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FSA Friday with Sean - 3/23/18: How to pay less for healthcare needs

For most Americans, healthcare comes through their employer, and prices for expenses -- like copays and doctor visits -- are largely determined by the available plans, before you even sign up.

But with the rising cost of healthcare in the U.S., skipping treatments or postponing doctors' appointments has become an unfortunate -- and unnecessary -- reality for some Americans.

Don't let these price increases affect your health when there are many ways to cut the costs of medical care! For this week's FSA Friday, we're going to explore some easy, money-saving tips to boost your finances.

1. Check prescription drug prices

We covered this in last week's column, but you may be spending more than you should for prescription drugs by not paying with cash. Pharmacy benefit managers (PBMs) may sometimes negotiate higher prices for co-pays than the actual cost of the drug, so you should always ask your pharmacist first if there's a difference between cash and insurance-covered prices.

2. Use free preventive care options

The Affordable Care Act mandated that insurance plans must offer a minimum standard of preventative services that are free of charge to the participant, as long as they stay within their insurance networks. has a full listing of these services, which includes vital screenings like colonoscopies, vaccinations, blood pressure testing, and more.

3. Enroll in an FSA/HSA

Maybe we're partial, but if you're offered an FSA or HSA option through your employer, this is one of the easiest ways to cut costs by reducing your taxable income. The money contributed to your account is exempt, so every purchase you make, whether it's sunscreen, co-pays or OTC medicines, is covered by tax-free money. That's way better than paying out of pocket!

4. Consider generic drug options

When you purchase name-brand medications, you're usually paying a premium for the name on the bottle. Over-the-counter (OTC) medications like pain relievers and antihistamines have identical generic versions that can offer real cost savings.

Another note -- be wary of pricey combo drugs. Instead of buying a less-effective combination cold and allergy medicine, check ingredient lists. It's often far cheaper (and effective) to buy a standard decongestant and a separate allergy medication. Of course, check with your doctor if you're unsure of how much you need of each active ingredient.

5. Track your health spending

This sounds like a no-brainer, but tracking spending is a major consideration if you have a deductible.

Let's say you anticipate having a medical procedure sometime over the next year. You can use this opportunity to make a huge dent in your deductible so that insurance can cover unexpected expenses later in the year.

Another option is to hold off on the procedure until later in the year, after you've met your deductible, when your insurance might possibly cover the whole cost. Both options make sense, as long as you track your costs so you can time your healthcare costs to match your insurance coverage.

For the latest info about your health and financial wellness, be sure to check out our Learning Center, and follow us on Facebook, Instagram and Twitter.


FSA Friday with Sean - 3/16/18 Are you overspending on prescription drugs?

Prescription drugs can be expensive. But your insurance provider is getting you the best prices, right? Well, maybe. According to a recent study by the University of Southern California (USC), this might not be the case, as up to 23% of Americans are paying more for insurance co-pays than they should.

The controversial co-pay "clawback"

In short, this prescription overpayment ("clawback") is the practice of charging more for a co-payment than the total cost of the actual drug. It stems from the "middle men" -- the pharmacy benefit managers (PBMs) that handle drug claims for insurance companies -- trying to grab back these funds from the pharmacy.

So, despite what your insurance provider says, in some cases, it's cheaper to pay for prescriptions with cash rather than through insurance.

According to The Balance, these PBMs are intermediaries between insurance companies and other arms of the healthcare industry. They can negotiate with both pharmacies and drug companies to get the best rates. ExpressScripts and CVS Caremark are two examples of these organizations.

Here's how it works: If you pay for a prescription through your insurance and owe a $10 co-pay, you probably assume that covers your end, and the insurance covers the rest. But what most people don't realize is that the drug could cost just $7 out of pocket. The PBM then "claws back" an extra $3 -- in other words, if you paid with cash, the drug would actually be cheaper.

According to Kaiser Health News, the USC study revealed that prescription drug overpayment is a much larger issue than we realize. It analyzed prices of 9.5 million prescriptions in the first half of 2013 and incredibly, found that overpayments were nearly $135 million during that six-month period.

How FSA users can avoid clawbacks

If you're using flex dollars to cover prescription drug co-pays, you could be subject to these same clawbacks as those filing through traditional insurance payments. Your best defense is to speak up! In most states, you can ask your pharmacist for the pricing difference between insurance co-payments and paying out-of-pocket.

Shockingly, some insurance plans have gag clauses that prevent pharmacists from telling patients the pricing difference. The National Conference of State Legislatures has additional information on these orders, so be sure to see where your state lands on this issue.

But these gag orders shouldn't stop you from asking questions! If you can't find a pricing difference between co-payments and cash, opt for cash payment and then file for FSA reimbursement later. If it's the same price, use the convenience of your FSA card.

With the right information on your side, you may just end up saving hundreds of dollars each year -- money you didn't even know you were overspending in the first place!

For the latest info about your health and financial wellness, be sure to check out our Learning Center, and follow us on Facebook, Instagram and Twitter.