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3 Effortless Ways To Save Money On Your Next Insulin Refill

We’re always looking for new ways to help people save on medication. Recently, insulin has been at the top of that list. Prices for popular medication like Levemir, Novolog, Lantus and Humalog have skyrocketed $100’s of dollars over the past ten years costing people thousands in out of pocket costs.

With a disease like Diabetes, maintaining proper insulin levels is essential for good health. Insulin is currently so expensive that many people have taken to skipping doses and rationing their medication use, which can have serious health consequences.

Three Ways To Save On Insulin, Right Now

Below are a few programs that many help with Insulin costs for the insured, underinsured, and uninsured.

1.   Get A Novo Nordisk Savings Card

Novo Nordisk is a global healthcare company, headquartered in Denmark, that offers a number of patient support programs for insulin medication.

If you have insurance, all you have to do is sign up for the Novo Nordisk Savings Card, which can be used for all Novo Nordisk diabetes products. Their website will ask you a few question about the medication you’re looking for and whether or not you have insurance. Fill those out and you’ll be guided through a process to receive your savings card.

Sign up for Novo Nordisk Savings Card here

Novo Nordisk Savings Rates

  Medicine Type “You may be eligible to pay as little as…”
Levemir Insulin detemir injection 100U/mL $45 per 30 day supply
Fiasp Insulin aspart injection 100U/mL $25 per 30 day supply
NovoLog Insulin aspart injection 100U/mL $25 per 30 day supply
NovoLog Mix 70/30 Insulin aspart protamine and insulin aspart injectable suspension 100U/mL $25 per 30 day supply
Ozempic Semaglutide injection 0.5 mg or 1 mg $25 per 30 day supply
RYBELSUS Semaglutide tablets 3 mg, 7 mg, or 14 mg $10 per 30 day supply
Tresiba Insulin degludec injection100U/mL or 200 U/mL $5 per 30 day supply
Victoza Liraglutide injection 1.2 mg or 1.8 mg $25 per 30 day supply
Xultophy® 100/3.6 insulin degludec and liraglutide injection 100U/mL and 3.6 mg/mL $30 per 30 day supply

You can also call the call the Novo Nordisk Savings Card Program at 1-877-304-6855 from 8 AM – 8 PM ET Monday - Friday.

How To Get Assistance From Novo Nordisk If You Don’t Have Insurance

[1] If you don’t have insurance, Novo Nordisk has programs to help with the cost of insulin. Their first option is a Patient Assistance Program, which we strongly advocate you look into. Their Patient Assistance Program provides medication at no cost to those who qualify. Click here to see if you qualify for the Novo Nordisk Patient Assistance Program.

If you don’t qualify for the Patient Assistance Program, they offer another option that can still help reduce the cost of insulin. It’s called My $99 insulin, and patients may be eligible to get a 30-day supply of a combination of Novo Nordisk insulin products (up to 3 vials or 2 packs of pens) for $99 for up to 12 months. Click here to apply for the My $99 insulin program.

Getting An Immediate Supply

For patients in need of insulin immediately, Novo Nordisk will supply a free, one-time supply of up to 3 vials or 2 packs of pens for patients with a prescription.

Patients can call (844) 668-6463 or visit NovoCare.com.

2.   Get A Savings Card For Lilly Diabetes Medicine

Similar to Novo Nordisk, Eli Lilly also offers savings cards specifically for diabetes medication and insulin. People with diabetes, who have commercial insurance,  may qualify for savings cards to help with the cost of certain Eli Lilly insulins and diabetes medicines.

Unlike Novo Nordisk, Eli Lilly does not make you fill out a few questions to apply for a savings card. You can have a savings card emailed to you or download it directly to your phone or computer.

Click here to download the BASAGLAR savings card

Click here to download the Humalog savings card

Click here to download the Humulin R savings card

Unfortunately, you cannot be currently enrolled in a governmental program to be elligible for a savings card. Excluded programs include, without limitation, Medicaid, Medicare, Medicare Part D, Medigap, DOD, VA, TRICARE/CHAMPUS, or any State Patient or Pharmaceutical Assistance Program.

3.   Try Walmart’s $25 OTC Insulin

What Is Walmart’s Insulin?

If you live with diabetes, ReliOn is probably a brand you’ve heard of before. Walmart’s house brand for diabetic testing supplies.

But you might not know that Walmart also offers affordable insulin medication over the counter—which means you don’t need an insurance plan. Depending on your location, ReliOn insulin usually costs about $24.88 to purchase.

ReliOn is FDA approved, but it is human insulin which is different than the insulin a doctor may prescribe.

How To Get ReliOn Insulin At Walmart for $25

Since this insulin is available over the counter, all you have to do is go to the pharmacy counter and ask the pharmacist for Novo Nordisk’s Novolin ReliOn Insulin. It’s that simple, no prescription needed.

However, there are differences between this type of insulin and the newer types of prescription insulin. Read below for more detail on the differences.

Caution: ReliOn Insulin Is Not The Same As The Analog Insulin That Is More Commonly Prescribed Today

While ReliOn may help patients in a pinch, especially those without health insurance, it’s also a formulation known as “human” insulin which was developed in the early 1980s. It was the first version of insulin medication that was identical to what the human body produces on its own. It is FDA approved and completely safe to use.

But, as the science and technology for producing insulin got more advanced, newer versions of the medication were introduced that featured ultra-rapid absorption and ultra-long lasting effects. Over time, doctors and drug companies have switched to prescribing newer versions of insulin instead of human insulin.

Insulins like Humalog and Levemir are commonly known as analogs. They were developed to be more effective at preventing dangerous blood sugar swings in people with Type 1 diabetes or those at a higher risk for severe low blood sugar.

Human insulin and analog insulin work exactly the same way in lowering blood glucose once absorbed in the bloodstream, however the types of insulin are different in how slowly or rapidly they are absorbed once injected.

Because of this: YOU MUST speak to your Physician before making any change in insulin. Your doctor will be able to help you in determining what your new dose should be as well as when and how to administer the insulin.

Remember, your doctor and pharmacist are there to help you! If you’re struggling to afford your medication, ask them for help. They can guide you towards savings options you didn’t know you had! Following these tips and talking to your doctor and pharmacist are a simple way to start putting the power of your healthcare back in your hands.

ken rose

Ken Rose, RPh

Ken is a multidisciplinary pharmacist, with over thirty eight years’ experience within Pharmacy and the Managed Care industries. He is a pharmacy savings gurus—helping people with all the ways they get their medicine: mail, retail, and hospital pharmacy, clinical programs, specialty pharmacy and health plans. 

Why Every Mom Needs A Telemedicine App On Her Phone

Megan Weddle works for First Stop Health, a company that specializes in bringing telemedicine to consumers, so it’s no surprise she’s a fan of technology itself. Her reason, though, is beyond professional—it’s personal.

Telemedicine helped Megan discover her twelve-year-old-son Brady—whom she thought was dealing with a simple stomach flu—was actually facing appendicitis.

Not the Stomach Flu

It all started when Megan decided to take her eleven and twelve year old children on a flight to the west coast to visit relatives. It was the first long flight for the kids, and her son Brady complained a little about his stomach hurting on the flight. They thought it was just upset from the cookies on the plane.

“The number one thing the kids wanted to do when we got to California was go to In-N-Out Burger,” Megan says. “After visiting the Hollywood sign, my son looked at me and said, ‘I need to find a bathroom NOW.’”

The flight, the burger, the time difference . . . Megan knew it could have been anything.

They hopped in the car on the way to Santa Monica, and Megan wondered several times if she’d need to pull over for Brady, who was still struggling with stomach issues in the back seat.

An hour later, as she was handing her card over to the receptionist at the hotel, Brady ran straight for the bathroom. He came out a few minutes later, saying he’d gotten sick.

As the rest of the family went to the pool—with everyone agreeing it was best to stay away from what was surely the stomach flu—Megan considered her options.

Where Megan Turned Instead Of Racing To Urgent Care

“It was close to the time an urgent care would be closing. Then, I thought to myself, I am going to call First Stop Health. I work for a telemedicine company. This is what it’s for: avoiding unnecessary visits to the ER or the doctor.’”

Megan picked up the phone and dialed. Although she could have opted for a video visit, she chose the phone option that time. Even though Brady wasn’t registered with First Stop Health, she was able to use her info and give his age, medical history, and presenting symptoms. She told the nurse that she thought it was the stomach flu and likely needed some anti-vomiting medication.

The Doctor’s Time Saving Diagnosis

When the doctor got on the line, he indicated he wanted her son to do a balance test, just to rule out anything more serious than the stomach flu.

“He told me to have Brady jump on one foot. I thought it was ridiculous—he’d been jumping all day, running around, before he started to feel bad. Brady refused to jump, though. Then the doctor said he hated to be the bearer of bad news, but my son was presenting with appendicitis.”

The doctor gave her information for two hospitals near where they were staying. They went immediately to the ER, where the doctor gave the same balancing test—which Brady failed.

His appendix was about to burst, and he needed emergency surgery.

Brady made it through the surgery just fine, but if his appendix had burst, there could have been serious complications. Megan credits First Stop for being a big reason why she got Brady to the hospital in time.

“The best part of this service is having access to a doctor 24/7. As a parent, sometimes you think you know it all. But, to be fair, we don’t. If Brady’s appendix would have ruptured, we would have been in California longer. Because we caught it and did the surgery right away, we only had to spend one night in the hospital. He bounced back.”

What’s Different About First Stop 

On top of being a quick way to talk to board certified doctors, First Stop has other benefits, too. The service costs just a couple of dollars every month for individuals, unlike other telemedicine services that charge up to $75 per call. 

First Stop can also be used by up to seven other family members, meaning the whole family can have instant access to care. 

A Good Call For Moms With Kids

In addition, using telemedicine can be uber-convenient and less risky to other members of the family who are not sick.

“Sometimes, you don’t want to drag your non-sick kids into a waiting room, which is a petri dish. There’s only so many times you can say, ‘don’t touch that.’ I know. I am a mom of four!”

In the end, telemedicine not only made the trip easier on Megan and her family, but it also could have saved Brady’s life. That’s a call that’s always worth it.

Saving $1,600 On A Knee Injury – How Kelly Pulled It Off

If you have a medical procedure coming up, do you feel like you’re limited to the doctors in your area and bound to pay whatever they charge? Think again. You can shop around.

Let’s take a look at how one woman did just that—and saved over $1,600 on the cost of an MRI in the process.

When Kelly Slater, a runner, injured her knee, she just knew it was a torn meniscus. Her doctor suspected the same and ordered an MRI to verify. 

The catch? 

Her insurance company said she needed to wait six weeks to get the MRI—and even worse, it looked like it was going to be expensive.

Limited Access To Healthcare Options

Kelly lives in lower Michigan in a rural area, so her hospital choices were limited. The local MRI option was going to cost around $2,000—$1,083 more than the national average of $917!

Because she had time—and at the insistence of a friend who just happened to write a book on being a consumer of healthcare —she opted to shop around.

“It never occurred to me to shop around before then,” Kelly said. “It’s kind of a one-pony show up here. You go to the place that’s available.”

Kelly said she considered paying cash to get a lower rate, but because she knew she’d need surgery and thus meet her deductible for the year, it was more cost-effective to find the cheapest route through her health insurance.

How To Find The Best MRI Cost

Kelly followed a step by step approach to research and shop for the best, most affordable care. Here’s how to do what Kelly did:

  1. Call the physician and ask for the procedure code. Note that there can be multiple codes for each type of procedure. For an MRI, for example, there are different codes for “with contrast” and “without contrast.” Be sure your doctor provides you with the code for the precise procedure you’re getting.
  2.  Call different facilities you’d like to price shop, ask for their facility code (or ICD10), and ask the medical billing department for their price based on the procedure code from your physician. See our list of healthcare transparency sites for resources to help you find and compare providers.
  3. Call the insurance company and give them the information: the procedure code, the facility code, and the quoted price—and have your insurance company confirm what you’ll owe.
  4. Make the decision that is most in line with what you want and need for your healthcare—and your bank account. You should also remember that most outpatient facilities offer payment programs, which can be a great fall back option.

Kelly’s Shopping Success Story

Ultimately, by using a simple online search to find facilities and then calling around to get the lowest price, Kelly found a facility that would do the MRI through her existing insurance for a price of $341—a savings of over $1,600. She scheduled the test for the exact day her six-week waiting period was up.

“Through this experience, I learned to shop around because the medical care that’s available to you isn’t always the cheapest. It pays to look for some competition,” Kelly said.

It’s important to note that the MRI Kelly received—the one that was $1,600 cheaper at another location—was a 2D MRI, not a 3D MRI. Both of these types of MRIs can generally be used to diagnose a meniscal tear with similar accuracy.

IMPORTANT NOTE: It’s critical to check with your doctor to see what kind of MRI you need in your situation, rather than go with the one that’s most convenient or cheapest.

“Here [at the local facility] I would’ve been paying for a fancier machine that I didn’t really need. My doctor didn’t care if the MRI was 2D or 3D. It definitely makes sense to do your research .”

Ultimately, the MRI confirmed what Kelly and her doctor had suspected, and she got the care she needed for her injured knee. She reports she is very glad to be back up and running!  

Fighting Back Against Healthcare Costs | Money Answers Podcast

I sat down with Jordan Goodman, host of the Money Answers Podcast, to talk about tactics you can use to fight against the high cost of healthcare.

Jordan is the author / co-author of 13 best-selling books on personal finance—including Master Your Debt and Fast Profits in Hard Times—and we had a great conversation on the one of the most important topics when it comes to managing your personal finances: healthcare.

In this podcast, we talk about what you can do to dramatically reduce your expenses. We also cover how to plan for healthcare costs when you retire—something almost no one considers when it comes to retirement planning.

Click the link below to listen to the episode

Scott Heiser Money Answers Podcast

How Eric’s Proven Negotiation Tactic Saved Him $2,000 On A Colonoscopy

If you have a planned hospital need, you aren’t at the mercy of the billing department: if it makes sense for you, you can pay cash and save—sometimes up to 75 percent! In this article, we’ll look at how.

Here at Uncovered, we get it. All those tests, procedures, and surgeries are stressful enough in premise alone. Then, you factor in the cost, the fear of medical debt (and the fact that it can feel impossible to know how much you’ll owe ahead of time), and your stress level goes through the roof, right?

It doesn’t have to be like that. With a few calls and by asking the right questions, you can learn your all-in price. What was Eric’s big trick?

Paying upfront, in cash.

When it doesn’t make sense to pay in cash

Look at what kind of plan you have. If you have a full plan that covers preventative care, you’re safe. Or, if it’s early in the year and you have a low deductible that you know you will hit—and need to hit to account for more upcoming expenses during that calendar year—you’re also safe. Nothing to do. (Just make sure you stay in network!)

When it does make sense to pay in cash

If you have short-term insurance, it almost never covers preventative care, so it makes sense to find out the cash price. If you have a deductible you know you will not meet during the calendar year and are having a non-preventative procedure, it also makes sense to find out the cash price. You’ll be paying it in cash anyway, so why not pay less?

Here’s how to find out the cash price:

Step One: Call the surgery center or physician and say you’d like to negotiate.

Step Two: Ask who is involved in the procedure, what services you will receive, and get a breakdown of those costs. For example, for Eric’s colonoscopy, they broke it down for him all the way to the cost per polyp removal.

Step Three: Tell them you’d like to negotiate an all-in price to pay on the day of service.

Step Four: Save big money!

These Tips in Action

Eric Neuville is the perfect example of what to do when it comes to negotiating hospital bills. When his doctor referred him for a colonoscopy, he knew it wouldn’t be covered under his short-term medical insurance because his plan didn’t pay for preventative care at all. He also knew his deductible was high–$8,000—and that he wasn’t going to meet it.

Eric’s doctor told him he wasn’t sure how much the colonoscopy would cost. What he refers to as his “sort-of” insurance carrier also told him they didn’t know (and wouldn’t until the surgery center billed them). The common refrain was that the procedure had to be done for them to know—which, according to Eric, was ridiculous. And he would know, as a twenty-five year veteran of the insurance industry who ran product development for Anthem Blue Cross and Blue Shield.

Eric’s wife called the surgery center and asked for the all-in cash price on a colonoscopy. They broke it down for her: if they paid in full on the day of service, it would be $1000 cash, a savings of almost 70 percent.

The day of the surgery, Eric walked in and told the receptionist he was quoted a cash price of $1,000. He gave them two cards: his insurance card and his payment.

When the couple later got a bill with a “discounted” price of over $3,000 for the surgery, Eric had to remind them that he’d already paid—and that he hasn’t paid nearly that much.

It wasn’t the couple’s first time using the cash method to save. When Eric’s wife had a hip and knee replacement due to arthritis, they got another 75 percent discount by paying a quoted all-in price up front.

What Eric Has To Say About Negotiating

Eric is an advocate for healthcare consumerism not just when it involves his bank account.

“We need to be as active in our healthcare choices as we are when we make a choice about what television to buy next,” he says. “We have to challenge ourselves. I have zero patience for the ‘I have insurance, so I don’t have to worry about it’ mindset. That drives up costs for us all.”

How To Safely Split Your Pills At Home | Ken’s Capsule

Splitting your pills can be a great way to save money, but there are some things that you must consider when deciding if it’s right for you. In this article, we are going to cover everything you need to know about splitting your pills; the do’s and don’ts and especially how you can do it yourself at home without special equipment.

Quick note: Some insurance companies will allow you to split you medication and offer savings to customers, so please ask your insurance carrier if they do offer savings incentives for pill splitting.

What Is Pill Splitting?

In the past, pill splitting has been the subject of debate, but that doesn’t mean it’s something to be afraid of.

The concept is simple: you get the same prescription at a higher dosage, then divide the pills into smaller pieces to get the dosage recommended by your doctor, which saves you money per pill. 

Here are a few examples of savings that you can achieve through pill splitting.

Generic Lexapro (escitalopram) tablet (prices may vary).

5mg #30 ~$9.00  
10mg #30 ~$7.20 <- price after pill split
20mg #30 ~8.60 <- price after pill split

Generic Zoloft (sertraline) (prices may vary).

25mg #30 ~$8.30  
50mg #30 ~$7.20 <- price after pill split
100mg #30 ~$6.60 <- price after pill split

First, Ask Your Pharmacist

Ask your pharmacist which of the pills you are currently taking can safely be split at home.

Your pharmacist is the expert here, and will take many different factors into account, including:

  • The brittleness of the tablet
  • If the tablet is scored
  • Does the table have a protective coating
  • If the tablet is too hard for splitting
  • If the table is too soft for splitting
  • If the table is timed or extended released or not
  • If the medication uses capsules, which can’t be split

The FDA also provides guidelines on best practices for splitting pills that you can read.

How To Safely Split Pills At Home

Option 1: Try using a pill splitter

Pill Splitters are the easiest way to split pills. BUT, pill splitters can be aggressive on delicate and sometimes expensive pills.

If you choose to use a pill splitter, make sure the tablets are durable enough to be split this way.

What are the signs of a pill that isn’t suited for pill splitting? You’ll noticed:

  • The pill crumbles
  • The split isn’t even
  • The tablet easily turns to powder

If you notice these things happening, try using one of the next two options.

Option 2: Split softer, curved tablets with your fingers

how to split curved pills

If your pills are curved, soft and scored then a great alternative to a pill splitter is to use your fingers. Softer pills split very easy with even pressure on each side of the score mark.

I’ve always enjoyed seeing how many people are surprised that this technique is so successful.

Option 3: What to do for flat, scored tablets that aren't too difficult to split

how to split flat pills

One trick that I have always used, is to place the score mark along a plastic ink pen and use the pen to evenly split the pill.

Press the tablet with your fingers evenly on each side of the score mark until the pill splits in half.  Sometimes this will take a decent amount of pressure. Just make sure that you’re using the tips of your fingers to apply even, steady pressure and it will result in a clean break.

Unevenly shaped pills need to be accurately split in half, long ways. I do not recommend this practice due to inconsistent results.

Make sure you keep safety in mind

  • Wash your hand before starting.
  • If you are splitting tablets for others, use surgical gloves. Also ask about latex allergies before using latex gloves.
  • When using a pill splitter, clean the pill splitter between different pills. (cross contamination can result in incorrect dosing).
  • Ask you pharmacist or physician if it is ok to split your dose. (There have been many dosing mistakes made when  a physician writes for 1/2 tablet and pharmacies fill the prescription with the directions saying fill for 1-2 tablets...please review your dosing with your physician.
  • If you current tablet does not have a score mark, ask you pharmacist if they have a manufacturer that does offer a scored tablet.

Little savings add up. Pill splitting is a great technique and easy way to make the price of your medication easier to swallow. And remember: your doctor and pharmacist are your partners. They’re there to care for you in the way that fits you best. Talk to them, have the conversation and take another important step to taking control of your healthcare.

ken rose

Ken Rose, RPh

Ken is a multidisciplinary pharmacist, with over thirty eight years’ experience within Pharmacy and the Managed Care industries. He is a pharmacy savings gurus—helping people with all the ways they get their medicine: mail, retail, and hospital pharmacy, clinical programs, specialty pharmacy and health plans. 

Proven Health Insurance Advice For Open Enrollment

I spoke with M.C. Laubscher on his podcast, Cash Flow Ninja, recently about the things everyone should be thinking about when they’re making decisions about their healthcare. His listeners come to him all the time with questions about healthcare…”What should I do? How much should I be paying? How do I find better information to make smarter decisions?”

M.C.’s audience is filled with entrepreneurs and investors and the advice I have for them is perfect for anyone who is looking for individual insurance during open enrollment this fall. We talk through:

  • The difference between healthcare and insurance
  • What everyone should be doing during open enrollment to find the best insurance plan
  • How to manage healthcare costs

Listen to the full episode below

How To Choose The Best Health Insurance For 2020

Picking your health insurance plan for 2020 is an important decision you’ll be stuck with for the entire year. Which means it’s worth taking the time to do a little homework and make the pick that’s right for you.

Follow these seven steps to make sure your insurance plan fits your health needs and your budget.

1. Start With Your Health History

Make a list of how much you used your health insurance last year. The list needs to include physician office visits, prescriptions, diagnostic and lab work, and medical procedures.

2. Find Out What Plans Are Available To You

Identify the plans available to you, the amount of cov- erage they offer, and the amount of upfront dollars you will need to pay.

Use a chart like this to help you organize:

Plan 1Plan 2Plan 3
Premium (cost per month)


Deductible (amount you pay before
insurance kicks in)



Co-pays


Out of pocket charges


3. See How Each Plan Stacks Up Compared To Your Expected Medical Costs

Compare the costs of every health plan available to you. Don’t automatically exclude any, even those with a high deductible. Which plan costs you the least in total?

4. Find Out What Can You Afford Monthly

Can you handle your healthcare costs in one payment or, if not, how much you can afford monthly. For example, can your pocketbook sustain $694 in monthly costs, or $8,365 annually? Be realistic.

Tip: check out the Kaiser Foundation’s calculator for help with this.

5. See If Your Current Doctors And Hospitals Are In Network

If you go to an out-of-network provider, your copay, deductible, coinsurance, and out-of-pocket maximums will generally double. You’ll have to decide if that doctor/provider is worth it or be forced to find another doctor. 

6. See What’s Covered

  • Pregnancy
  • Hospitalization
  • Emergency services
  • Outpatient care
  • Mental health
  • Prescription drugs
  • Rehabilitation services
  • Lab services
  • Pediatric services
  • Preventative services

7. List the tax deferred mechanisms of each plan

Ask for and study all tax deferring or saving mechanisms available like premium-only plans, flexible spending accounts, health reimbursement accounts, and health savings accounts. These plans all allow you to save and use your dollars before income tax is applied, kind of like a 401K. These options are no brainers when they’re available to you since they increase the amount of money you have to pay for your health expenses.

 Remember, don’t overinsure by selecting the plan with the lowest out-of-pocket fea- tures, because it will have the highest premiums, which are non refundable. This checklist will give you a clear idea of the most cost-effective plan that meets your specific needs. 

You only have one chance a year to make the best choice, so do your homework!

Check out Health Sherpa to find and compare the best insurance plans for you.

Uncovered’s Top Healthcare Transparency Services | 2019

Healthcare transparency sites give you access to information that could help you make smarter decisions and save you thousands of dollars. But not all healthcare transparency sites are created equal. Below is our list of the top healthcare transparency websites for 2019.

Be Careful Who You Trust

Healthcare transparency sites are usually built on access to real, anonymized healthcare records that allow them to analyze cost, effectiveness and provide reviews. The only problem is, sometimes this data isn’t accurate, or the site just isn’t pulling from a large enough population to provide accurate information.

The Sites That Made Our List

We’ve reviewed each an every one of these sites to make sure they’re helpful and user friendly—but most importantly, that you can trust them. They’ve earned our stamp of approval as insiders and we think you should use them.

Reviews, Affiliation & Scheduling | Qualitative Sites

Reviews & Comparison

Reviews & Scheduling

Procedure Cost Predictors | Quantitative Sites

Cost estimator tools

Carrier cost estimator tools

Coupons And Saving Sites

Patient assistance programs

Rx Coupon Codes

EHR vendors

Even More Sites Are Coming

Healthcare price transparency is a growing trend—more and more people want to know what they’re going to pay when they visit the doctor or hospital. Everyday new sites are started to help people better understand the cost of healthcare. 

Bookmark this page. We’ll continue to update this guide as new sites become available. But most importantly, use these sites! The information they give you could save you hundreds or thousands of dollars.

From No Coverage to Affordable Coverage, with HealthShare

“It’s not technically insurance—even though it is. And I can’t speak for everyone, but from my experience, there are no downsides.”

That is the way Nat Comisar describes the HealthShare program he and his wife switched to after finding the traditional route—searching on the Healthcare Marketplace (Obamacare)—to be far too pricey.

Nat was no stranger to the world of insurance, either. In the past, he was the employer who provided healthcare to his employees. When he became self-employed, he figured he’d have no problem securing insurance. After all, he was a healthy 55-year old man with no preexisting conditions and on no medications.

Easy, right? 

Wrong.

To the best of his memory, the best deal he could find was going to cost him $680 a month with a $7200 deductible. Because he rarely had any reason to go to the doctor in the first place, that could have amounted to almost $16,000 annually for something he didn’t even use.

So, what was next for Nat? He made the same decision a lot of people in that situation do: he went without insurance for five years, finding it far cheaper to simply pay the fine when tax time came around.

When Nat’s wife went to search in the Healthcare Marketplace, her premium was more reasonable—at first. It started at around $270 per month. Then, it started steadily increasing, all for the exact same coverage. When it approached $500 per month, Nat’s wife made the same decision as her husband: she went without insurance for about a 18 months.

Discovering HealthShare

While out to lunch with a friend—a friend who had just happened to be writing a book at the time about how to take control of your healthcare and save money along the way—Nat learned of an option he had no idea was out there: HealthShare.

“The way I understand it, the HealthShare Market is the way insurance is supposed to be,” Nat says. “It’s a pool of individuals who are funding a contingency for one another for health concerns.”

HealthShare programs are religion-based. Many don’t require you to be a member of that particular religion, just that you are a person of faith. Remember—each program is different, so do your research wisely.

Nat did just that, focusing on three major HealthShare companies. He ultimately chose the one that seemed easiest to join and most organized—Solidarity HealthShare, a Catholic Organization.

Practically, Nat now pays $300 a month to cover both him and his wife. Collectively, they have a $1000 deductible. 

“We still don’t use any of our insurance dollars,” Nat says. “In this last year that we’ve been a part of this, I bet we’ve only spent about $400 towards our deductible. Still, it’s so worth it. A plus is that with this company, if I do get to a place where I need assistance, I can see who it comes from. I can also see where my contribution is being sent and send a message to them, if I want.”

To be eligible for this program, Nat had to pledge a few things: that he was a nonsmoker, did not use illicit drugs, and was a moderate drinker, if he drank at all. If he had any preexisting conditions (he didn’t), he’d have to declare them up front—but that would not make him ineligible for coverage. Instead, it would mean he could not be reimbursed in the first year of being in the pool, and only up to $25,000 annually the second and third years. For everyone—preexisting condition or not—there is a $1 million lifetime cap.* 

Nat’s plan sends him and his wife to annual checkups, both of which are covered. There is no pharmaceutical component to his plan, but that’s okay—there are discount cards to help with that.

Sometimes, when Nat does need to use his HealthShare—which, by the way, satisfies the legal requirement for having health coverage, saving him that annual tax penalty—receptionists give him a funny look. He says he’s used to explaining from there.

“I tell them, ‘It’s HealthShare, not insurance. You should be able to file it. If you can’t, just consider us a self-pay, and we’ll file it.’”

The Bigger Picture

Nat says in the beginning, he was curious about the extent of the religious component. 

“In the end, I’ve found it to be a Christian organization that is a big group of people supporting one another,” he says. “There’s not a profit motive.” 

In retrospect, Nat says he wishes he would have known about HealthShare sooner.

“Before, I had 350 employees in the restaurant business. Had something like this existed—or had I known it existed—I could’ve covered everyone at 100 percent, purchased supplemental insurance, and still not have to ask for their financial participation.” 

If someone who was in the business of providing health insurance didn’t know about this option, odds are that this is your first time learning about HealthShare, too. We want to be clear: this option is not for everyone, but if it turns out to be for you, you could be on the receiving end of some big savings.

*Remember that not all HealthShare programs are the same. For more information the company Nat and his wife decided to use, visit Solidaryhealthshare.org. To find the right option for you, visit HealthSharingPlans.com.

Overpaying for Your Prescriptions? Here’s Proof You Don’t Have To

Prescriptions are expensive, but you have more resources available to help you cut those costs down than you think. Here, we’ll look at how one man saved $422 a month on his medication by leveraging a Patient Assistance Program (PAP)–and how you can get similar results.

(Yes, you did read that correctly: $422 a month!)

No one is immune to the high prices and feeling of bureaucracy that can sometimes shroud the world of healthcare and big pharma—not even Scott Heiser, who literally wrote the book on the subject.

The difference is that Scott knew what to do—and, by being here, that means you can, too.

In the past, Scott was hospitalized with deep vein thrombosis (DVT) and subsequent pulmonary embolism—i.e., a blood clot in the lungs. Scott recalls that the whole thing was a shock, kind of a “freak incident.” He talked with the physicians, who said he needed to be on a blood thinner for a year. 

Together, they discussed options: there was Warfarin, an older and relatively inexpensive prescription, or Eliquis, a newer-generation drug that was more costly. Each drug—as is true for them all*—had pros and cons: Scott learned it was easier to control bleeding and coagulate more quickly with Warfarin, but he’d also to test his blood often. With Eliquis, he wouldn’t have to test his blood, and he’d have the convenience of only taking one pill a day. Although an uncontrolled bleed was not likely in his case, if he faced one, it would take him longer to coagulate.

Because Scott’s risk factors were low for needing quick coagulation—and taking into account he only needed to be on the precautionary medication for a year—he and his doctor decided Eliquis was the best choice.

The problem? It was $432 a month. Because Scott knew about PAPs to reduce consumer costs, though, he was able to get that cost down to $10 a month.

That’s that mega monthly savings we’re talking about! Hardly chump-change. 

Let’s take a closer look at PAPs. 

PAPs: What You Need to Know

PAPs are offered by pharmacy manufacturers to provide financial assistance to those taking a particular drug and who meet certain requirements. While each PAP is different, they generally provide assistance to those who meet one or a combination of the following criteria:

  • Have a high deductible health plan
  • Have an income of at or below a certain point
  • Do not have health coverage

Just as qualifications for each PAP are different, so are their means of providing assistance and reducing consumer costs. Some will cover your copay. When this happens, the pharmaceutical company still bills your employer (if they provide your insurance) the full amount—that’s just business.

“Our whole philosophy is that you, as a consumer, should understand the cost being borne by the system and be aware so you can try to minimize that cost. Why? Easy: it will pay dividends to you in the long run by keeping your premiums low,” Scott says. “If your employer’s premiums don’t go up, they don’t raise them for you, either.”

How Scott Saved Over $5,000 

In the short game, though, Scott knows that money talks. And $10 is a whole lot more digestible than the alternative—which is an example of what makes PAPs so attractive.

Here’s how Scott secured the reduced rate:

  • He searched for the phone number of the manufacturer and called to ask if they offered any type of assistance program. (Spoiler alert: they did.)
  • He talked with the representative to see if he met the program requirements due to his high-deductible health plan. (Spoiler again: he did.)
  • The representative said he’d notify Scott’s pharmacy of his discount, which was good for 24-months. (That’s all, folks. Discount received.)

It took all of twenty minutes—for the online search and the phone call combined—for Scott to save more than $5,000 for the year he was on the drug (that, due to the timing of his hospitalization, he would’ve paid 100 percent out-of-pocket). 

Today, it’s not even necessary to do your own online investigation. Instead, you can simply visit RXHope.com. This free, reference-based website lists over 330 drugs for which PAPs are available; it’s all right there for you.

Note that your drug may or may not be on the list—and if it is, you may or may not qualify for the PAP—but isn’t taking a few minutes to check worth the effort? 

Discount Cards: Save $5, $50, or More!

Sometimes, a PAP may not be available for a drug you’ve been prescribed. In that case—and, really, in any case—Scott says he recommends utilizing a prescription drug coupon card. 

He recalls having a prescription for Fluorouracil, a mild chemotherapy topical. He brought his coupon card (SingleCare, in this case) to the pharmacy, knowing what discount he was eligible for. The pharmacist (from a big chain store) said the cream would be $200, but—good news!—the store offered a $50 coupon. 

Scott knew that with his coupon—one the pharmacist said he may not be able to accept because he couldn’t file it electronically through the store’s system—could save him $100. Ultimately, Scott requested the paperwork to file on his own, saving himself the extra $50.

The pharmacist wasn’t trying to pull a fast one; he was simply dispensing drugs and offering discounts in the manner in which he was trained. In fact, Scott even had a brief chat with him—to the benefit of others within earshot who were obviously listening—about the way the card worked as well as other ways to save on prescriptions (like visiting RXHope).

Had Scott not had the discount card and the pharmacy not offered its coupon, he would have had to pay the full $200 for the cream—in essence, meaning there was $100 that nobody would have known about that the insurance company was keeping. This shows that insurance companies aren’t passing down all the rebates to pharmacists—all the more reason to be an engaged consumer of healthcare.

Scott had a similar situation in which his wife went in to pick up a prescription for Estradiol, a hormone replacement patch. The brand name was $140, and the generic was $80. With the drug discount card, they were able to drop that price to $45—a substantial savings on any long-term medication.

What’s Next?

At the end of the day, you want to save money on prescriptions, right? Rebates go on in the pharma world to employers and insurance carriers all the time. How do you get your own rebate? The true examples above are here to show you that it is possible to get in on that game.

As we’ve illustrated, with certain specialty or single-sourced drugs, manufactures will deal directly with you in the form of PAPs (if you meet their requirements). With other, more generic drugs, a discount card might be the way to go. 

The bottom line? There is no downside to looking at your savings options—a little time could go a long way to the bank.  

How much could you be saving? Once you get your prescription costs down, tell a friend. Help them. The more we speak up as consumers of healthcare, the more premiums will come down, and the more we can be a part of changing this industry.

Healthcare Is Making Me Sick | Author Hour Podcast

I had a great conversation recently with Nikki Van Noy on her Author Hour podcast. We talked through the book and my background, but more importantly I walked her through the same actionable, plain-spoken tips that anyone can use to better empower themselves when dealing with the healthcare system.

All of us can make better choices in selecting our healthcare insurance plans, how we can maximize our coverage, how we can lower costs for treatment and prescriptions, and how we can generally make better choices that render better health results.

Listen below to hear the conversation.

Drug Patents Expiring in 2020 | Ken’s Capsule

It’s almost always cheaper to opt for a generic medication instead of a brand medication. However, generic medications aren’t always an option for drugs whose patent hasn’t expired yet. Pharmaceutical companies use patents to protect their R&D investment and try to maintain the exclusivity period as long as possible.

But that doesn’t mean you’re trapped with a brand drug. Patent terms for brand drugs expire every year, which means a more affordable option might be right around the corner.

First Ask: Does Your Brand Drug Have A Generic Equivalent or Alternative?  

When a patent expires, generic drug makers can enter the market with an equivalent generic alternative. These medications must meet strict FDA guidelines and must have the identical active ingredients and strengths as the originator drug. 

So how do you know if your brand prescription’s patent is on the verge of expiring?

The easiest way to do this is to search for your brand name medication patent expiration date.

Why take the time to search? After a generic equivalent comes out, you can expect the price of the generic to be 15-25% less than the brand drug. After 6 months and multiple generics makers have launched equivalent generics, the price should drop another 20-50%!

Biggest Brand Name Patents Expiring Next Year

When it comes to the biggest patent expirations in 2020, we’ve already done the hard work for you. Below are the most popular drugs that will be receiving a generic alternative in 2020.

Afinitor tablets

Brand prescription name: Afinitor 
Generic name: Everolimus
What it treats: Cancer
Expected savings per month: $3,000
When the generic gets released: Early 2020

Omnaris nasal spray

Brand prescription name: Omnaris
Generic name: Ciclesonide
What it treats: Nasal allergy
Expected savings per month: $185
When the generic gets released: Early 2020

Absorica capsule

Brand prescription name: Absorica
Generic name: Isotretinoin
What it treats: Acne
Expected savings per month: $1,600
When the generic gets released: Late 2020

Atripla tablet

Brand prescription name: Atripla
Generic name(s): Efavirenz; Emtricitabine; Tenofovir Disoproxil Fumarate
What it treats: Antiretroviral
Expected savings per month: $800
When the generic gets released: Late 2020

Chantix tablet

Brand prescription name: Chantix
Generic name(s): Varenicline Tartrate
What it treats: Helps you quit smoking
Expected savings per month: $225
When the generic gets released: Late 2020

Ciprodex ear drops

Brand prescription name: Ciprodex
Generic name(s): Ciprofloxacin; Dexamethasone
What it treats: Ear infections, swimmers ear
Expected savings per month: $180
When the generic gets released: In 2020

Dulera Inhaler

Brand prescription name: Dulera
Generic name(s): Formoterol Fumarate; Mometasone Furoate
What it treats: Asthma
Expected savings per month: $240
When the generic gets released: Late 2020

Noxafil tablets

Brand prescription name: Noxafil
Generic name(s): Posaconazole
What it treats: Anti fungal
Expected savings per month: Unknown
When the generic gets released: Early 2020

Thalomid capsule

Brand prescription name: Thalomid
Generic name(s): Thalidomide
What it treats: Cancer
Expected savings per month: Unknown
When the generic gets released: In 2020

Zortress tablets

Brand prescription name: Zortress
Generic name(s): Everolimus
What it treats: Transplant
Expected savings per month: $600
When the generic gets released: Early 2020

Other Ways To Save On Your Prescriptions

Check out our article 7 Insider Tips To Save Big On Prescription Drugs for some easy, quick techniques you can use the next time you go to fill a prescription. 

Generic Alternatives

If your brand name drug doesn’t have an exact match generic, look for generic “alternatives” within your medication drug class. A drug class is the broader category your prescription falls into. For example, Beta Blockers which treat heart disease, ACE Inhibitors which treat high blood pressure, or Lipid Regulators which treat high cholesterol. This can be a potential savings discussion with your physician with regards to a therapeutic alternative. 

Ask Your Doctor or Pharmacist

Ask your pharmacist about alternative medications or any potential savings that they may know of for a particular medication or class of drugs.

Remember, don’t be afraid to actually discuss your physician’s medication choice for you. It can be a great savings to you, and enjoy your new collaborative relationship with your physician. Every time you ask questions, you take another step closer to being in control of your health care. 

ken rose

Ken Rose, RPh

Ken is a multidisciplinary pharmacist, with over thirty eight years’ experience within Pharmacy and the Managed Care industries. He is a pharmacy savings gurus—helping people with all the ways they get their medicine: mail, retail, and hospital pharmacy, clinical programs, specialty pharmacy and health plans. 

How To Save $10,000+ On Your Healthcare Bills

The following is an excerpt from a conversation I had with Kirk Chisholm on The Money Tree Podcast

Are you happy paying thousands of dollars in healthcare costs you don’t use? Are you angry at the medical bills you incur for services that should cost a fraction of that amount? Are you looking for answers?

This week we interview a healthcare industry insider, Scott Heiser. He spills the secrets on what is actually causing the problems in our system. He also gives us some simple tips and tricks to save yourself thousands of dollars with only a few minutes of your time...

Listen to the entire episode to learn insider negotiation techniques on The Money Tree Podcast!

7 Insider Tricks To Save Big On Prescription Drugs

Now, more than ever, prescription drug prices are expensive—especially if you have high out of pocket costs.

Specialty drugs, single source branded drugs, and repack- aged generic drugs are all escalating in cost (7 percent per year, two times the Consumer Price Index). Remember the EpiPen story? A low-cost generic solution was repurchased and repackaged by Mylan. Then, the drug manufacturer increased it from $70 to $600 without offering any product enhancements—just price increases! 

If you aren’t aware of how to mitigate those costs, you might be needlessly throwing away thousands of dollars a year. Even if your insurance plan offers drug coverage, you can still use these tips to save even more money. The first step is to understand how drug manufacturers price their drugs and why they’re being prescribed.

The Questions To Ask Your Doctor To Save Money

If you’ve been to the doctor recently, you know that most visits end with you getting a prescription. 

Why is that? 

If you stop and think about it for a second, it makes sense. You go into the doctor expecting to be cured, and you want to walk away with something tangible that tells you you’ll get better. There are other things you could be doing to feel better, but that’s a topic for another post.

So when it comes to prescriptions, what can you do to save money?

Where To Start: Ask Your Doctor These Questions

  • How much does it cost?
  • Can the pharmacist substitute a cheaper, generic form of the medicine?
  • Are there cost-effective alternatives to this medication?
  • Does the drug company offer any discount or rebate programs?
  • Does the drug company provide a prescription drug assistance program?
  • Can you prescribe a half-year or year supply so I can buy in bulk?

Insider Tricks To Save Money On Prescriptions

So, how can you get the best price on your prescriptions? Think about it like anything else you would buy and SHOP! Here are some insider tips and tricks to save money:

Turn to big box stores.

Wal-Mart,Kroger,Costco,and even Amazon are getting into the drug business. Their goal is to get you in the door (or on the website) by any means necessary. For example, about a decade ago, Wal-Mart accomplished this by selling generic amoxicillin for just $4. Consumers came for the dirt-cheap drugs and, while they were there, bought orange juice, milk, and chicken noodle soup. It’s a straightforward model, and it still works today; you can find good deals on basic drugs at big box stores.

Use Price comparison tools

Check with your insurance plan for comparison tools. If you don’t have one with your plan or are uninsured, check with the following: GoodRx, One RX, or use our partner SingleCare’s tool on our How to Save page. They all will provide pricing for prescriptions at their negotiated prices. Compare them all. You’ll be surprised to find they are different. Also, compare one pharmacy location with one in another area of town. Sometimes there is different pricing, so it pays to look.

Note: When using one of the discount cards with your health plan, make sure the drug is on your formulary (approved drug list). Research the discount programs for the exact drug. Ask you pharmacist what the cost of the drug is through your health plan. If the discount card is lower, use it instead of your health plan. Then file that drug as a claim. You can access claims through your health insurance carriers’ web portal. It’s worth the extra effort. Check it out.

Use Over-the-Counter (OTC) First, Then Generic, Then Compare Brand vs. Brand 

Generics are generally cheaper than brands. Unfortunately, you need to be aware of the industry’s trend to “patent stack” generics, significantly increasing their price (EpiPen). Therefore, check the over-the-counter alternative. Many times, the prescription for a generic scripted drug is about convenience (for instance, take one pill a day instead of two or four). Remember, you pay for that! 

Also, check multi-source brand drugs (where there are multiple branded drugs, no generics, treat- ing the same symptom) and determine which has the highest efficacy: best price, similar medical outcome.

Get Your Prescriptions Through Mail Order

If you’re on a maintenance drug and your plan offers a mail order program, you may be able to save some money. If your plan has copays for a thirty- day supply, check what the copay is for the mail order at ninety days. It could be less, so it’s worth trying.

Also, the mail-order pricing may be more attractive than the retail.

Buy In Bulk. Get Your Doctor To Prescribe For Longer Periods

Did you know your doctor can prescribe a years’ worth of maintenance medication versus a thirty- or ninety-day supply? They can, and it can save you a lot. Use the highlighted shopping tools for a twelve-month supply. Currently, you can buy a year’s supply of atorvastatin, a generic statin heart medicine, for 20 percent less than buying a thirty-day supply each month for a year.

Buy In Higher Dosage And Split The Pills

Getting a higher dosage and splitting the pill may be less expensive. Ask your doctor, pharmacist, or insurance company if higher dosage and pill splitting would work in your situation.

Use Patient Assistance Programs (PAP)

RX HOPE is a website that lists over two hundred single source drugs that offer patient assistance programs based on income or for those participating in a high-deductible plan—i.e., 50 percent of the country in 2017. 

These plans will offer coupons with sometimes dramatic price reductions for a set period of time. I previously highlighted the Eliquis savings, which was through a PAP ($4,440 savings/year). You can also contact the manufacturer of the drug directly and ask for avail- able coupon plans. 

These are real techniques that can save you hundreds, even thousands of dollars on your prescription drugs. If you’re worried about talking about costs with your doctor—don’t be. It’s a conversation that is non threatening to them, it’s not like you’re challenging their diagnosis or treatment. Plus, they want to provide you with the best service possible, and if that means facilitating you saving on prescriptions they absolutely want to do it!

Navigating the health care system isn’t always easy, but this checklist gives you the tools you need to start saving.

Authority Magazine Feature: The Future of Healthcare

The following is an excerpt from a Q&A session I had with Authority Magazine’s Christina D. Warner

As a part of my interview series with leaders in healthcare, I had the pleasure to interview Scott Heiser. Scott has more than twenty years’ experience as a consultant for clients in the insurance and healthcare system. Scott was a partner and owner of a commercial insurance brokerage, in which he led and developed an employee benefit practice that managed more than half a billion dollars in health benefits. Scott is a strategic innovator who knows the ins and outs of what can feel like the overwhelming world of healthcare and insurance. Today, he is dedicated to sharing his knowledge to help educate and empower his readers. His goal is to improve your health outcomes while lowering your costs.

Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?

Afew years ago, I was meeting with a large multi-state client representing 16,000 employees. We were discussing ways to reduce costs for their prescription benefit program…

Check out Authority Magazine’s Medium Page to read the full article!

How Much Should You Pay For Health Insurance?

When it comes to health insurance, one of the most common questions I hear is, “Who pays for that?” At the risk of sounding like a smart aleck, the simple answer is: you do.

When it comes to health insurance, one of the most common questions I hear is, “Who pays for that?” At the risk of sounding like a smart aleck, the simple answer is: you do.

But that does not necessarily mean you’re responsible for 100% of the cost of health insurance. There are three basic categories of health insurance sources: employers, individuals buying health insurance, and government programs. In this article, we’ll examine each category in greater detail to more fully answer the question, “Who pays for that?”

Coverage Through Your Employer

Employer coverage is pretty straightforward: you work for somebody, they offer coverage, they pay for a majority of the premium, and you enroll. Employers with over fifty employees are required by the ACA to offer healthcare coverage to their full-time employees (those working over thirty hours per week) or pay a $2,000 penalty for each full-time employee every year. Most elect to offer the coverage.

They must offer at least one plan that complies with all ACA guidelines, including the essential coverage, the minimum plan design, and maximum employee monthly contribution of 9.86 percent of household monthly income for 2019 single coverage. Employers with fewer than fifty employees have the option to offer coverage or not; it depends on their financial situation. If you work for an employer who does not offer coverage, you will need to investigate options: purchasing directly or, depending on your financial situation, looking into government-sponsored plans.

Plan Options

Most employers offer multiple options for their employees. The range of options addresses plan designs that impact how much is covered and what you’ll have to spend if and when you use the healthcare system. Your premium cost impacts how much of your paycheck is paid monthly for your selected coverage. The options you are presented will be from the coverages we discussed PPO (Preferred Provider Organization), HMO (Health Maintenance Organization), or High Deductible Health Plan, usually with a Health Savings Account. Many offer tax-deferred savings vehicles to help offset the cost of healthcare.

Individuals Buying Directly

Buying health insurance directly under Obamacare has been like trading one nightmare for another. Before Obamacare, people with existing conditions were denied coverage. With Obamacare, those people can now buy coverage, but more and more often they can’t afford the monthly health insurance premiums or even find coverage.

Many of the national health insurance companies (Anthem, Cigna, Aetna, United Healthcare) have reduced the number of states to which they offer individual health insurance to the point that a number of counties had only one health insurance carrier option in 2019. And increasingly, the options offered have smaller provider networks.

Bottom line: if you are buying directly, you will probably need to consider increasing your deductibles and out-of-pocket costs to offset premium increases.

The Kaiser Family Foundation, www.kff.org, does an excellent job of tracking health insurance carriers offering coverage by state and the premium rate increases or decreases filed by health plans in each state. They are already compiling 2019 health insurance carrier offerings by carrier by state. Please review their site for updates under the heading Tracking Premium Changes on ACA Exchanges.

Doesn’t Obamacare provide premium subsidies for non-government health insurance to offset the cost? Yes, it does. Obamacare provides premium tax credits and cost sharing subsidies. A portion of the monthly health premiums may be offset for individuals earning less than 400 percent of the federal poverty level (FPL).

Interestingly, 84 percent of the people who signed up for individual health insurance since 2014 received subsidies. Luckily, because of inflation protection in the ACA subsidies, inflation increases are not passed on to those with subsidies. Their subsidies increased as the premium increased, keeping them whole. The people who bore the brunt of the increases were those without subsidies, and not all of them are rich.

The most efficient way to find out what plans, pricing, and subsidies are available to you is to access healthcare.gov or your state-sponsored healthcare exchange. The federal government’s website covers thirty-seven states and the District of Columbia, and will direct you to state-sponsored exchanges. They will start the session by asking basic financial questions that will determine whether you qualify for a subsidy.

In 2019, persons earning up to $48,560 may qualify for an individual’s health insurance subsidy while individuals earning up to $83,120 may qualify for a family health insurance subsidy. The dollar amounts are adjusted annually.

An alternative is Healthsherpa.com, which covers all states and all available health plans. They are a private company whose mission statement is “to help every American feel the comfort and security of having health coverage. [They] use design, technology, and customer service by real people to make insurance easier to understand, faster to sign up, and simpler to use.” The major differences are an easier and faster system, and real-time help. They provide counselors via chat rooms who walk through your enrollment and continue the chat room assistance throughout the year.

Government Programs

Note that the following information is true as I write this article, but—as we all know—nothing stays the same, especially in the government and in the world of healthcare. Visit www.healthcare.gov for the most up-to-date information about the status of the healthcare system in the US and what it means to you.

Medicaid

Medicaid is a joint federal and state program that, together with the Children’s Health Insurance Program, makes up the single largest source of health coverage in the United States. Its goal is to provide low-income individuals, families, and children health insurance with little or no premiums, and little or no out-of-pocket medical expenses.

The Affordable Care Act of 2010 created the opportunity for states to expand Medicaid to cover nearly all low-income Americans under age sixty-five. Eligibility for children was extended to at least 133 percent of the federal poverty level (FPL) in every state (most states cover children to higher income levels), and states were given the option to extend eligibility to adults with income at or below 133 percent of the FPL.

The majority of states have chosen to expand coverage to adults, and those that have not yet expanded may choose to do so at any time. Eighteen states have not expanded coverage as of 2019. They are Alabama, Florida, Georgia, Idaho, Kansas, Mississippi, Missouri, Nebraska, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.

The 2019 federal poverty level (FPL) income numbers are used to calculate eligibility for Medicaid and the Children’s Health Insurance Program (CHIP).

Medicaid Benefits

States establish and administer their own Medicaid programs and determine the type, amount, duration, and scope of services within broad federal guidelines. Federal law requires states to provide certain mandatory benefits and allows states the choice of covering other optional benefits. Mandatory benefits include services like inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and home health services, among others. Optional benefits include services like prescription drugs, case management, physical therapy, and occupational therapy.

You can enroll through healthcare.gov. Additional state-by-state information is on medicaid.gov. Or, you can try the American Council on Aging’s Medicaid Assistance site at medicaidplanningassistance.org/state-medicaid-resources. They provide state-by-state names and contact info, and free planning advisor services.

Children’s Health Insurance Program (CHIP)

Children’s Health Insurance Program (CHIP) is a federal/state health program managed by the states. It provides medical coverage for individuals under age nineteen whose parents earn too much income to qualify for Medicaid, but not enough to pay for private coverage. Program coverage varies from state to state, but all states’ CHIP plans cover routine checkups, immunizations, doctor visits, prescriptions, dental care, vision care, hospital care, laboratory services, x-rays, and emergency services. Some states also cover parents and pregnant women. Its goal, like Medicaid, is to provide health insurance with inexpensive or no premiums or out-of-pocket medical expenses.

It’s cumbersome to get coverage through CHIP, but it could be a huge winner for your family if you qualify. If you make up to $40,000 for, say, a family of three, you can still get Medicaid coverage. CHIP, on the other hand, is for people who make more than that but still have a tough time affording coverage. We run into plenty of people who keep their employer’s coverage for themselves but carve off their kids and put them on CHIP. To sign up, you can call 1-800-318-2596, or you can begin the process by completing an insurance application on healthcare.gov. The application will determine if you qualify for the program and will notify your state agency. Your state agency will contact you about enrollment. My advice is to do both and follow up.

Medicare

Medicare is the guaranteed-issue, government health insurance program for individuals over sixty-five, certain younger people with disabilities, and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). It does not have income requirements to join. Its goal is similar to Medicaid in providing affordable healthcare insurance to seniors. All four components of Medicare (Parts A, B, C, and D) require monthly premiums, deductibles, and out-of-pocket costs for services.

Different parts of Medicare help cover specific services:

Part A: Hospital Insurance. It covers inpatient hospital stays, some home healthcare, stays in skilled nursing facilities, and hospice care.

Part B: Medical Insurance. It covers outpatient care, preventive services, medical supplies, and some doctors’ services.

Part C: Medicare Advantage Plans. Offered by private companies that contract with Medicare. They provide Part A and Part B coverage, and most cover Part D benefits.

Part D: Prescription Drug Coverage. This is provided by private insurance companies and adds drug coverage to the other parts of Medicare.

Additional information is available at medicare.gov, or for supplemental assistance and supplemental policies, consult the American Association of Retired Persons (AARP).

But that does not necessarily mean you pay 100 percent of the cost. There are three basic categories of health insurance sources: employers, individuals buying health insurance, and government programs. In this article, we’ll examine each category in greater detail to more fully answer the question, “Who pays for that?”

Coverage Through Your Employer

Employer coverage is pretty straightforward: you work for somebody, they offer coverage, they pay for a majority of the premium, and you enroll. Employers with over fifty employees are required by the ACA to offer healthcare coverage to their full-time employees (those working over thirty hours per week) or pay a $2,000 penalty for each full-time employee every year. Most elect to offer the coverage.

They must offer at least one plan that complies with all ACA guidelines, including the essential coverage, the minimum plan design, and maximum employee monthly contribution of 9.86 percent of household monthly income for 2019 single coverage. Employers with fewer than fifty employees have the option to offer coverage or not; it depends on their financial situation. If you work for an employer who does not offer coverage, you will need to investigate options: purchasing directly or, depending on your financial situation, looking into government-sponsored plans.

Plan Options

Most employers offer multiple options for their employees. The range of options addresses plan designs that impact how much is covered and what you’ll have to spend if and when you use the healthcare system. Your premium contributions impact how much of your paycheck is paid monthly for your selected coverage. The options you are presented will be from the coverages we discussed (PPO, HMO, HDHP/ HSA). Many offer tax-deferred savings vehicles to help offset the cost of healthcare.

Individuals Buying Directly

Buying health insurance directly under Obamacare has been like trading one nightmare for another. Before Obamacare, people with existing conditions were denied coverage. With Obamacare, those people can now buy coverage, but more and more often they can’t pay for the insurance coverage or find coverage.

Many of the national health carriers (Anthem, Cigna, Aetna, United Healthcare) have reduced the number of states to which they offer individual health insurance to the point that a number of counties had only one health insurance carrier option in 2019. And increasingly, the options offered have smaller provider networks.

Bottom line: if you are buying directly, you will probably need to consider increasing your deductibles and out-of-pocket costs to offset premium increases.

The Kaiser Family Foundation, www.kff.org, does an excellent job of tracking health insurance carriers offering coverage by state and the premium rate increases or decreases filed by health plans in each state. They are already compiling 2019 health insurance carrier offerings by carrier by state. Please review their site for updates under the heading Tracking Premium Changes on ACA Exchanges.

Doesn’t Obamacare provide premium subsidies for non-government health insurance to offset the cost? Yes, it does. Obamacare provides premium tax credits and cost sharing subsidies. A portion of the monthly health premiums may be offset for individuals earning less than 400 percent of the federal poverty level (FPL).

Interestingly, 84 percent of the people who signed up for individual health insurance since 2014 received subsidies. Luckily, because of inflation protection in the ACA subsidies, inflation increases are not passed on to those with subsidies. Their subsidies increased as the premium increased, keeping them whole. The people who bore the brunt of the increases were those without subsidies, and not all of them are rich.

The most efficient way to find out what plans, pricing, and subsidies are available to you is to access healthcare.gov or your state-sponsored healthcare exchange. The federal government’s website covers thirty-seven states and the District of Columbia, and will direct you to state-sponsored exchanges. They will start the session by asking basic financial questions that will determine whether you qualify for a subsidy.

In 2019, persons earning up to $48,560 may qualify for an individual’s health insurance subsidy while individuals earning up to $83,120 may qualify for a family health insurance subsidy. The dollar amounts are adjusted annually.

An alternative is Healthsherpa.com, which covers all states and all available health plans. They are a private company whose mission statement is “to help every American feel the comfort and security of having health coverage. [They] use design, technology, and customer service by real people to make insurance easier to understand, faster to sign up, and simpler to use.” The major differences are an easier and faster system, and real-time help. They provide counselors via chat rooms who walk through your enrollment and continue the chat room assistance throughout the year.

Government Programs

Note that the following information is true as I write this article, but—as we all know—nothing stays the same, especially in the government and in the world of healthcare. Visit www.healthcare.gov for the most up-to-date information about the status of the healthcare system in the US and what it means to you.

Medicaid

Medicaid is a joint federal and state program that, together with the Children’s Health Insurance Program, makes up the single largest source of health coverage in the United States. Its goal is to provide low-income individuals, families, and children health insurance with little or no premiums, and little or no out-of-pocket medical expenses.

The Affordable Care Act of 2010 created the opportunity for states to expand Medicaid to cover nearly all low-income Americans under age sixty-five. Eligibility for children was extended to at least 133 percent of the federal poverty level (FPL) in every state (most states cover children to higher income levels), and states were given the option to extend eligibility to adults with income at or below 133 percent of the FPL.

The majority of states have chosen to expand coverage to adults, and those that have not yet expanded may choose to do so at any time. Eighteen states have not expanded coverage as of 2019. They are Alabama, Florida, Georgia, Idaho, Kansas, Mississippi, Missouri, Nebraska, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.

The 2019 federal poverty level (FPL) income numbers are used to calculate eligibility for Medicaid and the Children’s Health Insurance Program (CHIP).

Medicaid Benefits

States establish and administer their own Medicaid programs and determine the type, amount, duration, and scope of services within broad federal guidelines. Federal law requires states to provide certain mandatory benefits and allows states the choice of covering other optional benefits. Mandatory benefits include services like inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and home health services, among others. Optional benefits include services like prescription drugs, case management, physical therapy, and occupational therapy.

You can enroll through healthcare.gov. Additional state-by-state information is on medicaid.gov. Or, you can try the American Council on Aging’s Medicaid Assistance site at medicaidplanningassistance.org/state-medicaid-resources. They provide state-by-state names and contact info, and free planning advisor services.

Children’s Health Insurance Program (CHIP)

Children’s Health Insurance Program (CHIP) is a federal/state health program managed by the states. It provides medical coverage for individuals under age nineteen whose parents earn too much income to qualify for Medicaid, but not enough to pay for private coverage. Program coverage varies from state to state, but all states’ CHIP plans cover routine checkups, immunizations, doctor visits, prescriptions, dental care, vision care, hospital care, laboratory services, x-rays, and emergency services. Some states also cover parents and pregnant women. Its goal, like Medicaid, is to provide health insurance with inexpensive or no premiums or out-of-pocket medical expenses.

It’s cumbersome to get coverage through CHIP, but it could be a huge winner for your family if you qualify. If you make up to $40,000 for, say, a family of three, you can still get Medicaid coverage. CHIP, on the other hand, is for people who make more than that but still have a tough time affording coverage. We run into plenty of people who keep their employer’s coverage for themselves but carve off their kids and put them on CHIP. To sign up, you can call 1-800-318-2596, or you can begin the process by completing an insurance application on healthcare.gov. The application will determine if you qualify for the program and will notify your state agency. Your state agency will contact you about enrollment. My advice is to do both and follow up.

Medicare

Medicare is the guaranteed-issue, government health insurance program for individuals over sixty-five, certain younger people with disabilities, and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). It does not have income requirements to join. Its goal is similar to Medicaid in providing affordable healthcare insurance to seniors. All four components of Medicare (Parts A, B, C, and D) require monthly premiums, deductibles, and out-of-pocket costs for services.

Different parts of Medicare help cover specific services:

Part A: Hospital Insurance. It covers inpatient hospital stays, some home healthcare, stays in skilled nursing facilities, and hospice care.

Part B: Medical Insurance. It covers outpatient care, preventive services, medical supplies, and some doctors’ services.

Part C: Medicare Advantage Plans. Offered by private companies that contract with Medicare. They provide Part A and Part B coverage, and most cover Part D benefits.

Part D: Prescription Drug Coverage. This is provided by private insurance companies and adds drug coverage to the other parts of Medicare.

Additional information is available at medicare.gov, or for supplemental assistance and supplemental policies, consult the American Association of Retired Persons (AARP).

Why You Must Demand Transparency with Your Healthcare Costs

I wrote Healthcare Is Making Me Sick to help people learn the rules of healthcare so they can regain control of how they experience the system. A friend of mine asked me: What made me feel that I had to write it?

The answer is two-pronged—partly from the financial side, and partly from the quality of life side. The common denominator between them, though, is that it comes down to maximizing your coverage and experience when it comes to insurance.

Allow me to explain both sides of this equation in more detail.

Medical Providers Are in Business

Let’s start with finances: if you get service from a doctor and don’t inquire about the course of treatment, the appropriateness of the treatment, and the cost, you’ll more than likely have a less than optimal experience. Physicians and hospitals are in BUSINESS. One of their goals is to grow their business as profitably as they can. If you’re a passive healthcare consumer, the number of tests, where the tests are performed, and who performs them will affect the financial outcome of your treatment—it’ll cost you more!

Now, consider if everyone else with that same policy takes the same approach; they simply keep paying whatever the bill says and, while they may grumble, they don’t give it a second thought. What, then, are those expenses going to do? They’ll go up.

If those expenses go up, the insurance company’s expenses go up. What is the insurance company (that’s in business like the hospitals and physicians) going to do to your premiums? They are going to go up, too. And this dynamic does not change if you’re on your employer’s sponsored health plan, buying from the public exchange, or buying insurance directly. There’s no incentive for providers or insurance companies to change if they’re not challenged. They both make more money as the costs go up and are, in effect, negotiating with each other over their goals versus yours. I know learning the ins and outs of the industry is time consuming, but the benefits are long term.

Do the Work to Find the Best Doctor

The other side of the equation is life quality. It seems obvious that you’d want the best doctors, right? Why wouldn’t you? Yet, in our society, we haven’t adopted the mentality that we should scrutinize doctors the way we would other service providers, as they’re all not created equal. After all, the last to graduate medical school is still a doctor.

To overcome this hurdle, we must start insisting on transparency by any means available to us, and that includes referrals. Referrals can come from anybody close to us, such as friends, other doctors, and even the carriers themselves. Use any tool at your disposal in order to find the best doctor for you. If you do, you’ll have a better outcome, which means you save money long-term and have a better quality of life.

By allowing the status quo to continue—which means not questioning our doctors and paying whatever they tell us to—we are all complicit. At the end of the day, when my friend asks me why I wrote my book, I tell him it’s because I can make a difference—and so can you. You can change the definition of an industry, even if it’s something as big as healthcare. Doing the same thing over and over and expecting a different outcome hasn’t worked, so why not try something new? That question begs another: How do you tackle two giant industries representing one-sixth of the economy?

Information is Key to Transparency

Information! Information will lead to knowledge, and as Sir Francis Bacon stated, “Knowledge is power.” One piece of information you need to know is the mark ups on common medical services versus the cost and the range of prices for that service.

A quick look at information out there on hospital markups provides some staggering numbers. According to a report from John Hopkins University, on average, hospitals mark up their cost 4.32 times and, in some cases, over six times.

That’s right—for a service that costs them $100, they are charging you between $432–$600. The study also found that “certain types of hospitals had higher markups. In government-run hospitals, the ratio was 3.47; in nonprofit hospitals, 3.79; and in for-profit hospitals, 6.31. System-affiliated hospitals had an average ratio of 4.76, versus 3.54 for independent hospitals, and hospitals with regional market power had an average ratio of 4.56, versus 4.16 for hospitals that lacked such clout—supporting the researchers’ finding that hospitals that can mark up prices will do so.”

This can also be found in medicines within hospitals. Hospitals mark up medicines an average 500 percent of their cost—and have a markup of 250 percent even after negotiations with insurance carriers. The confusion does not stop there. HCCI’s 2015 report, “National Chartbook on Health Care Prices” found there’s a wide range of prices for the same services at different hospitals. Prices vary by state and within states too.

Transparency Tools You Can Use

So, what are you to do? Healthcare prices are crazy! Fortunately, the world is changing. There are a growing number of transparency tools for every healthcare industry sector (doctors, hospitals, and drugs) that you can access. This will help you pull the curtain back on the Great Wizard of Oz of healthcare.

There are categories of transparency sites. The first is what I call qualitative sites. They provide useful information such as: areas of specialty, college education, hospital affiliation, ease of scheduling, staff responsiveness, patient level of trust, and amount of time spent with patient. These sites are useful in helping determine the type of relationship you might have with your doctor. Here are some popular options:

The second set of sites focus more on the quantitative, or outcome-based, aspects of the doctor’s care. For example, they examine items such as costs and how the doctor ranks against his/her peer set for a procedure. Does the doctor you’re reviewing perform more or fewer procedures than their peers? This is important. Remember Malcolm Gladwell’s position that the more you practice the better you are.

The following websites provide you access to healthcare transparency.

For Hospitals

  • Leapfroggroup.org: Leapfrog Hospital Safety Grade
  • Hospital Patient Price List Information: (Look up each hospital’s published pricing list. Your pricing will vary based on your insurance.)

For Doctors

For Prescriptions

The Transparency Genie is Out of the Bottle

I haven’t found one single resource that has provided every answer or covered every area of the country yet, but these resources are growing, becoming more robust, and currently providing us more access to the real costs than we have ever had before. USE them. When comparing costs, look outside your area and see if your situation turns out like the knee replacement from Sacramento to Tucson or if your hospital has substandard records on the services you need covered.

If you’re on your employer’s health plan, ask to see if the health insurance carrier provides a price calculator and quality evaluation tool. If not, ask your employer to investigate offering one. Companies like Castlight, Amino Health, or Grand Rounds can be added, offering access to transparency. Remember, if you save yourself money, you save your employer money, too. They will direct you to the most cost-effective provider based on that carrier’s network and negotiated discounts.

When it comes to transparency, the genie is out of the bottle. If we seek it, demand it, and use it, there’s no way they (the industry) can put it back in.

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