Trimming the Average Budget: Healthcare

This is part of an ongoing series about how to trim the budget of the average American. As this series focuses on such broad-based tips, some will work for you and some will not. You’re invited to mention in the comments the tips that you found to be the most useful for inclusion in a comprehensive budget trimming guide at the conclusion of this series.

Healthcare – $2,853

This is one of those “averages” that somewhat hides the real truth of the situation. For some, there is almost no expense at all when it comes to health care. They’re covered fully by a strong health insurance policy and rarely (if ever) have doctor visits.

For others – those with poor health or those without insurance – the cost of healthcare in a year can be much, much higher.

Thus, there are two big ways to keep your health care budget under control. First, if you’re in the first group, do what you can to avoid slipping into the second group. If you’re in the second group, find ways to reduce the multitude of expenses.

Ask your doctor about independent and preventive steps. Whenever you have a doctor’s appointment about a particular ailment, always ask the doctor about independent steps you can take that don’t require a doctor’s constant monitoring. Are there exercises you can do? Are there natural remedies you can take to ease the situation? If there are simple independent steps you can take to reduce the number of doctor visits you have, then you’re saving money on the deductibles.

On the other hand, get regular checkups. Many people who are in great health never go to the doctor – and thus they often don’t take care of, or aren’t even aware of, serious conditions until they’ve progressed to the point that expensive treatments are the only option. Regular checkups are like regular maintenance on your car – you pay a little now to avoid paying a lot later on.

If you’re healthy, switch to a plan with a higher deductible. If you rarely visit the doctor, you’ll find that by switching to a less expensive plan with a higher deductible, you’ll save money annually. If this is a job benefit, you can re-route the savings into other benefits more useful to you.

Eat a healthier diet. Focus on making fresh fruits and vegetables a central part of the diet you consume. If you cook at home, this can actually be done quite easily.

Exercise. Be physically active at least thirty minutes a day, even if it just means walking around for thirty minutes. Our bodies are dsigned to utilize regular motion and exercise to maintain health.

Practice self-examination. Self-examination of your body can go a long way towards detecting many medical problems before they become too serious – and thus too expensive. If you don’t know how to do such things, ask your doctor, as this is clearly an indepnendent, preventive step.

Be aware of the health risks of lifestyle choices. If you choose to smoke, drink regularly, consume drugs, or eat excessive amounts of processed foods, you will have increased risk of many different serious ailments. Make lifestyle choices that promote good health, not only for your personal standard of living, but for the sake of your budget.

If at all possible, choose outpatient or same-day surgery. Few things can hit your finances like a long hospital visit when you’re expected to pay some percentage of the bill. If you can, avoid this by choosing outpatient care. Then, learn how to manage your own recovery at home.

Save the emergency room for genuine emergencies. If you can treat it at home, treat it at home. If you’re not sure, call a nurse hotline – a service offered by many hospitals to help filter the legitimate emergency room visits. If you can wait until a regular appointment with your doctor, you can save a tremendous amount of money.

Study your medical bills. When you receive a medical bill, review it carefully and make sure there are no errors or unclear items on the bill. If something doesn’t add up, request an explanation, and if it still doesn’t hold up, challenge it.

I want your help! In the comments, please let me know which of the tips you find most useful for trimming these costs. I’ll include the top choices in a comprehensive budget trimming guide at the conclusion of the series.

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  1. leslie says:

    For trimming shelter costs, I think the idea of having roomates is often overlooked. It’s a great way to afford living in a larger, nice place.

    If you already own a home, you might consider renting out the spare bedroom or basement space.

  2. Molly says:

    Take your medicine! Yes, it is expensive upfront, but it was probably prescribed for a reason – to keep you healthy.

  3. lurker carl says:

    “For some, there is almost no expense at all when it comes to health care. They’re covered fully by a strong health insurance policy and rarely (if ever) have doctor visits.”

    Something is radically wrong with this idea. That regular insurance payment typically is the largest healthcare expense most people incur. I would think those without a policy and seldom see a doctor have the lowest health care expenses.

  4. Candi says:

    Please remember when scheduling all of these doctor appointments to clearly state why you are making the appointment. A lot of primary care offices will only let you discuss the one reason you originally made the appointment for due to time constraints. If you need to learn how to do a thorough skin check, don’t tack it on after you discuss your cold symptoms. Make a seperate appointment or one for an annual exam, those tend to get the longest time block.

    Also, make a list of things you need to discuss so you don’t forget when the doctor is in the room (or take friend with you to help). And if you don’t understand the answers, please say so. One study found patients only remember something like 25% of what the doc told them.

    Antoher way to decrease the time to get an appointment and to possibly increase your face time with your healthcare provider: see the nurse practitioner or physician’s assistant. They generally see less patients per day which means more time for you!

  5. anna says:

    Urgent care, for me is the same price on my deductible ($35/visit) as a general doctors but without an appointment like an ER. It is great for me because when I get sick and need to get a prescription for some cold medicines it doesn’t cost me an outrageous amount ($150 for an ER visit) and I don’t have to wait a couple of days to get an appointment with a doctor.

  6. Ruth says:

    A tip if you aren’t insured or if your insurance doesn’t cover a particular thing (some people have insurance gaps for things like jaw problems, for example… some health insurance excludes it assuming dental will cover it and only some dental covers it) – you should DEFINITELY negotiate with your care provider, preferably before being treated. Insurance companies negotiate reduced rates for everything and usually you can get the same rates for yourself.

  7. Susanne says:

    Wow, that average seems so low to me! We spend about $4800 for health insurance alone, and that number rises every year. We have a bottom-of-the-barrel plan that covers preventative visits and catastrophic emergencies. Office visits aren’t covered.

    My son went to the ER a few months ago for a deep gash on his forehead. It came out to about $1000 in total, and all they did was basically superglue the laceration. Yeesh.

    I know health comes before wealth, but every time we need to see the doctor, I can’t help but feel sick over the cost.

  8. Ms. Clear says:

    Ha! I pay over $8K per year in health insurance premiums. It’s #2 after housing. Not much I can do about it either, save find another job.

  9. Snowy Heron says:

    Another thing to do to keep health costs low is don’t go into the doctor asking for some drug you saw advertised in a periodical or on TV. I know someone who told me that his company had employees that actually did that, and they didn’t even have the illnesses that the meds treated!

    Part of the health insurance problem is that if you are covered, there is very little motivation to keep costs down. When I asked my doctor (at Kaiser-Perm.) about keeping some cost down, he was actually confused about it. Why would I care? Because, eventually, I will be paying it.

  10. Courtney says:

    For households where both spouses have health benefits, review the rates and coverage annually during open enrollment periods to determine if you can save money on premiums by utilizing one spouse’s benefits instead of the other (or even both). When I was in grad school it was cheaper for my husband and I to each have policies through our individual employers. Once I graduated and started working elsewhere, it turned out to be cheaper for both of us to be covered by his policy – it’s a difference of about $600 a year versus getting benefits through my own employer.

  11. Looby says:

    I would have thought that in the US health insurance would have made up a large portion of healthcare costs?
    I’m a bit confused by this: “They’re covered fully by a strong health insurance policy”- which surely they are paying for? (I think I agree with Lurker Carl)
    Otherwise I agree with a lot of your points but I would like to point out that self-examination is not preventative, it is pro-active in looking for issues but to imply that breast self-exam may prevent breast cancer would be ridiculous- I’m guessing it’s just a typo but one I think you should change (much like the oft remarked upon shelter typo so I won’t hold out hope).

  12. Vicky says:

    My husband and I have no health insurance. We simply can not afford it.

    His employer does not offer it. I work for a VERY small company, and it is through the roof to cover the both of us.

    To cover my husband and myself, it would be 1/4 of our total income.

    For two young people who are hardly EVER ill, neither of us smoke or drink, we take care of ourselves, and we get our annual exams from walk-in clinics. I see Planned Parenthood once a year and pay $100 for an exam.

    Much cheaper than paying every month!

    I am terrified, though, of an accident landing either of us in the emergency room – and heaven forbid we ever need dental. But there just is no way we can afford to give up 1/4 of our income to a ‘maybe’.

  13. Carrie says:

    We pay over $7K a year just for health/dental insurance (my company pays an additional $5K). That doesn’t even include co-pays ($30 for a regular doctor) and deductibles ($1,500/person). Ridiculous.

  14. Maureen says:

    Trent, you neglected to discuss health savings accounts. These are accounts that people can put pre-tax dollars into that will cover their out of pocket medical expenses. And the money rolls over year after year. Better then a flex spending account which you loose every year if you don’t spend it.

    My employer only offered a high deductible policy with a mandatory health savings account and I was very dissatisfied with this option. But I had no choice since my husband’s coverage was far less coverage. So we took it. And it has turned out to be a better option in the long run. We have been banking this money and if we’re sick and need a prescription or coinsurance for the doctor’s visit, all we do is pull out the credit card from this account. This account is only for medical expenses and nothing else.

  15. Sheila says:

    My tip is to use your flexible spending account if you can–we use it for all copays, massage visits (dr. ordered), certain vitamins (dr. ordered), and all the OTC stuff that the IRS deems acceptable. The other tip isn’t financial, but if you have a loved one in the hospital, particularly an older relative, you must absolutely have someone with that person as much as possible. I’m pretty sure my father would have died sooner and in pain had I not been at the hospital with him every time he went. Once when I was in the hospital after getting my appendix out, the nurse forgot to do something and it turned out the call button didn’t work (dangerous!). After making attempts to yell for the nurse, I struggled painfully to pick up the phone and get connected to the switchboard so that I could ask the operator to contact the nurses’s station and send a nurse to my room. Sad, but true.

  16. asithi says:

    I usually use an local urgent care center (you can get a list from your doctor’s office) and the walk-in clinics at places like Rite Aid. Cheaper than an emergency room visit or waiting for an appointment with my doctor.

    I have a post on my site discussing low cost health care options (and Planned Parenthood is one of them). Since I am not sure if I can post links to the comments, just search for “getting health care” on my site if you are interested.

  17. Shevy says:

    This amount is unbelievably low, given the huge cost of health insurance in the US and the items that this line item covers.

    The 4 basic headings are:
    Health insurance, medical services, drugs and medical supplies. That includes everything from doctor visits to dental work to x-rays to eyeglasses to vitamins to contraceptives to bandaids.

    For all that, $237.75 seems impossibly low. Most Americans I’ve talked to seem to spend about $800/month just on their insurance premiums and I know many people whose medications run $200 to $300 per month.

    Is this so low because so many millions of Americans don’t have any medical insurance at all and therefore don’t go to the doctor or buy medicine unless it’s some dire emergency?

    This amount is actually pretty in line for what our family spends here in Canada. $108 for Medical Services Plan premium (covers the whole family no matter how many dependents you have). Extended medical through most employers covers dental, prescriptions and suchlike. Not sure what my hubby’s portion of the premium is but the last time I had extended it was about $35/month for the family. It costs $50 to $100 on average when someone goes to the dentist for cleaning or a filling (some charges exceed what the plan pays), we only pay 20% of prescription costs so rarely more than $10 or $15. No charges for xrays (except dental ones), MRIs, ultrasound, etc. No charges for copays, ER, surgeries or hospital (unless you request a private room, which is about like paying for a room at a Holiday Inn and no charges for things like how many tissues or aspirin you used). The biggest expenses are occasional things like eyeglasses or major dental work, like crowns (only 50% covered, so about $500 each for adults). Toss in vitamins and bandaids and I suppose we could pay $200/month on average although the MSP and extended come out of my hubby’s paycheque so it’s not noticeable. Out of pocket from net pay is more like $25 to $100/month.

    Now tell me the average American really spends that little.

  18. Debbie M says:

    I’d like to add that many insurance companies also have nurse hotlines. I love these for figuring out whether to see a doctor at all as well as whether something is an emergency.

    And I want to second the idea of checking your hospital bills. My mother audits hospital bills for a living and most of the time hospitals would rather pay a fee than have an audit because it’s cheaper for them. (My mom would find things adding up to more than the fee, but if they pay the fee, her company saves her travel expense.) If you have a friend who is a nurse (like my mom) or doctor, they might be willing to help you go through these–they will know better whether some of the charges make sense. (I also remember that if it’s not on the chart, they’re not allowed to charge you, but I don’t know if patients can get access to the chart.)

  19. leslie says:

    #12 Vicky, I went four years without health insurance and never had a problem until just a month before it was going to start with a new job. I explained to the hospital that I was completely uninsured and asked if they offered a payment plan. The hospital employee informed me that they actually offer a financial assistance program for those without health insurance and immediately cut my bill by 50%! The rest I could repay on a payment plan.

    It was still a lot, but definitely good to know that assistance programs are out there!

  20. chacha1 says:

    I would second the request to discuss health savings accounts.

    Best tips: be aware of health consequences of lifestyle choices, and avoid the emergency room.

    I’ve also written on this recently (“personal healthcare reform”) and can only add that people should do some RESEARCH, i.e. reading on an actual medical information site like the Mayo Clinic or WebMD, to determine whether they really need prescriptions, which are an enormous part of US healthcare expenses. Like the commenter who wrote about getting prescriptions when she has a cold!

    Save money, save the environment, avoid future superbugs. If you have a virus (cold, flu, etc) antibiotics will not work on it. They only work on bacterial infections, and on fewer and fewer of those.

    Bronchitis and pneumonia are generally bacterial infections that occur secondary to severe colds or flu. You may well need an antibiotic for these. A doctor can do a culture to verify that your infection can be treated by antibiotics. But if you just have basic cold/flu misery, please take care of it at home with OTC symptom relievers (decongestants, antihistamines, painkillers).

    Our country was probably a good bit healthier before pharmaceutical companies were allowed to advertise on TV. There is often a natural alternative to medication: nutrition, exercise, regular doses of sunlight, social activity, managing body weight: all, essentially, free.

  21. brad says:

    @ hsa’s. they are not only for medical payments. you can use them for glasses, dental work, otc medication, even cough drops!

  22. Kat says:

    Urgent care is an excellent happy-medium between a regular doctors office. Places like Immediate Care or Patient First will see if you if you have something that needs to be dealt with ASAP, but you need care on a holiday or at night or on a weekend and its cheaper than an ER.
    Also look into places like Target’s Minute Clinic.

  23. CB says:

    There’s even a no-frills health insurance to knock one’s medical bill down to the agreed upon price between doctor/hospital and the insurance company. If you don’t pay for insurance coverage, you are usually charged more.

    Having for-profit insurance companies involved in the medical- industrial-complex increases costs by a third. Lots more paperwork, and no incentive to cut costs since the object is to make as much profit as possible.

    The agribusiness industry plays a role, too. Much more profitable to manufacture an “apple tart” with cheap corn syrup than to sell a fresh apple, which turns out to be helpful in keeping the doctor away.

  24. Sherry says:

    As an RN, I encounter all kind of patients. The ones who do well after receiving care are those who are “educated” about their health & listen carefully to the instructions given & FOLLOW THEM!!

    I can’t tell you how many times, patients have been provided care & on the way out make the comment…well, I’ll wait until next week & if I don’t get better, I might get the prescription filled!! Really!! Please don’t waste the MD’s or staffs’ time if you know you are not going to be compliant.

  25. Gretchen says:

    Look into Prescriptions by mail, if offered. I have some chronic conditions and get, basically, 3 months for the price of one mailed to my door.
    I also try to get freebies when I go in for those presciption renewals.

    #9 about the meds for issues they don’t even have disgusts me if it’s true.

    Does this include vision and dental?

  26. deb says:

    Always pay attention to your insurance company’s EOB (Explanation of Benefits) statement you receive after a claim. Then compare it with the final bill from the doctor, hospital, whatever. Frequently they don’t match, and the insurance company’s total is what you’re supposed to pay, not an inflated amount from the health care provider. I’ve saved myself from paying thousands of $$ in extra charges.

  27. Jane says:

    “I’ll wait until next week & if I don’t get better, I might get the prescription filled!! Really!! Please don’t waste the MD’s or staffs’ time if you know you are not going to be compliant.”

    Last I checked, the staff and the doctor get paid whether I take the prescription or not. Therefore, even if I don’t fill the prescription, I am not “wasting your time.” I see your point – why go to the doctor if you aren’t going to listen to them – but I have often waited to fill a prescription, especially if it is an antibiotic and there is still a question in my mind whether it is viral or bacterial. I think it is a valid approach sometimes to “wait and see.” Pharmaceuticals are not the end all be all of health. They can be life savers, certainly, but the patient always has discretion about what they end up putting in their body.

  28. Marle says:

    I agree with Jane. Doctor’s aren’t perfect. I’ve been given antibiotics for allergies, and even constipation medicine for diarrhea. Listen to what the doctor says, but don’t take it as gospel – ask questions and make sure you understand AND that the doctor understood you!

  29. That is all good advice, but the older we get the bigger the risk becomes, and the more prescriptions we need. People over 50 might be spending 5000 a year on premiums plus copays.

    John DeFlumeri Jr

  30. Ruby Leigh says:

    I didn’t read ALL of the comments, so I hope I’m not being redundant.

    One thing to look into if you have no health insurance or poor health insurance – there are some clinics that will offer a discounts, or cater to the un or under-insured. Usually these are non-profits, that are trying to meet special needs.

  31. Meghan says:

    Oh the fun of the medical system. I recently found out I am pregnant, and without insurance. I talked to a few OBs/hospitals about receiving the bare bones of prenatal care: one ultra sound, one appointment during 1st and 2nd trimesters, more in the 3rd, and the possibility of home birth. Not even an option. The only way they will see me is if I follow standard prenatal care, their liability insurance demands it.

    For general advice, try taking some classes. It’s usually only a 13 week program (and can be done in the evenings) to become a medical assistant, not to work as one, but to give you skills and knowledge. If a kid needs stitches the a parent can do it, no need for the ER for smaller lacerations. Quit going to the ER/doctors for viral infections, colds and the flu. The best treatment is time.

  32. cv says:

    For those wondering about Trent’s comments on those covered by good insurance plans, some of us are lucky enough (or get paid enough less in salary compared to others in our field) to have our premiums entirely covered by our employers. I pay no premiums for my plan through my small nonprofit, and I’ve definitely heard of unions with good bargaining power (possibly including the teacher’s union that covers Trent’s wife) with low or no premiums paid by the individual. These situations are getting rarer, but they still exist.

  33. Shevy says:

    Meghan, if you’re interested in a home birth, start talking to midwives. It will cost you money in the US (unlike in Canada, where the cost of a midwife is completely covered, just the same as if you go through your pregnancy seeing your GP or an OB/GYN) but there will be no hospital cost and my home birth (the last one) was by far the best of all my births. Hospitals and their ever-changing arbitrary rules are just annoying. Also, midwives routinely spend much more time at each visit with you (typically up to 45 minutes per visit), explain your choices in much more detail, etc. For instance, advising if you actually *need* an ultrasound for some reason (large for dates, 2 heartbeats, etc.) rather than scheduling one automatically.

    And before you do anything else, go buy maternity vitamins with the recommended amount of folic acid and start taking them immediately (protects against neural tube defects).

  34. Jeroen says:

    There’s a lot of things I’m jealous about when it comes to Americans. Health care isn’t one of those things. The American Health care system seems to come straight out of bizzaro land. I really can’t get my head around it…

  35. I would add to the list getting enogh sleep.

    In our overworked society of today where no one has enough time for anything, it seems to be almost a bragging right with some people at how little sleep they get.

    Lack of daily sleep can have its health consequences as well.

  36. Jules says:

    Or, alternatively, move to Europe. J/k–but I could not imagine having to pay for my own health insurance in the US. I was lucky that my graduate program covered it. $3000/year is about right for how much the insurance cost–and I’m a young, healthy, female, and non-smoker. Here, my plan is the equivalent of about $700/year, and it includes a dental plan (I do have a rather large deductible, though).

    BTW, not all countries in Europe do a single-payer plan. Where I live, it’s privatized, just like in the US, with the key difference being that the plans are affordable and actually cover the cost of care.

    I absolutely agree with the point that maintaining a healthy lifestyle is paramount to cutting health costs. Getting regular checkups is also ABSOLUTELY NECESSARY if heart disease or Type II diabetes runs in your family.

    On a more frivolous note, I kind of resent that vet bills aren’t included in this category. For many of us (myself included) my pets are like family members, and while I never make the mistake of treating them like kids, I do feel obligated to ensure that they stay healthy, too.

  37. deRuiter says:

    You can shop around for local clinics for services, to keep health care costs down, because one way or another, we all pay! For years my friend had $100. deductible on her health insurance. I had no insurance, was healthy and owned my house outright (that’s where the money went instead of health insurance premiums, prepaying the principal.) In case of a catastrophe I could have tapped the house for money to pay the health care. We both went to local clinics which were sponsored by the town and very cheap. If a SMAC blood test cost $80. my friend paid out of pocket instead of tapping her health insurance, and I did the same. (Getting this test in the doctor’s office would have cost $140. at the time.) Ear wax clinics, hearing clinics, female exams, men’s exams, were all inexpensive, performed by local doctors, all records sent on to your primary care physician, paid charges in cash. I didn’t get health insurance until I was 47 years old and figured the gamble had been long enough for a healthy non smoker, non drinker who exercised and ate well. LOOK FOR LOCAL CLINICS WHICH WILL TREAT YOU INEXPENSIVELY. Ask the cost upfront, mention you pay cash and there is no paperwork for the staff. Negotiate with your doctor for cost, terms. A doctor is a business. If you buy his services and pay cash he makes more money than getting the same money as an insurance payment, plus he has the money immediately. He / she will generally take less from a cash paying patient. Even if my insurance is paying for a service, I negotiate the price if possible, and make sure that the company isn’t over charged.

  38. Pattie, RN says:

    Anna (#5)….I read your post three times to be sure I wasn’t seeing things.

    THERE IS NOT A SINGLE COLD TREATMENT THAT REQUIRES A PRESCRIPTION OR NEEDS A VISIT TO A PHYSICIAN!

    Colds are self-limiting, and frankly those of us in health care get very frustrated with misguided people like yourself who run to the doctor for every sniffle. While you are being seen, someone who needs medical attention is waiting. AND…you are spending money on nothing.

    Which was the original intent of my commenting….save the doctor’s visits for when you are really sick, and the ER visits for times when the pain, shortness of breath, change in mental status, injury or whatever is severe enough that you would cheerfully pay for immediate treatment. And please, PLEASE understand that antibiotics are not only useless against ALL viruses, they can and do lead to antibiotic resistant bacteria that can make you and yours sicker later, or even kill you.

  39. karyn says:

    @ Meghan. Our insurance covers very little but I did qualify for pregnancy medicaid – which will cover nearly all of the homebirth but only because the attendant is a doctor (they wouldn’t cover a midwife). On the other hand, a lot of midwives will accept a payment plan and/or will charge on a sliding scale. My homebirth was the best and I have chosen to go that route again this time.

  40. steamincuppaliz says:

    Healthcare is a huge part of our budget. $20,000 3 years ago, $13,000 last year. This does not include insurance payments for the two of us made through my husband’s employer. I had cancer 3 years ago (at 43) and have had relatively poor health ever since. It’s difficult to trim without simply skipping doctor’s visits no matter how important they are.

  41. Melissa says:

    Definitely check your medical bills and also your insurance records after doctors visits!

    At my last physical (with a new doctor), I was told that running a screen for sexually transmitted disease was a part of her standard physical. I said “sure okay.” When I got my insurance record about a month later I found out my insurance covered everything but these two screenings which totaled up to $98! Next year I will be sure to stipulate that I don’t want these tests run.

    The same thing happened when my husband went to a new dentist. They said it was standard protocol to use a fluoride treatment that we had never used at other dentist office. A month later when we received our insurance records we realized it was something not covered by our insurance. It would have been nice to save that $56 for something else.

    I’m not dissing these medical treatments, because for some people they are worthwhile. But each and everyone of us knows our body, and if you have strong healthy teeth and have never had a cavity, at age 30, then why do you need a fluoride treatment?? Be sure to ask your doctor questions about their standard protocols.

  42. Candi says:

    @ Meghan, please apply for your state’s medicaid plan. If that is not an option, your local health department would also be a good choice (though not all provide prenatal care). A midwife is also something to consider, though you must be a low-risk healthy pregnancy or they will probably not be able to treat you.

    I can tell you that if you recieve no prenatal care and show up in labor to a hospital, your bill is going to be significantly higher due to the testing that will need to be performed on the baby after birth (most of which would have not been done or be done for MUCH cheaper in an outpatient setting). And yes that testing is important. One of the above options should be available to you and will greatly benefit both you and the baby.

  43. GayleRn says:

    I am an RN working in cardiac critical care.

    I can’t tell you how many people I see who would greatly benefit from simply improving their lifestyle choices and following the instructions they are given by their health care providers.

    Number one on the list is STOP SMOKING. Almost everyone I take care of is a smoker, often the entire family smokes. At a conservative $5 a pack and an average of 2 packs a day (yes really) that is $10 a day going up in smoke. That is $3650 per year. You can buy a lot of insurance for that.

    Get to know your pharmacist. They can often come up with cheaper alternatives to the expensive medications that are equally effective and help you with prsenting the information to your doctor who is quite often completely ignorant about actual costs. I did this with my father’s cardiologist who prescribed a med that would not be covered by the VA and thus would cost my dad hundreds of dollars he did not have. When I called the doctor and explained the cost and the alternative the VA would pay for he was shocked and immediately wrote for the cheaper med.

    Stop smoking, stop drinking, stop eating fast food. These few things will vastly improve your life.

  44. Kevin says:

    “Our bodies are DSIGNED …”

    “this is clearly an INDEPNENDENT, …”

    … and the “trimming shelter costs” typo is still in the footer.

    I honestly don’t think Trent even reads these comments.

  45. SLCCOM says:

    Before you criticize the drug company marketing, keep in mind that many of us DO have the conditions they discuss and didn’t know it. My face had blood vessels breaking in it, and I didn’t realize I had acne rosaeca until I saw an ad for a treatment for it. I promptly went into my doctor, and got the diagnosis and medication. Then she lasered the blood vessels closed and I wear sunscreen each and every day.

    This is an autoimmune disease, and if I had not figured it out and gotten it treated I would end up with a cauliflower nose like my father had when he died. It isn’t a good look at all.

    And, since I had that diagnosis, years later when my eyes went dry, I was able to figure out that I had ocular rosacea, which can cause blindness. I also have a related autoimmune disease, Sjogren’s Syndrome. Which, by the way, cannot be prevented or treated by even the most fantastic diet and exercise plan in the world.

    Nobody has mentioned using safety precautions in other aspects of their lives, either. Wear your seatbelt. Wear a helmet when skiing, biking, sledding, or doing any other activity that puts your head at risk. Wear hats and sunscreen in the sun. Wear steel-toed shoes when you mow the lawn, and hearing protection. Get a gasoline can with a “dead man’s” latch, so it closes when you let go. These will pay off far greater and far faster than eating “right” and exercising.

  46. Amy K. says:

    My favorite tips:
    * Save the emergency room for genuine emergencies.

    * If you’re healthy, switch to a plan with a higher deductible.

  47. Tammy says:

    My advice is to know what services your local hospital offers. Our local hospital in years past did not have an urgent care center. I have been lucky enough to stay out of the ER until a few months ago, when I accidentally whacked myself in the eye, hard enough to break my glasses and blur my vision. So I went to the ER…and even with my excellent insurance plan, the ER visit cost $135. The next day I found out that yes, they opened an urgent care center at my facility and the cost only would have been $20. Urgent care could have taken care of my accident (it turned out to be not that serious, we just wanted to be on the safe side), but we didn’t even know we had that option.

  48. AnnJo says:

    More tips:

    1. Take a basic first aid course and stock a decent medicine cabinet, buying products on sale BEFORE you need them. You’ll have a better idea of when it is really necessary to seek medical assistance, whether you must go to the ER (most expensive), an urgent care walk-in clinic (less expensive), your doctor’s office (even less expensive), or just to bed with an ice-pack or an aspirin (basically free).

    2. If you AVOID problems, you won’t have to pay to treat them. Read all package inserts on BOTH prescription and all OTC medications and supplements and ask your pharmacist lots of questions. Just because something is sold over-the-counter does not mean it can’t kill you.

    The combination of Tylenol and alcohol can destroy your liver.

    Thousands of people die each year from gastrointestinal damage from aspirin.

    Vitamin E and aspirin are both blood-thinners which in combination or with other prescribed blood-thinners can cause uncontrollable bleeding.

    Medicines that induce drowsiness cause fatal car crashes and occupational injuries.

    Not all health care spending happens at doctors’ offices or hospitals. Some of it happens at the tire shop (good tires), the home improvement store(fire extinguishers and smoke detectors, safe ladders, well-sharpened knives because they’re safer, safe cleaning supplies), the sports equipment store, and of course the grocery store.

    3. If you don’t have prescription coverage and use meds for a chronic condition, sigh up for the drug company’s patient assistance program. Almost everybody qualifies for some savings, and low income people might get their medication free. Also, Internet coupon sites have discount cards and coupons that actually can save a lot. I used one a few weeks ago to cut the cost of a prescription from $36 to $17 – more than 50% off.

    4. Ask for copies of your lab reports and keep a chart on yourself. A spreadsheet that allows you to compare lab results over the course of years will identify trends your doctor might miss because they are not yet at clinically abnormal levels. Jot down significant medical events, surgeries, prescriptions, etc. A thorough and complete medical history can be a great help even just for your own use, but especially if someone else must help manage your care during an illness or disability.

    5. Donate blood and sign up for the organ donor program. You’ll get some free testing done! Use the blood pressure monitor at your local grocery store. Some health clubs sponsor blood draws for lipid levels (cholesterol, etc.) at low cost.

    6. Don’t automatically sign up for the insurance program with the lowest deductible. You can save substantial money with higher deductible policies, especially if it will encourage you to be restrained in your use of medical services.

    For those non-Americans commenting here on our health care system, please be aware – it works beautifully and affordably for a substantial majority of people. Having explored treatment delay data from Canada and the U.K., I, for one, am not looking forward to greater government control over my health care. Perhaps if I were indigent, it would offer some improvement in care of chronic conditions, but as a middle-class person, there’s simply no doubt that it is going to raise my costs and lower the quality and timeliness of my care.

  49. guinness416 says:

    Interesting post on NY Times’ Economix blog about US healthcare spending this evening. I won’t link it because the comment won’t get posted, but you can search for it on their site. Here’s an excerpt:

    “The federal government released its latest estimates of health spending last week, and they allow for some telling comparisons. In 2008, the country spent $2.3 trillion on medical care, or 16.2 percent of gross domestic product and $7,681 per person …… In per person terms, government agencies spent roughly $4,500 on medical care, while the private sector spent roughly $3,000. Here’s what’s notable about that $4,500 figure: It’s more than what a lot of other rich countries spend on health care — including both the public and the private sectors. All told, Canada, Belgium and Germany each spend about $4,000 per person on health care. Australia and Britain spend about $3,500 each. Japan spends a little less than that”

  50. anna says:

    #38 Pattie, RN.
    Sorry I wasn’t clear, when I said Cold Medicines I meant medicines for things like Strep Throat. I can only name 2xs in the last 6 years I have been to a doctor/urgent care. I have a great immune system and don’t go to urgent care for just a cold. The reason I said colds is because I am not a medical professional and am unfamiliar with the terminology but I should have said “I use Urgent Care instead of the ER for when I am sick and in need of a medical professional because urgent care is A LOT cheaper than the ER for when you want to see a Doctor immediately or don’t have a primary care physician.” Better?

  51. Scott says:

    I would offer a word of warning against the often-used tip of raising your deductible “if you’re healthy”.

    It can be hard to implausible to lower that deductible later, when you aren’t so healthy…which could mean that today’s quick budget-helper could later be a decades long budget buster.

    My parents owned their own business, so basically had to self-insure. Since the premiums were so expensive, they increased their deductibles to $10,000 per year at one point – to help their budget. Over the years, even with those high deductibles, their premiums kept rising, and now they are paying a ton in premiums, and they rarely meet the deductible in a years’ time…so their premiums are mostly just thrown away money each year.

    My mother now has Lupus, which would now be considered a “pre-existing condition” if they tried to switch providers. What’s worse is that if they try to now lower their deductible with their current provider, they would be re-assessed as if it were a new account – meaning her pre-existing condition would kick in and result in an exclusion. So effectively, they are stuck with the super-high premiums they set long ago, thinking they were saving money.

    They can’t even qualify for those health savings plans, that were designed to be used with high deductible policies, because their deductible is higher than the limit those plans allow!

  52. AnnJo says:

    @49Guinness416 – I would be careful of relying on the accuracy of anything you read in the New York Times. I thought it unlikely that public per capita spending was yet outpacing private, so I looked up the actual report, and sure enough, I was right. The correct figures for 2008 are private per capita spending is $4,046 and public is $3,635.

    The comparison of per capita spending health care across countries is an exercise in futility or political spin. No effort is made in such comparisons to measure such non-priced costs as patient convenience, lost productivity, pain and disability due to delays in treatment, etc. If it costs me and my insurer $2,000 in the U.S. to have a couple of bone spurs in my foot removed which are making it excruciatingly painful to walk, and I can do it in two weeks in the U.S. or in two years in the U.K. where it will cost the U.K. taxpayers only $1,200, which country’s health care is really more “expensive”? For me, it would unquestionably be the U.K.’s. YMMV.

  53. sandra jensen says:

    Hi Trent – you are the first financial blogger I started to read – quite a while a go! I now subscribe to a lot of sites – but your’s is still my favorite.

    This week I was paid back on a loan I had made to my daughter. I was going to use it to pay in full a hospital bill I have been paying $150 a month on – but I got the nerve to call and ask if they would reduce the bill if I paid it now in full – and (ta da!!!) they reduced it by 25%!! I saved over $300 – just for asking. Thanks for all your great ideas!

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