March 12, 2012
Health care remains one of the largest line items in any family’s budget, and finding ways to save is more important than ever. But people out of work are learning that coverage sold on the so-called individual market is typically not as robust as their work-based insurance was. And those still covered through employers are seeing more high-deductible plans, according to a November survey from human-resource consultant Mercer.
Whatever your situation, here are seven tips to help you save on medications, health insurance, doctors’ bills and more.
1. Understand New Legislation
Many people think that the Affordable Care Act doesn’t take effect until 2014, but that’s not entirely true. For instance, the law already allows young adults to stay on their parents’ policies until age 26. While this might mean more in premiums for a family, it could cut down on costs should your recent college graduate need care.
Insurer rebates are a possibility for some as well. The law requires that 80% of the premiums insurers collect from individuals be spent on health-care costs.
2. Use Preventive Services
Under the new law, many plans are required to cover preventive care without cost sharing such as co-pay or deductible requirement. Mammograms, well-baby visits, breast-feeding support and immunizations are covered, among other things.
Plans designed before 2010 aren’t required to comply with all of the new rules. But follow up with your provider if you think a bill is not right.
“Mistakes happen all the time, and if you just say ‘Oh well,’ you could owe a lot of money,” says Karen Pollitz, senior fellow at the Kaiser Family Foundation.
3. Get Consumer Assistance
The health law funds new programs that help consumers resolve disputes and find information about insurance.
If you are seeking coverage, healthcare.gov has a plan finder where you can browse available options. The site also reports on health plans that have requested premium increases and why. Starting in September, it plans to offer a summary of plan benefits and coverage for various scenarios.
4. Look for Cheaper Drugs
Whether you choose a generic or brand medicine, it makes sense to find out how your pharmacy benefits work and to choose drugs at the lowest price possible. Tracy Watts, a partner in the health-benefits practice at Mercer, says if your doctor prescribes a medication that your plan doesn’t have at a preferred price, ask the doctor if there is an equivalent medicine for less.
If you are a senior on Medicare, you can count on a 50% discount on brand-name drugs and a 14% price cut on generics if you find yourself in the so-called doughnut hole—when the cost of a medicine exceeds the initial coverage limit but isn’t high enough to qualify for catastrophic coverage.
5. Be Smart About High-Deductible Plans
Plans that offer you a reduced premium in exchange for higher initial out-of- pocket expenses are on the rise. Often these are paired with a tax-preferred savings account or linked to preventive-care programs.
Take advantage of wellness programs and incentives your employer offers that encourage preventive care. If you get a break on premiums for participating in a health-risk assessment, do it, says Ms. Watts. “That gives you free money, and good information on your health,” she says.
A few caveats: Make sure you can actually afford a high deductible. And before switching plans, make sure your doctor participates.
6. Stay in Network
“Stay in network whenever possible,” says Ms. Pollitz.
In-network doctors and hospitals contract with the insurance company for a reasonable agreed-upon amount; out-of-network providers don’t have to put a limit on what is “reasonable,” she says.
Another thing to check out is whether all the health-care providers you will be seeing during a hospital stay are covered by your plan’s network. Often hospitalizations include nurses, anesthesiologists and even doctors you may never see in person. It pays to check out in advance if they are in network, and to challenge bills you get from them if they are not.
7. Challenge Doctors and Insurers
Ask your doctor why a test is necessary, whether you can wait to have the procedure, and if treatment will change depending on the results, says Consumer Reports’ Ms. Metcalf.
Don’t be docile about billing, either. In the event that a doctor sends you a bill that you think your plan should have paid, make calls to the insurer and your doctor. Have an upfront conversation with the doctor’s office.
“If you get a bill, call them immediately and say ‘I’ve got an issue with my health plan and I’m working on it,’” says Ms. Pollitz. “That’s important because medical bills that aren’t paid promptly go straight to collections.”
This article is courtesy of Avery Johnson | The Wall Street Journal EG – Mon, Mar 12, 2012 2:30 PM EDT
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