Managing Healthcare Expenses

Managing a long-term (chronic) health condition can take a financial toll on you and your family. There are the costs of medicines, testing, copays, travel, and more. But help is available from your doctor and programs specially designed to lower healthcare costs.

Understanding health insurance terms

As you navigate your way through the healthcare system, it is helpful first to understand some terms related to health insurance:1

Primary care provider

Someone who offers or helps you to access healthcare services. They may be a physician, nurse practitioner, clinical nurse specialist, or physician assistant.

Deductible

The amount you pay for healthcare services before your insurance kicks in. For example, if your deductible is $500, your insurance provider will only pay for covered services once you have met the deductible.

Copay (copayment)

A set amount you pay for a service covered by your health insurance, usually at the time of service.

Network

The providers, facilities, and suppliers your insurer partners with to offer healthcare services. For example, a doctor may be “in network” or "out of network.”

Options for lower-cost healthcare

Private companies, nonprofits, and the state and federal government all offer free or low-cost programs to help pay for healthcare expenses. Here is a look at a few:2-9

Copay/prescription assistance programs: These programs offer financial help with copayments, co-insurance, and insurance deductibles for prescription drugs, equipment, and supplies. People qualify for these programs by proving they cannot afford their medicine or other healthcare costs. How you qualify for help varies with each program. Search online for “copay assistance” or “prescription assistance” to find help. One note: Some insurance companies use copay accumulator programs, which stop copay assistance coupons from counting toward deductibles and maximum out-of-pocket spending.

Medicaid: Medicaid is a joint federal and state health coverage program for low-income adults, children, pregnant women, older adults, and people with disabilities. Some states have additional options for coverage. To find out if you qualify for Medicaid, contact your state Medicaid agency or fill out an application through the Health Insurance Marketplace. Learn more at Medicaid.gov or Healthcare.gov.

Children’s Health Insurance Program (CHIP): CHIP is a joint federal and state health coverage program for uninsured, low-income children and pregnant women. Eligibility varies by state. To find out if you qualify for CHIP, contact your state CHIP agency or fill out an application through the Health Insurance Marketplace. Learn more at Medicaid.gov or Healthcare.gov.

Community health centers: These clinics offer low- or no-cost healthcare services and referrals to specialized care. Search online for the center nearest you or go to Findahealthcenter.hrsa.gov.

Veterans Affairs (VA): The VA offers healthcare for U.S. military veterans and people on active duty. Family members may also qualify for healthcare through the VA. You may apply online, in person at the nearest VA medical center or clinic, by phone, or by mail. Learn more at VA.gov.

More tips for lowering costs

Here are some extra tips for lowering your healthcare costs:

Nonprofit groups

National and local charities can help to save money on prescription drugs and healthcare services.10

Drugs samples

Some doctors give out free samples of brand-name drugs to help ease costs. Samples also allow you to check out a drug’s side effects and how well it works before buying it. Plus, they act as a stop-gap until you can sign up for a patient assistance program (PAP).11

Generic medicines

Ask your doctor or pharmacist if your medicine is available in a generic form or under a less expensive brand name. Mail-order pharmacies are another option to lower drug costs.10

Price-shopping

Check with different pharmacies in your area for the best price on prescription drugs.11

Referrals

Your doctor can also refer you to state-sponsored services and community assistance programs.11

Drugmakers

Drug companies offer 2 types of help. They have programs that allow you to use a discount drug card at the pharmacy. There are also PAPs, which offer free or low-cost medicines to people who cannot afford them.11

Clinical trials

Clinical research is a way to get medical care and access a new treatment before it is widely available. Keep in mind that the trial’s sponsor covers costs related to taking part in the clinical trial. However, you or your insurance company will pay for care costs such as hospital stays, lab tests, and doctor visits.12-14

To learn more about coverage options and your rights as a healthcare consumer, visit the CoverageRights.org and HealthCare.gov websites.

For more information and help, check out:
Workplace Considerations
Disability Benefits
Applying for SSDI
General Health Resources

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