High Medical Costs: How to save money on the doctor

Asking a few questions about your health insurance and knowing your options can protect your wallet after a doctor’s visit.

1.    Know your options

How much you’ll spend at the doctor depends on what type of doctor you visit. Most plans will cover a phone call with a nurse, an online doctor visit, or visits to a doctor’s office, an urgent care clinic, or a hospital emergency room. Nurse lines and online visits are usually cheapest (and often free). Emergency rooms are the most expensive.

2.    Ask if the doctor is in your plan’s network

Most health plans have a network of doctors, specialists, and other providers. You’ll pay more if you get care outside the network. Ask your health plan if the doctor, facility, or hospital you want to visit is in your network. If you go to a doctor outside your network, ask the doctor about the cost. Some might be willing to negotiate lower prices with you.

3.    Ask how to save money on prescriptions

Most plans have a list of drugs that they will pay for. The list also shows how much you’ll have to pay. If the drug is too expensive, ask your doctor if there’s a generic version. If you choose the brand-name drug, there may be coupons or discounts that can save you money. Ask your pharmacist where you can find coupons.

4.    Ask questions if you get a bill

If the visit was covered by insurance, don’t pay more than the explanation of benefits from your health plan states you may owe. If the bill was for more than you were expecting, ask the doctor or facility for an itemized bill. Look for errors or duplicate charges. Call your health plan if you have questions. You can also ask the doctor for a discount or an interest-free payment plan.

Resources

For more information, click here.

Teaching Suggestions

  • Ask students whether they or their family members have requested from their physician and pharmacist if a less expensive drug is available?
  • Are you aware that many states offer state pharmacy assistance programs that help pay prescription drugs based on financial need, age, or medical condition?

Discussion Questions

  1. Have you considered using a mail-order or legitimate online pharmacy for your prescriptions, especially if you will take a drug for a long time?
  2. What are your options to get the medical care you need and avoid a big bill?

COVID-19 Tests: A financial warning for consumers

The Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief and Economic Security (CARES) Acts required health coverage for the COVID-19 test – including the test itself, the related visit, and other services related to the testing with no cost-sharing for individuals covered by private health plans, Medicare and Medicaid. The CARES Act, passed by Congress in March 2020, includes a provision that states insurers must pay for an out-of-network COVID-19 test at the price the testing facility lists on its website. But it sets no maximum for the cost of the tests.

Although providers are required to post the price for a COVID-19 test on a public website, there is no regulated price for the test. However, Medicare covers the testing without cost-sharing for patients and reimburses providers $51 – $100 per diagnostic test depending on the type of test administered. This price contrasts sharply with the outrageous charges made by certain providers that can run from $2,000 – $5,000 per test.

There is a better way to control the cost of testing. Here are a few reminders to help protect consumers from balance billing, and insurance companies or your employer from a costly claim.

  1. Call your doctor’s office if you are experiencing symptoms like a fever, cough, fatigue or if you think you may have been exposed to the virus. Your primary care physician will schedule and direct you to an in-network testing site.
  2. DO NOT go directly to an emergency room. There are collateral charges for a COVID-19 test at an ER that you will be responsible to pay. Before going to an ER for the test, ask yourself: Would I call an ambulance right now if I suspect exposure to the virus?
  3. For a free COVID-19 test, call your local county health department to schedule a test. If the appointment results in an extended waiting period, call or go to an urgent care facility and request a test.
  4. If you are insured, stay in-network with your health carrier. If you are uninsured, you should utilize the testing resources of your local county health department.
  5. If your symptoms warrant a test, follow the posted CDC guidelines.

For more information, click here.

Teaching Suggestions

  • Ask students if anyone in their family received a COVID-19 vaccine.  If so, enquire if there was cost-sharing.
  • If the cost of each COVID-19 test, by law, is free to the public with health coverage, how can some providers charge from $2,000 to $5,000 per test?

Discussion Questions

  1. Why is it important to first call your primary care physician if you experience symptoms like fever, cough, fatigue or if you believe you have been exposed to the virus?
  2. If you are uninsured, what are your options to receive free COVID-19 test?

Resources to help you avoid scams during the COVID-19 Pandemic

Scammers are taking advantage of the coronavirus pandemic to con people into giving up their money. During this time of uncertainty, knowing about possible scams is a good first step toward preventing them.

Beware of these corona-related scams:

Vaccine, cure, air filters, and testing scams

The FTC warned  about an increasing number of scams related to vaccines, test kits, cures or treatments, and air filter systems designed to remove COVID-19 from the air in your home. There is no vaccine for this virus, and there is no cure. If you receive a phone call, email, text message, or letter with claims to sell you any of these items–it’s a scam.

What to do instead: Testing is available  through your local and state governments, but these tests are not delivered to your house.

Fake coronavirus-related charity scams

charity scam is when a thief poses as a real charity or makes up the name of a charity that sounds real to get money from you. Be careful about any charity calling you and asking for donations. Also be wary if you get a call following up on a donation pledge that you don’t remember making–it could be a scam.

What to do instead: If you are able to help financially, visit the website of the organization of your choice to make sure your money is going to the right place.

“Person in need” scams

Scammers could use the circumstances of the coronavirus to pose as a grandchild, relative or friend who claims to be ill, stranded in another state or foreign country, or otherwise in trouble, and ask you to send money. They may ask you to send cash by mail or buy gift cards. These scammers often beg you to keep it a secret and act fast before you ask questions.

What to do instead: Don’t panic! Take a deep breath and get the facts. Hang up and call your grandchild or friend’s phone number to see if the story checks out. You could also call a different friend or relative. Don’t send money unless you’re sure it’s the real person who contacted you.

Scams targeting Social Security benefits

While local Social Security Administration (SSA) offices are closed to the public due to COVID-19 concerns, SSA will not suspend or decrease  Social Security benefit payments or Supplemental Security Income payments due to the current COVID-19 pandemic. Scammers may mislead people into believing they need to provide personal information or pay by gift card, wire transfer, internet currency, or by mailing cash to maintain regular benefit payments during this period. Any communication that says SSA will suspend or decrease your benefits due to COVID-19 is a scam, whether you receive it by letter, text, email, or phone call.

What to do instead: Report Social Security scams to the SSA Inspector General online at oig.ssa.gov .

For more information, go to: click here.

Teaching Suggestions

  • Ask students if they or their families have received calls from scammers. If so, what was their response?
  • Ask students to prepare a list of actions to take if they receive calls from scammers. Share the list with others.

Discussion Questions

  1. Why is it important to do your homework when you donate to a charity? should you donate in cash, by gift card, or by wiring money?  Why or why not?
  2. What should you do if you receive a call, an email, text message, or a letter claiming that an air filter system will remove COVID-19 from the air in your home?
  3. How would you handle any communication which claims that Social Security will suspend or decrease your benefits due to COVID-19 pandemic?

Health Insurance Coverage in the United States

In September 2019, the U.S. Census Bureau published a report on health insurance coverage in the United States.  The report is based on information collected in The Current Population Survey Annual Social and Economic Supplement and the American Community Survey.

Here are some of the highlights from the report:

  • In 2018, 8.5 percent of Americans, or 27.5 million people, did not have health insurance at any point during the year.
  • The percentage of people with health insurance coverage for all or part of 2018 was 91.5 percent, lower than the rate in 2017 (92.1 percent).
  • In 2018, private health insurance coverage continued to be more prevalent than public coverage, covering 67.3 percent of the population and 34.4 percent of the population, respectively.
  • Between 2017 and 2018, the percentage of people covered by Medicaid decreased by 0.7 percentage points to 17.9 percent.
  • The percentage of uninsured children under the age of 19 increased by 0.6 percentage points between 2017 and 2018, to 5.5 percent.

For more information, click here.

Teaching Suggestions

  • Ask students if they have health insurance of their own or through their parents. What are the premiums for their coverage?
  • Ask students to make a list of available sources for private and public health insurance coverage in their states.

Discussion Questions

  1. What might be some reasons why 8.5% of people, or 27.5 million, did not have health insurance in 2018?
  2. While most people have a single type of health insurance, some people may have more than one type of coverage during a calendar year. Why?

SPREAD THE WORD, NOT THE VIRUS

The infectious disease experts are urging all Americans to do their part to slow the spread of the Coronavirus.  Even if you are young, or otherwise healthy, you are at risk and your activities can increase the risk for others.  It is critical that you do your part to slow the spread of the Coronavirus.

Work or engage in schooling from home whenever possible.  Avoid social gatherings in groups of more than 10 people.  Avoid eating or drinking at bars, restaurants, and food courts—use drive-through, pick-up, or delivery options.  Avoid discretionary travel, shopping trips, and social visits.  Do not visit nursing homes or retirement or long-term care facilities unless to provide critical assistance.  Practice good hygiene.  Wash your hands, especially after touching any frequently used item or surface.  Avoid touching your face.  Sneeze or cough into a tissue, or the inside of your elbow.  Finally, disinfect frequently used items and surfaces as much as possible.  Furthermore:

  1. Listen to and follow the directions of your federal, state and local authorities.
  2. If you feel sick, stay home. Do not go to work. Contact your medical provider.
  3. If your children are sick, keep them at home. Contact your medical provider.
  4. If someone in your household has tested positive for the Coronavirus, keep the entire household at home.
  5. If you are an older American, stay home and away from other people.
  6. If you are a person with a serious underlying health condition—such as a significant heart or lung problem—stay home and away from other people.

For more information, click here.

Teaching Suggestions

  • Ask students if they are practicing social distancing. If not, what are the reasons?
  • Ask students how difficult has it been since the world has almost come to a standstill. What has changed in their life?

Discussion Questions

  1. Are the President’s Coronavirus Guidelines for America fair to the citizens? Explain why or why not?
  2. Since older people are particularly at risk from the Coronavirus, why are younger people being quarantined?

Medicare Supplement Insurance (Medigap) policies

Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. Medicare Supplement Insurance policies, sold by private companies, can help pay some of the remaining health care costs for covered services and supplies, such as copayments, coinsurance, and deductibles. Medicare Supplement Insurance policies are also called Medigap policies.

Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, such as medical care when you travel outside the U.S. Generally, Medigap policies don’t cover long-term care (such as care in a nursing home), vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

Every Medigap policy must follow federal and state laws designed to protect you, and they must be clearly identified as “Medicare Supplement Insurance.” Insurance companies can sell you only a “standardized” policy identified in most states by letters A through D, F, G, and K through N. All policies offer the same basic benefits, but some offer additional benefits so you can choose which one meets your needs. In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized differently.

For more information, click here.

Teaching Suggestions

  • Ask students to read about different types of Medigap policies, what they cover, and which insurance companies sell Medigap policies in their area.
  • Ask students to find and compare drug plans, health plans, and Medigap policies offered in their state.

Discussion Questions

  1. What are the differences between a Medigap policy and a Medicare Advantage Plan?
  2. What types of services are not generally covered by Medigap policies?

Paying for Long-Term Care

Paying for long-term care (sometimes called “long-term services and supports”) includes non-medical care for people who have a chronic illness or disability. This includes non-skilled personal care assistance, such as like help with everyday activities, including dressing, bathing, using the bathroom, home-delivered meals, adult day health care, and other services. Medicare and most health insurance plans, including Medicare Supplement Insurance (Medigap) policies, don’t pay for this type of care, sometimes called “custodial care.” You may be eligible for this type of care through Medicaid, or you can choose to buy private long-term care insurance.

Long-term care can be provided at home, in the community, in an assisted living facility, or in a nursing home. It’s important to start planning for long-term care now to maintain your independence and to make sure you get the care you may need, in the setting you want, now and in the future.

For more information, click here.

Teaching Suggestions

  • Ask the students if they have Long Term Care insurance since 40 percent of the 13 million people receiving long term care services are between the ages of 18 and 24.
  • Ask students to prepare a list of services that long term care insurance policy may provide.

Discussion Questions

  1. If majority of Americans will be cared for at home by family members and friends, why should anyone purchase a long-term care insurance policy?
  2. Do younger people need long-term care insurance? If so, why?  If not, why?
  3. Why long- term care insurance is very expensive? Should everyone purchase long term care insurance?

Do You Really Need Dietary Supplements?

Ads abound for products that claim to treat or prevent serious health conditions. Unfortunately, these products often are unproven and useless. Sometimes the ads even make false promises for Alzheimer’s disease and dementia – diseases for which science has no cure.

In March 2019, the Federal Trade Commission (FTC) and the Food and Drug Administration (FDA) issued warning letters to certain companies making unproven claims that their products can treat or cure Alzheimer’s or other diseases .Many of these products are sold on websites and social media platforms – and called “dietary supplements” or natural remedies. But that doesn’t mean they are necessarily safe.  Products that claim to do it all often do nothing.

The reality is that phony miracle products can be dangerous, and not just because of interactions with medicines you’re already taking. They also might cause you to delay or stop proven medical treatment ordered by – or available from – your physician. They might also delay you from making important dietary and lifestyle changes to help your condition. And some may contain unlabeled and unapproved drugs, which can cause serious injury or death.

For more information, click here.

Teaching Suggestions

  1. Ask students to make a list of credible sources of health information.
  2. Ask students if they, their relatives or friends ever bought a dietary supplement or health-related product that did not work as promised. What action(s) did they take?

Discussion Questions

  1. Why is it important to talk to your healthcare professional before you take any dietary supplements?
  2. What are some of the most effective ways to stay healthy, instead of wasting your money on unproven dietary supplements?

Deceptive Stem Cell Therapy

People spend billions of dollars each year on health-related products and treatments that don’t deliver. People who buy them are cheated out of their money, their time, and even their health.

The Federal Trade Commission (FTC) reports  that California-based Regenerative Medical Group, Telehealth Medical Group, and Dr. Bryn Jarald Henderson, the founder of both companies, sold false hope at high prices.

These companies and Dr. Henderson used social media and websites to promote stem cell therapy for all kinds of health issues affecting older adults and children. Supposedly, it could treat and cure diseases and health conditions such as Parkinson’s disease, autism, dementia, depression, multiple sclerosis, cerebral palsy, traumatic brain injury, heart disease, macular degeneration, chronic kidney disease, osteoarthritis, and stroke. Dr. Gunderson  charged up to $15,000 for their initial stem cell therapy and up to $8,000 for follow-up treatments.

But, according to the FTC, these claims were not backed up by any scientific studies and, in fact, no studies have established that stem cells cure, treat, or reduce the severity of diseases or health conditions in humans. With the exception of a few FDA-approved treatments, stem cell therapy is still largely experimental.

Are you — or someone you know — thinking about stem cell therapy?  If so,

  • Be skeptical about amazing health claims.
  • Don’t trust a website just because it looks professional, uses medical terms, or has success stories from “real people.”
  • Talk to your health care professional before you consider any medical treatment.

For more information, click here.

Teaching Suggestions

  •  Help students understand that health information, whether online or in print, should come from a trusted source.
  • Let students make a list of the richest and most reliable sources of health information and share it with the class.

Discussion Questions

  1. Why is it important to seek a second or even third opinion from a qualified health care provider before trying experimental medical procedures?
  2. What can the FTC and other federal/state governmental agencies do to prevent such businesses to make deceptive treatments.

Fake healthcare plans

If you’re looking online for health insurance, there are lots of results that seem to offer good choices. But dishonest companies are literally counting on you being confused by all those choices. So, before you sign up and pay, take steps to know you’re getting exactly what the plan advertised. Otherwise, fake “coverage” can leave you exposed to substandard benefits and costly payments.

For example, according to the Federal Trade Commission, a Florida-based company, Simple Health Plans, LLC, allegedly tricked consumers into believing its plans offer comprehensive coverage and are compliant with Affordable Care Act (ACA) standards. The company allegedly lured people in through lead-generation sites, using logos of well-known health insurance providers to make itself look credible. Simple Health asked for personal information on the site, followed up with phone calls, and pitched what it said were affordable, comprehensive, ACA-qualified plans with low or no co-pays or deductibles.

But once consumers signed up — often at premiums as high as hundreds of dollars per month — the FTC says they did not get anywhere near the full coverage Simple Health promised, and the benefits were not ACA-qualified.

For more information, click here.

Teaching Suggestions

  • Ask students if they or any of their friends and relatives have received sham health insurance plans calls. If so, how did they handle such calls?
  • Help students understand that two best-known and legitimate sources of the government health insurance are Medicare and Medicaid.

Discussion Questions

  1. What are some ways to protect yourself against false health care plans?
  2. Why is it important to learn the difference between health insurance and medical insurance discount plans?