7 Things Savvy Shoppers Know about Finding Low-Cost Medical Care

When you buy a car, you don’t drive off the lot before looking at the price tag. Same goes for buying a house. You don’t just tell the real estate agent to pick out a nice one and send you the bill. After all, cars and houses cost a pile of money. So you shop around to find the right price.

Healthcare comes with a hefty price tag too. The average family of four spends nearly $8,000 a year on medical expenses. And that number can go way up if you add surgery or a serious illness to the mix.

In a report from the Kaiser Family Foundation, half of American adults reported putting off or skipping healthcare or dental care in the past year because they couldn’t afford it. And nearly a third said high costs prevented them from taking their medications as prescribed.

Some of this may not come as a surprise. You probably know from experience that healthcare is expensive. But how do you control the cost? A survey from researchers at Harvard University showed that only 3% of people compare prices for medical care.

That needs to change. With a little legwork, you can save big bucks. And finding the best price on treatment and tests isn’t as complicated as you think.

“You already know how to shop — you’ve been buying bananas for decades,” says Nicole Broadhurst. She’s a lead medical billing advocate for Tennessee Health Advocates based in Nashville. “Shopping for healthcare is different than shopping for groceries, but it’s not that hard. You can do this.”

Ready to master the medical market? Here’s how to make sure you’re getting the best price.

Tools that help you save money on health care

Compare prices on medical tests and procedures using online tools like Healthcare Bluebook. They can help you find the lowest price in your area.

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1. Start the money conversation in the exam room

Smart shoppers aren’t afraid to talk to their healthcare provider about the price of treatment. “There’s nothing wrong with telling your doctor, ‘This is coming out of my pocket — every test and treatment I get will be a check that I have to write,’” says AnnMarie McIlwain, CEO of Patient Advocators in New Jersey.

When doctors know that price is a concern for a patient, they’ll often work with you to find an affordable alternative. But remember: It all begins with an open conversation.

“We need to normalize conversations about cost and healthcare,” says Caitlin Donovan, a senior director of the National Patient Advocate Foundation. “Patients are often too shy to talk about cost—and then they can’t adhere to their treatment plan because it’s too expensive.”

2. Plan regular check-ins with your insurance agent

Does health insurance seem like an inscrutable mystery? Here’s how smart shoppers solve it: They open their wallets and pull out their insurance cards. The customer service number on the back gives you access to all the answers.

“As soon as you know you need a procedure, start gathering information by calling your insurer,” says Donovan. “They’ll have all the information you need.” That includes a list of nearby providers in your network, how much you have left to pay on your deductible, whether you need preauthorization, and what your copay will be.

If you work for a large employer, someone in your company’s HR department can also explain the details. Or, says McIlwain, “if you bought your plan through a broker, it’s their responsibility to answer your questions. Just call up and say ‘I need you to educate me about my plan.’”

Knowledge is power, and savvy shoppers arm themselves with all the information they need.

3. Look at several prices before deciding

It pays to shop around. Price check tools by Healthcare Bluebook and Guroo can give you estimates on what you should expect to pay, and you can check prices against your local providers.

Hospitals are one place to look, and you can find the prices at many of them by going online and looking for the hospital’s “price transparency” page. But also make sure to check freestanding clinics and independent labs. For routine procedures and scans, these almost always offer better prices than hospitals.

“The hospital is almost always the most expensive place to go,” says Broadhurst. You can eliminate the hospital every single time and get a better deal at a freestanding clinic, she explains.

As you’re looking at prices, don’t be tricked into thinking that higher costs signal a better experience, says Donovan. “There’s no real correlation between price and quality of care,” she says. Diagnostic tests such as x-rays, MRIs, and bloodwork, when they’re performed by a qualified technician, are the same everywhere.

4. Be prepared for an emergency

If you think your life is at risk, you need to go to the ER. But smart shoppers know that for non-emergencies, there are better options, says Broadhurst.

According to UnitedHealth Group, two-thirds of ER visits are for non-emergencies, and the average bill comes to more than $2,000. Those same conditions could have been treated at an urgent care clinic for just $193.

That’s why you should plan for where you’ll go for earaches, eye infections and minor injuries. In addition to having the name and number of an urgent care clinic stored in your phone, you should also know how to quickly get in touch with a doctor using video chat. Virtual care costs $160 less, on average, than an in-person doctor visit, according to a study from the University of North Carolina at Chapel Hill.

“Virtual care can be a great option,” says Broadhurst. “If the providers can manage the problem, they will — but they’re good about telling you if you really need to see someone in person.” If you don’t already have a go-to website for virtual care, check with your insurance company. Many now offer virtual services as a standard part of coverage.

5. Stop overpaying for medication

Modern medications can work wonders — but they can also cost a bundle. In 2019, the average American spent $1,376 on prescription medications, according to the Organisation for Economic Co-operation and Development.

But again, it pays to shop around. “There are lots of ways to lower the price you pay,” says Donovan. Compare costs at your local pharmacy, chain stores, even big-box stores. Mail-order prescriptions may be a good option too, she says.

To facilitate your cost-cutting effort, schedule a medication review with your pharmacist or primary care provider. This lets you go over all the medications you take with an expert who can identify redundancies and help you find low-cost alternatives.

“There may be some [medications] that your doctor will want you to wean off of, and for others you may be able to switch to a less expensive generic,” says Donovan. And switching to a generic can have a big impact. The average copay for a generic medication is $6.61, compared to $55.82 for a brand-name medication, according to a recent report from the Association for Accessible Medicines.

6. Ask for the code

Ever buy apples at the supermarket self-checkout? The cashier punches in a different code depending on whether you’re buying Red Delicious, Fuji, or McIntosh. Healthcare procedures work in a similar way. There isn’t just one kind of CT scan, for instance. There are dozens. And as with apples, each one has a unique code.

The most accurate way to compare prices for a procedure is to find the right code, or CPT code, says Broadhurst. And you can do that by asking your doctor. So instead of price shopping for a CT scan, you can shop for procedure 72191, which points specifically to a CT angiograph of your pelvis, both with and without dye.

The CPT code lets you compare apples to apples. And if you enter the code into price-comparison tools, such as those at Fair Health Consumer and ClearHealthCosts, you can quickly find expected prices in your area. (If you don’t know the code, you can also use these sites to search procedures by name.) Then you can use that information to see if your local provider is overpriced.

When you shop around, you’ll likely find big differences from one location to another. Even a routine blood test with the same CPT code can vary, says Broadhurst. It might cost more than $130 at the hospital but just $29 at a national lab chain.

7. Keep an eye on your bills

Medical bills are super complicated, and mistakes are common. “Almost half of all medical bills have errors in them,” says Donovan. “But it could be something simple that can be resolved with a quick phone call.”

Maybe your provider submitted your claim to the wrong insurance company or entered your plan number incorrectly. In some cases, you might see procedures that you didn’t receive. “So be sure to check your bills carefully,” says Donovan.

If you see something that looks off, follow up with your insurance rep or provider. And take notes during your call so that you have a record of how the issue is being handled.

These tips won’t get you out of paying medical bills, but they will allow you to find the best possible prices. And ultimately, they’ll leave you with more money to invest in things that make you happy.

Additional sources
Medical costs for a family of four: Peterson-KFF Health System Tracker (2019). “Tracking the rise in premium contributions and cost-sharing for families with large employer coverage”
Skipping care and medication due to cost: Kaiser Family Foundation (2021). “Americans’ Challenges with Health Care Costs”
Only 3% compare healthcare prices: Health Affairs (2017). “Americans Support Price Shopping For Health Care, But Few Actually Seek Out Price Information”
Emergency room costs: UnitedHealth Group
Virtual visits cost $160 less: Journal of Patient Experience (2021). “Evaluation of Patient Experience During Virtual and In-Person Urgent Care Visits: Time and Cost Analysis”
Pharmaceutical spending by country: Organisation for Economic Co-operation and Development
Cost of medication: Association for Accessible Medicines (2021). “The U.S. Generic & Biosimilar Medicines Savings Report”