From maximizing insurance benefits to shopping for discounts to funding tax-advantaged accounts, these tips will lower your costs no matter how you get your care.
Even after employers pick up a substantial amount of the cost, Americans spend thousands of dollars on health care annually. Workers who use employer health insurance plans pay an average of $1,243 a year in premiums for single coverage or $5,588 for family coverage, according to the Kaiser Family Foundation. The average annual deductible is $1,644 for single coverage, and those with family coverage often have an overall deductible of at least $2,000. Annual out-of-pocket maximums may run several thousand dollars. To help relieve the pain of high health care costs, check out these 20 money savers.
MAXIMIZE YOUR BENEFITS
1 Stay in your health insurer’s network. If you visit a provider that doesn’t fall within your plan’s network, you’ll pay more for care. If you have a preferred provider organization (PPO) plan, you may receive some level of coverage for out-of-network care. But with a health maintenance organization (HMO) plan, you’ll likely pay the full cost. Use your insurer’s online tools to search for in-network providers.
Starting in 2022, by federal law insurers must cover at in-network rates “surprise” medical bills, which result when patients unknowingly get care from out-of-network providers in emergencies. You may also get a surprise bill if you visit an in-network facility and see a provider (say, a physician or anesthesiologist) who is not in-network. In the interim, you can appeal with your insurer any surprise bills that you receive. And many states have their own laws that provide some protection against surprise medical bills.
2 Take advantage of preventive-care services. Most health insurance plans must cover certain preventive services without charging you, even if you haven’t met your deductible. They include immunizations; depression and blood-pressure screenings; cholesterol and diabetes screenings for those of specified ages or who have certain risk factors; mammograms for women older than 40; and vision screenings for children. (For a full list, see www.healthcare.gov/coverage/ preventive-care-benefits.) High-deductible health plans may cover certain treatments for chronic conditions, such as insulin for diabetes and statins for heart disease, before policyholders reach their deductible.
3 Tune in to telehealth. Consulting with clinicians by phone or video chat has grown by leaps and bounds during the pandemic. If your insurance plan partners with a vendor, such
as Teladoc, that specializes in tele-health services, using it may cost you less than seeing your regular doctor, says Anne Brunson, of benefits administrator Maestro Health. If you virtually visit one of your usual care providers, you’ll often pay the same amount out of pocket that you would for an in-office appointment, although some insurers may waive or lower your co-payments for telehealth appointments.
4 Schedule appointments after you hit the deductible. If you meet your insurance deductible, squeeze in any appointments that make sense to complete before the plan year closes. Otherwise, you may be on the hook for the full cost when the deductible resets next year.
5 Don’t miss out on employer perks. Your employer may make contributions to your health savings account or flexible spending account on your behalf (some employers match your contribution or require you to participate in a wellness program to receive funds). Or you may have free access to smoking-cessation or weight-management programs. Participating in such programs may come with incentives, too, such as a reduction in your monthly premium.
GET A TAX BREAK
6 Contribute to a health savings account. If you have a qualifying high-deductible health plan, for 2021 you can put up to $3,600 in an HSA if you have self-only coverage or $7,200 if you have family coverage (plus $1,000 in catch-up contributions for those who are 55 and older). Pretax (or tax-deductible) money goes into the account, it grows tax-deferred, and you can withdraw the funds tax-free for eligible medical expenses.
7 Stash money in a flexible spending account. If you have access to a health care FSA through an employer-sponsored health plan, you may be able to contribute as much as $2,750 in pretax funds for 2021, and you can withdraw the money tax-free for qualifying medical expenses. Typically, employers may allow employees to carry over a limited amount of unused funds to the following plan year, or they may offer a grace period of two and a half months to use the previous year’s funds. Because of special rules in response to the pandemic, however, employers currently may permit employees to roll over unlimited amounts from the 2020 plan year to 2021, and from 2021 to 2022. Or employers can lengthen the grace period for 2020 and 2021 plans to 12 months.
8 Brush up on HSA- and FSA-eligible expenses. You can withdraw HSA and FSA money tax-free to pay for deductibles and co-payments or coinsurance, as well as a variety of other expenses, including eyeglasses, medical monitoring and testing devices, and orthodontia. And thanks to rules that went into effect in 2020, you can now use the funds for over-thecounter drugs (such as pain relievers, cough suppressants and antihistamines) without a prescription, as well as for feminine-hygiene products.
9 Save for retirement with your HSA. HSA funds have no expiration, making an HSA a great vehicle to tuck away money for medical expenses in retirement. Premiums for Medicare parts B and D and Medicare Advantage plans (but not supplemental policies) are HSA-eligible, as are long-termcare insurance premiums (up to specified limits) and expenses for certain home improvements to accommodate medical conditions—say, widening doorways or adding support bars.
10 Deduct medical expenses. If you itemize deductions on your tax return, you may deduct qualified medical and dental expenses (such as prescription drug costs and payments to medical providers) that are unreimbursed by insurance and exceed 7.5% of your adjusted gross income. See IRS Publication 502, Medical and Dental Expenses, for more information.
LOWER PRESCRIPTION PRICES
11 Switch to generic or alternative drugs. Have your doctor prescribe generic versions of your medications, if available, or ask your pharmacist to switch to a generic drug at the counter. Generics cost as much as 85% less than brand-name drugs. If a generic drug is unavailable, ask your physician whether there are similar medications to treat your condition that could do the job just as well, and check whether your insurer covers those drugs at a more favorable rate.
12 Get 90-day drug refills. For maintenance medications that you take regularly, you may save money by ordering 90-day supplies rather than 30-day refills. Walmart, for example, charges $4 (without insurance) for 30day supplies of certain generic medications and $10 for 90-day supplies. Receiving mail-order medications—which often come in 90-day supplies—may save you money, too.
13 Compare drug prices and get discounts. At sites such as GoodRx .com, SingleCare.com and WeRx.org, enter the name of your medication and your zip code to see a comparison of prices at pharmacies near you and get coupons. In some cases, the cash price with a coupon may be lower than what you’d pay with insurance. Some pharmacies have their own discount programs. The Walgreens Prescription Savings Club ($20 yearly for an individual or $35 for families) provides discounts of up to 80% on cash drug prices. Check NeedyMeds.org for information on drug discounts and assistance programs, too.
You often can’t use coupons or discount programs in conjunction with your insurance—so a drug purchase with a coupon or discount program won’t count toward your deductible unless the insurer allows you to submit the purchase later. And if you occasionally bypass insurance or switch among pharmacies, the pharmacies may not be able to monitor for dangerous interactions between medications.
14 Compare the cost of care. Comparing prices for procedures at different facilities could save you big bucks. Typically, you’ll pay more for outpatient services—such as x-rays, MRIs and minor surgeries—performed at a hospital than at facilities not owned by a hospital, says Michael O’Neil, of Healthcare Bluebook, which collects information on health care pricing. When he needed orthopedic work on his knee, O’Neil estimates that he saved about $10,000 by asking his physician to order scans and perform a procedure at a clinic outside of the local hospital’s network. Visiting an urgent-care center often costs less than going to an emergency room.
At www.healthcarebluebook.com, you can use a free tool that offers estimates of fair prices in your area for a range of procedures. (Recently, the tool has been unavailable while being revamped, but it is expected to be up and running by July.) At www.fairhealthconsumer.org, you can see both
in-network and uninsured pricing estimates for procedures in your region. And new federal rules require hospitals to post on their websites price information for their services.
15 Reshop your health insurance plan. During each annual open enrollment period, review your options. Especially if your health or family status has changed, you may find that a plan with a different deductible, premium, network or drug formulary is most cost-effective. If you use the HealthCare .gov exchange, you have a special opportunity this spring to enroll in or switch plans (see the box at right).
Medicare beneficiaries should reevaluate their plans, too. “Insurance companies that offer Part D drug plans revise their benefits, premiums and co-pays each year, so it’s a good idea to review your annual notice of change each September,” says Danielle Roberts, of Boomer Benefits, which helps consumers navigate Medicare plans. Or you may find that it makes sense to switch to an all-in-one Medicare Advantage plan. Go to www.medicare.gov/plan-compare to shop for Part D and Advantage plans.
16 Get help choosing a plan. A knowledgeable agent or broker can steer you through plan options at no extra charge to you. If you’re buying a plan in the individual market, search for an agent or broker at https:// localhelp.healthcare.gov. Medicare beneficiaries can find local counseling and assistance by choosing their state at www.shiptacenter.org.
17 See whether you qualify for financial assistance. If your income is below certain levels or you meet other requirements, you may be eligible for financial assistance to help cover your medical costs. Medicare.gov has information on Medicare’s programs, including Extra Help, which defrays prescription-drug expenses for those with limited income and resources. Check with your state’s insurance
department, too—some programs have higher income thresholds than you might expect, says Casey Schwarz, of the Medicare Rights Center. New York’s Elderly Pharmaceutical Insurance Coverage program, for example, offers assistance for married Medicare beneficiaries with income of up to $100,000 ($75,000 if you’re single).
18 Ask about cash pricing. Before you schedule a procedure, ask the provider for its lowest price for patients who pay cash without insurance, says O’Neil. It may be lower than the insured rate, and sidestepping insurance may be worthwhile if you have a big deductible that you don’t expect to meet before the year ends.
19 Review bills and insurance explanations of benefits. Check to see that your insurer is covering medical costs appropriately and that you received all of the services and medications listed on your bills. For complex procedures and hospital visits, request an itemized bill that details each fee. If you see a problem, ask for a correction. Brunson, of Maestro Health, once noticed that she was charged for intravenous fluids that she never received during an emergency-room visit.
20 Appeal higher Medicare premiums. You will pay an “income-related monthly adjustment amount” (IRMAA) on your Medicare Part B and Part D premiums if the modified adjusted gross income on your tax return from two years ago exceeded certain levels. For 2021, an extra charge applies for those with 2019 income greater than $88,000 on an individual return or $176,000 on a joint return. If your income has fallen because of a major life-changing event, you can request an adjustment to your IRMAA by submitting Form SSA-44 to the Social Security Administration. ■
■ YOU CAN CONTACT THE AUTHOR AT LISA_GERSTNER@ KIPLINGER.COM.
Another Chance to Shop for Coverage
Between February 15 and May 15, 2021, Americans may sign up for or change health insurance plans through open enrollment at HealthCare.gov. Typically, the federal marketplace’s open-enrollment period is only in the fall, but President Biden has temporarily reinstated it to assist those who have new or altered insurance needs during the pandemic. Outside of open enrollment, you may sign up for a plan only in certain circumstances, such as getting married, having a child, or losing health insurance because of a job loss or another reason.
To sign up, select your state at HealthCare.gov. Many states that operate their own health insurance marketplaces have set up special open-enrollment periods, too, but dates and eligibility requirements vary.
In March, Congress passed a stimulus package that in 2021 and 2022 enhances tax credits that reduce plan premiums. Previously, those with income exceeding 400% of the federal poverty level received no tax subsidy; now, premium costs are capped at 8.5% of income for those with income of at least 400% of the poverty level. (In most states, the 400% threshold for 2021 plans is $51,040 for an individual, $68,960 for a family of two or $104,800 for a family of four; the thresholds are higher in Alaska and Hawaii.) The law boosts subsidies for individuals and families with lower income, too. Those with income between 100% and 150% of the poverty level pay no premium.
For laid-off workers the law covers through September the full cost of premiums for COBRA, through which former employees can continue employer-sponsored insurance coverage for 18 months.