10 Ways to Beat the Rising Cost of Health Care

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6. Get in, get out, and pay a whole lot less

Physicians jam so many appointments into a day that it can be hard to squeeze in on short notice. And if you have to take your kid to an emergency room for a weekend illness, it could cost you a co-pay of $100 or more, especially if the insurer deems it a nonemergency. But there are easier, cheaper ways to get treatment for minor ailments.

First, workplace clinics are making a comeback. Most common at large companies, they are generally staffed with nurse practitioners, RNs with additional training and the ability to prescribe. You can swing by at lunch. The price: gratis.

Walk-in retail clinics in chain stores also rely on nurse practitioners. They're a good choice if you know what's wrong and it's simple. (If you aren't sure if you should go to a doctor instead, go to a doctor.) Prices for treating earaches, sore throats, and the like are posted on the wall. If your insurance pays, the co-pay is usually the same as a doctor's visit and a lot less than the ER.

For more serious problems, such as cuts that require stitches, consider an urgent-care clinic. They employ doctors but are typically still cheaper than ERs.

7. Have an insurance game plan if you lose your job

You already know that you should have a cash emergency fund that covers six months' expenses. That figure should include insurance costs, because you don't want to let coverage lapse. Not only would you be vulnerable to huge costs if you fell ill, but if you let coverage slide for 63 days or more, your next employer doesn't have to immediately cover preexisting conditions.

To figure out how much to set aside, ask your HR department what you'd have to pay to extend your benefits under the COBRA law. Companies with at least 20 employees typically must allow you to stay in your plan for up to 18 months. But you'll have to pay the premiums. The good news: If you lose your job before 2010, you may qualify for a federal subsidy that covers 65% of COBRA premiums.

That subsidy makes COBRA your best bet in almost any circumstance for now. But after it phases out, you may find that an individual plan is less expensive if you are young and healthy. Check out quotes on ehealthinsurance.com.

8. Live healthier...Or else

Employers want you to be healthier, and not because they love you. They're trying to control their health costs, says Kathy Harte, a consultant at Hewitt.

Today nearly 90% of large employers offer some type of wellness program, including help with losing weight or quitting smoking, according to the Kaiser Family Foundation. Your company may even pay you - or charge lower premiums - for participating. Other plans are offering free access to a health-care coach, typically a nurse, who can offer one-on-one help for managing a chronic condition.

Sources: Fidelity Investments, Employee Benefit Research Institute

Employers are considering the stick as well as the carrot. According to Hewitt, some 17% of big companies charge or plan to charge higher premiums to employees who engage in unhealthy behaviors such as smoking. Yup, they can do that.

9. Avoid Medicare mishaps

Medicare has become a bit baffling. Besides traditional coverage, you can choose private plans called Medicare Advantage. And then there are all those new drug programs.

Here's how you can easily avoid a couple of big mistakes in the next open enrollment. First, don't go with a plan without checking to see if your pills are covered. (Use the formulary finder at medicare.gov to find a plan with your pills.) Second, if you split your time in different areas, only choose an Advantage plan with a provider network in both places. Or stick with traditional Medicare.

10. Cut vision and dental costs too

Your company may offer you optional vision benefits, which might seem pretty attractive. But run the numbers before you sign up. Add up the amount you spend on contacts, glasses, and optometrist visits each year. Then calculate how much you'd save with the plan's benefits. Some people find that the coverage costs about the same, or sometimes more, than they save. And remember, you can also pay for vision through your FSA or HSA.

Dental coverage is a better deal, but a third of employers don't offer it. In that case, consider a discount program through your health insurer or on sites like dentalplans.com. These give you 20% to 30% off at participating dentists and cost about $150 a year. Everything we said about negotiating a discount with doctors applies to dentists too. It's the No. 1 rule of 21st-century health care: You don't ask, you don't get.

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