Healthcare will most likely be my family's largest expense in a couple of years, when we've finished paying our home mortgage. We're not heavy users of the healthcare system: to take care of my own needs, for example, I have seen my family physician for a non-routine visit just 3 times in the last 15 years. Just one family member takes a prescription medicine on a regular basis. What have we done to incur such high costs? We're Americans who want to protect our family from a medically-induced financial disaster. We're not alone.

According to Davis Liu, M.D. and author of "Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America's Healthcare System" health insurance premiums grew 73% compared to wage increases of 15% from 2000 to 2005. Dr. Liu doesn't have a well-crafted plan to solve the national healthcare crisis but he does offer practical ideas for getting the most out of your healthcare dollar. Here are 50-plus ways to save money without compromising your well-being, drawn mostly from Dr. Liu's book but supplemented by my experience, research, and wisdom of the Wise Bread community.  

1. Skip the annual physical but get specific screening tests recommended by the U.S. Preventive Services Task Force (USPSTF).
2. Save on prescription medications if you meet certain eligibility guidelines found at Together Rx Access.
3. Review all medical bills and question anything that doesn't seem right, especially services that should be covered under your insurance plan; talk to your insurance agent, employee benefits counselor, and/or insurance company representative to make sure that covered items are paid correctly. 
4. Call your physician’s office to ask about a non-urgent problem (or to see if a symptom requires immediate treatment) rather than scheduling an appointment.
5. Ask your pharmacist about medications including prescriptions, over-the-counter drugs, and behind-the-counter remedies; you'll get free, valuable advice from a healthcare professional who has spent many years studying medicines. 
6. Compare your physician’s recommendations with clinical guidelines (e.g., pediatrics, obstetrics/gynecology, urology); ask about anything that you don't understand or seems to be unusual care.
7. Do self exams (see techniques for women and men).
8. Get high-deductible healthcare insurance rather than forgoing insurance because the uninsured have higher death rates from chronic disease and accidents.
9. Carry continuous coverage so that exclusions for preexisting conditions will be limited according to federal law associated with HIPAA (Health Insurance Portability and Accountability Act).
10. If you may lose your job or already have lost your job, compare the cost of COBRA coverage (extended to displaced employees but includes the employer’s and employee’s cost) to other options such as purchasing insurance on your own (either a comprehensive or high-deductible plan) or getting coverage on a spouse’s plan.
11. Open a HSA (Health Savings Account) linked to a high-deductible insurance plan and take a tax deduction for your contributions, subject to limitations as stated in the federal tax law.  
12. If your insurance company doesn’t cover USPSTF-recommended tests, question why it doesn’t cover expenses proven to prevent disease and start a letter-writing campaign asking for coverage; write your insurance company and your state’s insurance commissioner.
13. Take a tax deduction for medical expenses that exceed 7.5% of your adjusted gross income (AGI).
14. Go to a provider (physician, physician extender, or hospital) that is in your insurance company’s network so that you can take advantage of discounted rates already negotiated by your insurance company.
15. If the provider that you prefer is not in your insurance company’s network, ask the provider to join so that you can get discounted rates.
16. Choose a high-performing healthcare plan by checking out plan ratings by the National Commission on Quality Assurance.
17. Select a physician who follows standards of care according to evidence-based medicine; find those who meet the NCQA criteria in its searchable physician directory.
18. Get free blood pressure, blood sugar, and cholesterol checks at health fairs. Take the results to your physician for discussion and further testing if needed.
19. Wait at least 24 hours after the onset of a fever (with no other worrisome symptoms) before making a doctor’s appointment.
20. Take free or nominal-fee health classes on topics such as childbirth preparation and diabetes prevention; beware that some of these classes are sponsored by pharmaceutical companies.
21. Find free skin cancer screenings but don’t wait to find a free check if you think you may have a problem.
22. If there is a competitive market for healthcare services (e.g., more than one maternity hospital in your town), negotiate prices, preferably before you receive services.
23. Check out the safety, effectiveness, and clinical soundness of home remedies, herbs, and supplements at The People’s Pharmacy and Consumer Reports-Health.  
24. Evaluate hospitals using The Leapfrog Group's ratings.  
25. Donate blood and receive free blood pressure, iron-level, and temperature checks.
26. Establish a relationship with a primary care physician through an “establish visit.”
27. Get better, more informed, and quicker medical advice by preparing a written summary of your medical history (should include surgeries, medical conditions, medications, allergies, family history, and social history).
28. Communicate priorities during the initial part of the physician visit, rather than waiting until the very end of the visit to express your concerns about an important matter.
29. Help your physician arrive at a diagnosis with a minimum of tests by discussing your symptoms in terms of when you first noticed the problem and when it occurs; what it feels like (sharp or dull, constant or intermittent) and what seems to make the problem better or worse; where in the body it occurs; and why you are concerned.
30. Make sure you understand any diagnosis, additional testing requirements, treatment plan, and further assessments recommended by your physician before you leave the office.
31. Before allowing medical treatment (giving informed consent), determine the benefits, risks or complications, and alternatives to treatment plans.
32. Don't hesitate to get a second opinion not only on the diagnosis but also for the treatment plan, if you feel uncomfortable with your physician's plan and especially if you have a rare disease.
33. If you are waiting on test results, “Never accept the phrase, ‘we’ll only contact you if the results are bad.’” Ask for a call back or, preferably, written documentation of your test results.
34. Get immunizations to prevent certain diseases (see Center for Disease Control’s recommendations).
35. Ask your primary care physician what type of specialist treats the problems you are concerned about to avoid paying for a visit to the wrong type of specialist.
36. Make sure your physician is licensed by checking with state boards.
37. Don’t be overly influenced by ads for prescription medicine: ask about symptoms mentioned in commercials or ads rather than requesting specific medications; stick with your current regimen if it is working without complications. Heavily advertised medications are almost always more expensive than non-promoted ones.
38. Consider generic drugs to replace name-brand drugs; for a list of generic drugs with their equivalents, check out the Electronic Orange Book. 
39. Compare drugs in the same class by price using Consumer Reports-Health website.
40. Cut costs on prescriptions through patient assistance programs; learn more at Rx Assist or Partnership for Prescription Assistance.
41. Ask for free samples of medication from your physician.
42. Tell your physician about cost concerns and see if there is a less expensive but just as effective alternative treatment.
43. Read the labels and ingredient lists of over-the-counter medicines to make sure that you are not overdosing on certain active ingredients.
44. To get more face time with your physician, schedule multiple visits rather than signing up for concierge care (flat fee for dedicated service).
45. Say "no" to body scans that are more likely to lead to unnecessary testing and cause harm via radiation rather than detect deadly disease.
46. Take part in group visits with your physician or support groups for those with similar diseases.
47. Exercise, maintain a healthy weight, and don’t smoke.
48. Research medical issues using reliable sources such as the Mayo Clinic.
49. Sign up for discount programs with non-insurance companies such as Merck’s Prescription Discount Program (available to those who do not have prescription coverage) and Pfizer's program.
50. Visit a dental clinic associated with a dental or dental hygiene training program to save on fees (see health reasons for proper dental care).
51. Tap into hospital programs that offer aid for low-income, low-resource patients.
52. Take a vacation.
53. Leave the country to receive quality healthcare often at heavily discounted prices (see Adventures in Medical Travel article from Kiplinger and read about Amy's journey to wellness in India).

If you've saved money on healthcare and improved your health, tell me about it.

Note: I received a copy of Stay Healthy, Live Longer, Spend Wisely in exchange for a book review. Disclaimer: This book and my post are intended to provide readers with a general understanding of healthcare issues rather than provide personalized medical, financial, or legal advice. Please consult your physician, CPA, attorney or other advisors for help with specific situations.