Illustration by Shaunna Peterson
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Your Take-Charge Guide to Affordable Health Care
By Russell Wild, July & August 2006
55 insider tips for saving money on drugs, doctors, hospitals, dentists, and eye care
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The Divided We Fail effort advances the idea that partisan gridlock should not stand in the way of affordable health care and long-term financial security for all Americans.
• The Quiet Crisis: The Rising Costs of Health Care
How scared are you of big medical bills? If you're like most people, very. Americans fret more about their health care costs than they do about losing a job, paying the mortgage, or becoming a victim of terrorism, according to a recent survey by the Kaiser Family Foundation.
And that's not unreasonable. In this country personal expenditures on health care have skyrocketed, rising at more than twice the rate of inflation. Hit especially hard are those ages 50 through 64. People in that age range who buy insurance on their own pay chillingly high rates, with more than half shelling out $3,600 or more annually on premiums. And that's to say nothing of deductibles and copays.
At age 65, of course, Medicare kicks in, greatly lightening that load for most. But costs can still be substantial, even for those who take advantage of the new Medicare drug coverage. Recent estimates by Fidelity Investments show that a 65-year-old couple retiring today should have at least $200,000 saved just to cover out-of-pocket medical expenses during their retirement years. For couples ages 60, 55, and 50 planning to leave the work force at 65, the numbers jump to $275,000, $350,000, and $425,000, respectively. "This is considerably more than most Americans have planned for—if they have planned at all," says Brad Kimler, senior vice president of Fidelity Employer Services Company.
 
This harsh reality is starting to translate into a kind of revolutionary fervor among some Americans. "Our health care system clearly isn't working," says William Schwied, M.D., M.P.H., an 85-year-old retired physician who has organized hundreds of California retirees in a grass-roots effort to fight for a better health care system. "The only way we'll see change is for people to take to the streets," he says.
But you don't have to wait for systemic reform to save money on your own medical costs. You have the power to take matters into your own hands, starting now. Below, we'll show you dozens of strategies aimed at lessening the burden of health care expenses.
PRACTITIONERS
Go to the fair For free routine screenings, such as for blood pressure or blood sugar levels, stop by your community's next health fair. While the nurses or technicians there won't diagnose you, "they will often discuss your symptoms and tell you whether you need to be concerned," says Jennifer Campbell, M.S.W., Ph.D., who teaches at Bryn Mawr Graduate School of Social Work and Social Research in Pennsylvania. "In effect, you'll be getting free triage. And that may save you the cost of an office visit." Health fairs are often sponsored by hospitals, colleges, large employers, and government agencies; check your local papers for announcements.
Go back to school If you have a medical school in your hometown, chances are it has a low-cost clinic open to the public. You won't be experimented on, says Campbell: "That's nothing but a myth. In fact, the quality of care tends to be excellent." But there is a downside. "You'll often need to spend lots of time there as students and teachers discuss your case."
Consider an alternative Depending on your insurance coverage, acupuncture, massage therapy, and other alternative treatments can be less expensive than—and as effective as—traditional medical care for some chronic ailments. "Conventional medicine is best at dealing with acute problems, such as infections, broken bones, and bleeding," says Daniel Monti, M.D., director of the Jefferson-Myrna Brind Center for Integrative Medicine at Thomas Jefferson University Hospital in Philadelphia. "For chronic problems such as back pain or stress-related illness, you might want to consult someone such as an acupuncturist, massage therapist, or yoga instructor." Make sure your physician knows of any alternative treatments you are taking. For a list of ailments and potentially effective alternative treatments, visit the website of the National Institutes of Health's National Center for Complementary and Alternative Medicine.
Try retail therapy Some large pharmacies and retail stores, such as CVS, Eckerd, Target, and Wal-Mart, have recently opened in-store clinics. Often staffed by nurse practitioners (yes, they can diagnose you and even write prescriptions), they don't require an appointment, and the price—typically $25 to $60—is less than what a visit to most doctors' offices would cost you.
Visit a nurse's office Nurse practitioners can frequently offer the same care as a doctor, at a lower rate. "Nurse practitioners fill a needed void in the health care system today," says Allison Beard, spokesperson for the American College of Nurse Practitioners. Research comparing nurse practitioners with physicians shows that nurses tend to spend more time with patients, charge less, and do just as good a job of diagnosing problems.
Pick up the telephone Got that same old sinus infection again? Your physician might help you for free by phone. But if not, try calling TelaDoc at 800-835-2362. It provides real live doctors for quick telephone consults. Cost: $35, plus an $18 registration fee and a small monthly fee. If the doctor feels that your diagnosis is simple and obvious, he or she can call in a prescription to a nearby pharmacy. "We're not here to diagnose anything serious like diabetes or heart disease," says Roger Moczygemba, M.D., a family practitioner in San Antonio and one of TelaDoc's nearly 200 participating physicians. "But for simple problems and simple treatments, we're an easy and affordable option." For more information, go to www.teladoc.com.
MEDICATIONS
Comparison-shop The price of drugs can vary enormously from one drugstore to the next. Surfing the Web for the best prices can save you a bundle. For mail-order options, go to www.pharmacychecker.com to compare prices on many common medications sold by U.S. and Canadian pharmacies. (Caution: buying Canadian drugs is illegal, though rarely prosecuted.) For info on prescription-assistance programs, discount-drug cards, and discount pharmacies, go to the website of the nonprofit Medicare Rights Center and click on Discount Rx Resources. Consumer Reports also has a free website that will help you compare drug options to find what's most efficacious and economical. For more on the safest, cheapest, and most reliable drug for your condition, visit www.aarp.org/comparedrugs.
Consider generics or cheaper brands For most drugs, "there is absolutely no difference in the therapeutic value of generics and name-brand drugs," says Eric Mack, R.Ph., Ph.D., an associate professor of pharmaceutics at California's Loma Linda University School of Pharmacy. Kao-Ping Chua, spokesperson for the American Medical Student Association, suggests that you have a heart-to-heart talk with your doctor, explaining that you need to economize on the cost of your pills. Be grateful for free name-brand samples if you have a short-term need for a drug, but be cautious of them if your need is ongoing. You'll save more money in the long run if you take a cheaper generic that works just as well.
Pick store brands "What holds true for prescription drugs holds just as true for over-the-counter drugs," says Mack. "Store brands are often made by the very same manufacturer as the advertised name brands. But there's no difference except for the packaging and the price," he says.
Be inventive Sometimes doctors can't prescribe a generic because there is no generic. But, even then, consider asking your pharmacist about alternatives to bring up with your doc. In the case of the pain drug Arthrotec, for example, the name-brand version typically sells for more than $200 for 90 tablets. "Yet it's exactly the same as taking two generics—diclofenac and misoprostol—that together cost about $110 per 90 doses," says Bill Overkamp, R.Ph., president of Bill's Pills, an online pharmacy.
Ask if it's safe to split… "Most tablets and pills (but never capsules) can be split, often saving you a substantial amount," says Overkamp. For example, if your prescription is for 10 milligrams of a given drug, you may be able to buy it in 20-mg doses and then split the pills in half. Pills labeled "time-released" or "long-acting" are exceptions; they usually are not safe to split. Always check with your doctor, and never take less than the prescribed dose of your medication.
...or to double up Buying smaller doses of your medicine can sometimes save you money. Overkamp notes that the antidepressant fluoxetine generally costs about $90 for 45 40-mg pills, but you can often buy 90 20-mg capsules for only $50. Taking two of these lower-dose pills would save you $40 for 45 doses.
Freebies If you have a limited income, you may be eligible for free or low-cost drugs through your state or the manufacturer. The Partnership for Prescription Assistance can help you learn if you qualify. Call 888-477-2669, or go online. Those 65 and over with annual incomes less than $14,700 (single) or $19,800 (couple) and limited assets may qualify for drug coverage under Medicare at very low cost, and additionally may be eligible for a Medicare savings program (also known as a Medicare buy-in program) that can help pay for other Medicare out-of-pocket expenses. "Many people who could benefit from these programs know nothing about them, and that's sad," says Deane Beebe, a spokesperson for the Medicare Rights Center in New York City. Contact Medicare for more information by calling 800-633-4227 or visiting www.medicare.gov.
EYE CARE
See through the hype "The retail markup on eyeglass frames tends to run as high as 1,000 percent," says Doug, an optician who also works as a sales rep with a major eyeglass wholesale company and who asks that we not give his full name. The cheapest frames, he says, are available at large retail stores and optical chain stores. But these usually don't hold up as well as frames from eye doctors' offices or boutiques. And because of the markup, the price of the frames you really want may be more flexible than you think. "Negotiate," says Doug. "If you buy two pair, ask for 20 percent off. You'll probably get it. Also ask if they ever issue coupons or run seasonal sales. If you can't get a price reduction, try to negotiate something else, perhaps an extension on the warranty, an upgrade on the lens from plastic to polycarbonate (which is lighter), or scratch protection."
Score a free exam EyeCare America, a program run by the American Academy of Ophthalmology, has helped more than 760,000 people in the past 20 years. If you are 65 or older, have not seen an ophthalmologist in the past three years, and do not belong to an HMO or have coverage from the VA, then you may be eligible to receive a comprehensive eye exam and care for up to one year. The program is also open to people under 65 who are at increased risk for eye disease. You can find more information by calling 800-222-3937 or going online. Many Lions Club chapters work with optometrists and ophthalmologists in their communities to provide free eyeglasses to those with limited means. You can find the Lions Club nearest to you by calling 800-747-4448 or visiting their website.
HOSPITALS AND EQUIPMENT
Skip Saturday night at the hospital "Unless it's a true emergency, don't check yourself into a hospital on a weekend," says Charles Inlander, a consumer-health advocate based in Allentown, Pennsylvania. "Many hospital departments aren't open on weekends, and others have reduced staffs, which means you might be paying $1,800 a day for a room with a view of the parking lot." Better to schedule your hospitalization for Monday and get the attention you need to mend as quickly as possible.
Check your bill—twice Your hospital bill comes to you looking like a veritable rat's nest of codes, numbers, debits, and credits. How can you tell if the accounting is accurate? You often can't. Yet the number of mistakes on hospital bills is high. "In my experience, 50 percent of bills have an error or an overcharge somewhere," says Susan Dressler, president of the Alliance of Claims Assistance Professionals (ACAP), whose members help patients decipher their medical bills. "I was contacted by one woman, quite alive, I assure you, whose hospital bill showed a charge of $40 for 'cadaver-kit preparation,'" says Dressler. "I had another client who was charged a small fortune for 20 daily doses of a heavy-duty painkiller. If he had taken that much, he'd be dead!" If you think your hospital bill may be a bit overstuffed, ask the hospital accounting person to explain it to you, line by line. If that doesn't prove productive, contact ACAP at 630-562-1000 or online. Most members charge by the hour ($30 to $120), although some will charge a percentage of any amount they recover. They can also help you if your insurance company is reluctant to pay for your care, even though your policy seems to indicate it should. Similar services are rendered by a Philadelphia-based company called Healthcare Advocates. Call 215-735-7711, or go to their website.
Take your ailment on the road "Some of the best hospitals in the world today are located outside the United States, in countries like Thailand and India," says Paul Zane Pilzer, author of The New Health Insurance Solution: How to Get Cheaper, Better Coverage Without a Traditional Employer Plan (Wiley, 2005). "They often have U.S.-trained physicians, and sometimes deliver safer and better services in a comfortable, resort-type atmosphere." And—as reported on 60 Minutes recently—a quintuple-bypass operation might run $12,000, as opposed to $100,000 or so in the States. In South Africa an outfit called Surgeon & Safari advertises package deals that give you orthopedic, plastic, ophthalmologic, or dental surgery, plus the chance to spy on lions and elephants, all for less than you'd spend for a few days in an American hospital. If you prefer to stay in the Western Hemisphere, Costa Rica Health Escapes advertises that "Costa Rica not only offers quality medical care, but offers it at a fraction of the cost for the same procedures in the United States." Of course, wherever you go for surgery, whether in the United States or abroad, very carefully check credentials and get referrals.
Bargain like the big boys Your hospital may be charging you way more than it does some of its other patients—especially if you're paying your own way. Pulitzer Prize-winning investigative reporters Donald Barlett and James Steele, in their book Critical Condition: How Health Care in America Became Big Business & Bad Medicine (Doubleday, 2004), tell how a hospital in Orlando charged one uninsured patient $35,200 for an appendectomy. Medicare would have paid $6,200 for the same operation in the same hospital; a typical insurer, $7,000. There are currently no fewer than 70 class-action lawsuits involving at least 400 allegedly not-for-profit hospitals and hospital systems whose uninsured patients say they have been price-gouged. If you have no insurance or Medicare and feel you were taken for an anesthetized chump, don't be afraid to ask your physician and the billing department about cutting the bill down to size. If those talks go nowhere, you might want to hire a (contingency-based) attorney. Go to the CaseConnect website, or write to Attorney Sid Backstrom, Scruggs Law Firm, P.O. Box 1136, Oxford, MS 38655, for information about whether you just might have a case.
Accept hand-me-downs If you find yourself in need of a walker, wheelchair, reclining bed, or other piece of potentially pricey medical equipment, don't rush out and buy a new one. "Your church, senior center, or social club may know of people who have hardly used equipment that they'll sell you for a song. It never hurts to check," says Bryn Mawr's Jennifer Campbell. "Have a professional evaluate the piece of equipment to make sure that it's the right one for you."
INSURANCE
Handle COBRA with care The Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA) says that if you leave your job, you can take your health insurance with you and keep it for up to 18 months, provided you pay for it on your own. But that's not always a good idea. If you are fairly healthy, you might be able to find a policy that will be more economical than your COBRA plan, says Pilzer. The longer you wait, the older you'll be, and the more a new plan is likely to cost. Be cautious about moving from group insurance to individual, however, if you have pre-existing conditions. Your new insurer may try to exclude them from coverage. You might want to check with your state department of insurance to know your rights before you make any changes.
Think before you apply If you get turned down for health insurance once, you'll have to report it on all future applications. So don't apply in writing until you're fairly confident you will be accepted. How do you find that out? Apply in person or over the phone, or ask a good broker who represents many companies. Different companies have different "look back" periods—the span of your recent health history they take into consideration, usually from three to 10 years. If you had some health issues in the past, you may have better luck with a shorter "look back."
Check your health credit Few people know about it, but there is an outfit called the Medical Information Bureau (MIB). Similar to a credit bureau, MIB keeps tabs on things such as test results and serious ailments you suffer. Though not everyone has an MIB record, if you have applied for individual life, health, or disability coverage within the past seven years, chances are you do. And the bureau can tell insurers whether you are a good risk or not. MIB is subject to the Fair Credit Reporting Act, and so, if you ask to see a copy of your record, the bureau is required to send you one. Get your report by calling 866-692-6901 or going to the MIB website. You'll see what insurance companies are told, and that will give you a good idea of how easy or difficult it may be for you to get insurance on your own. And you can correct any errors that may be costing you coverage.
Silence is golden After you've made an application to a health insurance company, you'll typically get a telephone verification call. "Listen to each question carefully, pause, think about the question, and then answer only and exactly what has been asked. A simple yes or no without comment is often your best reply. Don't start a conversation. Don't elaborate on your answers. The person at the other end of the telephone is not your friend, and any extra information you provide can only be used against you—and may wind up on your MIB," says Pilzer.
Think short-term Normally, you wouldn't want a short-term health insurance policy. Unlike most policies, they are not guaranteed renewable. But because of that feature, they tend to cost much less than regular insurance—about one half to one third as much. If you know you won't need to renew the policy because you've got a job with good benefits lined up, "it makes sense to flip to a short-term policy and save yourself a bundle," says Pilzer. "Most carriers carry short-term insurance, so the switch may just require a call to your present agent."
DENTISTRY
Be a guinea pig Just as medical schools are a place to go for cheap medical care, "dental schools offer extremely high-quality care for about one third the price you'd pay elsewhere," says John Dodes, D.D.S., a dentist in private practice in New York City and author of several books on dental health, including Healthy Teeth: A User's Manual (St. Martin's Press, 1999). "Just be aware that going to a dental school for care isn't going to be quick," he adds. "It can be very time-consuming."
Watch the markup "It's perfectly okay to ask a dentist, 'Is this a fair price?' " says Dodes. One Pennsylvania man was handed a $90 bill for a single tube of hydrogen peroxide tooth-whitening gel. He went online, searched for "dental supplies," and rapidly discovered that the wholesale cost for the tube was about $7. "Er, excuse me, but that's a 1,200 percent markup," he pointed out to his dentist. The dentist charged him $21 for the tube and wrote "$69 professional discount" on the bill.
The Politics of Health Care
Nearly all the people interviewed for this story say that although take-charge tactics can help to reduce health costs, the need for such tactics is indication that our health care system is troubled. Or, as Peggy Cabaniss of the National Association of Personal Financial Advisors puts it, "the system is nutty."
Activist William Schwied, M.D., says that ultimately the only answer, if Americans want reasonably priced, effective health care, would be to adopt a national, government-funded health care system, similar to what exists in Canada and Western Europe. Pilzer, who is not only an author but also a former economic adviser to two former (Republican) White House administrations, agrees that a "complete reform" of the system is needed, though he favors a free-market approach. Among his proposals: allow health insurance to be sold across state lines, make all insurance premiums tax-deductible, and allow for international competition in pharmaceuticals.
Both experts, divergent as their opinions may be, do agree on one point: "Nothing is likely to change if government officials continue to have unlimited lifetime health benefits while the rest of us do not," says Pilzer. "How can they possibly understand what so many Americans must suffer to get decent health care?" says Schwied.
Russell Wild is a freelance writer in Allentown, Pennsylvania.
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