Por Emily Bazar
No matter what happens to the Affordable Care Act, one health care trend is fairly certain to continue: A growing number of you will have high-deductible health plans, whether you’re insured through your employer or buy on the private market.
A high-deductible health plan 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 IRS defines 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, Covered California, 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?
Emily BazarAsk Emily
A series of columns answering consumers’ questions about California’s changing medical landscape.
Send questions for Emily to AskEmily@kff.org
The 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).
“A high-deductible plan will work better for younger, healthier people who don’t expect to have a lot of medical expenses,” says Walter Zelman, a health policy professor at California State University-Los Angeles. “If you know you’re going to use a reasonable amount of health care in a given year, the high-deductible plan is to be avoided.”
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 certain preventive services for free, including mammograms, colonoscopies and routine vaccinations.
Taking advantage of them can prevent more expensive coverage down the line, says Elizabeth Abbott, director of California’s Office of the Patient Advocate.
“Get your flu shot,” she says. “If you keep up with all of your preventive services, you will save yourselves a fair amount of money because you’re less likely to get sick and won’t have to get invasive procedures.”
No matter what kind of appointment or procedure you’re scheduling, choose in-network providers whenever possible, says Betsy Imholz, special projects director for Consumers Union. “If you stay in network, your costs are going to be lower,” she says.
Cross-check with both your provider and your insurer to confirm network status.
And don’t forget — as I often do — that you may be able to avoid a doctor’s visit by calling your insurance company’s 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:
— Over-the-counter and generic drugs: If your doctor prescribes a brand-name drug, ask if there’s an over-the-counter or generic option you can try first. Generics cost a fraction of the brand-name version, says David Collum, assistant clinical professor for the Department of Pharmacy Practice at University of the Pacific in Stockton, Calif.
— 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’t be afraid to switch pharmacies or buy drugs from different places, Abbott says. “If you’re taking five drugs, price those all out,” she says. “Don’t assume a particular pharmacy offers the best price for every drug.”
Consumers Union generally finds the best drug prices at Costco or by using GoodRx’s online search tool, Imholz says.
— Patient-assistance programs: Ask your pharmacist or doctor if they know of programs that can help you afford your prescription.
Groups such as the Patient Advocate Foundation and NeedyMeds also have compiled links to organizations — and even drug companies — that provide financial aid.
— Shorter initial prescription: If your doctor prescribes a pricey drug you haven’t 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’s ineffective, at least you won’t be out for the cost of a full month of medication.
Comparison Shopping
Most of us wouldn’t 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 save hundreds or thousands of dollars.
First, ask your doctor for the specific medical code, called a CPT code, for the procedure or test that you need, says Jeanne Pinder, CEO of ClearHealthCosts, which aims to make medical prices more transparent.
Simply asking about the cost of a lower-back MRI won’t be sufficient. “You’ll want to call and say ‘How much does an MRI of the lower back, without contrast, CPT code 72148, cost?’” 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’s network.
Along the way, consider bypassing your insurance for a particular treatment or prescription.
“You might be better off, as an insured person, paying cash,” Pinder says. “Many people don’t reach their deductible by the end of the year, anyway.”
If you go this route, don’t call your insurance plan. Just call providers (who don’t have to be in your network) and ask them “How much will this cost me?” and “What’s your cash price?” Pinder counsels.
If the provider asks whether you have insurance, repeat that you want to be a cash customer.
“Just keep saying, ‘I’m looking for the cash price. I’m a cash customer.’ If they ask if you have insurance, repeat that you’d like to pay cash,” 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.
“We need to get used to having this conversation and asking those questions in that fashion,” she says. “By the time you start doing it, it doesn’t hurt anymore.”
This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
