Health costs

The Affordable Care Act requires insurers to provide several kinds of preventive care with no cost-sharing from you, including mammograms and routine vaccines. (Fotolia)

No matter how you get your insurance -- through your employer, from a state exchange, from an agent, or directly from an insurance company -- you're paying a bigger share of your health-care costs than in the past. Higher premiums are only part of the picture. Deductibles are rising, provider networks are shrinking, and insurers have been switching from fixed-dollar co-payments to coinsurance, based on a percentage of the cost of care.

Your out-of-pocket costs could rise significantly unless you learn some key strategies to become a better health care shopper. The following moves can help you save hundreds, or even thousands of dollars:

1. Stay in your network

Many insurers are shrinking their networks and including fewer doctors and hospitals.

"The most expensive health care mistake you can make is to go out of your health plan's network," says Jackie Aube, a senior vice-president of Cigna. The cost difference can be huge. Preferred provider organizations (PPOs) usually let you use out-of-network doctors but charge higher co-payments or coinsurance rates -- say, 50 percent for out-of-network care compared with 10 percent for in-network services.

If your plan is a health maintenance organization (HMO), you may not have coverage at all for out-of-network providers except in an emergency.

The out-of-network base price may also be higher because the network's providers agree to the insurer's negotiated rate, but outside providers can charge more. You may also have a higher deductible for out-of-network care and a higher annual limit on your out-of-pocket expenses.

Before you visit a doctor or have a procedure, ask both your insurer and the providers if they're included in your plan's network. If you're having surgery, check on the surgeon, anesthesiologist and facility.

2. Find out about super-preferred providers

Your health plan may provide extra incentives for you to use certain in-network providers or facilities. The UnitedHealth Premium designation program, for example, recognizes physicians that meet guidelines for providing high-quality, cost-efficient care, and you may pay lower co-payments or coinsurance rates if you use those doctors. Most health plans' search tools can help you find providers who participate in these special programs.

3. Save at stand-alone radiology centers

Different facilities charge vastly different prices for X-rays and tests. The average outpatient hospital cost for MRIs and CAT scans is $1,384 to $1,668, says Aube, but the average radiology center costs $445 to $725. And there can be a huge range between the highest and lowest cost in your area.

For example, among all facilities within 25 miles of New York, the cost of a knee MRI ranges from $238 at a free-standing radiology facility to $2,191 at a local hospital, says Victoria Bogatyrenko, vice-president for innovation at United Healthcare. Most insurers have tools to help you compare the costs of x-rays and tests at different types of facilities in your area.

4. Ask your doctor about cheaper facilities

Your doctor may work at several hospitals or outpatient surgery centers. While the surgeon's charge will be the same, "the hospital's fees can vary by thousands of dollars," says Aube. The cost may be even less at an outpatient surgery center, even though the same doctor is performing the procedure.

For example, the average cost nationwide for a colonoscopy, GI endoscopy or arthroscopy in a hospital is $2,548, but the average cost at an outpatient surgery center is $959, she says. Make sure the facility you choose is in your insurer's network.

5. Avoid the emergency room if you can

Sometimes you can't avoid a trip to the emergency room. But you may be able to go to a much less expensive urgent care center or convenience care clinic for some types of care. Visit an urgent care center for conditions such as minor cuts, burns and sprains, fever and flu symptoms, joint or lower back pain, and urinary tract infections, says Aube.

You may pay even less at a convenience care clinic at a supermarket, pharmacy or other retail store, where a clinician can treat you for sinus infections, rashes, earaches, minor burns and other routine medical conditions, she says.