Your Guide to Lowering Health Care Costs

Managing lupus can come with significant health care costs that can have a big impact on a person’s or family’s overall finances. And costs can be especially high during the diagnosis process. 

While lupus care can be expensive, there are steps you can take to help make it more affordable — including ways to find affordable health insurance, lower the cost of doctor visits, access free health care, save on your taxes, and pay less for prescription drugs.

Tips for lowering overall health care costs

Almost all people with lupus will have some costs for their health care. But there are steps you can take to help you lower your overall costs.

Prevention

A key way you can lower your overall health care costs is by working to prevent as many health problems and complications as you can. You can help to stay healthy by:

• Seeing your primary care doctor, dentist, and eye doctor for regular checkups and screening exams. They can check on your overall health and wellbeing and help you catch problems early — when they’re less expensive to treat.
• Avoiding lupus flares (periods when your lupus symptoms get worse). You can’t always prevent every flare. But avoiding any known triggers can help you keep your lupus symptoms in check and keep your health care costs down.
• Working closely with your lupus doctor. When you talk regularly with your lupus doctor about how you’re feeling, they can help you catch complications or signs of a flare early. It is also important to get regular lab work done in addition to urinalysis to catch lupus nephritis. 

Health insurance

Getting and using health insurance is one of the best ways to lower your health care costs.

If you don’t have insurance, the best thing to do is to try to get coverage as soon as possible. There are a few options:

• Health Insurance Marketplace — You can use the Marketplace to compare insurance plans, buy an insurance plan, and find other resources for paying for health care. If you don’t have insurance through your employer, the Health Insurance Marketplace is a good starting point for finding coverage.
• Medicare — This program provides insurance for people over age 65 or for people who have disabilities — including disabilities from lupus.
• Medicaid — This program provides insurance for people who have low incomes or disabilities. Each state sets guidelines for who qualifies for coverage through Medicaid.

Many people in the United States get health insurance through their employer. If your employer offers health insurance, you can save on health care costs by learning about your plan options and understanding what they cover. Check to see if your insurer offers tools to help you understand your coverage (sometimes called a benefits navigator) or a benefits specialist you can talk to. Your workplace’s human resources department can usually answer questions about health insurance benefits, too.

There are many different types of health insurance plans, and costs can vary depending on exactly what’s covered and how the plan is structured. Our health insurance guide can help you understand health insurance terms and choose a plan.

Once you’ve chosen a plan, the best way to keep your costs low is to only see providers who are in network. Each insurance provider has a network of preferred doctors and other health care providers. Staying in the network generally costs much less than seeing someone who’s out of network. You may be able to look up in-network providers on your insurance company’s website, or you can call your doctor directly to check if they’re in your network.

If your doctor refers you to another doctor or specialist, be sure to check that they’re in network, too. And keep in mind that even within a network, costs can vary from one doctor to another — it’s best to do your research and compare prices whenever you can.

Tax savings

Another way to help lower costs is to take advantage of tax savings when you can. For example, you can:

• Save money in a flexible spending account (FSA) or health savings account (HSA), if your employer or insurance plan offer them. You don’t have to pay taxes on any of the money you put into an FSA or HSA. Then, you can use the money in these accounts to pay for health-related expenses. Keep in mind that there are specific rules about how much you can save in these accounts, when you can spend the money, and what you can spend it on — so be sure to check the rules carefully.
• Deduct your health-related expenses from your income tax, depending on how much you spent. If you spend more than 7.5% of your adjusted gross income (AGI) for the year on medical or dental expenses, you may be able to deduct that amount from your taxes.

Free health care options

Sometimes, employers or community organizations may sponsor health fairs, vaccine drives, or free health care events. At these events, you may be able to get certain health care services — like flu vaccines, blood pressure checks, or other health screenings — for free.

For example, federally funded Health Resources and Services Administration (HRSA) clinics provide essential medical services, including primary care, at little to no cost based on your financial situation. Additionally, many community health centers and clinics offer sliding scale fees, which adjust the cost of care based on your income. These options can help ensure you receive necessary medical care, including routine check-ups, lab tests, and specialist visits, without overwhelming financial strain.

While visiting free health care events isn’t a replacement for regular doctor visits, it can be a helpful way to keep tabs on some aspects of your health.

Take charge of your health care costs

There’s no question that navigating health care systems and paying for care is complex. But the more you learn about how the system works, the more tools you’ll have for lowering costs where you can.

Try these strategies to bring your costs down:

• Ask questions. Don’t be afraid to ask your doctor why they’re recommending a certain treatment, medicine, or procedure, and how much it will cost.
• Negotiate prices for health care services. You might be surprised that many doctors can adjust the price they charge for their services — and it’s absolutely acceptable to ask them to. For the best chance at success, do your research. Call your insurance company before you get a procedure or service and ask how much they’ll pay for it. Tell your doctor what your insurer covers and ask if they’ll match that price. You might also be able to get better prices by paying with cash, if you can, and then getting reimbursed by your insurer after.
• Be open with your doctor about your financial situation. If you’re having trouble affording your care, talk with your doctor about it. They may be able to lower the rates they charge you, or help you find other ways of affording care.
• Request an itemized bill — and check it carefully. Ask your doctor’s office to send you a bill that lists out each item you’re being charged for, and make sure it’s accurate. Medical bills can have mistakes that end up making the total cost higher.
• Keep your explanation of benefits (EOB) documents. Be sure to save any EOBs you get from your insurer. Organize them by date in a folder or binder and refer to them when pay your medical bills to make sure that all the information matches and is correct. If you lose your paper copy, you can usually access an electronic copy of your EOB in your insurance portal.
• Don’t be afraid to ask for help! Taking charge of your health care costs doesn’t mean that you have to learn and do everything on your own. Many hospitals and doctor’s offices have patient advocates or representatives who are there to help you and answer questions.

Tips for saving on prescriptions

Paying for prescriptions can be a major expense for people with lupus. Just like with your general health care, there are some strategies you can try to save on the price of your medicines:

• Consider generics. Generic medicines can cost much less than brand-name medicines. Talk to your doctor or pharmacist to find out if there’s a generic option for medicines that you take, and whether they’re a good fit for you.
• Take advantage of Patient Assistance Programs (PAPs). PAPs are offered through pharmaceutical companies and can cover the cost of your medicines in certain situations. Keep in mind doctors apply for this program on behalf of their patients, so talk to yours about filling out the forms.
• Search for bargains. Try calling a few different pharmacies in your area and asking about their prices. You might be able to ask your preferred pharmacy to match a lower price that you were quoted somewhere else. Many pharmacies will also accept coupons from competitors.
• Ask your doctor for samples. Doctors often receive samples of medicines from pharmaceutical companies. If you’re having trouble affording the cost of a prescription, ask your doctor if they can give you free samples instead. Just be sure to tell your pharmacist that you’re taking the medicine, so that they can check that it’s safe to take with any of your other prescriptions.
• Use a drug discount card. Several companies, including NeedyMeds and GoodRx, offer free discount cards that can help you save money on prescriptions at the pharmacy. Note that these usually require you to pay cash and often don’t count towards insurance deductibles.
• Check if you can save by getting a 90-day supply. Some medicines can be prescribed as a 90-day supply rather than a 1-month supply. Buying more of a medicine at once can be cheaper than monthly refills.
• Ask your doctor if it’s safe to split your pills. Sometimes, you can get your medicine in a higher dose and split the pills. For example, if you need 20 milligrams of a medicine, you may be able to get a prescription for 40-milligram pills and cut them in half. This is not safe for all medicines, so talk to your doctor about it first — and only use a pill splitter, not a knife, to cut your pills.
• Check your insurance plan’s preferred drug list. Most insurance plans have a list of preferred brand-name medicines. Medicines on these lists typically cost more than generic versions, but less than other brand-name medicines that aren’t on the list. If you can’t get a generic version, ask your doctor to look at your plan’s preferred drug list and see if there’s a medicine on there that you can take.

More tools and resources

There are many ways to help lower the costs of your health care. These additional tools and resources may help:

• NeedyMeds is a nonprofit that provides information on 3,000 programs and 11,000 free and low-cost sliding-scale clinics nationwide, all free of charge.
• Healthcare Blue Book offers a free consumer guide to help you determine fair prices in your area.
• New Choice Health is an online comparison-shopping tool that helps consumers locate medical facilities and compare costs for common medical procedures.