Ways You Can Help Control
Your Health Care Costs

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An average of $7,861 was spent on the health care of each U.S. citizen in 2008, the latest year for which figures are available. The cost of health care continues to rise.

The best way to save money on medical treatment is, of course, to stay healthy. The Employee Insurance Program’s (EIP) Prevention Partners staff prepared this list of 10 tips to help you do that. To learn more about ways to improve your health, visit the Prevention Partners Web site.

Here are some other ideas about how to save money on health care if you are covered by the health plans offered through EIP:

Every October you can change health plans, and the plan you choose can help you get the most for your money. The State Health Plan, which includes the Savings Plan, the Standard Plan and the Medicare Supplemental Plan, and the health maintenance organizations, BlueChoice HealthPlan HMO and CIGNA HMO, all have advantages and disadvantages. Carefully review each plan to learn which one suits you best.

After you are enrolled, one of the best ways to save money on your health care is to take a few minutes to learn about your plan. Now is the time to do it. Don’t wait to find out how your plan works until you or someone you cover is pregnant, seriously ill or needs emergency care.

You can learn about your plan on the State Health Plan, BlueChoice HealthPlan HMO and CIGNA HMO Web sites and by reading the Health Insurance chapter of the Insurance Benefits Guide (IBG). If you are enrolled in Medicare, be sure to read the Medicare chapter in the IBG as well as Medicare and You, an excellent publication sent yearly to Medicare enrollees by the Centers for Medicare and Medicaid Services.

When you review the rules of your plan, pay particular attention to:

  • When changes in coverage can be made, which is usually within 31 days of a qualifying event
  • Preauthorization requirements and
  • Exclusions, which are services your plan limits or doesn’t cover.

Each plan has contracts with doctors, hospitals and other providers who have agreed to accept the plan’s allowable charge for covered medical services as payment in full. Here are links that will help you find network providers. Generally, health maintenance organizations, such as BlueChoice HealthPlan HMO and CIGNA HMO, only pay benefits if you go to a participating provider, unless it is a medical emergency. The Savings Plan and the Standard Plan pay for out-of-network services. However, the coinsurance, which you pay after you meet your deductible, is 40 percent for out-of-network care compared with 20 percent for care from network providers.

Another way to save money is by using generic drugs. They typically offer the same health benefits as brand-name drugs but cost less.

If someone you cover takes prescription drugs for an ongoing condition, you can save money by using your plan’s mail-order pharmacy. Standard Plan and Medicare Supplemental Plan subscribers can get the same prices from a local pharmacy that is a member of the Retail Maintenance Network.

If the State Health Plan is your primary insurance and you have cardiovascular disease, congestive heart failure or diabetes, you may qualify for the Wellness Incentive Program. It encourages members to take good care of themselves – and saves them money – by offering some free generic drugs.

A MoneyPlu$ Medical Spending Account (MSA) or, if you’re covered by the Saving Plan, a Health Savings Account and a limited use MSA, can save you money by enabling you to pay eligible health expenses with funds deducted from your salary before it is taxed.

Here are some other suggestions that may save anyone money, whether or not he is covered by health insurance:

  • Use the emergency room only for true emergencies. A doctor’s office or an urgent care center is a less expensive place to treat a problem that doesn’t require emergency care.
  • Keep your medical records well organized. Check for duplication of tests. Ask for itemized bills from your physician and from your hospital. Review the bills and Explanations of Benefits to make sure they are accurate and you are not charged for services or supplies you didn’t receive.
  • Have a good relationship with your health care provider but not so good that you’re embarrassed to be honest with him. In one survey, 52 percent of women reported that they routinely lie to their doctors. Some of the most frequent lies are about smoking, drinking, flossing, exercise, monogamy, use of sunscreen and drugs.
  • Don’t be afraid to ask questions – whether you’re dealing with your doctor or your insurance company. Physicians may joke about patients “diagnosing on the Internet,” but doing your own research can make you a better informed health care consumer.
  • Don’t be shy about taking a relative or friend with you when you see your doctor. If you’re sick, you may not in be in the best position to understand and remember instructions or ask questions.
  • Ask your physician for samples before paying for a new prescription. You can see if the drug works for you before you spend money on it. Also, ask if the drug requires preauthorization.
  • Try to avoid duplicating tests. Ask your doctor which blood tests, X-rays and medical procedures you can expect when you are treated for an illness.
  • Use outpatient services when you can. Many routine lab tests, diagnostic tests and surgeries can be done without an overnight stay in the hospital.

These are just a few ways you can manage your health care costs. With the money you save, you might think about buying a gym membership or some nice, fresh vegetables.