Aim to Save Next Year on Health Care Costs

For most people with employer-sponsored health insurance, changes in benefits take effect in January.

Total health-plan costs per employee rose 6.3% in 2008 and are expected to rise by a similar amount in 2009, according to the Mercer National Survey of Employer-Sponsored Health Plans. Because of increased cost-sharing by employers, most workers also are paying a greater share of the costs out of their own pockets.

Next year, resolve to save money on medical expenditures by following four simple rules whenever possible:

1 Use in-network providers.
Most health plans either require you to use doctors and hospitals within their network (HMOs) or charge you more for going out of network. Staying inside the network when possible can save you hundreds or thousands of dollars.

When obtaining preauthorization or precertifications for surgery or other procedures, check to make sure that anesthesiologists, physical therapists and other care providers also are in-network, not just your physicians and surgeons.

2 Use the right provider.
Going to a hospital emergency room for nonemergencies like sniffles or scrapes because the doctor’s office is closed can set you back big time: Fees for such emergency-room visits can range from $300 to $500, while an urgent-care facility could charge $120 to $135, a primary-care office visit $65 to $75, and a retail clinic like those inside pharmacies, supermarkets and discount retailers could charge just $45 to $55, according to Cigna, a major insurer.

If your health plan has a nurse telephone or online hotline, use it to help determine which is the best course of action for a medical problem. Of course, for severe bleeding, shortness of breath, head injuries, chest pains, poisoning or other real emergencies, don’t hesitate to dial 911 and go to the nearest ER.

3 Prefer generics.
Most companies today use multitier drug plans that charge the least for mail-order generic prescription drugs and the most for brand-name or lifestyle drugs for which generic equivalents are available. Always ask your physician if a generic is suitable and available when he or she writes a prescription.

For instance, a commonly prescribed medicine such as the antidepressant Prozac could cost $154 a month at a retail pharmacy but $145 a month by mail order and as little as $4 a month if obtained as the generic fluoxetine hydrochloride.

Also, some commonly prescribed maintenance medications are available more cheaply in 90-day supplies from pharmacies at discount retailers, supermarkets and the like.

4 Use online tools.
These let you comparison shop for prescriptions, procedures and high-tech radiological services. A growing number of insurers are providing online tools that enable you to compare prices for drugs and procedures.

Aetna’s cost-transparency tool, for example, lets you compare the cost of PET scans, CT scans and MRIs in your area. The difference between free-standing and hospital-based testing centers can be as much as $200 to $300 a scan, says Jeffrey Kang, Cigna’s chief medical officer. You share in the savings if you’re in a high-deductible plan or pay co-insurance. But be certain the scanning facility is properly licensed and accredited by a group such as the American College of Radiology.

Google Health offers a place to store your personal medical information in one easy to locate place even if your insurance provider changes from year to year. This is a handy way to track your medical information online, and keep consistancy over a number of years even as your health care provider or insurance provider may change. Also if you move or travel for prolonged periods, it is a great way to have this information nearby rather than at the doctors office.

Consider puting healthy dependents and spouses on individual health insurance coverage or see if your spouse can get on group coverage through his or her employer. Often times employers only cover a portion of the premium for the employee, and the monthly premium for spouses and dependents can be signifigant. By putting children on individual coverage, you can exclued things like maternity coverage to help reduce costs. Also, generally medically underwritten individual health insurance is less expensive the guaranteed issue employer sponsored health plans.