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By In Around the Web, Money-Saving Tips

Take Note, FI Folks — Walmart Is Serious about Price Transparency at Their New Health Clinics

Last week, Walmart opened its first standalone health clinic in Georgia, but it probably won’t be its last. It’s an ambitious project for the company that is already one of the leading health care retailers in the world, and it builds upon their “care clinic” idea, which they’ve launched around Georgia, South Carolina (my state), and Texas.

The idea is to put a lot of different kinds of services under one roof — which, like duh, is what Walmart does with consumer goods. Here’s all that they want to offer in their standalone health clinics, according to a Forbes article:

The larger Walmart Health Center puts “key health services under one roof,” a first for the world’s largest retailer when it comes to offering primary care, dental, optometry, counseling, laboratory tests, X-rays, hearing, wellness education and behavioral health.

-Forbes

But wait, there’s more! In true Walmart fashion, they’ve already published a price list. That’s a no-brainer for retail but revolutionary for health services. Seriously, when was the last time you went to a doctor knowing what you would pay for anything but the visit itself?

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By In Around the Web, Money-Saving Tips

What Trump’s Price Transparency EO Means for FIRE

Earlier this week, President Trump announced an Executive Order requiring health care companies, particularly hospitals and insurers, to make their negotiated prices for services publicly available. Trump said, with his trademark understatement:

“This is a truly historic day. I don’t know if it will be covered that way by the fake news, but this is truly a historic day this is a very big thing that is happening right now and it’s pretty much going to blow everything away.”

President Donald Trump, signing the Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First, June 24 2019

Since then, there’s been a slew of coverage about whether this order will have quite that impact. The hardcore health economists have been talking about Danish cement (seriously) in saying that forcing hospitals to publish what they’ve negotiated with health insurers to pay for services will simply encourage the ones charging the least to raise their prices. I personally asked an economist if the airline industry might be a better comparison, with its major players, barriers to entry and regional differences in supply and demand. Here’s what he sent me:

Here’s what this Executive Order on transparency could mean for the FI community: ultimately, smart and active consumers do better when they have more information, so this’ll be good for FI. Duh.

But health care has nuances—many, many nuances.

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By In Do the Math, High-Deductible Health Plan (HDHP), Money-Saving Tips

HDHP: Managing Your Costs Before Meeting Your Deductible

With car insurance, deductibles are relatively straightforward — anything not related to damage of some kind, i.e. any maintenance or services, is not covered. You get your oil changed, you pay for it. You get your car washed, you pay for it. You get in a wreck and your car is totaled, your insurance pays for all costs over your deductible. Simple as that.

With high-deductible health plans (HDHPs), it’s almost the opposite. There are a number of preventive care services that you can have covered at no cost to you, provided they are “in-network,” meaning the doctor or healthcare provider you choose much be “covered” by your insurance. That’s lesson 1: even though you’re paying out of your own pocket for most things, if you want your insurance to pay for something before your deductible it met, you have to follow their network rules.

These preventive services are things like an annual check-up or physical, as well as screenings and diagnostic tests frequently associated with an annual physical, and other tests like cancer screenings. These services are mostly mandated to be free under the Affordable Care Act, but some employers have “grandfathered plans,” which means the plans were exempted from ACA regulations on the premise that they would remain cheaper than ACA coverage (something that hasn’t proven to be true, but I digress…).

The best thing for you to do is to find your plan details or request them from your company’s HR/benefits manager or directly through your health insurance provider. My family is currently on an individual ACA plan and I found my information pretty easily through the site where I bought my insurance, HealthSherpa (full disclosure: I do consulting work for HealthSherpa but don’t get paid to post the link I just posted — I just think they’re a great company if you qualify for ACA coverage), as well as through my health insurance provider site, SCBlues (full disclosure: I don’t consult for SCBlues 😜).

Anyway, take a look at what pre-deductible services you get for free and take advantage of the ones you think you need or that a doctor recommends for you.

Now, lesson 2: Even before the deductible is met, you want to pay attention to your expenses, because they will impact your overall costs. How? Well, sadly, pre-deductible costs are not created equally, nor are qualifying expenses.

Say you tweak your knee skiing. You need an x-ray, so you call around to some places (always ask the price!) and get the costs. You will likely find, as I have multiple times, that there is a huge difference between the “covered” pre-deductible cost for the service and the “cash” cost. It’s not uncommon for covered costs to be double that of cash costs. That seems like a no-brainer to go with the cash cost, right? Well, here’s the kicker: If you opt to pay the cash cost (not “cash” per se but rather the listed “cash cost,” because you can pay the “covered cost” with cash), that amount DOES NOT COUNT TOWARD covering your deductible. Sadface.

I don’t know why it’s done this way and I wish a law will be passed that will outlaw this “network cost” practice, but in the meantime you need to be mindful of the consequences of cash vs. covered.

While there is never a guarantee, if the service you need is relatively minor with little or no need for follow-ups (read: no additional costs), you may be better off paying cash to save the money right there and then. It seems like a smart move if the covered cost is, say, $500 and the cash cost is $250, which is a realistic scenario. If you think that there’s no way that you’ll cover your deductible without some kind of catastrophic accident happening, then pay cash — sort of like paying cash for a minor ding to your car rather than going through the hassle of filing a claim.

Now, you may end up having more costs and then you will want to shift to paying the deductible cost, but that would seem to make sense only if you truly expect to exceed your deductible by a large margin. (As a reminder, once you cover your deductible, you pay $0 for any additional services through most HDHP arrangements.)

Obviously this scenario doesn’t apply for people with chronic conditions or planned medical needs like childbirth. But for those minor scratches and dings, always ask the price and decide on your own whether cash is best or you want to make sure you’re paying down your deductible. YMMV.

And yes, take advantage or your free preventive care! Not just because you can, but because keeping track of your health could save you a ton of money AND give you a happier, healthier life in retirement, early or otherwise.

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By In Around the Web, Money-Saving Tips, Student Loan Debt

Want to Pay Down Student Loan Debt Faster? Consider Moving to the Cleveland Suburbs

Back in the early ’90s, there was a show my mom and I used to love called Northern Exposure. It was about a doctor who, in return for getting his tuition paid, moved to a small town in Alaska to be the town’s general practitioner for a number of years. It’s a practice that still occurs and in fact may be expanded in the coming years as higher-education costs continue to go up up up.

A story from CNBC,”Here are ways to pay off student loans, using other people’s money,” reveals that a similar practice is available in several states, most notably in Maine, where your student loan debt is deductible on your state income taxes, and in Newburgh, Ohio, where you can get up to $50,000 toward paying off your student loan debt by buying a house you plan to live in inside the city limits. I did a Zillow search and it looks like apartments and houses are going for anywhere from $57,800-$250,000+ in this Cleveland suburb. Pretty good deal if you’re cool with Cleveland.

Other helpful tips are volunteer opportunities that will pay you a monthly stipend toward debt paydown and, of course, through your job. Tess wrote about what to look for in those job-based options.

Got your own advice? We’d love to hear it!

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By In Around the Web, Money-Saving Tips, Savings and Budgets, Student Loan Debt

How to Graduate from College Debt-Free, or, It’s Never Too Early to Live the FI Life

A lot of you were initially attracted to the FI movement by a need to change your situation, and most frequently that “situation” was student loan debt. As we all know, and as Hasan Minaj so brilliantly covered on his show (linked here), student loan debt is a national crisis and it’s really, really rare for anyone to come out of college and not have at least a little bit of debt.

That’s why when I saw a post on Twitter about a woman who graduated debt-free, and then I saw her tremendously useful recap of how she did it, I just had to share it. The main takeaway is that you CAN avoid debt before you even get it. There are major tradeoffs but I guarantee they’re worth it.

Read on for the tweet and the tips.

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By In Budgeting, Do the Math, General Benefits Knowledge, Money-Saving Tips, Savings, Savings and Budgets, Student Loan Debt, Taxes

How to Identify Your Scarcities and Use Them to Your FI Advantage

Recently, at a PTA meeting for my daughter’s school, the school’s two parent-volunteer yoga instructors gave a short presentation (with student participation) on the easy yoga and meditation techniques they practiced with our kids. It was fun, funny and heartwarming to see the kids really get into their practice. It was also illuminating for us as parents to try it ourselves. When it got to the mindful meditation part, one of the instructors mentioned how focusing on your breath opened a path to the amygdala, which “will get you off of the treadmill of worry and into relaxing mindfulness.” I used to find these types of descriptions a little silly, but the more I’ve tried to be more mindful in my own daily life, the more I can buy into this idea of needing a real shift in mindset to get from worry to deeper conscience.

It reminded me of a book I read last year called Scarcity: The New Science of Having Less and How It Defines Our Lives. It’s a wonderful book that can impact the way you approach both personal and professional challenges. It’s more of a research-oriented book than self-help, so don’t go into it expecting to get a blueprint for finding mindfulness. It’s more about the research the authors did on how scarcity impacts how we think and make decisions — and it really does.

As you seek financial independence, chances are you are making plans that are deeply impactful to the two most common forms of scarcity: money and time. You’ll want and need to ensure that you’re making the most of both to reach your FIRE goals. But you’ll also want to make sure that you understand when you’re making decisions based on a scarcity of one or the other, or both, and what you can do to work against making bad decisions.

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By In Do the Math, Money-Saving Tips, Prescription Drugs

Do Prescription Discount Cards Work? It Depends

I recently rolled off of my previous employer’s health insurance plan and bought an individual ACA plan for the first time. As a result, our prescription drug coverage changed as well and when I went to renew a prescription, I was asked to wait until Monday to get a reply. I couldn’t wait until Monday (it was Friday afternoon) for these two scripts, so I asked my options. Without coverage, they would cost $1,000 and $259, respectively, for a full order of each. Zoinks!

That’s when I remembered that I had gotten a prescription discount card at a healthcare conference I attended. I pulled the card from my wallet and asked the pharmacist if this would bring the cost down any. She looked at the card, smiled and said “This might actually make it cost more.” Ugh!

“The only discount card that usually works with us is GoodRx,” she said. I asked why and she didn’t seem to know the answer. So, I searched and found a bit…

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By In Do the Math, Health Insurance, Health Insurance Utilization, Money-Saving Tips

Should You Pay Cash for Medical Care?

In the “My Benefits ‘Intentions’ for 2019 and Beyond” post, I noted that it’s important to always ask the price for a service. The premise is pretty basic — we ask the price for pretty much everything else we want to buy, so why wouldn’t we ask the price and be able to see it before we have something done to us.

Of course, reality can be a relative term in healthcare. First, you’re not always in a position to shop around when it comes to your health. A recent article by Vox writer Sarah Kliff, who’s been tracking and reporting on outrageous emergency room bills for the past year, showed how the largest public hospital in San Francisco is “out of network” for ALL private insurance and the result is insured people getting bills for tens of thousands of dollars. Remember, this is the emergency room and, as one “victim” of a crazy bill noted, she was so overcome with the pain and confusion of her migraine that she didn’t have the capacity to ask where she was being sent for care and whether they were in-network for her insurance.

Second, and this is the nutso boondoggle of our system, prices are really, really hard to get straight because there are so many different negotiated rates that you might pay. There’s a different in-network and out-of-network rate for every different brand insurer and plan a provider accepts. There’s a Medicare rate, a Medicaid rate, and possibly many others.

The one (hopefully) consistent rate is straight-up cash. Depending on what kind of insurance you have and what kind of treatment(s) or service(s) you need, this might be your best bet.


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By In Do the Math, Health Insurance, Money-Saving Tips

Get Paid to Get Your Flu Shot! Srsly

We’re well into flu season but it’s never too late (well, if you’ve already gotten the flu, then it’s too late!) to get your flu shot. It occurred to me that some people, possibly even most people, don’t know that flu shots are typically free if you have health insurance. There’s this thing called “essential health benefits” (EHBs) that are provided under the Affordable Care Act, which essentially set a minimum of benefits and services covered by your health insurance. Plus, lots places have started providing extra incentives to get your flu shot, so you could actually come out ahead on taking care of yourself and the public health populi!

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