MONEY health

Reduce the Steep Cost of Diabetes

Timothy Archibald / Redux Pictures We had a large plastic container in the room and Eli had been playing in it the night before, putting his body all the way into it. I think I asked him if he wanted to make some photographs with it when it was sunny the next day. He started just being in it: standing, hiding beneath it. Then we realized that it could contain him lengthwise if he curled himself up as if he were in an egg.

Diabetes is common—and expensive. These steps can help lessen the impact.

Chances are you or someone you know has diabetes — or will soon.

Some 26 million Americans suffer from the disease, in which sugar builds up in the blood: 7 million of those are undiagnosed. Another 79 million are prediabetic, or at risk for developing the ailment.

Says Dr. Ron Loeppke, vice chairman of U.S. Preventive Medicine: “It’s a national crisis.”

And a costly one; diabetes patients can spend as much as several thousand a year out-of-pocket on treatment, says Loeppke.

If you have the disease or are in a high-risk group (have a family history of the illness and/or are overweight), try these strategies to keep the costs in check:

If you don’t have diabetes…

Take precautions. Make sure your doctor includes a blood-sugar screening in your physical; insurance will pick up the tab in almost all cases.

High-risk patients should get screened at least once a year, says Philadelphia-area primary-care doctor Charles Cutler.

And move more: In people with prediabetes, losing 5% to 7% of body weight and getting 150 minutes of exercise a week decreases the risk of developing diabetes by almost 60%, according to the Centers for Disease Control.

Struggle with your diet? Ask your doctor for a prescription to see a nutritionist — if you’ve been diagnosed as prediabetic, your insurer may cover the cost.

If you have diabetes…

Stick to older meds. Drug companies are touting new medications such as Januvia and Onglyza, designed to control blood sugar, but the drugs that have been around for years are just as effective for most people and often have fewer side effects, according to a 2011 report by the federal Agency for Healthcare Research and Quality.

Those who have a large co-pay for name-brand drugs or are on a high-deductible plan might pay a couple hundred dollars a month for the latest meds, while drugs such as metformin and glipizide are sold as generics and usually cost under $20 a prescription.

Save on supplies. Private insurance generally doesn’t pay for the home monitor, lancets, and testing strips needed to test blood-sugar levels multiple times a day.

Opt for the monitor that uses the cheapest testing strips, says Cutler, and order supplies in bulk from online wholesale supply firms.

Pay for supplies with pretax dollars via your work flexible spending account or see if you qualify for a medical tax deduction (you get a break on costs that exceed 7.5% of your adjusted gross income).

Seek support. Studies show that diabetics who join support groups better maintain normal blood-sugar levels.

Almost every large employer offers some sort of chronic-illness management program with access to nurses and support classes, according to the benefits consulting firm Towers Watson. Most major insurers do as well. Call your HR department or insurer and ask.

MONEY health

5 Things to Know About Foot Pain

Don't just tolerate frequent discomfort. Do something about it.

Recurring foot pain, a sign of ill-fitting shoes, and a red flag for a foot problem that could develop into something more serious.

1. Pay attention to everyday aches

Nearly 80% of people ages 21 and older have had a foot problem, according to a survey from the Institute for Preventive Foot Health.

Anything from improper shoes to high-impact exercise can trigger a condition. To avoid injury, take discomfort seriously.

Even seemingly minor issues, such as sore feet or bunions, can worsen and ultimately require costly surgery if left unchecked, says Dr. James Christina, of the American Podiatric Medical Association.

2. Fewer pounds mean happier feet

The institute also found that very obese people are 41% more likely to have a current foot issue and 16% more likely to have pain. No wonder: Walking puts up to three times your body weight on your feet with every step, says the group’s executive director, Robert Thompson.

Losing even a few pounds can reduce that wear and tear and may help shrink your risk of diabetes, which can cause foot pain from decreased circulation and nerve damage.

3. Good shoes are essential

Ill-fitting footwear is one of the biggest causes of problems. Look for a pair with a wide toe box, ankle support, and a firm grip on your heel.

Your foot extends when you walk, says Thompson, so pick a size that leaves a third to half an inch beyond the tip of your toes when you stand. He also suggests skipping cheaper brands, which sometimes use a sole that’s too small for the shoe, leaving wearers with wider feet unsupported.

4. Expensive orthotics may be overkill

Custom-fitted orthotics, which are worn inside shoes, can easily cost $300 to $500 – and are not often covered by insurance.

While serious athletes and people with foot abnormalities may need to spring for customized inserts, those who just need extra cushioning and support should stick with the $30-to-$50 off-the-shelf insoles available at running stores, says Dr. Steven Weinfeld, chief of foot and ankle surgery at Mount Sinai’s School of Medicine.

5. The right doctor will save your money

Whether you should see a podiatrist or an orthopedist depends on your condition.

In general, a podiatrist is the best bet for minor problems and for surgeries to correct chronic issues like hammertoes. Orthopedists are surgical specialists often recommended for breaks and other sudden injuries (they also tend to be more expensive).

Still not sure which doctor to see? Get an opinion from both types and compare treatments and prices.

MONEY Health Care

5 Things to Know About Dental Implants

Illustration: Gillian Blease Use your flexible spending account to save money by having dental implants done over two calendar years.

These alternatives to dentures have lots going for them—but the costs are higher.

Implants are a good long-term solution to replacing lost teeth, but they’re not cheap.

1. An implant beats bridges or dentures

Bridges, dentures, and implants replace missing teeth.

A bridge requires filing two adjoining teeth, which can make them weaker and prone to decay. Dentures often have fit problems and can interfere with taste.

For an implant, a titanium screw is placed in the jawbone and a prosthetic tooth is attached. A proper implant has no physical downsides and has good longevity, says Dr. Mark Wolff, associate dean at New York University’s College of Dentistry.

2. But you’ll pay a lot more for it

The problem with implants? Cost.

Implants are rarely covered by insurance, says MacKenzie Lucas, a spokesperson for benefits consultant Aon Hewitt.

Practitioners charge $3,000 to $4,500 for a single tooth. Most dentists refer patients to oral surgeons, periodontists, or prosthodontists.

If you need an implant near a nerve or sinus cavity, it’s worth paying for a dentist or surgeon who has specialized training.

3. Not all implants are equal

Most dentists use implants made by the original Swedish manufacturer; studies have found that these implants have high success rates (90% or more), says Dr. Michael Childers, dental director for the Florida region of Dental Care Alliance.

There are also some newer, generic implants that are cheaper but may not have been studied yet. So ask your doctor what kind of implant he uses and the success rate he’s had with it.

4. There are ways to nab discounts

Join a discount plan. and charge an annual fee of $80 and $99, respectively, and offer a 15% to 25% discount on implants (ask about availability and pricing before you join).

Visit a school. Advanced students at some oral-surgery programs may do implants under close supervision for a fraction of the usual cost. You can find local schools at the American Dental Association.

5. Timing can also help

Implants are usually a two-part process — first putting in the implant, then covering it with a crown six to 12 weeks later, says Wolff.

If you know you need one, schedule the initial procedure at the end of a calendar year, then have the crown put on in the following year. That way you can use two years’ worth of your pretax flexible spending account at work to pay a chunk of the cost. You’ll reap as much as 30% savings if you’re in a high tax bracket.

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