How can you save on health care, from getting pharmaceuticals to urgent care? And do you know what doughnut holes have to do with your health?
Take this short quiz and find out some important information that you can put to use if it ever becomes necessary.
1. The price of brand-name drugs rose ____ in 2008.
a) 4 percent
b) 6 percent
c) 8 percent
d) 10 percent
2. Many health plans are now encouraging patients to use __-day mail orders, instead of the usual 30-day prescriptions, to save money.
3. True or false: Before a new drug is approved, its maker must run clinical tests to prove it works better than older drugs.
4. A formulary is?
a) The chemical name for a medicine.
b) A list of drugs a health insurer will cover and the copayments associated with them.
c) Official guidelines for doctors on which drugs they should prescribe for which conditions.
d) The “play-by-play” plan for a surgical procedure.
5. The prices of the following drugs are likely to fall sharply this year because generic versions will be introduced:
a) Prevacid (heartburn), Topamax (migraines), Valtrex (herpes)
b) Lipitor (cholesterol), Zyprexa (schizophrenia and bipolar disorder), Viagra (impotence)
c) Adderall (attention deficit hyperactivity disorder), Plavix (blood clots), Flomax (enlarged prostate)
d) Concerta (attention deficit hyperactivity disorder), Lexapro (depression), Risperdal (schizophrenia)
6. Copayments for visiting doctors outside a person's health plan network average about _____ percent higher.
7. True or false: Vitamins can be claimed as an expense on a flexible spending account.
8. In 2008, the average premium for an employer health plan covering a family of four was _____.
9. Health Savings Accounts are intended to help people save for certain health expenses, tax-free. This year, the maximum annual individual contribution is ____, and the maximum family contribution is _____.
a) $4,500 and $6,000
b) $2,000 and $7,525
c) $5,000 and $8,025
d) $3,000 and $5,950
10. The nickname “doughnut hole” refers to:
a) The portion of Medicare spending coverage where a patient's out-of-pocket costs increase until he or she spends a certain amount.
b) Pills that are designed to dissolve when eaten with a sugary snack.
c) Prescription drug spending not covered under Medicaid.
d) The fact that Medicare does not reimburse for expenses on weight-loss products.
1. (c) 8 percent, according to Medco Health Solutions, a pharmacy benefits manager. That compares to a 7 percent increase in 2007. Drug prices tend to rise the longer a product has been on the market, as drug makers account for inflation and try to increase profits before a product loses patent protection.
2. (c) 90. Health plans get discounts on 90-day orders. Some of the savings are passed on to patients, who pay less than they would for three separate 30-day prescriptions. They can be save you money on drugs you take routinely to manage chronic conditions like high blood pressure or high cholesterol.
3. FALSE. Experimental drugs have to show they work better than a placebo, commonly a sugar pill, to gain approval. A new-to-the-market, heavily advertised drug hasn't necessarily been shown to work better than existing drugs, which often can cost less.
4. (b) Health plans create lists of drugs they'll cover and the what part of the cost of the drug the patient will have to pay. You should be able to get a copy of your plan's formulary through your employer or the company that provides your health coverage so you'll know in advance what a drug will cost.
5. (a) Prevacid, Topamax, and Valtrex will lose patent protection this year, paving the way for sales of generic copies, which can cost 30 to 80 percent less. If you're on a drug that's losing patent protection, you should ask your doctor if switching to the generic is an option.
6. (b) The copayment for a visit to an out-of-network doctor averages about 50 percent more than a copayment for a doctor who is part of your insurer's network. Be sure to know and follow the rules of your plan to
avoid unnecessary expenses.
7. TRUE, but only if the vitamins are recommended by a medical practitioner to treat a specific, diagnosed condition. You can be reimbursed for vitamins including calcium, folic acid, and iron if you have a letter from a physician that names the medical condition and says the vitamins will treat it.
8. (c) According to a study published in the journal Health Affairs, the average premium was $12,700. While premiums continue to increase, growth has slowed: The average premium for a family of four went up 4.9 percent in 2008, down from 7.7 percent the year before and 9.2 percent in 2005.
9. (d) $3,000 to $5,950. Health Savings Accounts let you save money tax-free for health care expenses, though restrictions apply to who's eligible. They differ from flexible-spending accounts in that the money in them is yours to keep, even into retirement. Check with your employer on your options.
10. (a) Medicare Part D, created in 2006, helps elderly patients cover some drug costs. In 2009, Medicare Part D covers the first $2,700 of a patient's drug spending. The patient is responsible for the next $4,350 in costs – the doughnut hole – with coverage restarting after that.
If your final score is between:
0 and 3: Consider doing more research and investigating your options. Become a more informed health care consumer.
4 and 6: You're on your way, but make sure you stay on top of policy and business changes.
7 and 10: Looks like you're well informed and in good shape.