MONEY best of 2014

4 Best New Health Care Tools of 2014

Lightbulb with Band-Aids
MONEY (photo illustration)—Getty Images (2)

The apps and websites that can keep you healthier and make you a smarter health care consumer.

Every year, there are innovators who come up with fresh solutions to nagging problems. Companies roll out new products or services, or improve on old ones. Researchers propose better theories to explain the world. Or stuff that’s been flying under the radar finally captivates a wide audience. For MONEY’s annual Best New Ideas list, our writers searched the world of money for the most compelling products, strategies, and insights of 2014. To make the list, these ideas—which cover the world of technology, investing, retirement, college, and more—have to be more than novel. They have to help you save money, make money, or improve the way you spend it, like these four health care innovations.

The Best New Health Care Tool: Your Smartphone

The smartphone in your pocket can help you count your steps or calories. But the phone’s potential is far greater, says Eric Topol, a cardiologist at the Scripps Research Institute. Diabetics can connect an IGBStar glucose meter to their phone and share blood-sugar info with their doctor; other apps let heart patients record their EKGs. (The Health app built into the iPhone operating system can integrate much of this data.) And the giant health system Kaiser Permanente now offers members a mobile app to access medical records.

Best State Law the Other 49 Should Adopt—Stat: Health Care Price Transparency

Employers and insurers are making you foot more of your health care bills in the hope you’ll pay more attention to the bottom line—and even seek out less expensive care. That’s one reason the average deductible now tops $1,200.

The problem: How can you shop around when you can’t find out what doctors and hospitals charge?

The breakthrough: Massachusetts has become the first state to require hospitals, physicians, and insurers to share price estimates. As of October, residents can go online and compare costs—especially helpful for screenings, lab work, and other straightforward care you can plan for in advance. With in-network prices varying by as much as 300%, the payoff for doing homework can be big.

The workaround: If you live in any other state, your best bet is to check out your insurer’s website, which often lists what you’ll pay for routine services like MRIs in-network. At Healthcarebluebook.com you can see what insurers pay in-network providers for a particular service in your area.

Best New Way to Help Emergency Workers Help You

When you need serious medical help fast, you can aid doctors and emergency workers by filling out Apple’s new Medical ID feature, available with iOS 8. You enter potentially life-saving information, such as conditions you have, medications you take, and your blood type, as well as emergency contact information and whether you’re an organ donor. The information can be pulled up on your phone—without your four-digit passcode—by tapping the Emergency button. Fill it out, then hope you’ll never need to use it.

Best Backup to Help You Talk to Your Doctor

You’ve done this: You feel weird, so you Google your symptoms—and diagnose yourself with something awful. A new web tool called Isabel can give you a clearer view. Based on a tool already used by more than 100 U.S. hospitals and doctors’ offices, Isabel asks you to input your symptoms, and then draws on medical research to produce a list of possible conditions. (Its database is far deeper than other popular symptom checkers’.) Isabel understands layman’s terms like ”stomach ache” and tells you which diagnoses are common vs. rare. Isabel can’t replace your doctor, says founder Jason Maude (who tells the story of the site’s founding in the video below). But the site can help you pose better questions about tests and treatments—crucial now that you’re being asked to shoulder more of your health care costs.

 

MONEY best of 2014

7 Ways Tech Made Your Life Better in 2014

A new reason to ditch your cellphone contract, safer credit cards, and five more bright ideas that can help you save money in the year ahead.

Every year, there are innovators who come up with fresh solutions to nagging problems. Companies roll out new products or services, or improve on old ones. Researchers propose better theories to explain the world. Or stuff that’s been flying under the radar finally captivates a wide audience. For MONEY’s annual Best New Ideas list, our writers searched the world of money for the most compelling products, strategies, and insights of 2014. To make the list, these ideas—which cover the world of investing, retirement, health care, college, and more—have to be more than novel. They have to help you save money, make money, or improve the way you spend it, like these seven tech innovations.

  • Best Side Effect of the Hacking Mess

    Chip and Pin credit card transformed into a lock
    Image Source—Alamy

    Safer Credit Cards…Finally

    Chip-and-PIN credit cards include a special chip that makes them harder for hackers to replicate. Though you’re legally protected from having to pay most charges when a card number is stolen, more-secure plastic can save you a lot of hassle. Card companies had been slow to roll out chip-and-PIN—until millions of credit card numbers were stolen from major retailers such as Target and Home Depot. “The frequency and size of the breaches absolutely are driving more rapid adoption of the technology,” says Paul Kleinschnitz of First Data, a payment technology firm. Here are two more things to know about the new cards:

    They don’t eliminate all your risk. Chip-and-PIN makes it harder to create fake plastic but doesn’t stop numbers from being used at online stores. So you should still check your statement regularly for weird charges. Chip-and-PIN is already common in Europe; the new cards work in automated machines there that don’t accept old-fashioned plastic.

  • Best Smartphone Savings

    No-Contract Plans

    Old way: Commit to a contract and pay $200 for a smartphone that really costs $650. Of course, you still pay for the phone as part of your monthly bill.

    New way: Wireless companies are making it easier to separate the cost of the phone and the price of service.

    You can shop for a new plan with your old phone. Low-cost players and now the big carriers offer no-contract plans, which may be $100 cheaper per month for a family. Check with carriers for phone compatibility; look up network quality in your area at rootmetrics.com.

    Or get a new phone. You can buy a phone outright or on installment, and combine that with a no-contract plan. Sometimes, but not always, the total price beats the comparable contract option, so run the numbers. If you do go contract, mark your calendar: After 24 months, switch to no-contract if you don’t care to upgrade.

  • Best Reason to Rent, Not Own, Your eBooks

    Amazon Kindle

    All-You-Can Read Subscriptions

    As with music, books are moving toward an all-you-can read subscription model.

    The Services: The service you pick will hinge on the device you prefer to read with. Scribd ($8.99 per month) lets you read an unlimited number of books, and it quintupled its library this year to 500,000, with 30,000 audiobooks. The service now includes many titles from the big publishers Simon & Schuster and HarperCollins. Works on: iOS, Android, Kindle Fire (but not e-ink readers), Nook tablets.

    Though Scribd is the better service overall, it doesn’t work on Kindle e-ink readers. If you’re devoted to that device, Amazon has its own options. With an Amazon Prime subscription, you can choose from thousands of titles to read for no extra charge (one per month). Kindle Unlimited ($9.99) is like Scribd, but customers and reviewers say it’s hard to find books from the “Big Five” publishers. Works on: iOS, Android, Kindle Fire, and Kindle readers.

    The Gadget: Phone and tablet apps are fine for many readers, but e-ink devices provide a more booklike experience. The new Kindle Voyage has a screen that’s 39% brighter than its predecessor.

  • Best Reason to Rent, Not Buy, Your Music

    Streaming Services

    Why buy songs that you’re rarely going to listen to in a few months? What if you could listen to just about anything—except for a few famous holdouts, like Taylor Swift and the Beatles—for less than the price of one CD per month? (Remember those?) A smart new pricing plan could make 2015 the year you make the switch from buying music to legally streaming it.

    The Service: Spotify lets you listen to any song you want in its vast catalogue. A free version, with ads, works on desktops or allows you to play artists or albums on Shuffle on your phone. Paying up for Spotify Premium ($9.99 a month) gets you no ads and total control on any device. Spotify has rolled out a family plan that lets you add new users for $4.99 each; that way two people in your family can play their own tunes at the same time. Works On: iOs, Android, desktop

    The Gadgets to Listen On: Docking stations are easy to use, with no setup or wires required. The $130 iHome iDL48 works with most iPads and iPhones. A portable speaker lets you get your music off your little earbuds and carry it to any room. The reliable Jawbone Mini Jambox ($130) connects to smartphones, tablets, and most computers through Bluetooth. If your existing stereo has an auxiliary input, an easy fix (in you’re not a hi-fi purist) is to run a cable from the headphone or line-out jack on phone, tablet or PC. Cords are $5 to $10 at Monoprice or Amazon.

  • Best Retro Tech

    2015 Ford Focus
    2015 Ford Focus

    Dashboard Knobs are Back!

    For years cars have become more tech-laden, with systems to let you make phone calls, find local pizza joints, or answer email. Which is nice, unless you prefer to keep your focus on driving. Interiors became a maze of numeric keypads and other control points. Ford says its research shows drivers don’t use or want all that tech. Now it’s retro time. For the 2015 model year Ford Focus, the automaker has eliminated many buttons, and added old-fashioned knobs to systems such as heat and A/C. In the next Fusion, the company is even getting rid of touch screens. — Bill Saporito, Time assistant managing editor, car reviewer at Money.com

  • Best Online Security Fix

    Two-Factor Verification

    Worrying about bank and brokerage hacks is understandable. But money can be replaced—and you have legal protections. What you should worry about is a hacker mining your more vulnerable iCloud photos, Facebook page, or email account and impersonating you. Two-factor verification, a login protocol, makes it vastly harder for hackers to steal your digital life. Here’s what you need to do to set it up:

    Select “login approval” or “two-factor verification” under settings at sites you want to protect. The first time you visit that site on a new computer, you will have to enter a code that’s texted to your phone. (You only need to enter this code the first time you log in from a new computer.) In case you lose your phone, you can print out backup codes, which work once. Once you’ve done this, a hacker would need to guess your password and have physical access to your computer in order to steal your data.

  • Best Apps to Get Before You Travel

    Chi Birmingham

    Taxi Apps

    It’s not always easy to scare up a cab in an unfamiliar city. (Where are the best streets to try to hail one? Should I find a taxi stand? Call ahead?) But smartphones are making it much easier to get around. The Uber app can summon a for-hire private car in numerous cities in 45 countries (though the service has recently come under fire in a few cities). In some big towns, like New York, it will also hail a traditional taxi. Curb and Flywheel also grab regular cabs—check first if they work in the town you are visiting. Want help navigating subways and metros? Hopstop has stop-by-stop directions and travel times, as do the transit directions on the Google Maps app.

MONEY Health Care

What You Need to Know About This Year’s Obamacare Kick-Off

Obamacare Take 2 film clapper
Sarina Finkelstein (photo illustration)—Getty Images (clapper)

It's Year Two for health reform, as the online insurance exchanges open on Saturday. Here’s what to pay attention to if you're in the market for a plan.

Starting Saturday, consumers who buy their own health insurance can finally sign up for a 2015 plan. Healthcare.gov, the troubled online insurance market created by the Affordable Care Act—a.k.a. Obamacare—will begin accepting enrollees, as will the 14 state-run insurance exchanges.

This year the government opened the federal site for window shopping in advance, so you’ve been able to get a sneak peek at what’s available in your area before the formal sign-up process kicks off this weekend. Although experts can’t promise that open enrollment will run smoothly this go-around, they do think the process will face fewer problems.

If you bought insurance last year, you may figure that you don’t need to do anything in year two. Or if you went without last year, perhaps you plan to do the same. Not so fast. Read this before you make any health-care shopping decisions.

Skipping Insurance Will Cost You More

If you decided to go without health insurance in 2014, you’ll likely get hit with a penalty when you file your income taxes this April. It’ll be the greater of $95 for an adult ($285 per family) or 1% of family income.

But going without insurance in 2015 will cost you even more. For the 2015 plan year you’ll owe the greater of $325 for an adult ($975 per family) or 2% of family income, which you’ll pay with your taxes in spring 2016.

You may qualify for an exemption if the lowest-cost plan in your area would cost you more than 8% of your income, or if you went without insurance for fewer than three months.

Even If You Enrolled Last Year, You Should Shop Around Again

By now you should have received a notice from your current health plan explaining that your coverage will end December 31. You’ll also be told whether the insurer will offer that same plan in 2015 and, if so, what it will cost and how it will change, says Karen Pollitz, a senior fellow at the Kaiser Family Foundation.

If you signed up for coverage last year, or even just a month or two ago, you may think you’re all set. Why go through what was likely a taxing experience, given the technical problems the exchanges had last year? Here’s why.

First, there’s a good chance you’ll have different plans to choose from this year. Some insurers will exit the marketplaces, but many others have joined. In 35 states, the number of insurance companies offering coverage on a state exchange is increasing, according to the Kaiser Family Foundation; only two states, California and Oregon, will see a slight decline. New Hampshire, which had one insurer participate in its exchange in 2014, is adding four new insurers for 2015. In Ohio, you’ll find five new insurers, and four in Pennsylvania.

Premiums are also changing. An early analysis of monthly plan costs across 15 cities found that the premium for the second-lowest-cost silver plan, before taking any income-based tax credits into account, is decreasing by an average of 0.8%, according to the Kaiser Family Foundation. However, that’s not true everywhere. The premium for that silver plan will jump 8.7% in Nashville, for example, 6.6% in Burlington, Vt., and 6.0% in Portland, Ore. The cost will drop 15.6% in Denver and 11.4% in Providence.

You’ll want to get to know your new choices and reassess your options. “It’s a good idea for consumers to check in, see what is being offered and its cost, and make an active decision to keep their plan or make a change,” says Pollitz.

Your Subsidy Could Change (Even If Your Income Didn’t)

What’s more, if you qualified for a tax credit last year, which about 85% of exchange enrollees did, update your income information and financial assistance application and see how much of a subsidy you’ll qualify for in 2015. Even if your income hasn’t changed, the subsidy you’re eligible for may go up or down. That’s because it is based off the price of the second-lowest silver plan in your area, which could have changed.

You can use this newly updated calculator from the Kaiser Family Foundation to estimate your subsidy.

You’re Not Stuck With Healthcare.gov

While the federally run site garners most of the attention, it isn’t the only place you can sign up for a plan.

If you expect to qualify for a premium subsidy (available if your income falls between 100 and 400% of the federal poverty level), your options are somewhat limited. You’ll either have to shop on the exchange or a health comparison site that’s authorized in your state to sign you up even if you qualify for a subsidy, such as ehealthinsurance.com and gohealth.com.

If you aren’t going to qualify for a subsidy, you can buy insurance anywhere, including directly from a private insurer. Just keep in mind that if you look at only a single insurer’s plans, you may miss less expensive or more appropriate options from competitors.

For the first time this year many Walmart stores have kiosks manned with insurance agents to answer questions about your plan options. They won’t be able to sign you up in the store, however. You’ll need to call or go online to directhealth.com to enroll.

Given the complexity of your options and the sign-up process, it’s understandable if you’d like telephone or in-person help. You can find local navigators or other resources in your area, such as nonprofits and consumer advocacy groups, at localhelp.healthcare.gov.

Drag Your Feet and You Could Be Auto-Enrolled

Don’t wait until the last minute to shop, warns Pollitz. In most states consumers who have not actively chosen a new plan by December 15 will be automatically re-enrolled in their current plan, or switched to a similar one if that plan is no longer available. While you can still swap coverage even after you’ve been re-enrolled, try to avoid that headache.

In a few states, such as Massachusetts and Oregon, there won’t be any auto-renewal, says Pollitz, so if you want coverage next year you must actively renew. You also won’t be auto renewed if your insurer is exiting the market in your area.

You Could Be Locked Out if You Delay

Pre-Obamacare, you could buy an individual health insurance plan at any time (assuming you were in good enough health to be approved, of course). Now the annual open enrollment window, which runs from November 15 through February 15 this year, is the only time you can sign up for individual coverage for 2015 (and you can’t be turned down based on your health).

Unless you have what’s called a qualifying event during the year, such as losing job-based health coverage or moving to a different state, you will not be able to buy a plan, putting you at risk of paying a penalty.

Despite all of the media attention and outreach last year, many consumers who didn’t buy during the 2014 open enrollment period were surprised to find out later that they were locked out, says Carrie McLean, director of customer care at ehealthinsurance.com.

Others found themselves locked out until next year because they had lost insurance due to a life change (new job, divorce) and didn’t realize the window to buy coverage closed in 60 days. If they finally got around to trying to sign up months later, it was too late.

Since the new rules have kicked in, ehealthinsurance.com has recorded a spike in interest in short-term health plans. These plans, however, offer limited benefits and do not fulfill the requirement that you buy a qualified plan or pay a fine. All the more reason you need to shop now.

MONEY Health Care

Take the Sting Out of Alternative Medicine Costs

Acupuncture needles stuck in $100 bill
Claire Benoist—Prop Styling by Brian Byrne for Set in Ice

Spotty insurance coverage means you'll often be stuck with the bill. Here's what you need to know about the costs and benefits of four common natural-healing strategies.

A visit to a chiropractor, acupuncturist, or other nontraditional healer has become increasingly commonplace; more than a third of Americans use some form of complementary or alternative medicine, according to the National Institutes of Health. But even though a growing number of studies suggest that these treatments can be beneficial for many patients, insurers are still reluctant to cover all types of alternative medicine, often leaving you on the hook for the costs.

You may consider that money well spent, especially if you suffer from chronic pain. “Combined with traditional medicine, alternative therapies are important treatment tools,” says Dr. Marc Brodsky, medical director of the Center for Integrative Medicine and Wellness at Stamford Hospital in Stamford, Conn.  These common approaches have research to back up their effectiveness. Still, they don’t work in every case. The key is figuring out when shouldering the cost pays and when it doesn’t.

Here are some considerations to factor into your decision.

Chiropractic

What it’s best for: These adjustments to the spine and elsewhere are most helpful for low-back pain, research indicates. “A lot of chronic pain is musculoskeletal, and chiropractic increases movement in joints and relaxes muscles,” says Dr. Melissa Young, an integrative medicine specialist at the Cleveland Clinic Center for Integrative Medicine.

The pro to see: One with a state license, which requires four years of postgraduate training at an accredited chiropractic college.

The cost: $40 to $125 per session. Fifteen to 25 visits are typically covered by insurance. You can also pay with tax-free dollars from your health savings or flexible spending account.

Acupuncture

What it’s best for: Inserting thin needles into the skin has been shown to help with headaches and low-back, neck, and knee pain. “Acupuncture increases endorphins, or feel-good hormones,” says Dr. Houman Danesh, director of integrative pain management at the Icahn School of Medicine at Mount Sinai in New York City.

Still, if you haven’t seen any results after four to six visits, you may want to move on, says Simsbury, Conn., acupuncturist Steve Paine.

The pro to see: Look for a state license and National Certification Commission for Acupuncture and Oriental Medicine certification.

The cost: $50 to $150 per session. For insurance coverage, you may need a diagnosis of a specific condition, such as migraines. The typical cap is 12 to 20 visits a year. As an alternative, your insurer may offer discounted rates at certain providers, says Susan Connolly, health and benefit consultant for Mercer.

Bar graph of insurance coverage
MONEY

Biofeedback

What it’s best for: You’re hooked up to sensors that display your heart and breathing rates and other vitals. With exercises such as guided imagery, a therapist teaches you to, say, lower your heart rate. “Since it’s a relaxation technique,” says Young, “it makes sense that it helps with issues that are exacerbated by stress.” Those include hypertension and chronic pain.

Some patients see their symptoms gradually improve, says Dr. Michael Sitar, president of the Mid-Atlantic Society for Biofeedback and Behavioral Medicine. Others report more erratic results.

The pro to see: A therapist certified by the Biofeedback Certification International Alliance (bcia.org).

The cost: $75 to $200 per visit. Insurance typically doesn’t cover it; some plans do for a diagnosis such as headaches or fibromyalgia.

Naturopathy

What it’s best for: Based on the theory that the body can heal itself through diet, lifestyle, herbs, acupuncture, and chiropractic, it’s especially good for chronic pain, including low-back pain. “Rather than providing a Band-Aid solution for symptoms, practitioners try to get to the root cause of the disease,” says Dr. Melinda Ring, medical director of Northwestern’s Integrative Medicine center.

The pro to see: A licensed naturopathic physician who has finished a four-year program at an accredited school, not a so-called traditional naturopath. Find one at naturopathic.org.

The cost: $250 to $400 for an initial 90-minute visit; $100 to $200 per follow-up. Insurance doesn’t typically pay for naturopathy, but that’s starting to change. In five states, including Washington, Connecticut, and Vermont, it’s typically covered.

MONEY home financing

It Could Soon Be Easier to Get a Mortgage

Fannie Mae headquarters in Washington, DC
Kevin Lamarque—Reuters

The nation's largest mortgage firms plan to once again buy loans where the borrowers put as little as 3% down.

Perhaps you thought the days of putting little money down for a home were gone. Well, not so fast. On Monday the CEO of Fannie Mae, Timothy Mayopoulos, announced that the housing giant planned to once again buy loans for which the borrowers put as little as 3% down. Mayopoulos told the crowd gathered at the Mortgage Bankers Association conference in Las Vegas that Fannie, which along with Freddie Mac supports the bulk of the mortgage market today, is working to finalize the details of the offering and gain regulatory approval to proceed. “We want this business,” he said.

So far no details have been announced about what income or credit score requirements borrowers making such small down payments will need to meet the group’s standards. Mayopoulos said more information would be released in the coming weeks. Both Fannie and Freddie previously purchased loans with 3% down but had stopped in recent years. Today the firms usually require at least a 5% down payment on most loans.

Melvin Watt, director of the Federal Housing Finance Authority, which regulates the two government enterprises, said his group was working with them to develop “sensible and responsible guidelines” for the 3% loans, in an effort “to increase access for creditworthy but lower-wealth borrowers.” He cited “compensating factors” in evaluating such borrowers, though he didn’t say what those factors would be.

A 3% down payment is not exactly nonexistent today. The Federal Housing Administration has been offering mortgages with as little as 3.5% down for years. Traditionally, most borrowers were lower income, and the amount they could borrow was capped, but today even higher income folks use FHA loans to buy homes in expensive areas (loan limits vary by state but typically top out at $625,500). In recent years, these mortgages—which come with higher fees than traditional loans, as well as pricey mortgage insurance—have accounted for a larger than normal share of the market.

Now Fannie seems intent to grab some of that business. The low-down-payment loan, Mayopoulos promised, “will also be competitively priced, including against FHA execution.”

In a related move, FHFA’s Watt also announced that the agency is working to provide more details on when the housing giants can force a lender to buy back a loan that goes bad, which he hopes will encourage banks to loosen their lending standards. Over the past few years Fannie and Freddie have required lenders to buy back millions of dollars of bad loans, “sometimes for seemingly minor issues, such as missing a piece of paperwork,” said Keith Gumbinger, vice president at mortgage information publisher HSH.com.

“This clarification might allow lenders to look at riskier borrowers with less fear of having to buy these loans back in the future,” he said. He noted, though, that any changes are likely to be incremental: “It might let a few more borrowers in at the margin, but it won’t be like flipping a light switch where FICO scores down to 640 are now in.”

It’s important to note that Fannie and Freddie can’t force banks to lower their lending standards. In fact, most banks today require tougher standards than the government agencies impose, partially because they are fearful of having to buy back loans that go bad. For example, Fannie and Freddie will buy loans with FICO scores as low as 620, but most banks require at least a 660 or 680, Gumbinger said.

Similarly, lenders could always decide not to offer 3% down loans, even though Fannie and Freddie have agreed to eventually start buying them again. So it remains to be seen whether and how much the rule changes, when they are formally announced in the next few weeks, will ease the way for borrowers.

Read More About Getting a Mortgage in Money101:
How Much House Can I Afford?
What Mortgage Is Right for Me?
How Do I Get the Best Rate on a Mortgage?

MONEY Rentals

The Money Mistake That 48% of Renters Make

List of bills to pay, with "paid" written in red on top
David Gould—Getty Images

They assume their on-time payments will help boost their credit score, according to a new TransUnion survey.

Most Americans know that a good credit score can open the door to lower cost loans for big adult milestones, such as buying a home or car.

Yet it turns out that many renters are misinformed about what goes into that somewhat mysterious three-digit number: Nearly half of renters ages 18 to 64 think rental payments to their landlords are automatically reported to the credit bureaus, according to survey results released last week by TransUnion, one of the nation’s three major credit reporting agencies. The survey also revealed that more than half of renters believe payments for cable and internet, utility and cellphone bills are regularly reported to the bureaus.

Credit agency firms TransUnion and Experian did recently start allowing rental payments to be collected and factored into credit reports. But in practice, most landlords do not yet share with the data collectors that you’re paying on time each month, says Ken Chaplin, senior vice president of TransUnion’s consumer division. Cable, internet, utility and cell providers also typically do not, he says.

Even if your landlord or service firm is one of the few that does report, the payments may not be included in the most common credit score lenders use, called the FICO score. So if you were counting on your on-time monthly rent checks to help you build your credit score, you’re out of luck.

Keep in mind that although being conscientious on paying your rent and utilities won’t help you, your failure to make a payment can hurt you. Some landlords and utility companies do report delinquent customers—not to mention the fact that your accounts could end up in collections. So this isn’t an excuse to stop paying these bills.

Instead it should serve as a wake up call that you may need to work in other ways to improve your credit score, such as paying car loans, student loans and credit card bills on time each month.

Related:

What is a credit report and when is it used?

How is my credit score calculated and how can I improve it?

MONEY Health Care

How to Save Lots of Money on the Health Tests You Need

Legs on scale at doctor's office
Scott M. Lacey

Catching medical problems early is good for your health—and your wallet. But don't go overboard. Learn to weigh the pros and cons of what the doctor orders.

The latest big push in health care is keeping you from getting sick in the first place. Insurers are sending you reminders to schedule regular exams. Employers are rewarding workers who quit smoking or lose weight. And a key provision in the Affordable Care Act, a.k.a. Obamacare, is full coverage for certain preventive care—with no out-of-pocket costs for you.

Getting a handful of basic tests ­every year can reap rich rewards. “So many diseases, such as hypertension and diabetes, are symptomless in the early stages, when they can be easily caught and controlled,” says Dr. Nieca Goldberg, director of the NYU Women’s Heart Center. So see your primary-care doctor annually once you reach your forties (until then, every two or three years is usually sufficient).

Even though fully covered tests are getting more common, for many ­others you will face co-pays or co-­insurance—and shoulder the full cost until you reach your deductible. To keep those costs to a minimum, we recommend two strategies.

First, look for ways to save on every test you take. Prices can vary widely for the same service, even when you stick with in-network doctors and facilities.

Start by checking your health insurer’s website—many list doctors that insurers believe offer quality care at fair prices. Keep in mind that MRIs, CT scans, and other imaging tests often cost much less at free­standing radiology centers. ­(Just be sure the facility is accredited by the American College of Radiology and that your doc will accept the results.) And when your doctor orders a blood test, ask about all your options, including outside the office. “Labs are so standardized, a $10 lipid panel will get the same results and same quality as a $200 lipid panel,” says Scott Matthews of Castlight Health, which helps big businesses manage their health care costs.

Second, learn which screenings are worth your health care dollars and which you can skip. Here’s what you need to know:

6 Essential Tests for Everyone

1) Skin exam

With skin cancer on the rise, it’s smart to have a dermatologist examine the skin over your entire body, looking for suspicious growths, moles, and lesions.

When to get it: At least once a year. “If you have risk factors, such as being fair, having a lot of moles, or having a family history of skin cancer, you may need to be seen as often as every three to six months,” says Dr. David Leffell, chief of dermatologic surgery at the Yale School of Medicine. You could go to your ­primary-care doctor, but dermatologists are better at diagnosing potentially cancerous lesions, studies show.

Cost: $50 to $150. Insurance covers the visit after you meet your deductible; your usual co-pay or co-insurance will apply.

2) Cholesterol check

This blood test, a.k.a. a lipid panel or profile, reports your total cholesterol, your LDL (“bad”) cholesterol, your HDL (“good”) cholesterol, and a type of fat in the blood called triglycerides. High levels of all but the good stuff raise your risk of heart disease and stroke.

When to get it: Men over 45 and women over 50 should be checked every one to three years, says Goldberg. (Until menopause, women have the protective benefits of estrogen.) At younger ages, test every four to six years. Among the reasons for more frequent screenings: Your results aren’t normal, there’s a family history of heart disease, or you have risk factors like being overweight, you smoke, or you have high blood pressure.

Cost: $110 to $305 for test alone. Cholesterol testing is often included in an annual physical, which insurance covers in full.

3) Blood-pressure check

High blood pressure raises your risk of heart disease, stroke, kidney failure, and other serious conditions.

When to get it: Every two years as part of a routine physical; once a year or more if your pressure is above 120/80.

Cost: $70 to $200 for a doctor’s visit, but insurance pays the full tab for your annual preventive checkups

4) Eye exam

Even if you think your vision is 20/20, have your eyes examined regularly—­especially after 40. As you age, you’re at risk for conditions such as glaucoma, which is symptomless. “An exam can also find signs of another disease that may be affecting your eyes, such as diabetes or high blood pressure,” says Dr. Rebecca Taylor, an ophthalmologist in Nashville and a spokesperson for the American Academy of Ophthalmology.

When to get it: Before age 40, Taylor suggests getting a full exam with an optometrist or ophthalmologist every five to 10 years (yearly if you wear glasses or contacts). After that, make it every two years. Reasons to get more frequent exams include a family history of eye disease, previous eye injuries or surgery, diabetes or high blood pressure, or you are over 65.

Cost: $75 to $200 with an ophthalmologist; $50 to $150 with an optometrist. Insurance coverage varies.

5) A1C blood test

This has become the screening test of choice for diabetes, as it measures your average blood glucose over roughly three months; the fasting blood glucose test tells doctors just what your level is at that moment.

When to get it: The standard recommendation is every three years starting at 45. The American Diabetes Association advises beginning earlier if you’re overweight and have certain risk factors, including high blood pressure.

Cost: $40 to $260 for test. If you have high blood pressure, insurance covers in full.

6) Colonoscopy

This exam is your best defense against colon cancer. While there are other screening tools, a colonoscopy is considered the gold standard: “It doesn’t just diagnose; if the doctor sees adenomas [potentially precancerous polyps], he can remove them then and there,” says Dr. Seth Gross, director of endoscopy at Tisch Hospital at NYU Langone Medical Center.

When to get it: Start at age 50, earlier if you’ve got other risk factors, such as a family history or if you have suspicious symptoms. If the test is negative, get one every 10 years.

Cost: $1,100 to $2,800. Insurance pays every 10 years for adults ages 50 to 75.

4 Essential Tests for Women

Insurance will cover the basic pelvic and breast exams that are part of your annual visit to a gynecologist. Other tests aren’t needed as often—and your insurance coverage will probably reflect that.

1) Pap smear

A Pap smear, also called a Pap test, is when your gynecologist collects cells from your cervix to screen for precancerous changes. Thanks to this test, the cervical cancer death rate declined by almost 70% between 1955 and 1992, according to the American Cancer Society (ACS).

When to get it: Every three years, provided your last test was normal; most women can stop at age 65.

Cost: $75 to $350. Insurance pays in full every three years from ages 21 to 65.

2) Mammogram

There’s been controversy in recent years about when to begin breast cancer screening and how often to do it, but the American Cancer Society and American College of Obstetricians and Gynecologists still recommend getting your first mammogram, an X-ray of your breasts, at 40— earlier if you have risk factors like a family history. Ask your doctor about 3-D mammography, now available at some major medical centers: It reduces false positives and slightly bumps up detection rates, according to a recent JAMA study.

When to get it: Once a year starting at age 40.

Cost: $150 to $375. Screening is covered every one to two years at age 40-plus. Most plans don’t cover more precise 3-D mammograms, so you may owe $40 to $60.

3) DEXA scan for bone density

An X-ray test to measure bone density, this screening is recommended for all women at age 65. But you may want to get one around menopause, when declining estrogen levels increase your risk of osteoporosis.

When to get it: Start at age 65, then consult doctor. With risk factors like smoking and osteoporosis in family, begin at menopause.

Cost: $60 to $385. Insurance pays in full when 65-plus; with preapproval, it often pays for younger postmenopausal women too.

4) HPV (Human – papilloma- virus) test

Typically done at the same time as a Pap, this checks for strains of HPV that are most likely to cause cervical cancer. Before age 30, nearly all sexually active people contract HPV at some point, according to the Centers for Disease Control. Most of the time, HPV is harmless and clears up on its own. But since HPV infection is less common in women over 30, a positive test result is more apt to signal a potential problem.

When to get it: Women ages 30 to 65 should get an HPV test paired with a Pap smear every five years.

Cost: $30 to $125. Insurance pays in full every five years from 30 to 65.

6 Tests You May Need

1) Vitamin D test

Vitamin D helps you absorb calcium and maintain strong bones. Since up to 75% of Americans have low levels (a 2009 study suggests), ask your doctor about adding this to your physical, advises Dr. Marianne Legato, professor emeritus of clinical medicine at Columbia University Medical Center.

Cost: $25 to $150; some, but not all, insurers cover

2) Thyroid-stimulating hormone test

Experts disagree about whether routine thyroid screening is necessary, but make sure to get your blood level of TSH checked if you have fatigue and unexplained weight gain.

Cost: $15 to $115; often covered. Deductible and co-pay or co-insurance apply.

3) Cholesterol particle tests

People whose particles of LDL cholesterol are mostly small and dense have a threefold greater risk of coronary heart disease. Ask your doctor about this test if your cholesterol is borderline, especially if you’re debating whether to go on cholesterol-lowering medications, Goldberg says.

Cost: $15 to $265; not usually covered for routine screening but may be covered in part if you have risk factors.

4) Coronary calcium scan

A CT scan of your heart is used to look for specks of calcium in your arteries that may indicate early signs of coronary artery disease. While this scan is not recommended for everyone, it can be useful if you’ve got a family history or other risk factors. “A score greater than 300 tells us that you’re at increased risk of cardiovascular events in the next five to 10 years,” Goldberg says.

Another heart exam—an exercise stress test—isn’t a useful screening tool if you’re low risk, she adds, due to a high rate of false positives. As a rule, it’s best reserved for people who have risk factors or symptoms such as chest pain or an irregular heartbeat.

Cost: $10 to $300; not usually covered for routine screening, but may be covered in part if you have risk factors.

5) CRP (C-reactive protein) test

This measures blood levels of CRP, an inflammatory protein associated with heart disease. It’s most predictive in men over 50 and women over 60, Goldberg says. In a 2010 study, people in these age groups who were at intermediate risk of heart disease and who had normal cholesterol but high CRP levels benefited from going on cholesterol-lowering medications.

Cost: $10 to $115; not usually covered for healthy patients but often covered in part if you have risk factors.

6) Prostate exam

Screening for prostate cancer used to be a must. Now it’s a maybe. “Intuitively, it makes sense to treat prostate cancers early,” says Dr. Richard Wender, chief cancer control officer at the American Cancer Society. “But some grow so slowly that they’d probably never be life-threatening, and the treatment would be worse for quality of life than the disease itself.” That said, a study published in The New England Journal of Medicine this past March found that men under age 65 who underwent surgery for early-stage prostate cancer (instead of watchful waiting) had better survival rates.

Bottom line: At 50, talk to your doctor about your risks (like a family history). If you decide to undergo a PSA (prostate-specific antigen) blood test and it’s under 2.5 ng/mL, you can wait at least another two years to retest. If it’s over that, test annually.

Cost: $25 to $125 and may be covered by insurance for men older than 50, or starting at age 40 if you face certain risk factors.

 

 

 

MONEY home financing

If You Still Haven’t Refinanced, Now’s a Good Time (Again)

hand turning over house picture on cards
Mark Hooper—Getty Images

Homeowners who missed the last refinancing boom are being given another chance, albeit not quite as sweet as the last one.

Growing fears over the health of the global economy are sending ripples far and wide. Along with Wednesday’s cratering stock market and worrisome bond yields comes another consequence, albeit one that may carry a silver lining for some: Mortgage rates are at their lowest levels since June 2013.

According to mortgage website HSH.com, the rate on a conforming 30-year-fixed loan has dropped to about 4%, after hovering around 4.25% for most of the summer. That’s still well above the 3.5% some fortunate homeowners snagged back in late 2012, but certainly lower than where many economists expected rates would be today.

What’s behind the drop? “Growing concerns about weak economic growth in Europe caused a flight to quality into U.S. assets last week, leading to sharp drops in interest rates,” Mortgage Bankers Association chief economist Mike Fratantoni noted in a statement. The 30-year fixed rate tends to move in the same direction as 10-year Treasury yields, which fell below 2% on Wednesday morning for the first time in 16 months.

If you are among the homeowners who never took advantage of the historically low rates during the last refinancing boom, now could be your opportunity. Maybe you simply never got around to it (the so-called “failure to refinance” that strikes approximately 20% of homeowners who stand to benefit)—or, more likely, you didn’t qualify then. The good news is, now you might get approved.

“Some people over the last six months may have had things align so they can qualify,” says Keith Gumbinger, vice president of HSH.com. For example, previously you may have had a credit score below 740, the minimum threshold often required for the best rates. Or you didn’t have enough equity in your home; most lenders require a stake of at least 10% to 20%. The median home price nationwide, though, has shot up an average of 42% since its January 2012 bottom, according to the National Association of Realtors. That spike lifted millions of homeowners—nearly one million in the second quarter alone, according to Corelogic—out from underwater loans, meaning they no longer owe more on their mortgage than the place is worth.

Or maybe, like former Fed chairman Ben Bernanke, you’d just changed jobs last time and now have the two-year employment history lenders like to see.

“Is the drop in rates enough to drive a substantial amount of people into the marketplace? No,” says Gumbinger. “But it could open the window to a few stragglers.”

HSH.com offers calculators to help homeowners decide if the savings will be significant enough to make a refi worthwhile. A general rule is that you should aim to shave at least one percentage point off your current rate to benefit, Gumbinger says, although the sweet spot will vary depending on your goals, such as whether you’re aiming for a lower monthly payment or to pay less in total interest over the life of the loan.

Another potential opportunity for savings: refinancing into a shorter loan, such as a 15-year fixed mortgage, which runs about 3.35% today. If you’ve been in your home for a few years, you may find that a 15-year product offers a slightly lower monthly payment, as well as shaves thousands of dollars off the total interest.

Of course, you may be wondering if you should wait in case rates drop further yet. Gumbinger suggests that if you see a deal that works for you today, grab it. “American mortgage borrowers are benefiting from the trouble in the world,” he says. But there’s no telling how long that benefit will continue.

Related:
Money 101: What Mortgage Is Right for Me?
Money 101: How Do I Get the Best Rate on a Mortgage?
Money 101: How Much Will My Closing Costs Be?

MONEY Health Care

The Simple Way to Get a Flu Shot for Free

Flu Shot sign in pharmacy
Terry Vine—Getty Images

Under Obamacare, most Americans will pay nothing for an influenza vaccine. And skipping the shot can be costly.

When you think of the flu, the cost of getting sick probably isn’t the first thing that jumps to mind. But coming down with the virus can prove pricey.

A visit to the doctor’s office can run $80 to $100—or more. If you need to head to the ER on a night or weekend for care, the tab can easily total $500. With the average health plan deductible rising, you could owe the whole bill, or at least a decent share. In extreme cases, if you land in the hospital the cost (before insurance) can be $2,000 a day. And the average stay for the flu is about four days.

As a parent, you also need to think about time away from work if your child gets sick. A 2012 study found that when children under the age of 5 came down with the flu parents missed an average of seven work hours if the child was treated in an outpatient setting, 19 hours if the child went to the ER, and 73 hours if the child was hospitalized.

The good news is that you probably don’t have to pay a penny for the best defense against the flu. Under Obamacare, a flu shot is free as long as you have health insurance (though plans that were in place before the law passed in 2010, known as grandfathered policies, are exempt). It’s one of the preventive services that insurers must fully cover without charging you a co-pay or co-insurance—even if you haven’t met your annual deductible yet. Under Medicare, you also pay nothing.

Still, even though the U.S. Centers for Disease Control recommends that everyone older than six months get the vaccine annually, many skip it. Vaccination rates top 70% for children ages six months to four years and are almost as high for those 65 and older, according to the National Foundation for Infectious Diseases. But 18-to-64-year-olds lag, with fewer than 40% rolling up their sleeves last year.

Where to go for the vaccine

Your vaccine should be free as long as you choose a provider that’s in your plan’s network. That could mean making an appointment with your doctor, or walking into your neighborhood drug store, urgent care clinic, or big-box retailer. Walgreens, CVS, Target, Walmart, and Kroger all dole out the vaccine, though make sure the branch near you offers the service (not all do). You can use this vaccine finder tool to look up providers near you.

Without insurance or outside your insurance network, you’ll probably pay the list price. At Walgreens, that’s $30 to $55, depending on the form of vaccine. Although a shot in the arm is the most common, you have options, including a nasal spray.

This week Sam’s Club announced it will match any competitor’s price at its in-store pharmacies. Other stores are running flu shot promotions to get you in the door, offering discounts on whatever else you buy on your visit. One caveat: Not every state allows stores to vaccinate children, so call ahead.

Your employer may also offer flu shots in its medical center or conference room, letting you get in and out in five minutes. Some schools provide free shots for students. (In a few states, including New Jersey and Connecticut, it is mandatory that children in licensed day care centers and preschools be vaccinated.) Many community health centers also offer the vaccine.

No matter where you go, don’t worry about missing out: The National Foundation for Infectious Diseases reports a “plentiful” supply this year. But don’t wait until the last minute. It takes about two weeks for the protection to kick in.

MONEY health insurance

You Can Now Buy Health Insurance at Walmart. Should You?

America's largest retailer is expanding more aggressively into the insurance market, hoping to become the go-to place for all your health care needs. But the store is far from the only place to get your coverage questions answered.

UPDATED: 5PM ET

Want help choosing a health insurance plan? Superstore Walmart is betting that many consumers do—and that they will visit a big-box store for guidance.

The company announced this morning that it is teaming up with the health comparison website DirectHealth.com to house insurance agents in 2,700 of its 4,300 U.S. stores. The agents will help shoppers understand and compare individual insurance plans as well as private Medicare plans, including drug, supplemental, and Advantage policies.

The agents will be in stores from this Friday, October 10, through December 7, a time frame that captures the kick-off of the annual enrollment periods for both individual health plans and private Medicare policies. Medicare open enrollment starts October 15; you can begin shopping for an individual policy for 2015 on November 15.

“For years, our customers have told us that there is too much complexity when it comes to understanding their health insurance options,” said Labeed Diab, president of Walmart’s U.S. health and wellness group, in a press release announcing the program. Since 2005, Walmart has hosted insurance agents from individual insurers in some stores to answer questions and enroll customers in health plans. This new program expands on that.

A bid for more health care business

This move isn’t the first time Walmart has dabbled in health care. The company has been slowly adding retail clinics to many of its locations, letting shoppers get primary care such as strep tests and treatment for ear infections at the store. Walmart’s total number of clinics, though, falls far short of what pharmacy chains CVS or Walgreens offer.

By adding insurance agents to its stores, the retailer appears to be aiming to get consumers to think of Walmart as a one-stop resource for health care. Walmart will not receive commissions on the sale of health plans, the Associated Press reports, but hopes the agents will attract consumers who will then rely on the stores for other health care needs, such as prescriptions. The agents will receive a commission from the insurers whenever a patient enrolls in a plan in the store, The Washington Post reports.

Where else to get help

In announcing the program, Walmart noted that many consumers have difficulty understanding their health plans. While that’s true, Walmart will be just one of many places where you can find guidance. Other comparison websites, such as ehealthinsurance.com and gohealthinsurance.com, already offer online and call-in assistance, though neither have retail locations around the country.

So should you head to Walmart face-to-face help with an individual or Medicare plan? The store will offer individual plans from 300 carriers, and Medicare plans from 13 firms. So you should be able to find options in your area. But keep in mind what other help is out there.

•For individual health insurance plans: Unless you qualify for a special enrollment period because you, say, lost your employer-based coverage or got divorced, you are generally locked out from buying a new individual health insurance plan or switching policies until the annual open enrollment period, which this year begins November 15 and runs through February 15. You’ll be able to buy a policy either through your state insurance exchange (find yours at healthcare.gov), an insurer, a comparison website, or an insurance agent.

Once open enrollment begins, many community centers and non-profits around the country will be staffed with counselors, navigators, or other assisters who can offer explain a plan’s details (though many aren’t supposed to tell you which plan is best for you). Find a group offering assistance in your area at localhelp.healthcare.gov. For questions about a plan sold on the public exchange, Healthcare.gov lists the 1-800 number for your state.

Unless you qualify for a subsidized policy under Obamacare (in which case you may be required to buy through an exchange), you should compare policies on the exchanges with those sold directly by insurers. You can find a local insurance agent who can sell you an on- or off-exchange individual policy at nahu.org. Comparison websites also list details for both types of plans, though there’s no guarantee every off-exchange plan available from an insurer will be listed on each site.

One caveat: the in-store agents will be able to explain plan details and help with comparison shopping, but they won’t be able to actually enroll you in an individual plan in the store, according to a Walmart spokesperson. To sign up you’ll need to call Direct Health, Walmart’s partner, or go to the website. (The agents will be able to enroll you in a Medicare plan while you’re in the store.)

Keep in mind that while DirectHealth.com is required by law to list every plan available through the exchange, it won’t necessarily include the full details for each plan. Instead, the site attempts to determine which plans may best suit you, says Michael Mahoney, senior vice president of marketing at GoHealth, which powers the DirectHealth.com comparison site. “We want to make sure people have the right amount of choice without overwhelming them,” he says. You decide if you’d rather see all your options, or only a limited choice.

•For private Medicare plans: You can make changes to your Medicare drug or Medicare Advantage plan starting on October 15. It is a good idea to analyze your current plan and new options every year instead of sticking with what you’ve got, since plans and premiums change and new options appear.

The Medicare Rights Center offers a national help line (800-333-4114) to help seniors understand the program and determine if their income qualifies them for other resources, such as a prescription drug subsidy. Your local State Health Insurance Assistance Program offers one-on-one assistance to Medicare beneficiaries and their families. Find your state’s at shiptalk.org.

The medicare.gov tool run by the Centers for Medicare and Medicaid Services lets you compare plans in your local area. This tool also lists every possible plan available to you, which is not the case with Walmart’s program. For example, a 67-year-old woman who lives in one Northern California zip code and takes no drugs has 11 Part D prescription drug plans options listed on DirectHealth.com. On medicare.gov, that same woman would find more than 30 choices.

 

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