How to Save Money on Things Your Health Insurance Doesn't Cover
11 Min Read | Dec 15, 2022
Looking for ways to save on health insurance costs? Most Americans are!
Many are turning to high-deductible health plans (HDHP) to lower their premiums. That’s a smart move if you’re healthy and have an emergency fund to cover your deductible. And for the cost-conscious, alternatives like health sharing ministries are also on the rise. We love both these options.
These plans can help you save on health insurance costs, but is there any downside? Well, they don’t always cover everything you need. Things like dental, vision and prescription drugs may not be included—or at least not fully. Out of pocket, you could be looking at thousands of dollars over the course of a year.
Let’s talk about the cost of health insurance, what it covers, what it doesn’t, and thrifty ways to cover anything that’s missing.
What Health Insurance Covers
Your health insurance provider agrees to cover certain benefits. (With premiums like this, there better be some benefits!) In fact, the Affordable Care Act requires all private health insurance plans offered through the health insurance marketplace to cover the following services:
- Outpatient care (the care you receive without being admitted to a hospital)
- Emergency room services
- Maternity and newborn care (before and after your baby is born)
- Mental health and substance abuse disorder services (including behavioral health treatment, counseling and psychotherapy)
- Prescription medication
- Services and devices that help you recover after injury, or if you have a disability or chronic condition (including physical and occupational therapy, psychiatric rehabilitation and speech-language pathology)
- Lab tests
- Preventative and wellness services (including counseling, screenings and immunizations) and chronic disease management
- Pediatric services (including dental care and vision care for children)1
- Benefits offered in state-run marketplaces may differ from benefits offered in federally facilitated marketplaces. There can even be differences between plans within the same state.2
And just because a service isn’t included in the list of 10 essentials, such as dental and vision care, doesn’t mean your insurance provider doesn’t cover it. Review your insurance policy to know exactly how you’re covered.3
What Health Insurance Doesn’t Cover
No plan is perfect, and you need to know about the gaps.
Do you have the right health insurance coverage? Connect with a Trusted pro today.
Whether you’re in the market for a new policy, going on Medicare, or simply want to know how your current plan covers you, here are a few services you may think are accounted for, but aren’t necessarily:
- Travel vaccinations (such as a typhoid or yellow fever vaccine in preparation for a trip overseas)
- Alternative therapies (such as acupuncture, massage therapy or chiropractic care)
- Cosmetic surgery
- Long-term nursing home care
- Dental, vision and hearing care
- Weight loss surgery or treatment
- Preventative tests
- Private nursing
- Infertility treatment
- Medical fraud
Keep in mind that this list isn’t exhaustive. The only way to know what you are (or are not) covered for is to read your policy.
Also worth noting: Some of the benefits included in this list may actually be covered by your policy. Insurance covers things that are deemed "medically necessary."
Want an example? Reconstructive breast surgery following a mastectomy is considered medically necessary and is likely covered. If you suffer a back injury from an accident, chiropractic care is likely medically necessary under the outpatient care category. However, if you visit the chiropractor every week to keep your back feeling healthy, that care might not be covered.
Here's the bottom line on coverage: never assume anything, one way or the other. Before either skipping a treatment (thinking it will never qualify) or getting something done (while assuming it’s eligible), always check with your insurer to confirm the facts.
So much for coverage questions. Once you know the kinds of services that your plan won’t cover, you’ll be on the lookout for ways to get them covered on the cheap. Let’s talk about savings!How Health Cost Sharing Can Help Lower Health Insurance Costs
Healthcare cost-sharing programs don’t fit the technical definition of health insurance. But they work pretty much the same way insurance does, with a couple of differences. One of those is the chance to save on healthcare costs. How does it work?
Although cost-sharing programs have monthly premiums, they don’t work with doctors and hospitals directly, and they don’t pay your bills for you. Instead, the cost-sharing program sends you the money you need for medical services, and you pay your own bills. That lowers overhead and by extension your premiums. It also means you’ll be paying cash up front and awaiting reimbursement and haggling for cash discounts! That spells big savings on healthcare.
Use Your Health Savings Account
If you’re eligible for a Health Savings Account, use it! The health insurance cost savings here are just about endless. A Health Savings Account (HSA) is a type of savings account available to those who are enrolled in a high-deductible health plan (HDHP).
And it’s a triple tax-free miracle: You can get tax-free contributions, tax-free growth, and tax-free withdrawals to pay qualified medical expenses.
If your employer doesn’t offer an HSA, you can open one at a bank, insurance company or other financial institution.4
Check out the benefits:
HSA contributions can come from you, your employer, a family member or virtually anyone else who wants to contribute to your HSA.
Can you say tax shelter? Contributions made through your employer are not (repeat not) subject to federal income taxes. Sweet! Depending on where you live, your contributions may not be subject to state income taxes either.
Contributions made with after-tax dollars are deductible from your gross income when you file taxes, even if you don’t itemize them on tax form 1040.
Interest and other earnings on the account funds are tax-exempt. Take that, tax man!
Tax-Free Withdrawals for Qualified Medical Expenses
Note the key word here: qualified medical expenses (more on that below).
Funds Roll Over
Contributions to your account stay there until you use them. They roll over year after year and earn interest—you can even invest the money in your HSA to grow tax-free! This thing is like a health-savings machine!
Easy to Use
Most HSAs will give you a debit card to pay for prescription medication and other medical expenses on the spot. You can also use the card at an ATM to withdraw cash. As far as the IRS goes, these expenses are subject to audits for up to three years, so just be sure to save your receipts in case you someday have to prove the purchases were legit medical needs.
Your HSA stays with you if you change employers or leave the workforce.5
To qualify for an HSA, you must meet the following requirements:
- You’re covered under a high-deductible health plan with a minimum annual deductible of $1,400 per person or $2,800 for a family.
- You have no other health coverage.
- You are not enrolled in Medicare.
- You are not claimed as a dependent on someone else’s most recent tax return.6
There are literally hundreds of health expenses you can pay for with your HSA—and many that you can’t. Fortunately, the IRS explains both in detail. Here are a few examples of qualified medical expenses:7
- Chiropractic care
- Dental treatment
- Doctor’s fees
- Eye exams, glasses, surgery and contact lens supplies
- Fertility services
- Hearing aids and batteries
- Hospital services
- Lab fees
- Prescription medications
- Psychiatric care
- Therapy or counseling
How to Save on Prescription Drugs
Ask for samples.
It can’t hurt, and it could be free! Your doctor may not know how much the drug they’re prescribing costs. If you don’t have good prescription drug insurance, tell your M.D. They may be able to give you some free samples until you’re better.
Request the generic.
Never assume your doctor will prescribe the generic version of your medicine. Double-check, or you might double pay!
Be choosy about your pharmacy.
Drug prices are one of the steepest parts of health insurance costs. But a little cost comparison can help—would you believe some meds can cost hundreds of dollars more depending on the pharmacy? A Consumer Reports study found that drugs can be 22 times more expensive depending on where you shop. In one instance, a drug cost $12 at one pharmacy, and $270 at another—for one month’s worth of the same exact prescription! And that wasn’t the odd one out—they found these huge price differences with lots of different drugs.8
Use your HSA.
That’s why you have it! Save money on prescription medicines, drugs and copays.
Find a discount.
Ask your family practitioner or pharmacist about cash discounts, discount cards or loyalty programs you can join. Every little bit helps you save money on health insurance overall.
Contact the drug company directly.
If you still can’t afford a specific medication, contact the drug’s manufacturer directly. Many companies have patient assistance programs to provide their drugs for free or at a significantly reduced price.
How to Save on Dental Care
Search for a deal.
Scan the internet for new client specials from individual dentist offices. Or check out sites like Groupon and Living Social. You can usually score a cleaning for around $50 to $60.
Get a second opinion.
If what you need costs a lot, like a root canal or braces, get a second opinion. And shop around for prices at other offices. For example, you don’t have to buy your kids’ braces from your pediatric dentist’s preferred orthodontist.
Use your HSA.
Don’t forget, you can use your Health Savings Account for everything from fillings to cleanings to crowns to dentures.
Ask for a discount and a payment plan.
Need some serious work done pronto? Ask for cash discounts and a payment plan. This way, you aren’t hit with a huge bill all at once.
Visit a dental school.
For cleanings, X-rays and preventative care, consider making an appointment at a dental school.9 Sure, a dental student will take significantly longer than an experienced dentist. But their work is always double-checked by a licensed, insured supervisor—and the money you’ll save is well worth the wait.
How to Save on Vision Care
Buy online or at a warehouse.
With low-cost online shops like ZenniOptical and Warby Parker, you can get a complete pair of glasses for under $100. As for contacts, check out Costco Optical or an online retailer like 1-800-Contacts. Contact customer service to see if you can get an even bigger discount or expedited shipping. Just make sure you’re getting free shipping, or it might not be such a deal after all.
Use your HSA.
Sensing a pattern with this puppy? Your Health Savings Account covers contacts, glasses, eye drops, eye exams and even contact solution. Use it!
If you’re considering LASIK, save first.
Spending $1,000 to $2,000 per eye might not sound like a cost-saving measure, but if you add up all you’ll spend for exam fittings, new contact lenses, cleaners and new glasses year after year, it could make sense. Just don’t go into debt in the name of "saving future money." If you can’t pay cash today, wait until you can.
Ask for self-pay or cash discounts.
Even if you don’t have rock-star health coverage, you can still get what your family needs for less if you work the tips we’ve outlined here. And this point can’t be stressed enough—always ask for a discount! Always. When you’re determined to get a deal, you usually will.
As always, cash is king in negotiating great deals for healthcare. And like we said before, health cost sharing gives you the chance to pay cash for services and haggle for that sweet discount!
If you’d like to combine getting great healthcare coverage with the opportunity to help others in a time of need, our trusted partner Christian Healthcare Ministries (CHM) can help you figure out your options. Thousands of people in all 50 states have used CHM to cover their healthcare needs. Plus, they’re a RamseyTrusted partner, so you know they’ll cover the medical bills they’re supposed to and honor your coverage.
Ready to get excellent healthcare coverage in place? Connect with CHM today!