You probably gasped the last time you went to the doctor and paid the bill. Small wonder: The cost of staying healthy keeps going up. But you don't need to sacrifice your family's well-being for the sake of your budget. These tips will help you get the most out of your health insurance, or find quality coverage from government or private sources, if you don't have it.
If you are insured: Don't miss out on benefits
Learn about your plan so you can make the smartest decisions.
Know what you're eligible for. Read your benefits booklet from start to finish. Take advantage of all the services that are covered, including well-baby care, gynecological checkups and hearing and vision tests. Many plans charge only a small co-pay, as long as you use doctors in the plan's network. Check when making your appointment that the doctor still accepts your plan; printed materials from your insurance company may be out of date.
Bonus tip: If you have insurance but still can't afford drugs, co-pays and other out-of-pocket costs, the HealthWell Foundation may be able to help. It's a nonprofit organization that provides financial assistance to people having trouble paying their health-care bills (certain income limits apply). For information visit healthwellfoundation.org.
Know insurance lingo
Familiarize yourself with these common terms.
Co-pay: The amount you owe for a medical expense at the time the service is rendered. For example, your policy might require a $10 co-pay per doctor's visit.
Deductible: The total amount you must pay for health expenses before your health insurance begins to cover costs. Generally, the higher your deductible, the lower your premium.
Exclusion: Medical services that are not covered under an insurance plan. For example, a plan may not cover plastic surgery or certain kinds of drugs.
Lifetime maximum benefit: The top amount a plan will pay over your lifetime. Maximums generally range from $1 million to $5 million.
Premium: The periodic amount you pay for your policy.
Provider: The person or facility that gives health-care services. Providers can include doctors, therapists, hospitals, labs and clinics.
Maximize the coverage you already have
Spend less and still get the most out of your plan.
Ratchet down your insurance. If you're young, healthy and childless, you need less coverage than someone older with a large family. Consider switching to a policy with a higher deductible―you could save $100 or more a month in premiums. Some plans even have extremely high deductibles―up to $10,000. You'll be covered in case of a catastrophic illness, but routine health-care expenses will come out of your own pocket, up to the amount of the deductible. High-deductible plans are often paired with a health savings account (HSA), into which you put tax-free dollars. You use the account to pay medical costs not covered by insurance. If you put $1,000 into an HSA and you're in the 15 percent federal tax bracket, you've just saved $150 on your tax bill.
Bonus tip: Watch out when investigating HSAs: Some charge as much as $120 per year in maintenance fees. To find a plan with low or no fees, go to hsafinder.com.
Insure your family separately. If you get insurance through your job, you probably have the option to cover your spouse and children, too. But adding your family to your policy may not be the best move. Employers typically subsidize 80 percent of the premiums for their employees, but 70 percent or less--or none at all--for the employee's family. That means your premiums could jump by hundreds of dollars a month if you add your family to your plan. Check with an insurance broker (find one at nahu.org) or a Web site such as ehealthinsurance.com to see if it's cheaper to buy a separate policy elsewhere for dependents.
Play it smart if you leave your job. Whether you quit, are laid off or are fired, you're entitled to COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage. But you must pay for it, and the premiums can be stiff. Don't accept this option right away. By filing your paperwork at the last minute, you can actually get 105 days of coverage free.
Keep a lid on health-care spending
Find simple ways to cut costs on medication and doctor's visits without compromising your or your family's health.
Save on prescriptions. There are lots of ways to pay less at the pharmacy. First ask your doctor if there's a generic equivalent for any drug you're taking. Then shop around. If you live near a Wal-Mart, check out its prescription program, which offers a 30-day supply of hundreds of drugs (mostly generic) for $4--there's no income limit--as well as some birth-control and fertility medications for $9. Also consult mail-order pharmacies, especially for brand-name drugs. Recently, drugstore.com was charging 30 percent less than a local pharmacy for Paxil, an antidepressant, and 23 percent less for the cholesterol drug Lipitor. Medco offers similar savings; see tourofchampions.com to enroll.
Economize on doctor's visits. For common ailments, try a retail clinic, such as those found in CVS (under the name "Minute Clinic") and some Wal-Mart stores. One study showed that these clinics cost 25 percent less than a visit to the doctor. But make sure records of any treatment you receive are sent to your regular doctor. "These clinics aren't a substitute for your family physician," says Brenna Haviland, manager of the Institute of Health Care Costs and Solutions with the National Business Group on Health. "It's important to have a medical 'home' where all your treatment is coordinated." Finally, never consider such clinics a substitute for the emergency room. If you're in urgent need of care, go to the nearest hospital.
Negotiate fees. For expensive procedures ($500 and up), ask if you can pay in two installments. Or ask for a discount if you lay out cash in advance. Don't feel squeamish about speaking up; one survey showed that about two-thirds of consumers question their doctors about treatment options and costs. Simply say the expense was unexpected.
Get insurance if you don't have it
Research different policies so you can choose the plan that best fits your situation.
Find a plan online. Two good places to start are healthinsurance.com and ehealthinsurance.com. After typing in your zip code, age and whether you smoke, you'll see a list of policies available in your area. When we checked ehealthinsurance.com, it listed 107 plans with monthly premiums from $171 to $1,070 for a couple with one child living in Virginia; healthinsurance.com showed 58 plans. Avoid sites that don't provide instant quotes--they ask for personal information and sell it to insurance salespeople.
Tap government programs. Income thresholds for Medicaid, a federal program, are quite low. To see if you qualify, go to the Web site of the Centers for Medicare and Medicaid Services at cms.hhs.gov. You can find state programs by visiting familiesusa.org; click on "Resources for consumers," then on "State guides to finding health insurance."
Look into short-term insurance. If you've lost your job, don't go without coverage. In addition to your COBRA rights, you should consider short-term policies, which last up to six months (some go for a year). They cover only catastrophic illness, so you won't be reimbursed for doctor's visits or preventive care. Depending on where you live, short-term coverage costs as little as $50 a month.
Consult a broker. A good insurance broker will know which plans have the best rates and most doctors in your area, says Teri Gutierrez, president of Integrated Benefits Solutions in Raleigh, N.C. There's no charge for a broker's services: Insurance companies pay the commissions. To find a broker, visit the Web site of the National Association of Health Underwriters (nahu.org).
Bonus tip: Make sure your broker represents many insurance providers, not just one. This will give you the widest choice of policies.
Find free and low-cost services. Sliding-fee clinics, which let you pay what you can afford, will often offer a full range of medical and dental services. To find one in your area, go to ask.hrsa.gov/pc. You may also be eligible for a program that offers free or low-cost mammograms and Pap smears; for more information, click on the Web site of the Centers for Disease Control and Prevention (cdc.gov/cancer/nbccedp). Finally, if you have a dental school nearby, ask if they run a clinic. In Philadelphia, for example, Temple University's dental school offers checkups for $20, with third- and fourth-year students doing the work under supervision. There's one drawback: You may be in the chair for up to half a day.
Shopping for a policy?
Before buying a policy, visit ncqa.org. You'll find report cards on hundreds of health-insurance plans nationwide.
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