No matter what happens to the Affordable Care Act,聽one health care trend is fairly certain to continue: A growing number of you will have high-deductible health plans, whether you鈥檙e insured through your employer or buy on the private market.
A is just what it sounds like: In exchange for a lower premium, you pay more of your own money for medical care until your insurance coverage kicks in.
The a high-deductible plan as one with a deductible of at least $1,300 a year for an individual or $2,600 for a family.
Many deductibles are higher. For instance, , California’s health insurance exchange, offers bronze-level plans this year with a $6,300 individual and $12,600 family deductible, plus a separate deductible for prescription medications.
How many of you have that kind of money lying around?
Ask EmilyThe most important thing you can do to lower your costs is to choose the right plan for yourself and your family during open enrollment (assuming you have a choice).
鈥淎 high-deductible plan will work better for younger, healthier people who don鈥檛 expect to have a lot of medical expenses,鈥 says Walter Zelman, a health policy professor at California State University-Los Angeles. 鈥淚f you know you鈥檙e going to use a reasonable amount of health care in a given year, the high-deductible plan is to be avoided.鈥
But since most of you are stuck with your plans until the next open enrollment period, here are some simple steps you can take now to control costs.
The Basics
Under the Affordable Care Act, most health plans must offer , including mammograms, colonoscopies and routine vaccinations.
Taking advantage of them can prevent more expensive coverage down the line, says Elizabeth Abbott, director of California鈥檚 .
鈥淕et your flu shot,鈥 she says. 鈥淚f you keep up with all of your preventive services, you will save yourselves a fair amount of money because you鈥檙e less likely to get sick and won鈥檛 have to get invasive procedures.鈥
No matter what kind of appointment or procedure you鈥檙e scheduling, choose in-network providers whenever possible, says , special projects director for Consumers Union. 鈥淚f you stay in network, your costs are going to be lower,鈥 she says.
Cross-check with both your provider and your insurer to confirm network status.
And don鈥檛 forget 鈥 as聽I often do 鈥 that you may be able to avoid a doctor鈥檚 visit by calling your insurance company鈥檚 nurse advice line, Zelman says.
Prescription Drugs
Unless you take only specialty drugs to treat serious or rare conditions, these steps can probably save you money:
鈥 Over-the-counter and generic drugs: If your doctor prescribes a brand-name drug, ask if there鈥檚 an over-the-counter or generic option you can try first. Generics cost a fraction of the brand-name version, says , assistant clinical professor聽for the Department of Pharmacy Practice at University of the Pacific in Stockton, Calif.
鈥 Shop around: Many pharmacies (both chains and independents) offer discount programs for common generic drugs, charging $4 for a 30-day supply and $10 for a 90-day supply.
Don鈥檛 be afraid to switch pharmacies or buy drugs from different places, Abbott says.聽鈥淚f you鈥檙e taking five drugs, price those all out,鈥 she says. 鈥淒on鈥檛 assume a particular pharmacy offers the best price for every drug.鈥
Consumers Union generally finds the best drug prices at Costco or by using聽鈥檚 online search tool, Imholz says.
鈥 Patient-assistance programs: Ask your pharmacist or doctor if they know of programs that can help you afford your prescription.
Groups such as the 听补苍诲 聽also have compiled links to organizations 鈥 and even drug companies 鈥 that provide financial aid.
鈥 Shorter initial prescription: If your doctor prescribes a pricey drug you haven鈥檛 taken before, ask her to write the prescription for a few days or a week and monitor the results, Collum suggests.
If the drug works for you, request a new prescription for a longer period. If it鈥檚 ineffective, at least you won鈥檛 be out for the cost of a full month of medication.
Comparison Shopping
Most of us wouldn鈥檛 buy a car or plane tickets without comparison shopping. So why not shop around for medical care, whose prices can vary wildly from provider to provider?
You could hundreds or thousands of dollars.
First, ask your doctor for the specific medical code, called a , for the procedure or test that you need, says Jeanne Pinder, CEO of , which aims to make medical prices more transparent.
Simply asking about the cost of a lower-back MRI won鈥檛 be sufficient. 鈥淵ou鈥檒l want to call and say 鈥楬ow much does an MRI of the lower back, without contrast, CPT code 72148, cost?鈥欌 she says.
Armed with the code, reach out to different providers and your insurance company. Ask both how much the procedure would cost you, and whether the provider is in your plan鈥檚 network.
Along the way, consider bypassing your insurance for a particular treatment or prescription.
鈥淵ou might be better off, as an insured person, paying cash,鈥 Pinder says. 鈥淢any people don鈥檛 reach their deductible by the end of the year, anyway.鈥
If you go this route, don鈥檛 call your insurance plan. Just call providers (who don鈥檛 have to be in your network) and ask them 鈥淗ow much will this cost me?鈥 and 鈥淲hat鈥檚 your cash price?鈥 .
If the provider asks whether you have insurance, repeat that you want to be a cash customer.
鈥淛ust keep saying, 鈥業鈥檓 looking for the cash price. I鈥檓 a cash customer.鈥 If they ask if you have insurance, repeat that you鈥檇 like to pay cash,鈥 Pinder says.
Take detailed notes, including the name of the person who gives you the quote, Pinder adds. Better yet, get it in writing.
Pinder took her own advice recently when a family member needed an MRI, which can cost thousands of dollars. She found one for $450 cash.
鈥淲e need to get used to having this conversation and asking those questions in that fashion,鈥 she says. 鈥淏y the time you start doing it, it doesn鈥檛 hurt anymore.鈥
This story was produced by , which publishes , an editorially independent service of the .
