Even if you have Medicare coverage, you will still want to manage your out-of-pocket costs. (And your doctor can be a great ally.)
Those costs could include:
Copays, or the fixed fee you pay for each doctor visit, prescription drug or other service.
Coinsurance, or the percentage you pay of the costs after you have reached your deductible (that is, what you have to spend before your plan starts paying).
Your doctors need to know about your ability to afford medical products and services so that they can find financially friendly alternatives.
There is a general movement towards greater transparency in all medical billing, especially hospital bills. So there is no reason for that trend not to move to the doctor’s office. And if your doctor is not willing to work with you, you may not be at the right doctor.
Here are five questions you can ask your doctor to try and save some money:
Do you accept Medicare assignment, and if so, are you a participating or a nonparticipating provider?
Medicare assigns a value to every medical service and refers to it as the “Medicare-approved amount.” This is how much it reimburses your provider for the given medical service or item you receive. But Medicare providers can be divided into “participating” and “nonparticipating” providers.
Participating providers “accept assignment” for Medicare. They are under contract to accept the Medicare-approved amount as full payment. As a result, they only charge you the amounts defined in your health plan for deductibles, copays and coinsurance, even if their standard fees are higher than the Medicare-approved amount.
Nonparticipating providers accept assignment for some services, but maybe not all. And such providers can recover some of the difference between their fees and the Medicare-approved amount by charging “Part B excess charges.” While limited to an extra 15% of the Medicare-approved amount, these out-of-pocket costs can add up quickly, especially on large-ticket services such as surgeries.
If you have Original Medicare, you can avoid excess charges by buying a private Medicare Supplement Insurance (Medigap) plan and selecting one that offers that coverage. If you do, the plan will pick up any excess charges your providers file.
Takeaway action step: Before receiving any treatment or services, ask your physician, provider or medical device supplier if they accept Medicare assignment. In the case of surgeries, you also have to confirm that other providers, such as anesthesiologists, accept assignment.
Can you prescribe a cheaper medication?
Whether your prescriptions are covered by a private Part D prescription drug plan or your Medicare Advantage plan, the out-of-pocket cost for medications can add up quickly, especially while still working towards satisfying your plan’s deductible.
How can you lower those costs? By replacing costly name-brand drugs with generic ones, which work similarly and provide the same clinical benefit.
Because generic drugs haven’t paid the original manufacturers’ initial research and development costs, they can be sold at an estimated 80% to 85% discount off branded counterparts.[1]
Takeaway action step: When your doctor prescribes a medication, ask if it is the generic version of the drug. If not, ask to switch the prescription to the less expensive version. And if there is no generic for the medication prescribed, ask if there is a less-expensive medication that treats the same condition.
Can I use an outpatient facility for that service?
It is often less costly to have a procedure or surgery performed at an outpatient clinic than in a hospital. But it will depend on the gravity of the illness or injury – and the urgency for treatment. This won’t be feasible if you are running to the emergency room for urgent treatment. But if you have a minor illness or injury, a little research could make a big difference in costs.
Takeaway action step: If your doctor recommends a procedure or surgery, ask if it can be done at an outpatient clinic instead of a hospital. If you have the luxury of time, ask the doctor for the exact name of the procedure, and call your different venue options to obtain prices. Even if surgery is called for, you may be able to have it done at an ambulatory surgical center – a facility focused on same-day surgical care, which includes diagnostic and preventive procedures.
Can I use an independent facility for testing?
Hospitals have to be on standby 24/7 to provide all services at all times. As a result, they have very high overhead costs that are reflected in your bill. That is not the case with independent labs or free-standing imaging facilities.
Doctors are often affiliated with hospitals, and their first reaction might be to have the hospital lab or radiology department perform the testing. However, you can likely save money by using an independent facility instead.
Takeaway action step: If your doctor recommends testing such as blood work, mammograms, MRIs or other scans, ask if they can be done at an independent facility instead of a hospital. That may not be possible in urgent situations, but for non-urgent testing, it should be. The exact test will be identified on the prescription form. Use this information to call various providers for the best pricing.
Are there free preventive care benefits I could use?
Medicare covers the entire cost of specific preventive care because it lowers the cost of overall health care. That can include regular screenings for diseases (like cancer, diabetes and depression), immunizations and exams. In addition to yearly check-ups and flu shots, these might include mammograms and colonoscopies after a certain age.
If you participate in free annual wellness visits, your doctor may catch potential issues early enough to treat them easily. Then you can either change behaviors to avoid the health issues entirely or minimize their impact – and their cost.
Takeaway action step: Ask your doctor if there are any free services available to you that could help keep you healthier or detect future health issues early. By letting your providers know you are interested in proactively maintaining or improving your health, you may be able to save considerable money in the short and long term.
[1]U.S. Food & Drug Administration. “Generic Drugs: Questions and Answers.” fda.gov (accessed April 27, 2022).