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The cost for health care in the United States is often steep and unpredictable.
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That's a tricky combo. It means it's possible for two different people — at the same facility, having the same common medical procedure performed — to be charged different amounts based on their insurance coverage. Compounding this challenge: Often, the price only becomes apparent months after the procedure, as bills trickle in.
Opening an envelope (or several) could be the moment you discover your insurance doesn't cover a test of vitamin D levels, that the anesthesiologist wasn't covered by your insurance or any number of other pricey surprises. (It's worth noting that the government passed legislation in December 2020 aimed at protecting people from surprise bills due to out-of-network care, per the Centers for Medicare and Medicaid Services.)
It's all enough to make someone leery of visiting a doctor or health care facility, particularly if it's not an emergency. But skipping preventive care such as health screenings and vaccinations tends to avert the need for higher-cost emergency care, says Terrell Smith, MD, MPH, director of clinical health at Spora Health.
In other words: "Pay a little now, save a lot later," Dr. Smith says.
And although the landscape of health care can be daunting, there are many strategies that can help you cut costs while still receiving care. Take a look at these expert-backed recommendations.
1. Get Insured
There are more insurance options than before, says Lauren Abrams, MSW, MPH, associate director of programs for Health Quality Partners (HQP), a subsidiary of Health Center Partners (HCP) of Southern California, a health care policy advocate for community health and underserved patient populations.
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If you have children who aren’t covered by insurance, look into Medicaid and Children's Health Insurance Program (CHIP), which “provide health insurance for low- and middle-income families,” per the Nemours Foundation.
Options through the Affordable Care Act (ACA, aka Obamacare) vary from state to state, as does coverage from state-level Medicaid programs.
To enroll, visit your state's health care marketplace — there's a list of websites on the Healthcare.gov registry. Typically, you'll need to create an account and share some details about yourself (such as your income and address) to determine available options and the cost of coverage.
"These plans come at various levels, which offer various types of coverage," says Jeremy Radziewicz, MAcc, chief financial officer at Community Health of South Florida, Inc. (CHI).
Overwhelmed? There’s Help Available
Creating an account and assessing the options can be daunting, particularly because the health care field is filled with jargon (think: deductible, copay and so on).
“Most people find this landscape confusing and intimidating,” Abrams says. But there are resources available, including community organizations aimed at helping people sign up and Healthcare.gov resources, such as agents and brokers, who can assist with the sign-up process.
2. Shop Around
Be proactive, Dr. Smith recommends — this can have a huge effect when it comes to finding affordable health care.
Take a colonoscopy, one of several common screening tests for colorectal cancer, according to the Centers for Disease Control and Prevention (CDC). For anyone with an average risk of this cancer, screening begins at age 45, per the American Cancer Society.
If you need this routine procedure, it's worth checking on the price. That's easy to do online, with sites such as PriceMedic and FairHealth Consumer.
Tip
Looking up health care costs for procedures and tests is often easier if you know the CPT (Current Procedural Terminology) code. You can look this up online. Or, ask the billing department at your health care provider or clinic.
The CPT code for a colonoscopy screening for someone who is not at a high risk for colorectal cancer is G0121.
Head over to the FairHealthConsumer website, for instance, and you can look up the costs for ZIP codes near you — here's one illuminating comparison based on two ZIP codes in Los Angeles county, well under 50 miles apart:
ZIP Code | Out-of-Network or Uninsured Price | In-Network Price |
|---|---|---|
91007 | $1,799 | $895 |
90210 | $2,508 | $1,114 |
Driving between these two locations takes around an hour (and potentially far longer with Los Angeles' notorious traffic), but as you can see, the savings could be worth it.
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Price Compare for Medications, Too
“You can find very affordable medication — prescription and over-the-counter medicine — online,” says Brynna Connor, MD, a board-certified family medicine physician and health care ambassador for NorthWestPharmacy.com.
Her organization, NorthwestPharmacy.com, is one option, as well as Mark Cuban Cost Plus Drug Company. To comparison-shop costs, you can look up prescriptions at GoodRx.com — this website also offers coupons, which you can use at the pharmacy of your choice.
“There are many online apps that offer discounts (usually in exchange for patient data),” Dr. Connor notes.
3. Compare Prices With and Without Insurance
If you have insurance, it may feel confounding to not use it — particularly if you pay hefty monthly bills for coverage, or have money deducted from your paycheck.
But sometimes, paying out of pocket in cash can be "significantly less expensive" than using insurance, says telemedicine physician Dustin Cotliar, MD, MPH.
"Many of my patients save money by doing this and by opting not to use their insurance for prescriptions," Dr. Connor says.
Here's what you'll need to do: Ask your health care provider for the cash price of your visit and any procedures you'd have, as well as the CPT codes. Then, before your medical care, call your insurance company and check on the price, Dr. Cotliar says.
There are cases where procedures may be cheaper if you pay out of pocket rather than the insurance copayment. Just keep in mind that any out-of-pocket spending will not count toward your deductible, Dr. Cotliar says.
4. Look Up Nearby Community Health Clinics
Community health clinics often provide a sliding fee scale, Abrams says. Your local community health center will often provide primary care as well as dental, and services are open to everyone, she says — that includes people without insurance, as well as people who are undocumented.
To find locations, try these options, courtesy of the Nemours Foundation:
- Visit the Health Resources & Services Administration (HRSA) "Find a Health Clinic" feature, and look up area clinics using your ZIP code
- Browse by your state for a rural health center on this PDF list provided by the Centers for Medicare and Medicaid Services
- Search for clinics through the National Association of Free and Charitable Clinics
Another option for affordable care is a federally qualified health center (FQHC), Radziewicz says. They're available in every state and territory. "You will only pay a discounted fee for your visit," Radziewicz says.
For example, at CHI — the FQHC where Radziewicz works — that might mean spending as little as $35 to see a mental or medical health provider, depending on your income level, he says.
Tip
If you need hospital-level care and do not have insurance, opt for a public (not private) hospital, Radziewicz says — that’s because they’re “mandated to provide what is known as charity care discounts,” he says.
5. Talk to Your Provider
An oddity of health care costs in America is that when you're in the doctor's room — perhaps feeling vulnerable in a paper gown — and your doctor suggests a blood test or procedure, neither you nor the doctor may know the sticker price. If you don't inquire, cost might not factor into your doctor's prescription or treatment choices.
So while it may not feel easy or comfortable to do so, always ask about the cost of a referral, test or image, Dr. Smith recommends. Even if your provider doesn't know the answer, they can point you in the right direction to find out more information, he says.
"If you remind your PCP that your financial situation is less than ideal at a given time, they can help balance the pros and cons of waiting on a test," Dr. Smith says.
Plus, doctors may be able to point you toward resources to help with costs or brainstorm less pricey treatments, Abrams says. Doctors are "truly problem-solvers by nature," she says.
Health care is a classic "if you don't ask, you don't get" situation.
"Some health care centers may offer reduced fees or payment plans for people on low-income insurance plans, and they may be able to help you take steps — like switching from brand-name to generic medication, for example — to help reduce the cost of your care," Dr. Smith says.
But if you don't mention your financial situation, health care providers may not know to share options.
Tip
If you don’t feel comfortable asking your doctor questions — or if you feel rushed during the appointment — seek out another provider. Same goes if you don't feel at ease being honest with your doctor.
Plus, Talk to the Financial Department
"Many facilities have financial assistance programs that are not automatically put into place," Dr. Smith says. It's worth checking, because you may qualify for coverage, he says. "You would not want to pay for something you did not have to!"
6. Try Telemedicine
There are a growing number of online direct-to-consumer health care organizations. For instance, through Nurx, you can access prescriptions and tests (for everything from STIs to acne) with or without health insurance after a low-cost online medical consultation with one of the company's providers.
Many online outlets are geared toward prescriptions and coverage of conditions people may feel a bit reticent about (think: hair loss).
Some places, like Spora Health, where Dr. Smith works, offer telemedicine that's more akin to a in-person doctor's appointment with a monthly subscription.
"Telemedicine can also help you save money on quality medical care," Dr. Smith says, noting that along with the visit being less expensive, you can also reduce associated costs, such as travel and child care expenses.
7. Know What's Covered — and What's Not
Your biggest weapons toward keeping costs down are advance planning, asking questions and research. That's true with health care providers — and your insurance, too. Aim to understand what your plan covers, and what it does not cover, Dr. Smith says.
"Some plans may only cover preventive care visits and/or visits with in-network providers," Dr. Smith notes. When you get a referral, check that they're in network, Abrams says.
If you do get a large or unexpected bill (or a bill that's both of those things), don't ignore it — but don't assume that you have to pay it as-is. You have rights when it comes to appealing insurance decisions, per Healthcare.gov. Search for your state's Department of Managed Care for how to lodge a complaint or have an insurance company decision reviewed. It's not uncommon for people to be billed for things they shouldn't be charged for, Abrams says.
"Whether you're disputing a claim, asking what is covered by your plan or inquiring about an upcoming payment, staying organized is key when you are communicating with your insurance company," Dr. Smith says. Come to any conversation with documentation, and take notes throughout, he recommends.
