Medical costs are on the rise and, if you're anything like me, can add up in no time at all. I know that I'm not the average patient when it comes to my annual medical spend (I hit the max every year... thank you chronic illness) but even low utilizers can find themselves paying more than they should for medical care. I wanted to take a few minutes today to pass along a few ways to make sure you are getting the best deal on your medications- the bulk of most people's annual medical cost.

If you haven't yet read my post about questions to ask before choosing a medical plan please click over as the number one way to save money on medications is simply to understand your medical and prescription drug plan. 

Flexible Spending Plans (FSA) and Health Savings Plans (HSA) are accounts you are able to put money into on a per paycheck basis for medical bills on a pre-tax basis. If you have these plans available to you a strongly suggest that you explore those plans and run the numbers in various scenarios as they can save you a lot of money each year. In the case of HSAs they can also let you invest for future health care costs in retirement as well plus both of these plans lower your taxable income which is a plus.

When you are prescribed a new medication you are typically given a script for a month's supply. Sometimes that new medication simply doesn't work out due to negative side effects or incorrect dosage and the rest of the prescription is wasted as you can no longer take it and have to get a new prescription. This waste- or resources and money- can be stopped by asking for a sample from your doctor before filling th prescription. They can often give you a week or even a month of medication for free to try before you buy as it were. If it works for you- awesome, less money out of pocket for something you love. If not- at least you didn't spend money on something you won't use.

The insurance program's app is often under utilized. Heading to the app can give you an e-card if you don't have a physical card with you can be helpful but they often have price comparison guides, lists of covered medications, contact buttons, and more just a click away so that you can check before you even leave the doctor's office what your costs are going to come out to (estimated of course). 

Generic medications are not the exact same formulation as the name brand but they are very similar and depending on your other medications, treatment needs, allergies, and etc. you could very easily be taking a generic form of a medication and see no difference whatsoever- other than big savings. There are circumstances where people are not able to tolerate one generic form of a medication or must take a specific brand name medication and those circumstance would out weigh the financial situation but the chances are that you can, and should switch to generics whenever possible.

Example (according to GoodRx): EpiPen

If you are on a pricey drug and have seen medications on the shelf at Wal-Mart that claim to treat the same ailment your prescription is treating you might need to switch to that over the counter (OTC) medication. Check with your doctor before making any medication switches as there may be other ingredients or drug interactions that are at play. I am currently on 3 OTC medications that the doctor has included in my daily treatment plan. This does mean that those costs -are not included in my deductible or out-of-pocket max though so I personally pay more per year due to this but I hit that max every year with my medical conditions... for the average consumer this will be more likely to help their budget than hurt it. Run the numbers to find out though and you may even be able to do this in reverse if there is a covered prescription drug rather than the OTC version. 

Just because the medication is double the strength doesn't mean that it is double the cost. Ask your doctor if the medication you are taking two times a day is available in a scored tablet for twice the dosage. If it is you may be able to split the pills yourself each day and save money. Its important to ask if your medication can be split or not as extended release medications, caplets and some other medications cannot be split safely.

Often times you can get a discount on the medications you take every month by having your doctor write you a script for 90 days rather than 30 days. You can have this 90 day prescription filled by an online pharmacy and shipped directly to your house saving you money on gas as well as the cheaper-per-dose prices for ordering in bulk. I typically use the one my insurance recommends but there are cheaper alternatives sometimes... just be very careful if you do this to verify the legitimacy and legality of having that particular pharmacy ship you your medications.

Bet you didn't know you could coupon medications. You totally can! Not every medication has a coupon or program available but a quick Google search of "Medication + Coupon" or "Medication + Patient Assistance" could net you big savings. I personally am enrolled in a program that pays most of my costs for a medication that costs over $2,000 per month up to $10,000 per year as well as using a coupon for my annual Epi-Pen (generic brand, of course). I have also had coupons for free inhalers and other medications. Many of these coupons and programs have requirements and stipulations (such as being under a certain income, having or not having a certain type of insurance or etc.) and an approval processes but taking the extra time to fill out the forms could save you hundreds or even thousands of dollars each year. The coupons might get you a discounted rate on the medication, a rebate for your medications if you mail in the receipt, or even free medication for a limited time. Most of these are from manufacturers so you do have to get the exact brand which isn't always the easiest to do but its worth it. My pharmacy is special ordering the generic Epi-Pen that I have a coupon for so that I can get the lowest possible price for my necessary medications, it will take a few extra days or maybe even a week but I'm willing to wait as those savings add up.

This one is one that I will tell you to be careful with. While you can save money at point-of-sale for your medications potentially you may be going around your insurance plan to do so. Doing this means that it isn't being counted in your deductible and out-of-pocket amounts so, like moving to OTC medications, it may actually cost you more in the end if you are going to be getting up towards that out-of-pocket maximum amount by the end of the year so run the numbers and make sure you're making the best decision before you do this. Some cards don't go outside the insurance and work the same as a coupon though... just be careful and ask the Pharmacist to explain all your options and how it will interact with your insurance plan before choosing this option.

Pharmacies are always trying to get customers in the door and need repeat business just like any other business so they often will have discount programs for their customers that they run... especially big-box stores like Kroger and Wal-Mart. Wal-Mart has a $4 prescription plan for instance for a 30 day supply of medications for a list 2 pages long. If you are taking one of these medications then it would be a good choice to consider them for filling it. They make money off the other medications you fill with them as a repeat customer so it makes sense for them and it makes sense for you as its cheaper. One thing to note here is that if you are getting medications at different pharmacies you should make sure that they all know all medications you are taking. If they don't they can't give you important information about drug interactions or valuable suggestions on alternative options. They may even be able to match price with the pharmacy you are getting your other medication from if you let them know that's why you aren't getting all of your medications from them.

Depending on your situation you may qualify for additional assistance from the federal or state government. If you think this could apply to you it is important you reach out to to their assistance agencies to find out if you qualify. These programs are often limited to those in lower income brackets, on other assistance programs, enrolled in Medicare or etc. but looking at all of your options is an important part of advocating for the best possible care you can get.

If you have a question about why you are being given a specific medication or if there are alternative options then the best person to ask is your doctor. Being open with them and discussing the financial implications of your treatment plan is the first step towards being an informed, involved participant in your own care which is what we all should strive to become. If you let your doctor know that X medication is higher priced than you can afford and ask for alternatives they can help. Often they are not aware of medication costs as they are not involved in the negotiations your insurance company has annually with drug manufacturing companies, but once they are aware they can help you find an alternative treatment option that is a better fit financially but also works for your health management.

The last tip today is simple to ask the pharmacist: is this the cheapest option? They may know of a coupon or other discount that can save you money on the spot. 

• Skip doses or under medicate to save money. You can end up with more serious health repercussions that not only would cost you more money in the long run but could also risk your life.
• Buy medications from someone other than a licensed pharmacist.
• Forget to verify the legitimacy of an online retailer/pharmacy before purchasing medications.

I've been wading through this costly medical system most of my life but hopefully you won't have to waste as much money as I'm positive I did over the years while still learning about these options with these tips.

​Until next time,

​Is there a per person deductible or per family? Does it include prescription medications or is that a separate deductible? Some plans will have a separate prescription deductible that you will have to meet before medications reduce in price or become paid for. This deductible will typically go towards to you out-of-pocket maximum just like your medical deductible but its important to know if you are going to be juggling multiple deductibles.

​If you have one high utilizing family member then its important to note that often plans will include a per-person cap that can keep your costs lower... you many not have to get all the way to the family out of pocket max to stop paying for that person's care for the year. This can be a lifesaver when it comes to the budget.

​Once you hit your deductible you will often still be responsible for some of the costs until you reach a higher number, the out-of-pocket maximum. This is usually calculated at a percentage. So if you have a co-insurance of 80% once you hit your deductible that would mean that you are responsible for paying 20% of the cost for your care until you reach that number. In and Out of Network still apply for this portion of your yearly cost so its important to stay in-network if at all possible.

For certain medications, typically higher costing medications and ones that require temperature control, some plans will require you to use their Specialty Pharmacy in order to get them filled. This saves them money which in turn saves you money in the long run but it can be a little frustrating to have to schedule delivery for these medications and call in your payment/authorization to ship each month. If you have a medication that falls under this type of requirement they will let you know when you try to fill it at a retail pharmacy but if you think it may apply to your situation it could speed up the process to simply call the insurance company to ask up front what their policy is in regards to that medication. Processing at these pharmacies takes much longer than your corner CVS so planning your doses out is imperative for these kinds of medications.

Certain medications, treatment plans, surgeries or even provider types may require Prior Authorization in order to be covered. These will typically span a length of time and then require renewal if it is an ongoing treatment. This is a pain to go through and number two cause for my personal medical plan headaches but its important to understand and follow this process or you could end up paying the full cost of treatment as the charges will be denied.

I am personally on a medication that costs over $2,000 per month for me to take... you can bet it requires Prior Authorization. Every 6-18 months (depending on how long they authorize the treatment plan) my doctor's office has to file paperwork showing that I still need the care. Sometimes its easy but other times its a fight. Sometimes its just not worth that fight and we will chose an alternative treatment or I will pay out-of-pocket, like i did for my current rescue inhaler. Being prepared for this process and not letting it frustrate you if important- the insurance company is trying to keep their costs down by verifying that the treatment is necessary which helps keep costs from rising even more for everyone.

For some types of plans all you have to do is show up to receive covered care but for other you may need a referral. Knowing this up front will save you headaches and money from fees for seeking care without a referral. 

If you are looking for a specific type of care then ask up front if it is available on plan and if so how many sessions/how often you are able to get it. A good example of this is chiropractic care. Some plans offer it but they may limit the number of sessions you are able to have covered per year. Other options could be infertility treatments or in-home care. If its not then you may need to purchase supplemental insurance or go with a different plan.

I am with Blue Cross Blue Shield of Texas currently and there are a ton! My plan includes an identify theft program, a gym membership discount plan, teledoc services, free coupons to all kinds of health related retailers, discounted magazines, a wellness points plan and even discounts on services they don't cover like acupuncture and massage at certain providers through one of their free programs. On the wellness plan I get points for doing things like going to the gym, taking an online class, entering my stats quarterly, and etc. which I can exchange for prizes like kitchen gadgets, gift cards, and more. You can bet I participate in this when I have time... a few minutes while waiting around gets me a little closer to a free blender. :)

Flexible Spending Plans (FSA) and Health Savings Plans (HSA) are two ways that you can pay for medical costs with pre-tax money. They both have their own requirements as well as good/bad points but having access to pre-tax money can save you quite a bit of money. I'll do a separate post on these plans but if your employer offers them please learn about them and utilize them. They may also have a Limited FSA just for Dental and Vision, a Dependent Care FSA to help pay for childcare expenses pre-tax or an Health Reimbursement Program (HRA) that, while it isn't tax free, is free money to help you meet your medical costs if you submit for it. All of these plans are going to be employer specific in whether they are provided and through which providers but making sure to really understand your benefits package is an important part of providing health care for your family and being an advocate for your own.

I hope this helps you navigate your medical insurance journey.

Until next time,

It’s difficult to explain how important it is to lower my monthly expenses by paying off my student loans- as well as other debt- without explaining where a huge chunk of my annual income goes without any real choices… my medical expenses.

​For someone like me who has chronic illnesses, maintaining health insurance coverage can literally be the difference between a fairly normal life and absolute destruction. I make the joke that I work for health insurance but to be honest it’s not much of a joke. According to BCBSTX the billed amount for my medical expenses in 2018, a really good year for me with only one chronic illness really causing problems rather than all three, was $46,823. That’s a full time salary for many in the US and it doesn’t even take into account costs that I incur outside of the insurance plan for uncovered medications and services. In order for me to ever be fully financially independent I need to eliminate as many of my monthly debt payments as possible while also building a large emergency savings so that in the event of a job loss I could afford to maintain my healthcare costs without going bankrupt.

For this reason, I thought taking you through a summary of my anticipated costs for 2019 would be helpful. So here we go. First, some important terms then a summary of this year’s insurance plan and then a quick run through of additional costs.
This post is part of a series that will look at ways to save money on medication, questions to ask your HR representative during Open Enrollment season so that you can make an informed decision and more. Insurance and healthcare are, understandably, a huge passion of mine which I have only dug deeper into since beginning to work in Human Resources four years ago. I hope that this series can be beneficial to you.
 
Important Terms

• Premiums: This is the amount you pay in order to be covered by insurance. Typically this number is expressed either as a per month or annual cost.
• Deductible: This is the amount that you have to pay for your care (of covered services, some services are not covered depending on the plan you are under) before the insurance company will pick up any of the cost. This does not mean you are not gaining benefit from having insurance though. If you are ‘in network’ you are only going to pay for the negotiated prices of services which can be a significant cost savings.
• Out-of-Pocket Maximum: This is the highest amount you will pay for covered services in a given period, typically a year.
• Co-Pay: This amount is a set fee for certain services such as a doctor’s visit or a prescription. You will typically not see these on the type of plan I am on- High Deductible Health Plans- but if they are on your plan you will likely see them as a set of tiered costs, some for prescriptions and others for types of doctor’s visits.
• Co-Insurance: This is the percentage of bills you are required to pay while you are in that gap between the deductible and out-of-pocket maximum.

 
My Insurance Plan
I currently have a fairly good plan but it is a High Deductible Health Plan which can get very costly if not budgeted for and fully understood. Being an informed consumer is of utmost importance with this kind of plan as 100% of the cost for services is on you from day 1 until you meet the deductible. Here are the details for my exact plan:

• Premiums: $544.26 per month, of which I pay $61 and my employer pays the difference. Annually this amounts to $732 which is low. It is a High Deductible Health Plan though so most of the cost comes in from the other costs throughout the year as a rule.
• Deductible: $2800 annually, this means that I pay all costs 100% until I have paid $2800. For me this is typically February. This year it is March due to a medication being filled on 12/31/18 rather than actually in January so I didn’t have to pay costs usually on my budget for January which was lovely.
• Out-of-Pocket Maximum: This one is $5400 annually… for an individual plan. Like I mentioned earlier, most of the costs for a HDHP tend to come in areas not related to premiums.
• Co-Pay: I have no co-pays on my plan. I either pay 100% or my co-insurance rate depending on how much I paid already in the year.
• Co-Insurance: My co-insurance is an 80/20 split so I will pay 20% of costs after I meet my deductible until I hit the out-of-pocket maximum after which I will pay $0 for care (so long as it is covered).

My insurance plan does not cover two of my currently prescribed medications (up from one in 2017) or any of the over-the-counter medications that my doctor utilizes as part of my treatment plan. This part is standard though, no prescription drug plan will cover OTC medications as a rule and have exclusions for covered prescription medications. Since this particular medication is purchased at a compounding pharmacy is was pretty much known up front to be an uncovered expense. 

It also doesn’t cover some of the testing I have to do at my allergist/immunologist’s office when I am in a flare, vitamins and minerals that I supplement with when symptomatic, or any of the alternative treatments that I have found helpful to maintaining my health. While it is true that most of these costs boil down to personal choices that I have made to seek these treatments the quality of my life has increased drastically since introducing them so keeping them in my treatment plan if possible is ideal.
 
Not Covered Costs Breakdown

• OTC Allergy Medications: $326 per year, approximately (at current prescribed dosages)
• Inhaler: $55/each so, hopefully, $110/year
• Mast Cell Stabilizers: $468/year at current rates which have historically changed mid-year to account for increased shipping costs
• Tests and Treatments Not Covered: Varies. If it’s a breathing test at my allergist is may run $25 but if it’s extra sessions at the chiropractor’s office or a more expensive blood test that my insurance doesn’t cover it may be a few hundred or even thousands of dollars.
• If it’s outside of traditional medicine altogether it can get pretty pricey as well. For instance, I’ve been trying IV Hydration Therapy in seasons of high symptoms with really good success but that’s not covered at all and runs $75 to $150 per session in office. Its helped ward off migraines that would have cost me significantly more than that (as well as a lot of pain) as well as helped my boost low blood pressure related symptoms at times but for now it’s not something I can afford to use regularly.
• When it comes to alternative pain treatments the costs are similar to the last bit… all out of pocket and all things that I wish I could use more as they help my pain drastically but don’t fit in the budget regularly. The first one is massage. Massages and reflexology paired with chiropractic care has helped my pain levels significantly but the cost of a massage can be anywhere from $50-100 per hour in my area depending on type of massage and facility. I’ve been using reflexology more often recently as they costs are more reasonable. Other things that go in this category are OTC medications, TENS units (and the pads, batteries, etc. required for use), essential oils and etc.

Without any of the ‘not covered treatments’ category we’re looking at:

• Premiums + Out of Pocket Maximum + OTC Antihistamines + Inhaler + Mast Cell Stabilizer... $732 + $5400 + $326 + $110 +468= $7036
• If I include in a minimal amount of additional treatments I can easily get another $1-2k added to that
• I do utilize coupons and programs from manufacturers to save money so I will likely save $2-3k this year (it’s impossible to guarantee or know exactly how much due to the exact programs/coupons I will be using)
• So final expenses for the year, baring any emergency out-of-network expenses, will be between $6000 and $8000 more than likely.

 
Other Costs
One thing that isn’t accounted for in any of these numbers is the fact that I have to be careful about the foods that I eat and products that I use. I am allergic to a lot of things- most artificial scents, gluten, celery (random I know), bananas, and a slew of other things. This translates to needing to use more expensive personal hygiene and cleaning products in many cases as well as having a more heavily padded food budget than your average single person. I wish I could discount this but its part of my life and relates directly to my health issues so it likely should be mentioned. In my house you will find no scented candles, plug-ins, or etc. as they trigger migraines for instance and just this past Christmas I borrowed some basic laundry detergent while on vacation and was covered in hives for three days… so you can imagine a lot of shampoos, detergents and etc. can ruin my week pretty easily.
 
Ways I Lower My Costs

• Coupons on medications (yes they exist, I’m doing a post on them soon!)
• Copay/Deductible Assistance Program for my most expensive medication ($2,100-$2,600/month without assistance)
• Samples of medications and products before purchasing full size products to avoid unusable purchases
• Putting the maximum into HSA or FSA plans when they are available.
• Alternative medical treatments (pain medications are expensive, can be dangerous in high dosages and can lose effectiveness with long term use… and the last migraine that I wasn’t able to stop cost me $3k by the end of it due to needing someone to pick me up and drive me to the hospital to get stronger medication)
• Buying off brand and in bulk- medications and household products both. If something costs 20% more than normal in order to get something that doesn’t break me out or give me a migraine but I can buy in bulk and save 10% then its not really 20% more expensive. The same goes with medications. The costs of my OTC and other non-covered medications are all off-brand and bulk quantities as monthly 30 day supplies would be almost double in some cases.

 
I write all this out not to convince you to feel sorry for me or what have you, because I think that I am extremely lucky to be able to work at all as I have many friends who are not able to do so. And not only that but I have a job I love, that pays me enough to afford the life I have- including insurance and salary that can encompass these expenses, a life that’s amazing with hobbies that bring me joy and friends that bring light and happiness to it, and a family that is just without words wonderful. It’s more than I deserve and I will always be grateful for it all. I write this to show you a window into my life for better understanding of one of my largest “why’s” when it comes to becoming financially independent and debt free. Having a “why” for your goals is important as without one you will be more likely to convince yourself out of the hard but necessary tasks along the way towards reaching your goal.
 
Until next time,