How to Lower Your Medical Bills

If your healthcare costs are ballooning, you have plenty of company. About 25 percent of Americans reported having trouble paying their medical bills in the past year, according to a survey from the Kaiser Family Foundation and the New York Times.

Everything from insurance premiums to out-of-pocket payments for medications and doctor visits has increased in price for most of us in recent years.

According to the Bureau of Labor Statistics, healthcare expenses made up 7.8 percent of the average consumer’s expenses in 2015. In 2006, they were only 5.7 percent. And your medical bills have likely gone up no matter what kind of health insurance you have—Medicare, employer-­sponsored insurance, or a marketplace plan.

“Even if you have ‘good’ health insurance, you’re probably paying more out of pocket than you’d like, especially since deductibles, coinsurance, and co-pays can eat up so much money,” says Lydia Mitts, senior policy analyst at Families USA, a consumer healthcare advocacy organization.

Currently, about two-thirds of consumers are trying to curb healthcare costs.These expert strategies can help.

Save Money on Medications

The average out-of-pocket payment for those who take prescription drugs is $792 annually.

About 11 percent of us spend more than $1,200 per year, according to a national poll from Consumer Reports Best Buy Drugs. To trim costs:

Check prices with the doctor. When your doctor prescribes a new medication, ask about price before you leave the office. Though almost 8 out of 10 prescriptions are filled today with generics, which can be up to 90 percent cheaper than brand-name drugs, not all drugs are available as generics. (And some generics cost plenty.) In those cases, talk to your doctor or pharmacist about lower-cost options in the same drug class. (If your doctor is unsure about pricing, you can go to websites such as GoodRx or Blink Health before you fill a prescription.)

Ask for a three-month prescription. This can be significantly cheaper for drugs you take long-term. If you use insurance, you’ll pay one co-pay rather than three. Retailers such as Costco and Walmart often offer discount generic drug programs, where you pay $10 for a 90-day supply—which works out to less than $4 every 30 days.

Shop around. Some commercial plans, as well as Medicare Part D and Advantage plans, have preferred pharmacies, which may offer lower prices to plan members. But you may not always get the best deals this way, so look for a pharmacy that offers the best prices on medications you need regularly. In general, our research found that big pharmacy chains charged the most, and big-box retailers had the most competitive pricing.

Ask for a price break. Representatives for Costco told us that their contracts with Medicare Part D plans prohibit pharmacists from offering a better price—unless a customer asks directly. “Even if pharmacists refuse to lower your medication cost, it will prompt them to dig for any available discount programs, cards, and coupons,” says Jeff Rice, M.D., CEO of Healthcare Bluebook, which helps consumers determine pricing for health services. And don’t rule out independent pharmacies, where “you can often have luck asking for a lower price, since pharmacists might have more flexibility to match or beat competitors’ prices,” Rice says.

Consider an online pharmacy. You may save by using a low-cost online pharmacy, such as HealthWarehouse. But be sure to use an online retailer that operates within the U.S. (it’s illegal to order foreign medications), is licensed, and has a state-licensed pharmacist. (Check the National Association of Boards of Pharmacy website to find accredited sites.) It should display the VIPPS symbol to show it’s a Verified Internet Pharmacy Practice Site.

Do a med check. The average adult takes 4.6 prescriptions regularly. At least once a year, go over your medications with your doctor. “There may be some you simply no longer need,” says Davis Liu, M.D., a family medicine doctor for Kaiser Permanente in Roseville, Calif., and author of “The Thrifty Patient” (Stetho Publishing, 2012).

Save at the Doctor's Office and Hospital

The price that you're charged for medical tests and procedures may depend on factors such as your insurance or the particular healthcare provider or facility you use. "It's amazing how much cost varies, even in the same zip code," Rice says. For example, Healthcare Bluebook found that cataract surgery costs $2,684 to $8,662 at different Charleston, W. Va., facilities.

Try these saving strategies:  

Check prices beforehand. Most health insurers have online tools that help consumers determine their out-of-pocket costs with in-network providers. (Or you can go to healthcarebluebook.com or clearhealthcosts.com to find local pricing.) Consumers who used their health insurer’s tool to pinpoint costs for sleep studies and imaging tests spent about 12 percent less, according to a study in JAMA Internal Medicine.

Ask for a lower price for a procedure. By using local pricing information, you may also be able to negotiate directly with your doctor or hospital. “If they realize you may go someplace cheaper for medical care, they may automatically lower the price,” Rice explains.

Know when to pay out of pocket. If you have a high deductible and don’t think you’ll meet it during the year, you may get a smaller medical bill by paying the “cash” or noninsurance price.

“It’s a hassle for your physician’s office to fill out paperwork and follow up with insurance companies to get paid, so they often welcome the chance to avoid that by offering a discount,” says Jeanne Pinder, founder of Clear Health Costs, which compares healthcare costs in several cities across the U.S.

Pinder experienced this when her daughter needed an MRI. “I called different facilities and asked their ‘cash’ price, getting a range of $600 to $900,” she says. “One said they’d had a last-minute cancellation, and if we came that evening, we could get it done for $450.”

Be Wise About Medical Bills

Whether you’re dealing with a long-term medical problem that requires a string of doctor’s visits, preparing yourself for a scheduled surgery, or visiting the emergency room, the resulting medical bills can be overwhelming. Four key steps can help:

Check with the hospital before elective surgery. According to a 2015 survey by the Consumer Reports National Research Center, nearly one-third of privately insured Americans had received a “surprise” medical bill in the prior two years. “This can happen, for example, when you have an operation and it turns out one of the doctors, like the anesthesiologist, is out of network,” says Families USA’s Lydia Mitts.

Even if you chose a hospital in your insurance network, your insurer may not cover that charge and the hospital or doctor can legally bill you. So if you’re having an elective procedure, inform the hospital and surgeon beforehand that you want to use only in-network providers. Ask for the names of all physicians and outside labs that may be involved in your care. Then call your insurance company to confirm that they are in your network.

Choose an ER ahead of time. Many emergency rooms are staffed by physicians who may not take your insurance—even if the hospital itself is in-network. One recent study in the New England Journal of Medicine found that more than 20 percent of people who go to the ER get treated by an out-of-network doctor.

Consider planning ahead. Call the billing department at your in-network hospital of choice and ask whether it uses out-of-network ER doctors. Then, if a time comes when you must go to the ER, request that you see only in-network providers. You or the person who accompanies you can do this while filling out admission forms.

Fight any unfair bills you get. If you receive an out-of-network medical bill, try negotiating with the doctor who billed you. Then ask your insurer to cover the charge. If neither will budge, file an appeal with your insurance company. To bolster your case, have your primary care doctor or specialist send a letter stating that ER treatment was medically necessary. The Patient Advocate Foundation offers no-charge help for billing concerns.

Read medical bills carefully. Almost half of Medicare claims audited by the government contain errors, according to a 2014 review by NerdWallet. And the American Medical Association notes that about 7 percent of medical bills have mistakes. So always make sure you get itemized medical bills from your doctor or hospital, read through and save all medical bill-related paperwork—including your Explanation of Benefits statements—and familiarize yourself with common mistakes, such as incorrect codes and spelling errors.

Notify your insurer, healthcare provider, or hospital if you see anything amiss in the medical bills you receive. “A seemingly small error like misspelling your name or getting a policy number wrong can lead to a claim denial,” Pinder says.

Embrace a Healthy Lifestyle

Stay in good health and you're likely to lower your medical bills. So, eat right, avoid tobacco, maintain a healthy weight, and exercise often. People who do roughly 30 minutes of moderate activity on most days of the week save an average of $2,500 per year on healthcare costs, according to a study published recently in JAMA—in part because they end up in the doctor’s office much less often. “Sometimes, that’s the best savings of all,” Liu says.

Editor's Note: This article also appeared in the February 2017 issue of Consumer Reports on Health.

More from Consumer Reports:
Top pick tires for 2016
Best used cars for $25,000 and less
7 best mattresses for couples

Consumer Reports has no relationship with any advertisers on this website. Copyright © 2006-2017 Consumers Union of U.S.