If your health-care costs are ballooning, you have plenty of company. About 25 percent of Americans reported having trouble paying their medical bills in the past year, according to a survey from the Kaiser Family Foundation and the New York Times.
Everything — including insurance premiums, out-of-pocket payments for medications and doctor visits — has increased in price for most of us in recent years. According to the Bureau of Labor Statistics, health-care expenses made up 7.8 percent of the average consumer’s expenses in 2015. In 2006, they were only 5.7 percent.
About two-thirds of consumers are trying to curb health-care costs. Consumer Reports’ expert strategies can help.
Take medication-savvy steps.
The average out-of-pocket payment for those who take prescription drugs is $792 annually. About 11 percent of us spend more than $1,200 per year, according to a national poll from Consumer Reports Best Buy Drugs.
To trim costs:
● Check the price with the doctor. When your doctor prescribes a new medication, ask about price before you leave the office. Although almost 8 of 10 prescriptions are filled today with generics, which can be up to 90 percent cheaper than brand-name drugs, not all drugs are available as generics. In those cases, talk to your doctor or pharmacist about lower-cost options in the same drug class.
● Ask for a three-month prescription. This can be significantly cheaper for drugs you take long term. If you use insurance, you’ll pay one co-pay rather than three.
● Shop around. Some commercial plans, as well as Medicare Part D and Advantage plans, have preferred pharmacies, which may offer lower prices to plan members. But you may not always get the best deals this way, so look for a pharmacy that offers the best prices on medications you need regularly.
● Ask for a price break. Representatives for some stores, such as Costco, told Consumer Reports that their contracts with Medicare Part D plans prohibit pharmacists from offering a better price — unless a customer asks directly.
● Consider an online pharmacy. You may save by using a low-cost online pharmacy, such as HealthWarehouse.com. But be sure to use an online retailer that operates within the United States (it’s illegal to order foreign medications), is licensed and has a state-licensed pharmacist.
● Do a med check. The average adult takes 4.6 prescriptions regularly. At least once a year, go over your medications with your doctor.
Save at the doctor’s office, lab and hospital.
The price for tests and procedures may differ depending on factors such as your insurance and the health-care provider or facility you use. Try these savings strategies:
● Check prices beforehand. Most health insurers have online tools that help consumers determine their out-of-pocket costs with in-network providers. (Or you can go to healthcarebluebook.com or clearhealthcosts.com to find local pricing.)
● Ask for a lower price for a procedure. By using local pricing information, you may also be able to negotiate directly with your doctor or hospital.
● Know when to pay out-of-pocket. If you have a high deductible and don’t think you’ll meet it during the year, you may benefit by paying the “cash,” or noninsurance, price.
Be wise about billing.
● Watch for out-of-network bombshells. According to a 2015 survey by the Consumer Reports National Research Center, nearly one-third of privately insured Americans had received a “surprise” medical bill in the prior two years. “This can happen, for example, when you have an operation and it turns out one of the doctors, like the anesthesiologist, is out of network,” says Families USA’s Lydia Mitts.
Even if you went to a hospital in your insurance network, your insurer may not cover that charge and the hospital or doctor can legally bill you. So if you’re having an elective procedure, inform the hospital and surgeon beforehand that you want to use only in-network providers. Ask for the names of all physicians and outside labs that may be involved in your care. Then call your insurance company to confirm that they are in your network.
● Choose an ER ahead of time. Many emergency rooms are staffed by physicians who may not take your insurance even if the hospital itself is in your network. So plan ahead. Call the billing department at your network hospital of choice and ask whether it uses out-of-network ER doctors. When filling out admission forms if you must go to the ER, request that you see only in-network providers.
● Fight unfair bills. If you get an out-of-network bill, try negotiating with the doctor who billed you. Then ask your insurer to cover the charge. If neither will budge, file an appeal with your insurance company. To bolster your case, have your primary-care doctor or specialist send a letter stating that ER treatment was medically necessary. The Patient Advocate Foundation (patientadvocate.org) offers no-charge help for billing concerns.
● Read medical bills carefully. Almost half of Medicare claims audited by the government contain errors, according to a 2014 review by NerdWallet. And the American Medical Association notes that about 7 percent of medical bills have mistakes. So always get itemized bills from your doctor or hospital, read through and save all bill-related paperwork — including your Explanation of Benefits statements — and familiarize yourself with common mistakes, such as incorrect codes and spelling errors. Notify your insurer, health-care provider or hospital if you see anything amiss.
Embrace a healthy lifestyle.
Stay in good health and you’re likely to spend less on health care. So, eat right, avoid tobacco, maintain a healthy weight and exercise often. People who do roughly 30 minutes of moderate activity on most days save an average of $2,500 per year on health-care costs, according to a recent study — in part because they end up in the doctor’s office much less often.
For further guidance, go to www.ConsumerReports.org/Health, where more detailed information, including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products, is available to subscribers.