14 Smart Ways Seniors Can Cut Medical Costs

Are rising healthcare costs hammering your budget? If so, you're not alone. One in four people on Medicare laid out 30% or more of their income on healthcare in 2006, according to a recent analysis by the Henry J. Kaiser Family Foundation.

As healthcare costs continue to swell, people on Medicare likely will be required "to put even more skin in the game to pay for their health expenses," the foundation concludes.

But there are plenty of ways for the savvy senior to stretch a dollar. Here are some strategies that may lower your overall healthcare tab.

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Trim your healthcare costs by selecting the health plan that best suits your needs.

For example: Medicare Advantage ("Part C") plans typically have lower premiums than traditional Medicare (Parts A and B). The trade-off? Your choice of doctors and hospitals may be more limited, says Derek J. Fitteron, founder and CEO of Medical Cost Advocate, a Wyckoff, N.J.-based medical-bill negotiation and healthcare-advocacy provider.

"If you're relatively healthy and you're wanting to save money on your monthly premium, a Part C plan might be good for you," he says.

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Whether you have Medicare, Medicaid, private insurance, or a combination thereof (say, Medicare and a "medigap" supplemental policy), you should know how it works.

The first step is to know what your deductible is—and if you've met it.

If you've satisfied the deductible for the year, you may, for example, schedule a medical procedure right away, Fitteron says. On the other hand, if you haven't spent much toward the deductible, you might delay having the procedure until the next year when you are going to be closer to meeting your deductible.

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To rein in spending, choose doctors in the health plan's network.

"The use or nonuse of the network can drastically affect a person's out-of-pocket costs," says Terry Bay, president of Senior Patient Advocates in Casper, Wyo.

With Medicare, try to use doctors and medical-supply and equipment vendors that "accept assignment," she says. That means they accept Medicare's approved amount as payment in full. You pay only the coinsurance and deductible. Providers that don't accept assignment may charge up to 15% above Medicare's approved amount.

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Medicare Part B (medical insurance) covers doctor visits and other outpatient services. You pay a monthly premium for this benefit. But you may not need it if you or your spouse has group health coverage through an employer. In that case, you might consider deferring your enrollment.

"For the average Medicare beneficiary in the country that earns under $170,000 a year as a couple, that's $115 and change per month that they don't have to pay if they are still working," says Bay.

Many preventive healthcare services are available to health-plan members free of charge. If you have Medicare, you can get an annual flu shot and shots to protect against hepatitis B (a series of three) and pneumococcus, the most common cause of bacterial pneumonia. Smokers can get free smoking-cessation counseling. A variety of health screenings, including tests to detect colon, breast, and prostate cancer, are also offered gratis.

If a screening results in treatment, however, you'll have to pay your share of the tab for that care.

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It's a no-brainer: To avoid ballooning health expenses, ditch extra fat if you can.

Chronic care and obesity cost a bundle. According to a 2009 study in the journal Health Affairs, an obese person's medical costs are about 42% higher per year than a person of normal weight.

Obese seniors' share of Medicare spending nearly doubled from 1987 to 2002, the study found.

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New to Medicare Part B? You get a free "Welcome to Medicare" visit, where you and your doctor can make a plan for staying healthy and figure out what your costs will be.

If you've had Medicare Part B for more than 12 months, you get a free wellness visit every 12 months to update this "personalized prevention plan."

This can improve your health and keep tabs on costs, says Nora Dowd Eisenhower, director of the National Center for Benefits Outreach and Enrollment at the National Council on Aging in Washington, D.C.

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Do you really need back surgery? A hip replacement? Before undergoing expensive tests or treatments, you may want to consult another physician for a fresh perspective on your condition.

A study of one large employer's second-opinion program found that the greatest savings are for big-ticket procedures.

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If you don't have insurance, are paying out of pocket, or have a high deductible, it pays to comparison shop. If you have insurance, shop around for providers in your network.

The billing office for your provider should be able to tell you the cost of the procedure. Be sure to let them know if you have insurance or, if you are going to pay for the procedure yourself, ask for the "self-pay discount."

Healthcare Blue Book, an independent group that focuses on healthcare spending, offers a free consumer guide to help you get an idea what a fair price is for the medical service you need.

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Credit cards can be lifesavers when you need health services and don't have cash. But think twice before whipping out the plastic.

"I generally recommend not using credit cards to pay for medical expenses because unfortunately a lot of people don't pay off their balance monthly and they end up with interest charges," Bay says.

You may even be able to get a reduced "cash price" for the procedure, she adds. Pricedoc.com is a free website that lists the cash price for many medical services.

Medicare doesn't cover dental services (such as cleanings and fillings) or devices (dentures, for example). But there are ways to cut costs. The National Institute of Dental and Craniofacial Research suggests clinical trials or local dental or dental-hygiene schools, as they may give free or low-cost treatment.

Your state or local health department or United Way chapter may be able to point you to reduced-cost dental services. If you qualify for Medicaid, you may get dental care, depending on the state in which you live.

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EyeCare America, a program of the Foundation of the American Academy of Ophthalmology, provides eye care through volunteer ophthalmologists at no cost to seniors who qualify.

If you are 65 or older, a U.S. citizen or legal resident, and you haven't had an eye exam in three or more years, you may be eligible for a free eye exam and up to one year of eye-care services at no out-of-pocket cost. Uninsured individuals at risk for glaucoma may also qualify for a free glaucoma exam.

Although Medicare does not cover eye care for most members, people who have a high risk of eye disease, such as those with diabetes and a family history of glaucoma, are eligible for routine eye exams.

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• Clip coupons from circulars or go online to find coupons good for discounts on everything from vitamins and pain relief medications to bandages and hearing-aid batteries. Internet Drug Coupons offers coupons for many brand-name and over-the-counter drugs.
• Bay, however, strongly advises people not to purchase medicines online because of the risk of counterfeit drugs. But if you want to try to buy your drugs online, make sure the website is “VIPPS-certified”.

If you've tried but failed to negotiate a medical bill, it sometimes makes sense to work with a company that specializes in this, according to Healthcare Blue Book.

They recommend you find a company with a good reputation and experience negotiating medical bills; don't pay any fees upfront (the company gets a cut only if the bill is reduced); and make sure the negotiator gets a signed document from the provider (called a "release") documenting the reduced bill.

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