Every month, Dad spends nearly half his income on medical care. As shocking as this may seem, it is not that uncommon, especially for seniors living on Social Security checks alone. The elderly often have multiple medical conditions that require a number of medications and doctors to manage. Chronic illnesses, such as diabetes, are on the rise as people live longer and these long-term conditions require a great deal of care. Add in acute care episodes that require unplanned emergency room trips, and the cost of medical care for seniors can rise to the point that they cannot afford other basic necessities such as food or utilities.
While Medicare is a great help to seniors, it does not cover all medical costs. It also is not entirely free to seniors. The average senior will pay around $105 per year for Medicare Part B, usually taken from the gross Social Security check. Medicare Part A is free to most seniors, and covers a number of hospitalization costs, though not everything.
Medicare is also divided into a dizzying alphabet soup of sections, each covering a different type of healthcare need. For example, prescription coverage is covered under Medicare part D. Medicare does not cover dental care except under certain circumstances, so seniors will need to plan their dental care into their budgets. Seniors who can afford it will also need to purchase a Medicare supplemental plan of some sort to cover those items that Medicare does not. Thus, medical costs add up quickly.
Despite this, there are ways seniors can save on medical care. Here’s what I have learned over the past year and a half working with Dad, or learned while working on my MHA. Ask your parent’s healthcare practitioner for more ways to save money.
- Use a general or family care practitioner for most healthcare needs. The co-pays for a generalist can be half that of a specialist. Americans tend to overspend on specialist practitioners when they can get many of the same care needs taken care of by a less expensive doctor. I see a physician’s assistant (PA) for my basic healthcare. Another option for a healthy senior is a nurse practitioner (ARNP). Dad sees an MD because of his multiple medical conditions.
Another advantage to seeing a generalist is that they will help manage the communication between specialists, including prescriptions. Monitoring prescribing by specialists is extremely important to preventing dangerous drug interactions. When Dad first came to live with us, his medications were a mess. After a first go-around with organizing them, I realized that I needed to have someone with greater drug knowledge review them. Dad’s family care practitioner had retired, so we got him signed up with a new doctor who was comfortable coordinating his care.
- Stay up-to-date on vaccines. Preventable infectious diseases are a significant contributor to medical costs in the elderly. Medicare covers some or all vaccine costs depending on the particular vaccine. Even with any out-of-pocket costs, vaccines will be a far better price for healthcare than hospitalization for diseases like the flu or pneumonia. Getting your parent vaccinated properly may also save their life.
Seniors should receive the following vaccines according to each vaccine’s schedule:
- Influenza (Flu)
- Shingles (herpes zoster)- note this is the same virus that causes chickenpox, but the elderly should not receive the chickenpox vaccine
- DpT (diphtheria and tetanus)
- Pertussis (whooping cough)- note that the childhood vaccine for whooping cough does not confer life-long immunity so adults will need a booster shot
- Pneumococcal (Pneumonia)
- Eat a good diet and get regular exercise. This seems obvious, but with aches and pains, tremors, dementia, and memory loss, seniors can miss out on important basic lifestyle choices that maintain good health and prevent expensive medical care.
For example, Dad needs help preparing meals because of his tremor and memory loss. If no one is around to prepare him food, he tends to snack on the closest item available because it is easiest for him, regardless of whether it leads to a balanced diet. And, without someone to help him maintain his balance while walking or exercising, he tends to remain sedentary.
- Get enough sleep. Many elderly suffer from sleeping problems. Parkinson’s disease disrupts sleep cycles, but not all insomnia in the elderly is disease-related. Regardless of the cause, fatigue due to sleep deprivation will make any symptoms worse and can lead to injuries and accidents that increase medical costs. See a physician about treating insomnia since many elderly are on medications that can cause insomnia or interact with over-the-counter (OTC) sleep aids.
- See the eye doctor. There is growing evidence that some falls in the elderly, and the resulting serious injuries, are due to poor vision. Correcting vision problems in your parent will protect them and their bank account. Additionally, some medical problems like diabetic retinopathy and glaucoma are treatable with intervention. Medicare will not pay for all eye care associated costs, but the supplemental insurance may pick up what Medicare does not.
- There are several ways to save on prescription drug costs. Medicare covers drugs under Part D, but covers drug costs at a lower rate once the dreaded “donut hole” kicks in. The Medicare donut hole is a coverage gap period in which beneficiaries are required to pay a higher percentage of their drug costs. After seniors pay a certain amount of money, Medicare kicks back in again at the higher rate. The donut hole rates change yearly, so be certain to review statements from Medicare.
Like many people, Dad moved into the Donut Hole after the first quarter of the year, and will not leave the donut hole this year. Although we ask the pharmacy every time for a cost estimate for each prescription, the estimate is never quite accurate because Medicare can update pricing throughout the year. This moving target scenario makes budgeting difficult, so the pharmacy actually has an account for Dad with money sitting in it. When Dad needs a prescription filled, the pharmacy deducts the cost from Dad’s credit first, before we need to cut a check.
Your healthcare practitioner or pharmacist may be able to help you reduce drug costs, so be certain to mention to them that you would like to lower your parent’s drug costs. Here are some common ways to do it:
- Switch to generic drugs when possible
- Order from a mail order pharmacy when possible
- Have a pharmacist review your parent’s drugs. The pharmacist that reviewed Dad’s prescriptions found that one drug was prescribed at too high a dosage, and another that was likely to cause a dangerous drug interaction, putting Dad at risk of a quick trip to the ER. A couple of drugs were also easily switched to generics. The pharmacist called Dad’s doctors and got the drugs changed. The result was that Dad paid less money for safer prescriptions.
- Ask your parent’s healthcare practitioner for drug samples. Dad was able to get a 90 day supply of one of his more expensive drugs via free samples at his doctor’s office.
- Ask your parent’s healthcare practitioner if any prescription dosages can be lowered. Many drug dosages are based on body weight. A small adult may get relief from a smaller, and therefore cheaper, dosage.
- Check out different supplemental insurance plans, they may have different coverage rates for drugs.
For seniors that require more assistance beyond the ideas listed above, there are a number of government programs that help with drug costs:
- Take care of your parent’s teeth. Investigations into dental health point to a link between healthy teeth and gums, and a healthy heart. Although dental care is not covered by Medicare and most supplemental plans do not cover it either, there are ways to save on dental care.
- Ask if the dentist offers a senior discount. Dad’s dentist gives a 20% senior discount, and his dentist’s charges are not much different from the state-contracted dentists for seniors.
- Ask if the dentist will give a discount for paying cash. If your parent does not have dental insurance, the dentist may provide the “I don’t have to haggle with an insurance company” discount.
- Dentists may also be willing to set up a payment plan with you. Ask, and get the payment plan agreement in writing.
- Seek out free dental care from dental schools or dentists offering pro bono services.
- RAM events are also one way to acquire free dental and medical care. http://www.ramusa.org/
- Review medical bills carefully for errors. More than once I have found errors in medical bills. Errors are common, and providers do not have much incentive to improve since the unwary will pay bills for which they are not responsible. Most medical providers have a lot of bad debt these days, or patients unable to pay, so they look for any area in which they can recoup costs. The American medical system is for-profit and thus any medical systems which are backed by shareholders are under enormous pressure to make a profit. Even non-profit medical systems have ever tighter bottom lines as numbers of indigent patients grow, and the numbers of wealthy benefactors decrease.
- Most hospitals and insurance companies now have free patient advocates which can help people read and check medical bills for accuracy. Some state programs will also help through programs like SHINE or the state insurance commissioner’s office. Patient advocates will also help set up billing payment plans with providers on behalf of patients. Professional billing advocates are also available for hire to review bills, but depending on the frequency of medical care and size of bills, these services may or may not be cost effective.
- A common error I see on Dad’s bills is failure to bill the secondary supplemental Medicare insurance. The provider billed Medicare and then sent the remaining charges directly to Dad. If you see this, call the provider and give them the secondary insurance information. Make sure to take notes of the call for future reference.
- Another error I have seen less commonly is billing for services that were not provided. Medical billing is incredibly complex. Every insurance company has their own CPT/DRG, or billing codes, for services rendered. As a result, there will be some rate of unintentional error in billing. I was once charged for a blood draw that never happened. I was able to prove this because there were no lab test results to accompany the blood draw. The hospital quickly reversed the charge.
- However, a common and pervasive rate of errors is known as upcharging or upcoding, and is illegal. It should be reported to CMS or your insurance company. CMS inspectors have uncovered upcharging schemes in some medical centers and fined the medical centers for fraudulent charges, often in millions of dollars. Some of the mergers that have occurred in medical systems were due to high CMS fines. Common signs of upcoding are billing for pneumonia when the patient simply had a bad cold. This may be harder for a single patient to uncover. But, do check your parent’s bills for accuracy. If something doesn’t look right, or you don’t understand the charges, call the provider and ask. If it still doesn’t seem right to you, call Medicare or the insurance company and talk to them about it.
- Other causes of extra charges can be for duplicate tests, or bundled payments. Some types of testing and treatment are bundled together. A common bundle is for an annual physical exam and accompanying tests. If the provider erroneously unbundled the charges, that can lead to extra billing costs. Medicare lists bundled tests, so you can cross check against their recommendations. Or just call them up and ask.
- Save money by preventing unnecessary or duplicate testing. Because the US is the most litigious society in the world history, many medical providers practice defensive medicine to protect themselves against the possibility of a malpractice lawsuit. They will order tests that they expect to be normal just to prove that they did not forget anything that would lead to a medical error.
Talk to your medical provider about what tests are actually necessary for your health. Ask if it would safe to run some tests later if the first tests your provider expects to be the cause of your illness turn up negative.
If your lab tests were recently performed, you may not need to have them run again. If you are switching providers, have your records transferred through release of information. You will need to request the transfer of your records, as your previous medical provider will not transfer them automatically for you because of privacy laws. Expect to be asked to sign a release of information form. It would also be a good idea to review your medical record for accuracy at this time to ensure that your new provider does not get erroneous information about your health.