Health insurance is a must-have (not to mention a legal requirement), but it doesn’t protect you fully from medical costs. The average employer plan has an individual deductible of $1,135, and the popular Silver plans sold on state marketplaces in 2014 had an average deductible of about $2,900. Here are nine ways to get the most value from the health care dollars you spend.
1. Don’t pay for care you don’t need.
An estimated 30 percent of our health care spending is unnecessary. Consumer Reports is partnering with a group of medical societies in a campaign called “Choosing Wisely” to let patients know what care they might not need. For instance, you rarely need an X-ray, CT scan, or MRI for uncomplicated headaches or back pain, or antibiotics for sinusitis. Unless you are at high risk for heart disease or have chest pain or other symptoms, electrocardiograms and stress tests are a waste of money. Watch the video above for more, and go to ConsumerReports.org/choosing-wisely.
2. Find out the price ahead of time.
Obviously this tactic works only for non-emergency situations. But did you know that the price of a routine MRI might vary four-fold among imaging centers that participate in your health plan? Or that an elective hip replacement might cost twice as much at one hospital as at another of equal quality? Most insurers allow you to look up at least some negotiated prices for treatments or tests by registering on their website. Take advantage of that service and save.
3. Mind tiers to avoid tears.
A growing number of health plans feature tiered provider networks. If you go to a doctor or hospital in the lowest tier, you’ll pay less out of pocket than for a provider in a higher tier. Likewise, a plan’s list of covered drugs usually features three or even four tiers. Whenever possible, select a drug in the lowest available tier. If your doctor prescribes a drug in a higher tier, ask whether he or she can substitute another medication from the same class in a lower tier.
4. Stay in network.
Even if you have a plan that allows you to use nonparticipating doctors and hospitals, try not to. Not only will you be reimbursed a smaller percentage, but even worse, the plan will most likely base its reimbursement on what it considers a fair price for the service. If the provider charges more, which happens frequently, you’ll be liable for the balance of the bill. If you must go out of network, use HealthcareBlueBook.com to look up what is a reasonable fee for the service and ask the provider to agree to it ahead of time. You can even download a contract for the two of you to sign.
5. Compare prices for generics.
With insurance drug co-pays on the rise, you may actually be better off paying cash for certain generic drugs. Last year our secret shoppers paid $4 for a month’s prescription for lovastatin through generic drug discount programs at Sam’s Club, Target, and Walmart, compared with a generic drug co-pay of $10 for the average employer plan.
6. Substitute an OTC drug for the prescription version.
This won’t work for all types of drugs, but when it does, it can save you big. If you have heartburn, substituting the equally safe and effective over-the-counter generic omeprazole (Prilosec) for prescription esomeprazole (Nexium) will save you more than $200 per month. Save more than $100 per month by substituting generic OTC loratidine (Claritin) for levocetirizine (Xyzal), and more than $175 by substituting OTC generic naproxen (Aleve) for celecoxib (Celebrex).
7. Put money into your Health Spending Account.
About 20 percent of people with employer group insurance are in high-deductible health plans that come with Health Spending Accounts (HSAs). You can buy HSA-eligible high-deductible plans in state insurance marketplaces as well. Contributions to HSAs are tax-deductible or even tax-exempt for most employer-sponsored plans, and you can withdraw money tax-free if you spend it on qualified medical expenses such as deductibles, co-pays, hearing aids, and eyeglasses. Best, money in an HSA is yours to keep forever. It’s a great deal, but only if you put money in the account in the first place.
8. Front-load your FSA spending.
Many employers offer flexible-spending accounts (FSAs) to which you can contribute up to $2,500 per year through pre-tax payroll deductions to spend on qualified medical expenses. The great thing about FSAs is that you can spend your entire projected annual contribution right away, even before you’ve put all of the money in, and you won’t have to pay it back if you leave your job before year’s end. But don’t put in more than you can spend in a year (some employers provide a grace period of a few months into the following year) because you’ll forfeit anything that’s left over.
9. Work your deductible.
Deductibles reset annually, which means that you’ll be paying more out of pocket for services subject to the deductible early in the year than later on. If it’s getting toward the end of your plan year and you’ve met your deductible, try to schedule elective tests and procedures before the plan rolls over into a new year and the deductible resets.