Friday, February 28, 2014

7QT: Seven Ways to Save on Family Healthcare

By Joy Pullmann

Linked up with Conversion Diary.

Since my husband and I are both self-employed, we have to pay for our own health coverage. So, since saving money is very important (every bit saved goes towards paying off our mortgage early or giving to charity), and since we work hard we can't claim money the government has forcibly taken from other people who work hard, we have discovered a number of ways to save money on healthcare costs, even amid our country's expensive, cumbersome, and non-transparent healthcare system.

1. Try alternatives to health insurance.* We purchase catastrophic health expenses protection through a sharing program called Medishare. It works similar to insurance, but is not insurance: So we have in-network health providers, with whom Medishare has negotiated lower rates, and out-of-network health providers, just like typical insurance, but through Medishare members' monthly fees (ours for a family of five with a deductible of $5,000 is approximately $350) literally pay other members' health expenses. Insurance providers try to make money on top of that. I'm not against people taking risks in order to make money, but buying health insurance from a company would cost us at least twice what we pay. There are downsides: For one, Medishare doesn't offer preventative care incentives that might reduce overall costs like a no-copay annual physical; and for two we get put in this catch-22 where if we declare an expense and have health providers bill Medishare, we still have to pay the final bill out of pocket because of our high deductible and then we end up paying insurance rates, which are typically higher than cash rates. But if we pay in cash, we don't get the expense applied to our deductible, so we have to actually pay a lot more in health expenses than our deductible to go over our deductible and start to have our coverage kick in.

Another thing that may matter to some people is that Medishare, as a Christian organization, does not cover the health consequences of immoral behavior, such as getting drunk or getting pregnant outside of marriage. Members also may not smoke. They do refer people to charities that help with such problems, but they are not a charity and such restrictions drastically cut down on member costs.

This is probably not a good option for people with chronic health problems or who are elderly, but even for a growing family that has lot of regular medical bills (although no chronic health conditions so far), and coupled with the other ways we save on healthcare, we have so far found this an economical option despite the drawbacks. Medishare is not the only health sharing service: There are others, like Samaritan Ministries, and I encourage you to cost-compare.

2. Get a health savings account (HSA). Although the great federal government has recently further restricted this fabulous tool through ObamaCare, HSAs are a tax-protected account that allow you to pay most healthcare expenses (including health insurance premiums) with pre-tax dollars. You must have a high-deductible health plan, but if you do this is a great way to save at least something on your annual tax bill. Money you put into the accounts rolls over annually, and after you've saved a certain amount you can use the account as an investment account to get higher interest than a savings account (where, again, thanks to our great government's inflationary policies, interest rates are worse than zero).

3. When you have babies, use a midwife. I had a really great, conventional health insurance plan when I got pregnant with our first child. So I trotted off to the nearest in-network women's clinic for my first doctor's appointment after finding out we were pregnant. It was such a horrible experience (I felt like a slice of meat tossed on a conveyor belt—the doctor I saw for three minutes didn't even look at my face) I decided to look for something better. I found it with a local pair of midwives who had opened their own practice. One partner was a previous labor and delivery nurse with 20 years of experience who had delivered literally more than a thousand babies. Having a midwife is like having a boutique personal pregnancy doctor. I have developed warm relationships with these wonderful, weird women who for some reason delight in waking at 2 a.m. repeatedly to help women while they scream  and gush blood and body parts. That relationship has been, for me, essential to having positive birth experiences. And, baby, if you don't know yet, it is hard to have a baby. You need all the trust and warmth and comfort you can get.

For people with more practical concerns, also, midwives have for me cost between $3,000 and $3,500 for each birth, all inclusive (except if you want special items like a birth pool, and some basic birth supplies and of course baby items like clothes and diapers). Midwives also have far lower incidences of C-sections (your midwife can supply you with research showing why), which is good, because an average C-section costs almost $28,000. An average hospital birth costs more than $18,000.

4. See a nurse practitioner. Another benefit to midwives is that they are often networked with low-cost alternatives for typical health needs. Mine, for example, has an office co-located with a nurse practitioner, another low-cost health professional. Nurse practitioners can quickly and inexpensively care for all kinds of routine maladies, and refer you to other specialists if you need more help, just like a doctor. Our family has decided to move from having primary care doctors be our point of reference and keeper of our individual health records to having a nurse practitioner do the same. Learn more here and here and here.

5. Use low-cost clinics. In the same vein, you can get a lot of routine, basic medical services at retail clinics like MinuteClinic and local vaccine clinics. Almost every county has a vaccine clinic because widespread vaccination is good for everyone, and that's where we have moved where we get our kids' basic shots after bills at the pediatrician started climbing past $400 for every visit. Those of you with kids know that you have to visit the doctor for those shots at least every three months, and sometimes more often. That's a lot of money! The latest visit to the vaccine clinic for my two-year-old cost around $125.

Two downsides: If you are a first-time parent, you may find it more comforting to have the pediatrician assuring you that your child is growing just fine and explaining what developmental milestones are. We did. But with our second and third child, we have pretty much learned that the kids are fine and when something is out of the ordinary and cause for concern. I read those books like "Your Child's First Year" to make sure they're doing what they should like noticing patterns and listening to music and able to hop on one foot, etc. Second, the nurses at the vaccine clinic were not as fast with the needle as the nurses in our former pediatrician's office. Not a biggie, but it's nicer for the kids the faster injections go.

With the retail clinics, last year I got a common infection (I will spare you the details), but I took my feverish self to our local RediMed, within a half hour saw a very nice doctor who did look at my face and take time to talk with me, and got a diagnosis and a prescription for antibiotics, all for about $125. It was overall a very good experience.

6. Compare prices. Except at the absurd doctor's offices that have no idea what their services cost—which is far too many and utterly infuriating to a consumer who largely pays her own way—an obvious cost-saver is to shop around. I think the doctors are all in collusion with each other to prevent this by simply keeping prices a secret from everyone except the insurance companies. BUT! When you can, do this. I do on dentists before almost every annual cleaning.

7. Pay in cash. Always ask for the cash rate or uninsured rate if you are going to pay yourself. Most places we go offer lower self-pay rates to people who are uninsured or who are insured but who disregard that question and ask to pay in cash rather than pinging their insurer for the particular expense. For example, one of my ultrasounds was $600 for insured people and $325 for uninsured. We paid cash from our HSA. You can find doctors who are cash friendly here.

More excellent, cost-saving advice particularly tailored for people confused and concerned about saving money in our new, even-more-mangled ObamaCare miseconomy is in this recent article. And I do have a question for you: How do you save on dentists, besides shopping around? Is $179 for a cleaning reasonable, because it doesn't sound that way to me! And how do you find a dentist who doesn't lie and say you have a cavity when you don't? (That actually happened to my husband recently.)

*I have not been compensated or encouraged in any way to discuss these options by anyone in any health or other industry, and all these opinions are mine alone. Image by Vic.

1 comment:

  1. Thanks for the tips; this isn't something I've thought of much. For saving on dental: One woman I know (her kids are pretty much grown) told me she and her husband had no money when they started out, so they'd go to the dentist's office for a cleaning on a regular basis (six months?) but not see the actual dentist except rarely (once a year?). Seeing the actual dentist about doubled their cost, they said.


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