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Once upon a time, many of us had a health insurance plan that gave us most of what we needed for a $10 or $20 co-pay.

That’s no longer true: many of us now are on insurance plans with a high deductible, a high co-pay, out of network, out of pocket — or paying a percentage of whatever costs we incur.

Come January, a couple of things will happen. First, the new health plans bought under the Affordable Care Act come into effect, covering a percentage of your costs (bronze plans cover 60%, silver 70%). That makes it important for people to know: 60% of what? Second, people who have never been on high-deductible plans will join the increasing number of people who have such plans, and will now learn of the new realities. A recent PricewaterhouseCoopers Touchstone survey suggested that 44% of employers would offer only a high-deductible plan in 2014, up from 17% in 2013.

Prices vary, by a lot, and it’s increasingly important for you to be aware of that.

So here are four radical and not-so-radical ways to save on healthcare costs.

1. Don’t Use Your Insurance (and Always Ask What Stuff Costs)

Or, better, compare the price insurance will pay with the price you would pay out of pocket if paying cash. How? Ask the provider for a cash or self-pay rate. Ask to pay in advance, or if there’s a prompt-pay discount.

Here’s an example from Gilles Frydman, a co-founder of SmartPatients.com, an online community where cancer patients and caregivers learn from each other about treatments, trials, the latest science and how it fits into their experiences. He had a nasty fall last summer; early treatment with a CT scan showed nothing serious. The pain persisted, and after a few months his provider wanted a new X-ray.

“I looked for a local X-ray place and asked on the phone how much would the X-rays be, if I paid cash,” he wrote in an email. “When I went there, I was asked to sign a document stating that I would not file for any further insurance reimbursement, if I paid cash. The reason: The cash price is 1/3 of the regular price sent to insurance companies, which I am sure, then argue to pay 1/3 of the original price.”

Peggy Zuckerman, who conquered kidney cancer, had a similar experience with her CT scans in early 2012. The billed price to the insurance company was $8,010, and her responsibility under her insurance plan was $4,074.85. The cash price, she learned after the fact, was $930.

2. Keep Good Records (and Always Ask What Stuff Costs)

This can be especially fruitful with prescription costs. Moyra Phillips of Huntsville, Ala., keeps a binder with records of what medications people in her family are taking. Many pharmacies post or print lists of prices for common drugs; she keeps a printout of current prices in that binder, and takes that with her to doctor’s appointments and pharmacy visits.

She says it’s easy that way to show a medication to a provider or pharmacist, ask the current price, and ask if there’s another medication that would serve as well. Pharmacies and insurance plans can change prices frequently, so being able to show alternatives has allowed her to save hundreds of dollars.

Insurance can be a downside here, too; she has a medication that had a $20 copay at one pharmacy, but could be bought for $8.90 cash without insurance at another pharmacy. An increasing number of pharmacies at big-box stores (Publix, Winn-Dixie) offer some free medications, while others have low-cost medications. Costco is famous for low prices, and Target, Walmart, Walgreens, Kroger and other chains have deals, too. Also, don’t overlook your local independent pharmacy.

3. Use the Growing Number of Online Tools

You’re not going to be price-shopping for emergency care or big-ticket items. But for places where you can choose, there are ways to find out what things will cost. There are medication price sites like goodrx.com and needymeds.com; there are price comparison sites for procedures, too. Our tools at clearhealthcosts.com give cash or self-pay rates for common procedures at a range of providers in seven U.S. metro areas, and also shopping tools including the Medicare rate for a given procedure anywhere in the U.S. You can compare these results with other price transparency sites like faircaremd.com (a bid/ask marketplace like eBay); fairhealthconsumer.org (gives ballpark prices); healthcarebluebook.com (finds what it describes as “fair prices” in your area); newchoicehealth.com (you tell them what you want and they promise to find a price for you).

4. Take Charge of Your Health and Wellness

People who are actively involved in their healthcare have better health, and that — no surprise — is very cost-effective. Understand your treatment and your costs. One good way to do that, especially if you have something complicated going on: join a reputable online community of people who are knowledgeable about your issues.

Frydman calls it the network effect, which he saw first in ACOR — the first cooperative of online communities for cancer e-patients, which he created in 1995, when his wife was diagnosed with cancer — and now at SmartPatients.

“These networks of smart patients, suffering from serious diseases and working together with some of the best experts in their disease have revolutionized the care and the scientific knowledge about their disease,” he said.

Frydman cites examples of a group that built a centralized tissue bank for a rare cancer, lead to significant scientific discovery related to immune reactions, and another group that contributed to a rapid-fire study of a large patient population on the relative danger and prevalence of a significant, unreported adverse event. That study led to a significant change in labeling information.

There’s another value of these groups — which also include patientslikeme.com, psychcentral.com, the Society for Participatory Medicine, and others — they provide a place for people to gather online and talk about, among other things, treatments and prices.

There’s an active conversation out there among peers about how to save money. Join in. You’ll be glad you did.

Image: ziquiu

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