Ten Ways to Control Your Healthcare Costs

One in five Americans is in a family having problems paying medical bills; one in four is in a family paying medical bills over time; and one in 10 is in a family that had medical bills they were unable to pay at all. One of the most important ways to prevent medical debt and protect your family’s financial health is to have an appropriate health insurance program and know how to use it. Here are some suggestions.

1. Keep your health insurance policy paid up. According to the Department of Health and Human Services, 19 to 50 percent of non-elderly Americans have some type of pre-existing health condition. The Affordable Care Act prohibits insurers from discriminating against people with pre-existing conditions, but that provision does not take effect for individuals over age 19 until January 1, 2014. Until then, if you have a pre-existing condition, insurers can deny coverage, charge you significantly higher premiums, subject your coverage to an extended waiting period or have your benefits curtailed.
   
   
2. “Self-insure” for minor and predictable health costs by raising your deductible. Your out-of-pocket expenses will increase, but your premiums will drop considerably. By saving the difference, you can build a reserve fund and use your insurance coverage for the catastrophic health expenses it is intended to cover.
   
   
3. Eliminate duplicate coverage. Under the Affordable Care Act, most health plans that cover children must make coverage available to children up to age 26 regardless of marital or student status, so consider your options carefully before buying a student group or individual policy for a college-aged child. Note: “grandfathered” group plans do not have to offer dependent coverage up to age 26 if a young adult is eligible for group coverage outside their parent’s plan.
   
   
   Likewise, if you have coverage under two plans, such as your own employer’s plan and a spouse’s plan or Medicare, consider whether you really need both. Most group policies and Medicare have coordination of benefits provisions, which prevent an insured from receiving more in benefits than the actual medical bill. (For more information on coordination of benefits, please see our February 2012 issue.)
   
   
4. Eliminate unneeded coverages. In some states, you might pay extra for certain coverages, such as maternity benefits or alcoholism/addiction treatments. If you don’t expect to use these coverages, eliminate them to save money.
   
   
5. Save on drugs. Ask your doctor if there are generic or over-the-counter alternatives to your prescription drugs. Many drugs formerly available only by prescription are available over-the-counter—and they have the advantage of being time-tested for effectiveness. Using generic drugs, which are chemically identical to their branded counterparts, saves consumers $8 to $10 billion a year at retail pharmacies, estimated the Congressional Budget Office. And if you regularly take a certain medication for a chronic condition, consider mail order prescription services, which often offer discounts of 10 to 20 percent or more off regular retail prices.
   
   
6. Use network providers. Most insurers require higher copayments and coinsurance amounts when you use out-of-network providers. Before using any non-emergency healthcare services, check whether the provider is a member of your plan’s network. This includes doctors, hospitals and other providers, such as imaging centers, outpatient surgical centers and urgent care clinics. 
   
   
7. Know your plan’s requirements for seeing a specialist. Many plans require insureds to get a referral from a primary care provider to see a specialist. If your plan requires a referral and you fail to get one, you may have to pay for a specialist’s care out of pocket.
   
   
8. Take advantage of preventive care services your plan covers. This includes vaccinations, screenings, mammograms, etc. Preventive care can help prevent small problems from becoming serious ones.
   
   
9. Evaluate elective treatments before consenting. If your doctor suggests a test or procedure, ask if it’s covered, if it’s necessary, how effective it is and what are possible outcomes if you decide not to proceed, along with itemized costs. If your insurance doesn’t cover it and you cannot afford it, ask about alternatives. 
   
   
10. Review medical bills and insurance payments carefully. Mistakes happen, so verify that you received the services billed. If you receive a bill for services your insurer should have covered, call the provider immediately to avoid having your case sent to collections.

Finally, the most cost-effective thing you can do to control healthcare costs is to take care of your health. The Centers for Disease Control says adopting healthy behaviors such as eating nutritious foods, being physically active, and avoiding tobacco use can prevent or control chronic diseases, which account for more than 75 percent of healthcare costs.

For more information on insuring your family, please contact us. 

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