someone covering three children would likely pay more than a co-worker covering only two. Sixteen percent of employers surveyed said they plan to simply raise employee contributions for all dependents.

Does the change apply to all health care benefits?

No. It’s important to note, Raetzman says, that the new law covers medical benefits and that coverage for other care, such as dental and vision, may not apply. “You have to look closely for the eligibility of each benefit,” Raetzman says. “The official source of what you are entitled to is your employer’s plan.” 

What about pre-existing conditions?

Although the new health law prohibits insurers from denying coverage for children under the age of 19 who have pre-existing conditions, that doesn’t apply to young adult children applying for coverage in the individual insurance market. They can be denied coverage because of existing medical conditions or disabilities that require ongoing medical care, says Carrie McLean, consumer specialist at online broker .Ìý

“People automatically assume insurance companies have to allow children back on their plan until age 26. They’ll allow them back on the plan only if they can pass medical underwriting,” McLean says. During medical underwriting, insurers review age, gender and health history before offering coverage. That exemption also expires in 2014.

Some young adults joining their parents’ employer-sponsored health plans can face a pre-existing condition exclusion for up to 12 months in which care for the existing illness is not covered. The rules vary by state. Once the exclusion period expires, the young adult will be covered for the illness.Ìý

Can I find a better deal for my child if I decide to go outside my employer plan and get my adult child an individual policy?

If the cost of adding an adult child to your employer-based health plan seems high, parents can also explore options on the individual market.

EHealthInsurance evaluated more than 288,000 individual health insurance policies sold to consumers ages 18 to 24 and found that the average national monthly premium as of last February was $109 with a $2,651 deductible.

Parents who buy their family’s insurance on the individual market also may save money on their adult child’s coverage by purchasing a different plan tailored to that individual child’s needs instead of adding him or her to the family plan, McLean says.

How do I sign my child up?

Insurers and employers are required by law to notify consumers about a special 30-day dependent open-enrollment period. It must begin no later than the first day of the plan year that starts after Sept. 23.ÌýMany employers will simply fold this into their annual open-enrollment period beginning in late fall for a benefit year that starts on Jan. 1, 2011.

Are there other dates to watch for?

July 1 is the second most common benefit start date, according to Raetzman. But a company can begin its plan year at any time, so it’s critical to check with your employer about when your child will be eligible for coverage.

In the individual market, the majority of policies start on Oct. 1. You’ll need to contact your insurer or agent to fill out the necessary forms.

This <a target="_blank" href="/insurance/under-26-young-adult-health-insurance/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

This story was produced in collaboration with the 

Looking to save money on healthcare? Consider asking your doctor for a discount.

That’s what Shelly Gordon of Palo Alto did. Gordon, who has a Blue Cross health plan with a $5,000 deductible and a $500 monthly premium, buys her own insurance since starting her own public relations and communications firm. When she had her annual checkup, she learned that it came with a $350 price tag.

Gordon explained to the doctor that her insurance would not pick up any of the expense because she had not yet met her deductible and that the payment would be a financial struggle for her. So the doctor removed a few routine tests from the bill, saving Gordon about $125.

“I asked the doctor directly for a discount and she agreed,” says Gordon, 57. “Given what I was paying and how ridiculous it was, I just got in the habit of asking all my doctors.”

Gordon’s situation is far from unique. As monthly insurance premiums, deductibles and co-payments increase, even people with insurance can have trouble paying their out-of-pocket medical expenses.

Rising premiums also have prompted more people to choose high-deductible plans that require payments of about $1,200 or more before insurance will cover a dime for medical care. Employers too are turning to this option for workers. According to a recent health insurance from the federal Centers for Disease Control and Prevention, about 20 percent of Americans with employer-provided coverage and 47 percent of those with individual coverage were enrolled in a high-deductible plan in 2009.

“It’s very difficult for consumers to control their healthcare costs,” says Betsy Imholz, director of special projects with Consumers Union. “But that’s not to say it’s not worth trying.”

Adds Carrie McLean, a consumer specialist with the online insurance broker eHealthInsurance.com: “Do your homework and negotiate upfront It’s better than trying to do it once it’s already happened.”

Here are some tips to help get the best price on medical services:

Understand Treatments

“The best way to save money is to avoid care you don’t need,” says Dr. Jeffrey Rice, founder of the , an online consumer guide to fair healthcare prices.

Researchers with the Dartmouth Atlas Project have found that as much as 30 percent of healthcare is unnecessary. Such unneeded care is caused by many factors, Imholz says. “It could be duplicative things, like two mammograms because you got referred to another place that did it again because they didn’t have the first mammogram readily available. Or it could be an intervention you didn’t need and would have been better off without. The problem is we’re not used to thinking that with healthcare less can be more.”

Candice Butcher, chief executive of , advises patients to ask their doctors precisely what is involved in the procedure, what it will be used for and if there are options. She also recommends getting a second opinion about the need for the treatment.

Although that can add some initial cost, it may save you more overall.

Find The Best Price

Ask your doctor, hospital or other provider up front how much you’ll be charged for the medical service you need. Prices vary greatly among healthcare providers. A recent survey-of-charges by the insurance industry trade group America’s Health Insurance Plans found that some doctors charged patients who did not have insurance as much as 1,000 percent more than the Medicare reimbursement rate for the same procedure.

When negotiating for a better price, remember: Cash is king. “Some providers will give anywhere from 10 percent to 60 percent off for paying cash,” McLean says. “It saves them time in having to bill you or set up a payment plan.”

For those staying within an insurance network, it is also important to ask the doctor or hospital about price. Insurers have a separate contract with each provider in their network that establishes how much they’ll pay for medical services. Providers with stronger negotiating power tend to be paid more than others for the same medical procedure. If you are picking up a share of the cost for the visit or procedure, finding the facility that gives your insurer the best price will save you money.

“Even people with managed-care plans who understand that it’s cheapest to see a doctor or have surgery at a hospital that is in their insurer’s network don’t often realize that even in-network prices can vary by as much as 500 percent,” Rice says.

Also, if you have insurance but the procedure is not covered by your policy, ask the medical center to give you the same discount it gives to your insurance carrier.

Be Careful About Location

Setting makes a big difference too.

“If your doctor sends you to the hospital for imaging or labs, you’ll pay significantly more on average,” says Rice, pointing out that freestanding ambulatory centers and doctor’s offices are typically less expensive.

To make sure you’re comparing like services, ask your provider for the CPT code, or common procedural terminology. These codes are assigned to every medical service and procedure and are used by healthcare providers to bill insurers. Call your insurance company to find out how much they reimburse and what you’ll be responsible for paying yourself.

Also, you can look at a federal for a tool that compares hospitals. Among the listings there is data on what Medicare pays individual hospitals for some common procedures. This can be a helpful guide for non-Medicare consumers, but they should expect to pay about 25 percent above the Medicare payment.

Get It In Writing

After you’ve reached an agreement with your doctor or medical facility, get that price in writing.

“Most provider organizations don’t do their own billing; it goes to a billing company. If they agree to a discount in the doctor’s office and there is staff turnover, the information may not get to the billing department or they may not remember,” Rice says.

Butcher suggests consumers write that they “agree to pay fair and reasonable costs, and for compliant billing,” in the financial responsibility section on hospital admitting forms. This can help to deter hospitals from engaging in unfair billing practices, such as charging for items such as sutures and cotton balls that should be included in the price of the hospital room. “Put your initials [next to the statement] and have the administrative personnel sign and date it as well,” she says.

Having this kind of documentation, Butcher says, will make it easier to fight any unfair charges after you’ve left the hospital.

This <a target="_blank" href="/insurance/doctor-discounts-patients/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

This story was produced in collaboration with

Parents, mark your calendars. Starting Sept. 23, adult children will no longer be left to fend for themselves in their search for health insurance. The new federal health law requires that insurers give parents the option of  covered until they’re 26 years old.ÌýIt becomes effective for the health policy at the beginning of the plan year.Ìý 

New individual and group health plans that provide family benefits are required to extend coverage to young adult children, including those who had previously fallen off their parents’ plans. However, if a child has an offer of insurance through a job, some group plans that were in existence when the law was enacted on March 23 the young adults from their parents’ coverage. That exemption expires in 2014.

Married children and financially independent children are eligible for the coverage, but their spouses or children are not.

About 30 percent of young adults do not have health insurance, according to the Department of Health and Human Services. HHS that the new law could provide coverage to about 1.2 million people ages of 19 to 25 who are currently uninsured.

Cost and access are a problem for many of these people. Only 25 percent of young adults are offered insurance through their employers, says Aaron Smith, co-founder of Young Invincibles, a national organization representing the interests of 18-34 year-olds. The organization provides information on this provision at .

Some questions and answers about the change:

Will my benefits change if I add my adult child to my plan? 

The majority of employees won’t see significant changes to their benefits packages, according to Steve Raetzman, a partner in consulting firm Mercer’s health and benefits consulting practice. However, some employers are expected to alter the way they share costs with employees as a direct response to this provision.

What’s the likely charge for adding an adult child?

That will vary. But under the new law, young adults cannot be charged more than any other dependent. In a recent Mercer of nearly 800 employers, 20 percent said they’ll account for any additional costs by offering four or more rates based on how many dependents an employee chooses to cover, instead of the traditional two-tiered rates for employee-only and family coverage. Under such a system, someone covering three children would likely pay more than a co-worker covering only two. Sixteen percent of employers surveyed said they plan to simply raise employee contributions for all dependents.

Does the change apply to all health care benefits?

No. It’s important to note, Raetzman says, that the new law covers medical benefits and that coverage for other care, such as dental and vision, may not apply. “You have to look closely for the eligibility of each benefit,” Raetzman says. “The official source of what you are entitled to is your employer’s plan.” 

What about pre-existing conditions?

Although the new health law prohibits insurers from denying coverage for children under the age of 19 who have pre-existing conditions, that doesn’t apply to young adult children applying for coverage in the individual insurance market. They can be denied coverage because of existing medical conditions or disabilities that require ongoing medical care, says Carrie McLean, consumer specialist at online broker .Ìý

“People automatically assume insurance companies have to allow children back on their plan until age 26. They’ll allow them back on the plan only if they can pass medical underwriting,” McLean says. During medical underwriting, insurers review age, gender and health history before offering coverage. That exemption also expires in 2014.

Some young adults joining their parents’ employer-sponsored health plans can face a pre-existing condition exclusion for up to 12 months in which care for the existing illness is not covered. The rules vary by state. Once the exclusion period expires, the young adult will be covered for the illness.Ìý

Can I find a better deal for my child if I decide to go outside my employer plan and get my adult child an individual policy?

If the cost of adding an adult child to your employer-based health plan seems high, parents can also explore options on the individual market.

EHealthInsurance evaluated more than 288,000 individual health insurance policies sold to consumers ages 18 to 24 and found that the average national monthly premium as of last February was $109 with a $2,651 deductible.

Parents who buy their family’s insurance on the individual market also may save money on their adult child’s coverage by purchasing a different plan tailored to that individual child’s needs instead of adding him or her to the family plan, McLean says.

How do I sign my child up?

Insurers and employers are required by law to notify consumers about a special 30-day dependent open-enrollment period. It must begin no later than the first day of the plan year that starts after Sept. 23.ÌýMany employers will simply fold this into their annual open-enrollment period beginning in late fall for a benefit year that starts on Jan. 1, 2011.

Are there other dates to watch for?

July 1 is the second most common benefit start date, according to Raetzman. But a company can begin its plan year at any time, so it’s critical to check with your employer about when your child will be eligible for coverage.

In the individual market, the majority of policies start on Oct. 1. You’ll need to contact your insurer or agent to fill out the necessary forms.

This <a target="_blank" href="/insurance/under-26-young-adult-health-insurance/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

This story was produced in collaboration with the 

Looking to save money on healthcare? Consider asking your doctor for a discount.

That’s what Shelly Gordon of Palo Alto did. Gordon, who has a Blue Cross health plan with a $5,000 deductible and a $500 monthly premium, buys her own insurance since starting her own public relations and communications firm. When she had her annual checkup, she learned that it came with a $350 price tag.

Gordon explained to the doctor that her insurance would not pick up any of the expense because she had not yet met her deductible and that the payment would be a financial struggle for her. So the doctor removed a few routine tests from the bill, saving Gordon about $125.

“I asked the doctor directly for a discount and she agreed,” says Gordon, 57. “Given what I was paying and how ridiculous it was, I just got in the habit of asking all my doctors.”

Gordon’s situation is far from unique. As monthly insurance premiums, deductibles and co-payments increase, even people with insurance can have trouble paying their out-of-pocket medical expenses.

Rising premiums also have prompted more people to choose high-deductible plans that require payments of about $1,200 or more before insurance will cover a dime for medical care. Employers too are turning to this option for workers. According to a recent health insurance from the federal Centers for Disease Control and Prevention, about 20 percent of Americans with employer-provided coverage and 47 percent of those with individual coverage were enrolled in a high-deductible plan in 2009.

“It’s very difficult for consumers to control their healthcare costs,” says Betsy Imholz, director of special projects with Consumers Union. “But that’s not to say it’s not worth trying.”

Adds Carrie McLean, a consumer specialist with the online insurance broker eHealthInsurance.com: “Do your homework and negotiate upfront It’s better than trying to do it once it’s already happened.”

Here are some tips to help get the best price on medical services:

Understand Treatments

“The best way to save money is to avoid care you don’t need,” says Dr. Jeffrey Rice, founder of the , an online consumer guide to fair healthcare prices.

Researchers with the Dartmouth Atlas Project have found that as much as 30 percent of healthcare is unnecessary. Such unneeded care is caused by many factors, Imholz says. “It could be duplicative things, like two mammograms because you got referred to another place that did it again because they didn’t have the first mammogram readily available. Or it could be an intervention you didn’t need and would have been better off without. The problem is we’re not used to thinking that with healthcare less can be more.”

Candice Butcher, chief executive of , advises patients to ask their doctors precisely what is involved in the procedure, what it will be used for and if there are options. She also recommends getting a second opinion about the need for the treatment.

Although that can add some initial cost, it may save you more overall.

Find The Best Price

Ask your doctor, hospital or other provider up front how much you’ll be charged for the medical service you need. Prices vary greatly among healthcare providers. A recent survey-of-charges by the insurance industry trade group America’s Health Insurance Plans found that some doctors charged patients who did not have insurance as much as 1,000 percent more than the Medicare reimbursement rate for the same procedure.

When negotiating for a better price, remember: Cash is king. “Some providers will give anywhere from 10 percent to 60 percent off for paying cash,” McLean says. “It saves them time in having to bill you or set up a payment plan.”

For those staying within an insurance network, it is also important to ask the doctor or hospital about price. Insurers have a separate contract with each provider in their network that establishes how much they’ll pay for medical services. Providers with stronger negotiating power tend to be paid more than others for the same medical procedure. If you are picking up a share of the cost for the visit or procedure, finding the facility that gives your insurer the best price will save you money.

“Even people with managed-care plans who understand that it’s cheapest to see a doctor or have surgery at a hospital that is in their insurer’s network don’t often realize that even in-network prices can vary by as much as 500 percent,” Rice says.

Also, if you have insurance but the procedure is not covered by your policy, ask the medical center to give you the same discount it gives to your insurance carrier.

Be Careful About Location

Setting makes a big difference too.

“If your doctor sends you to the hospital for imaging or labs, you’ll pay significantly more on average,” says Rice, pointing out that freestanding ambulatory centers and doctor’s offices are typically less expensive.

To make sure you’re comparing like services, ask your provider for the CPT code, or common procedural terminology. These codes are assigned to every medical service and procedure and are used by healthcare providers to bill insurers. Call your insurance company to find out how much they reimburse and what you’ll be responsible for paying yourself.

Also, you can look at a federal for a tool that compares hospitals. Among the listings there is data on what Medicare pays individual hospitals for some common procedures. This can be a helpful guide for non-Medicare consumers, but they should expect to pay about 25 percent above the Medicare payment.

Get It In Writing

After you’ve reached an agreement with your doctor or medical facility, get that price in writing.

“Most provider organizations don’t do their own billing; it goes to a billing company. If they agree to a discount in the doctor’s office and there is staff turnover, the information may not get to the billing department or they may not remember,” Rice says.

Butcher suggests consumers write that they “agree to pay fair and reasonable costs, and for compliant billing,” in the financial responsibility section on hospital admitting forms. This can help to deter hospitals from engaging in unfair billing practices, such as charging for items such as sutures and cotton balls that should be included in the price of the hospital room. “Put your initials [next to the statement] and have the administrative personnel sign and date it as well,” she says.

Having this kind of documentation, Butcher says, will make it easier to fight any unfair charges after you’ve left the hospital.

This <a target="_blank" href="/insurance/doctor-discounts-patients/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">