Ten Ways to Beat the Rising Cost of Health Care

It seems that in good times and bad, you can count on health-care costs to defy economic gravity. And it doesn't get much better when you hit 65 and qualify for Medicare. By one estimate, a couple retiring this year will need a cool quarter-million in savings just for medical expenses.

So for better or worse, managing your own health care has become an essential part of financial planning. Washington is hotly debating how to fix our high-cost health-care system, but in the meantime there are some things you can do to lower your bills without compromising on care. Here are your best strategies for easing the pain.

1. Before you say "ahh," ask "how much?"

Most of us still aren't used to the idea of talking money with a doctor. But you won't be shocking his delicate sensibilities. "The uninsured frequently ask for a discount or a payment plan, but most insured consumers don't realize that they can negotiate," says Ruth Levin of Continuum Health Partners, a New York City hospital system.

2. Don't just swallow high-priced prescriptions

Health plans have gotten picky about pills. About 77% of workers with a drug benefit face three or more price tiers - one cost for generics and higher charges for "preferred" and "nonpreferred" brands. If Prevacid isn't on your preferred list, it could easily cost you $300 a year more than a generic version of Prilosec.

3. Get your free money. Sign up for that FSA

Need any more proof that humans aren't as rational as economists assume? Look at flexible spending accounts, a benefit that can put hundreds of bucks in your pocket. About 80% of large employers offer FSAs, but a mere 22% of their workers enroll, according to the consultancy Mercer.

4. Look before you leap into a high deductible

Wish you could pay a lower monthly premium? Many firms offer you a choice between a traditional plan and one with low monthly costs but a much bigger annual deductible. But high-deductible plans aren't a good fit for everyone.

5. Max out an HSA (but use it wisely)

If your family's insurance deductible is higher than $2,300 you likely qualify for a health savings account, or HSA. Like FSAs, these accounts let you save pretax dollars for health costs. The key difference is that you get to keep your money there as long as you want. And so long as you use it to buy health care, you don't pay taxes when you withdraw it either.

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.

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.

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.

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.

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.