MONEY Health Care

Why You Could Get Stuck Paying for More of Your Health Care

Red traffic light
Your insurer may put a stop to how much it will spend on your surgery. iStock

A growing number of companies are capping what your insurance will pay for certain medical procedures. Get more expensive care, and you could be on the hook for the extra.

Aiming to contain health care costs, a growing number of employers and insurers are adopting a strategy that limits how much they’ll pay for certain medical services such as knee replacements, lab tests and complex imaging. A recent study found that savings from such moves may be modest, however, and some experts question whether “reference pricing,” as it’s called, is good for consumers.

The California Public Employees’ Retirement System (CalPERS), which administers the health insurance benefits for 1.4 million state workers, retirees, and their families, has one of the more established reference pricing systems. More than three years ago, the agency began using reference pricing for elective knee and hip replacements, two common procedures for which hospital prices varied widely without discernible differences in quality, says Ann Boynton, CalPERS’ deputy executive officer for Benefit Programs Policy and Planning.

Working with Anthem Blue Cross, the agency set $30,000 as the reference price for those two surgeries in its preferred provider organization plan. Members who get surgery at one of the 52 hospitals that charge $30,000 or less pay only their plan’s regular cost-sharing. If a member chooses to use an in-network hospital that charges more than the reference price, however, they’re on the hook for the entire amount over $30,000, and the extra spending doesn’t count toward their annual maximum out-of-pocket limit, Boynton says.

“We’re not worried about people not getting the care they need,” says Boynton. “They have access to good hospitals, they’re just getting it at a reasonable price.”

In two years, CalPERS saved nearly $6 million on those two procedures, and members saved $600,000 in lower cost sharing, according to research published last year by James C. Robinson, a professor of health economics at the University of California, Berkeley, and director of the Berkeley Center for Health Technology. Most of the savings came from price reductions at expensive hospitals.

The agency recently set caps on how much it would spend for cataract surgery, colonoscopies, and arthroscopic surgery, Boynton says.

Experts say that reference pricing is most appropriate for common, non-emergency procedures or tests that vary widely in price but are generally comparable in quality. Research has generally shown that higher prices for medical services don’t equate with higher quality. Setting a reference price steers consumers to high-quality doctors, hospitals, labs and imaging centers that perform well for the price, proponents say.

Others point out that reference pricing doesn’t necessarily save employers a lot of money, however. A study released earlier this month by the National Institute for Health Care Reform examined the 2011 claims data for 528,000 autoworkers and their dependents, both active and retired. It analyzed roughly 350 high-volume and/or high-priced inpatient and ambulatory medical services that reference pricing might reasonably be applied to.

The overall potential savings was 5%, the study found.

“It was surprising that even with all that pricing variation, reference pricing doesn’t have a more dramatic impact on spending,” says Chapin White, a senior policy researcher at RAND and lead author of the study.

Even though the results may be modest, a growing number of very large companies are incorporating reference pricing, according to benefits consultant Mercer’s annual employer health insurance survey. The percentage of employers with 10,000 or more employees that used reference pricing grew from 10% in 2012 to 15% in 2013, the survey found. Thirty percent said they were considering adding reference pricing, the survey found. Among employers with 500 or fewer workers, adoption was flat at 10% in 2013, compared with 11% in 2012.

The approach is consistent with employers’ general interest in encouraging employees to make cost-effective choices on the job, whether for health care or business supplies, says Sander Domaszewicz, a principal in Mercer’s health and benefits practice.

This spring, the Obama administration said that large group and self-insured health plans could use reference pricing.

The health law sets limits on how much consumers have to pay out of pocket annually for in-network care before insurance picks up the whole tab—in 2015, it’s $6,600 for an individual and $13,200 for a family plan. But if consumers choose providers whose prices are higher than a plan’s reference price, those amounts don’t count toward the out-of-pocket maximum, the administration guidance said.

Leaving consumers on the hook for amounts over the reference price needlessly drags them into the battle between providers and health plans over prices, says White.

“You expect the health plan to do a few things: negotiate reasonable prices with providers, and not to enter into network contracts with providers who provide bad quality care,” White says. “Reference pricing is kind of an admission that health plans have failed on one or both of those fronts.”

Some experts, however, say the strategy can work for consumers.

“What I think is that reference pricing is a choice-preserving strategy, when you look at the alternative, which is a narrow network,” says Robinson.

That may be a question of semantics, if relatively few providers meet the reference price.

Recent guidance from the administration spells out some of the requirements that health plans must meet in order to ensure that there are adequate numbers of high-quality providers if reference-based pricing is used. Among other things, it suggests that plans consider geographic distance from providers or patient wait times.

Like so much about reference pricing, it remains a work in progress. The administration says it will continue to monitor the practice, and may provide additional guidance in the future.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

MONEY 529 plans

Why the Best College Savings Plans Are Getting Better

stack of money under 5-2-9 number blocks
Jan Cobb Photography Ltd—Getty Images

Low-cost 529 college savings plans continue to rise to the top in Morningstar's latest ratings.

Competition is creating ever-better investment options for parents who want to save for their kids’ college costs through tax-preferred 529 college savings plans, according to Morningstar’s annual ratings of the 64 largest college savings plans.

In a report released today, the firm gave gold stars to 529 plans featuring funds managed by T. Rowe Price and Vanguard. The Nevada 529 plan, for example, which offers Vanguard’s low-cost index funds, has long been one of Morningstar’s top-rated college savings options. The plan became even more attractive this year when it cut the fees it charges investors from 0.21% of assets to 0.19%, says Morningstar senior analyst Kathryn Spica.

“In general, the industry is improving” its offerings to investors, Spica adds.

You can invest in any state’s 529. In many states, however, you qualify for special tax breaks by investing in your home-state 529 plan. If you don’t, you should shop nationally, paying attention to fees and investment choices.

Morningstar raised Virginia’s inVEST plan, which offers investment options from Vanguard, American Funds and Aberdeen, from bronze to silver ratings, in part because Virginia cut its fees from 0.20% to 0.15% early this year.

Virginia’s CollegeAmerica plan continued as Morningstar’s top-rated option for those who pay a commission to buy a 529 plan through an adviser. American Funds, which manages the plan, announced in June it would waive some fees, such as set-up charges.

But there are exceptions. Morningstar downgraded two plans—South Dakota’s CollegeAccess 529 and Arizona’s Ivy Funds InvestEd 529 Plan—to “negative” because of South Dakota’s high fees and problems with Arizona’s fund managers.

Rhode Island’s two college savings plans moved off the negative list this year after the state started offering a new investment option based on Morningstar’s recommended portfolio of low-cost index funds. Given the potential conflict of interest, Morningstar did not rate the plans in 2014.

Joseph Hurley, founder of Savingforcollege.com, which also rates 529 plans, says he hasn’t analyzed the Morningstar-modeled funds because they are new and don’t have enough of a track record. But, he adds, the Rhode Island direct-sold 529 plan offers several low-cost index fund options.

Here are Morningstar’s top-rated 529 plans for 2014:

State Fund company Investment method Expenses (% of assets) for moderate age-based portfolio (ages 7 to 12) Five-year annualized return for moderate age-based portfolio (ages 7 to 12)
Alaska T. Rowe Price Active 0.88% 11.25%
Maryland T. Rowe Price Active 0.88% 11.42%
Nevada Vanguard Passive 0.19% 8.65%
Utah Vanguard Passive 0.22% 8.01%

Related:

 

 

 

MONEY Love + Money

Ladies, This Is Why You Should Let the Guy Pay on the First Date

He wants to impress you. So let him, says Love + Money columnist Farnoosh Torabi.

A confession to the men I’ve dated: If I ever insisted on paying my half at the end of a first date when you offered to treat, it may have been because I never wanted to see you again.

My persistence to pay was—at best—code for, “Let’s just be friends.” At worst, “Beat it.”

We all carry assumptions surrounding that first date bill and how it ought to be settled. When those expectations aren’t met, the evening could end awkwardly. She might be offended if he doesn’t let her pay; he might be annoyed if she doesn’t at least offer to chip in.

It’s an early stage financial crossroads that could make or break chances for a second date.

So, when in doubt, how should men and women best handle that first date tab? And was I right to offer to split the bill if I didn’t like the guy?

I tapped relationship experts Marni Battista, founder of DatingWithDignity.com and Bernardo Mendez of Your Great Life TV for some guidelines.

Men: Offer to take the lead.

Battista and Mendez both agree that it’s generally best for men to pay on a first date. Yes, even still in 2014—a time in which, as I myself have written, women often outearn men.

But the fact of the matter is that men typically want to pay: In a poll last year conducted by LearnVest and T.D. Ameritrade, 55% of men said they thought the guy should take the check. As Mendez explains, many men feel fulfilled and accomplished when they see an opportunity to provide, even if it’s in simple ways like paying for a drink.

Perhaps more importantly, paying is a way for him to preen. “Even a guy who doesn’t make much money if he really likes you will try to impress you to the utmost that he can,” says Battista

As for women? “In my experience, 90% will be offended if a guy doesn’t offer to pay,” says Battista.

The data seems to support her claim, at least to some extent. That LearnVest poll found that 63% of women expect the guy to pay. And when researchers at Chapman University recently surveyed more than 17,000 people on the topic of first-date finances, they found that 39% of women who offered to pay said they secretly hoped the men would not let them. Meanwhile, 44% of women said they were annoyed when expected to help pay the bill.

So guys, pick up the check. It’s just a first date dance move that—more often than not—leaves each person happy and satisfied.

The exception: If she asks him out and picks the place, the experts say, she ought be prepared to settle the bill.

Women: “Practice Being Courted”

In the olden days, men routinely paid because women, generally speaking, didn’t have the means to do so. But if he offers to pay nowadays, it’s not because he thinks she can’t handle it; and he’s not trying to offend. He’s most likely just doing what feels instinctively appropriate in the moment.

So when he offers to pick up the tab, says Battista, “Let him. Practice being courted.”

Mendez agrees, and says letting him pay initially can be a small way of letting a relationship blossom. “It does let him know, in a subtle yet important way, that you are the kind of woman who is confident enough to accept his generosity,” he says.

This is not meant to set some sort of precedent where he pays all the time.

Remember that you can—and should—reciprocate (assuming there’s a next time). Let him pay for the first date and then offer to treat him the very next time you go out.

Or, if you’re planning to stay out after dinner, offer to grab a round of drinks or dessert at the next stop. This way you both get to practice your generosity, and it feels a bit more romantic than going halfsies all the time.

But what if she’s just not that into him?

Okay, but say she decides midway through the date—or even five minutes in—that this relationship has no future. Should she accept his offer to pay, or would that be leading him to think she’s interested in seeing him again?

The experts don’t see eye to eye on this. According to Mendez, “If during the course of the first date you decide that you absolutely don’t want to see this guy again, insisting on paying for your half can help you signal more clearly that you’re not open to it.”

Battista, on the other hand, says women shouldn’t worry too much about sending mixed signals by accepting his offer to pay.

“A lot of women think, ‘if he takes me out, then I owe him something,'” she says. “You don’t owe him anything. If he wants to pay, either be direct [and turn him down] or just allow him to pay because that’s part of the game of dating.”

Farnoosh Torabi is a contributing editor at MONEY. She is the author of When She Makes More: 10 Rules for Breadwinning Women.

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 First-Time Dad

Why Work-Life Balance Is Just As Impossible for Dads

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This mug is what I'm missing out on when I'm working late.

We're struggling with the same issues working moms face, says MONEY reporter and first-time dad Taylor Tepper.

Sometimes I feel like a bad dad.

Doubts over my parental savvy often correlate with how long I’m at the office. When I call to tell Mrs. Tepper that I’ll be here until 7:30 p.m. working on a magazine feature—and won’t be home to put our son Luke to bed—the soft disappointment in her voice stays with me like a faint ember.

The same guilty feelings apply to my job, too.

I’m 28 and now is the time to work long hours, take on more responsibility and show my bosses just how willing I am to immolate myself for the greater good. Every time I leave the building at 5:30 p.m., a part of me thinks I’m sacrificing future promotions, raises and glory.

What it means to be an American father, and the responsibilities therein, have changed radically in the last few decades. In 1975, 45% of families consisted of a male breadwinner and a stay-at-home mom; today 31% do. And now, men are taking on more chores and spending more time with their children than their dads spent with them.

But this blending of gender roles has done much to confuse the male mind. We want to spend more time with the kids and earn accolades on the job; we want to attend the soccer game and become senior management; we want to be Bill Cosby and Steve Jobs.

Many of us feel—just as working moms do—that we’re succeeding at neither.

The Research Backs Me Up on This

According Boston College’s Center for Work & Family, 86% of dads agreed or strongly agreed that “my children are the number one priority in my life.”

That’s well and good.

At the same time, though, more than three in four fathers wished to advance to a position with greater responsibilities and three in five demonstrated a strong desire to reach senior management.

Half of working dads say they find it very or somewhat difficult to balance the responsibilities of work and family, according to Pew.

And on the whole, we don’t feel like we’re living up to the dad role either. Almost eight in 10 dads want to spend more time with their children on an average workday, and one in two say they spend too little time with their kids. (Only 23% of mothers feel that way.) From first-hand experience, there is nothing quite as enervating as coming home from work to an already-sleeping son.

In Boston College’s research, you also see dads grappling with perceptions of what they want and the reality of how things are.

While today’s fathers also recognize that parenting is a two-person job—65% say they believe that partners should take care of a child evenly—only one in three say that they actually split the work in half. Women typically spend more than three times as many hours per week solely looking after the child than men.

Even on weekends, men fail to live up to their ideal. On Saturdays and Sundays, moms spend 1.2 more hours on housework and childcare than dads do. When it comes to time spent on leisure activities, dads out-loaf moms by an hour.

While Mrs. Tepper and I have something of a modern marriage—split chores, female breadwinner—she almost certainly watches Luke more on the weekends, especially when sports are on.

In spite of my few hours more on the couch, however, I’d still argue that achieving and maintaining true work-life balance is impossible. You can’t achieve these competing goals—working at the top of my game, being the best dad and husband ever, and getting in a few NBA games to recharge my own engine—within a finite number of hours in the day.

So, What Is a Modern Dad to Do?

I put that question to Sara Sutton Fell, the CEO of FlexJobs.com, a job search site focusing on companies that allow for flexible schedules and telecommuting. Her advice: to think of work-life balance as more of a journey than a destination.

“As a working parent with two young sons, I believe that work-life balance is often mistaken as an end-point that we reach eventually,” she says. “In my experience, it’s more of a balancing act—shifting your weight back and forth between your various responsibilities.”

Some days you’re going have to work long hours at the office to close out a project or meet a deadline, in other words; and some days you’re going to work from home to take your kid to the doctor.

Try to find an employer that will embrace that flexibility, Fell says.

This makes sense.

But we’ve also got to try to overcome our own guilt. That means accepting our limitations as parents and workers and people, and setting realistic expectations for ourselves.

It’s difficult to remember, but today’s dads spend more time with their kids than their fathers spent with them by a factor of three. Today’s fathers are by and large more engaged in their kids’ lives than previous generations. So we’re definitely doing better, if not up to the standards we’d hold for ourselves.

When I’m stuck in the office until dark, maintaining that perspective is difficult. But I try to remember that the next morning I’ll be there when Luke wakes up, and with any luck, arrive home in time to help his mom put him to sleep.

And if not, there’s always tomorrow.

Taylor Tepper is a reporter at Money. His column on being a new dad, a millennial, and (pretty) broke appears weekly. More First-Time Dad:

MONEY family money

This Company Will Give You $500 If You Have a Baby Today. Wait, What?

141017_FF_BabyMoney
Mike Kemp—Getty Images

It's no joke. As part of its rebranding campaign, investment firm Voya will give money to the newest of new parents.

Lucky for you if you’re in labor right now.

A company called Voya Financial has announced that it will give every baby born today—Monday, Oct. 20, 2014—500 bucks.

The promotion, timed to coincide with National Save for Retirement Week, is part of a marketing campaign to alert the public that the business that once was the U.S. division of ING is now a separate public company with a new name.

Get out the castor oil and order in Indian if you’ve already hit 40 weeks, because the offer is only available to those who exit the womb before midnight tonight—though soon-to-be-sleep-deprived new parents have until December 19 to register a child.

Voya estimates that it may have to kick in as much as $5 million, since there are about 10,000 babies born every day in the U.S.

While the company has promised that families will not have to sit through a marketing pitch to get the money, and that the baby’s information would be kept private, this special delivery still comes with a catch.

The money is automatically invested into Voya’s Global Target Payment Fund, which according to Morningstar has above-average costs and below-average performance.

Regarding the fees, Voya’s Chief Marketing Officer Ann Glover says that the funds Morningstar uses as comparison are not apples to apples. In any case, Glover says families are free to sell out of the fund if they so choose. “Of course, we would hope people would hold on to the investment,” she adds.

But hey, money is money, so if you’re due, you may as well take what you’re due.

And for those mamas and papas whose progenies aren’t quite ready to make their debuts? While you won’t get money from Voya, you may have other opportunities to get big bucks for your little one.

Start by checking in with your employer to see whether the company helps with college savings. A growing number do. Unum, for example, offers its workers with newborns $500 towards a college savings account.(Our Money 101 can help you find the best 529 college savings plan.)

Also, in several communities around the country, charitable or government programs seed savings accounts for kids. For example, residents of northern St. Louis County in Missouri can get $500 through the 24:1 Promise Accounts. Babies born in Connecticut get $100, plus $150 in matching funds by age four, thanks to the CHET Baby Scholars program.

“This is gaining significant momentum nationwide,” says Colleen Quint, who heads one of the nation’s most generous free savings program, the Harold Alfond College Challenge. Started by the founder of Dexter Shoes, the charity gives every resident newborn in Maine a $500 college savings account.

In fact, Mainers can get the most free money for their children according to a survey of such programs by the Corporate for Enterprise Development, which has gathered details on at least 29 free childrens’ savings programs.

Besides the $500 college savings account, a state agency will match 50¢ for every $1 parents contribute each year up to $100 a year and $1,000 over a child’s lifetime. So Mainers can, in theory at least, get up to $1,500 in free college savings money on top of any additional freebies they can get from companies.

That should be more than enough to buy a chemistry textbook in 2032.

MONEY psychology of money

Why You Almost Never Dream About Money

woman sleeping at night
You're more likely to be dreaming about cats than checkbooks. rubberball—Getty Images

If your sleeping hours are filled with visions of your financial life, you're in the minority. Here's what that means.

In your sleep, do you dream about money? Surprisingly, most people do not—at least not literally. And if you believe the thoughts that enter your head while you sleep actually mean something, this may suggest we’re shockingly content.

Dream analysts say that winning the lotto or a boat, or getting a bonus aren’t even among the top 50 most common thoughts in slumber. Money is nowhere to be found on a state-by-state chart of popular dream symbols. The dream map is dominated by things like “family” in Texas, “cats” in New York, “pigs” in Nebraska, and “sex” in perhaps the most honest states Missouri and New Hampshire.

We each have three to nine dreams per night, and most of us think about money everyday. Yet up and down the list of most common nighttime visions are things like dancing, school, guns, drugs, movies, and food. Nothing about greenbacks. Zilch. “This shows that people place more importance on the quality of their real happiness,” says dream expert Anna-Karin Bjorklund, author of Dream Guidance. “If you never dream about money, chances are your happiness is not related to feeling powerful or having the means to acquire material possessions.”

That’s good, right? Our subconscious is telling us that our pets and friends and experiences are what we really care about—even if we’re carrying a credit card balance and haven’t earned a decent raise in five years. To a degree this confirms much of what polls have shown since the Great Recession: a broad rediscovery of basic values and things that money can’t buy.

But before we congratulate ourselves on being phenomenally high-minded, we need to dig a little deeper. For one thing, materialism creeps onto the dream list in the form of “beach house” in Alabama; in the fourth richest state in America, Connecticut, “shopping” and “malls” make the top-five list. “Cruise ship” sneaks onto the list in Florida.

Besides, dreams are rarely literal—and thankfully so because on the list of popular dream subjects we find cheating, adultery, cemetery, and murder. If you dream about doors opening or being given the keys to an important room—that may be dreaming about a cash windfall, says dream expert Kelly Sullivan Walden, author of It’s All in Your Dreams. And, she says, “If you’re stressed about money in your waking life, you might find yourself dreaming of a leaky faucet, animals fighting over food, or your teeth falling out.”

Got that? How you view whatever you are dreaming is far more important than the dream itself. “If you have a dream where someone is stealing your vegetables, this could indicate that you feel what you’ve been planting has been taken away,” says Bjorklund. According to dream expert Lauri Loewenberg, author of Dream On It, financial stress also shows up in dreams as:

  • Drowning (debt)
  • Bleeding (savings disappearing)
  • Falling (diminishing financial security)
  • Getting lost (directionless career)
  • Calling 911 but no one answers (poor financial advise)

“Dreams are symbolic and speak to us in metaphors,” says Loewenberg. “If you want to look for your dreams to help you with your financial situation, they will, but they may not use money to get the message across.” So maybe a good deal of our subconscious nighttime adventures are about money after all. We just don’t know it.

MONEY Shopping

Here’s How to Save Hundreds on Groceries

Shopping Carts
Baldomero Fernandez

These 29 surprising and easy moves will help you find the best prices, avoid the sneakiest store tricks, and prevent those costly impulse buys.

Regardless of whether you’re feeding just yourself or a whole family, you probably find that groceries take a big bite out of your paycheck.

Food is the third-largest household expense, the Bureau of Labor Statistics reports. And for a family of four, the average monthly tab runs between $568 for the super thrifty to $1,293 for those on a more liberal budget, according to the USDA.

MONEY consulted supermarket-savings experts for strategies that would help you trim the fat, without giving up the foods you love. Employing just a few of these 29 tricks—because let’s face it, you hardly have time to cook let alone turn shopping into a project—can take your bills down by 25%.

In other words, you could realize between $1,700 and $3,900 in annual savings.

Now that’s pretty delicious.

Plan Ahead

1. Do an inventory. Take stock of your pantry and freezer once a month to get a sense of what items you need and what you can skip buying, says Annette Economides, co-author of Cut Your Grocery Bill in Half with America’s Cheapest Family. Her husband and co-author Steve adds, “you don’t want to get in a panic when you’re in the grocery store and impulse buy an item at full price only to go home and find you’ve already got it.” Use an app like Out of Milk to help with your inventory.

2. Plan meals by the ads. “A lot of people make a weekly meal plan and then go look for a deal,” says Steve Economides. “Instead, look first at the deals and plan your meals around what’s on sale. This way, you can get meals for half price.”

3. Use up your pantry. Americans typically toss about 25% of the groceries we buy, according to the National Resources Defense Council. To prevent your food from turning into wasted money, sort through your fridge and pantry about once a week for items that are about to expire and place those in a designated space so that you remember to eat them before they go bad. Plug in what you’ve got at Supercook to find recipes that will help you use up your ingredients.

4. Shop only once a week. “The less you shop, the more you save,” says Annette Economides. Reduce impulse purchases and save gas by planning your shopping list so that you get a week’s worth of groceries in one shot.

5. Look for substitutes. Review your last grocery receipt and circle your most expensive purchases. When you’re next in the store, consider swapping these items for lower-cost alternatives—like ground turkey for ground beef. Subbing out a few items each trip can add up.

Get the Best Price

6. Do some reconnaissance. Pick the 10 or so items you most commonly buy (e.g. milk, cereal, bananas, chicken, detergent) and make a one-time mission to a few stores in your area (supermarket, Walmart, Target, Costco, dollar store) to compare the prices. A spreadsheet like this one from the Balancing Beauty & Bedlam blog can help. Your goal: to find out if you’re actually shopping the store with the lowest overall prices for your needs, says Stephanie Nelson, founder of the CouponMom.com.

7. Know the rock-bottom price. Learn the price range of the items you buy most frequently so that you’ll be able to recognize when they hit their lowest and stock up then, says Nelson. “For my family, one of our biggest grocery expenses is boneless chicken breast,” she says. “In my area, they’ll drop to $2 a pound and peak at $5 a pound over the course of three weeks. By stocking up at the lowest price, I’ve saved nearly $500 a year on just one item.”

8. Be wary of 10 for $10 sales. Or any promotion in which a store is offering several items for one price. Check the price of the item to make sure it is actually discounted, and not just clever signage making you think 89¢ cans being sold 10 for $10 is a steal. Also, if it is actually a discount, keep in mind that you don’t need to buy 10 to get the lower price.

9. Weight it out. Compare items by not just the sticker price but the price per ounce or pound to be sure you’re getting the best deal. Most stores post this number on the label on the shelf. For meats, look at the cost per serving instead so the bones and fat included in the weight of the item don’t mislead you.

10. Download coupons… Couponing doesn’t require circulars and scissors anymore. Visit Coupons.com, SmartSource.com or redplum.com to easily see what coupons are currently available in your area, then either print them out or load them onto a store loyalty card so you don’t even have to remember to bring them with you, says Nelson.

11. …then deploy them wisely. “When we find a coupon, we feel like we must use it right away,” says Nelson. “But wait until the item is at a really good sale price. This way you get savings from both the store discount and the coupon.”

12. Buy for 10 weeks at a time. Sales run through cycles, typically on an eight to12 week rotation, lifestyle and money-saving blogger Leslie Lambert of Lamberts Lately found. So if you know you’ll go through a box of cereal a week, buy 10 when they’re a deal to see you through the weeks when the item will be at full price.

13. Get an IOU. If a sale item is out of stock, ask the store for a rain check. It’s a slip of paper that grants you the sale price once the item’s back in stock regardless of whether the promotion is still running. Or if you don’t want to come back into the store, ask a manager if you can sub a similar item for the one on sale, recommends Annette Economides.

14. Photograph your receipt. You can earn cash-back on your groceries with apps like Ibotta, SavingsStar and Checkout51. These services offer weekly cash-back deals on a range of goods and all you need to do is take a photo of your receipt showing you bought the item to take advantage of the kickback, says Nelson.

Be Smarter in the Store

15. Be loyal. Pick one grocery store and one drugstore you go to frequently. “Sign up for their loyalty programs and get familiar with the promotions they run and what rewards they give out,” says Nelson. Understanding the program will help you concentrate your efforts so that you can get items for free, she notes.

16. Learn the layout. The more aisles you walk down, the more likely you are to add things to your shopping basket that you hadn’t initially intended to buy. Shoppers who decreased the number of aisles they visited checked out with only half their items being unplanned purchases vs. 68% of items for those who visited most or all aisles in a shop, according to a Marketing Science Institute study.

17. Go alone. The larger your shopping party, the more likely you are to make impulse purchases. About 65% of the items in our baskets when we group shop are unplanned, an eight percentage point increase over shopping alone, according to that same Marketing Science Institute study. So leave your spouse and your kids behind.

18. Pack mints. Or eat before you go. A study in the Journal of Consumer Research found that consumers are likely to spend more if their appetites have been stimulated beforehand. That’s probably why baked goods and rotisserie chickens are placed by the entrance of the store. Combat those tempting odors by eating a mint—which satiates hunger and can help overwhelm other scents—or by making sure your belly is full.

19. Bring your own soundtrack. Studies show that stores play music with a slower beat to encourage you to move more slowly through the aisles. That slower pace can lead shoppers to buy 29% more, found Martin Lindstrom, author of Brandwashed: Tricks Companies Use to Manipulate Our Minds and Persuade Us to Buy. Create your own mix of upbeat songs.

20. Use a Goldilocks cart. Lindstrom told CNBC that doubling the size of a cart makes people buy 40% more. And opting for those handheld baskets can be equally dangerous. A study from the Journal of Marketing Research found that the strain of carrying the basket made us more likely to pick up “vice products” like candy and soda as an unconscious reward for putting up with the hassle. Opt instead for a smaller wheeled cart.

21. Look high and low. Avoid the middle shelves and end caps. Companies pay to place products at your eye level—and your kid’s. Scan the top and bottom shelves instead as most of the time you’ll find the less expensive brands and best deals there.

22. Check yourself out. Impulse purchases dropped by 32% for women and about 17% for men when shoppers used the self-checkout line instead of a staffed checkout, found a study by IHL Consulting Group. The reason: There is less merchandise for you to pick up last minute around self-checkout stands, and the wait time is typically shorter—giving you less time with those tempting items.

Save on Specifics

23. Skip the deli. Whether you’re buying freshly cut meats from behind the deli counter or pre-sliced by the hot dogs, you’re spending more on cold cuts than you need, according to Steve Economides, who instead opts for large chunks of prepackaged meat called chubs. He then asks the deli or the butcher to slice the chubs for him. “At the deli, I can get a pound of ham for $7 to $9,” says Economides. “If I go to the meat counter and have a chub of ham sliced, it costs between $3 and $5 a pound, meaning I can save up to 66%.” You could also cook up larger portions of a meat, say a roast beef, and slice up those extras for sandwiches.

24. Do your own slicing and dicing. Prepackaged and single-serving foods are easy mark-up territory. (Example: Through New York City’s Fresh Direct delivery service, we found a cut and cored pineapple cost $5.99 while an uncut pineapple cost $3.99.) Though it may be more time-consuming, buy the whole chicken, block cheese or pineapple and do the chopping yourself. You can create your own smaller servings—say, for school lunches—by dividing up the food into baggies or Tupperware.

25. Don’t get milk at the supermarket. Moo juice sold at drugstores and convenience stores typically costs 30¢ to 50¢ less per gallon, Teri Gault, founder of TheGroceryGame.com, told Reader’s Digest.

26. Grow your own herbs. Stop buying bundles of herbs—at $2-plus a pop—that you’ll never be able to use up in time and instead plant a couple pots with fresh herbs to keep in your kitchen or porch. For a one-time cost of around $5, you’ll always have fresh herbs ready, and you won’t end up wasting any.

27. Follow the produce cycle. “You can save 30-50% on the price of produce by buying what’s in season,” says Annette Economides. If you do want those berries in the off-season, buy extra when they’re cheap and freeze them so you can enjoy them year round. For a guide to when certain produce is in peak-season, see this chart from the USDA.

28. Check seafood labels. At the counter you’ll find products labeled “previously frozen” in small type. That product is often the same thing you can find in the frozen-food aisle for as much as 40% less. Buy frozen and do the thawing yourself. Your fish will be fresher and you won’t have to use it right away.

29. Get meat in bulk. Washington-based Zaycon Foods offers consumers very competitive rates—e.g. chicken breast for $1.79 a pound—for those willing to buy orders starting at 40 pounds. To get these deals, you’ll have to order online and then pick your food up at a prearranged time from the back of a refrigerated truck waiting in a church or shopping center parking lot. Can’t store 40 pounds of meat? Split it with a friend, and you’ll both save.

Read next: Amazon Will Start Delivering Fresh Groceries in New York Today

MONEY Kids and Money

You Can Teach a Two-Year-Old How to Save

child's hand with ticket stubs
Frederick Bass—Getty Images/fStop

Worried about your children's retirement? With the help of a few carnival tickets, says one financial adviser, you can get them started early on saving.

A new type of retirement worry has recently surfaced among my clients. These investors are concerned not just about their own retirement, but about their children’s and even grandchildren’s retirement as well.

Much of our children’s education is spent preparing them for their careers. But in elementary school through college, there is little discussion about what life is like after your career is over. Little or no time is spent educating children about the importance of saving — much less saving for their golden years.

When it gets down to the nitty-gritty, parents want to know two things: One, at what age should they start teaching their children about saving? And two, what tactics or strategies should they use to help their children understand the importance of saving?

While parenting advice can be a very sensitive subject, discussing these questions has always worked out well for my clients and me. I keep the conversation focused around concerns they have brought up. In a world where student debt is inevitable and other bills such as car loans and mortgage payments add up quickly, parents are concerned for their child’s financial future. We now live in a debt-ridden, instant-gratification society, so how can our children live their lives while still saving for the future?

Here is what I tell my clients:

You can start teaching children the value of saving as early as two years old. At this age, most children don’t necessarily grasp the concept of money, so instead I recommend the use of “tickets” or something similar — maybe a carnival raffle ticket. As a child completes chores or extra tasks, he or she receives a ticket as a reward. The child saves these tickets and can later cash them in at the “family store.” This is where parents can really get creative: The family store consists of prepurchased items like toys or treats, and each item is assigned a ticket value. The child must exchange his or her hard-earned tickets to make a purchase.

I’ve seen first hand, and been told by others, that the tickets end up burning a hole in children’s pockets. They want immediate gratification, so they cash their tickets in for smaller, less expensive prizes. This is where parents can begin to really educate kids. Through positive reinforcement, they can encourage their children to save their tickets in order to purchase the prize they are really hoping for.

Eventually, saving becomes part of the routine. As children receive tickets, they stash them away for the future with the intentions of buying the doll, bike, video game or whatever their favorite prize may be.

As the child gets older, parents can transition to actual money using quarters or dollars. Now the lesson has become real. Parents can also implement a saving rule, encouraging the child that 50% of the earnings must go straight to the piggy bank. By age five, most children can grasp the concept of money and can begin going to an actual toy store to pick out their prizes. By starting out with tickets, parents are able to educate children about the power of saving at a younger age. By switching over to real money, children can then begin to learn the importance of saving cash for day-to-day items while still setting aside some money for later.

While this tactic may seem like it’s just fun and games, I have received feedback from several clients and family friends that it does in fact instill fiscal responsibility at a young age. Most importantly, I have seen it work first hand. My wife and I used this system with our five-year-old daughter. She was like most children in the beginning and wanted to spend, spend, and spend. Now, it is rare that she even looks at her savings in her piggy bank. She has graduated to real money and seems to really value its worth. She identifies what she wants to buy and sets a goal to set enough money aside for it. Before purchasing, she often spends time pondering if she actually wants to spend her hard earned money, or if she wants to continue saving it. In less than a year, she developed a true grasp on what it means to save and why it is important.

By implementing this strategy, financial milestones like buying their first car, paying for college, or purchasing their first home could potentially be a lot easier for both your clients and their their children. And the kids will learn the value of saving for their retirement, too.

———–

Sean P. Lee, founder and president of SPL Financial, specializes in financial planning and assisting individuals with creating retirement income plans. Lee has helped Salt Lake City residents for the past decade with financial strategies involving investments, taxes, life insurance, estate planning, and more. Lee is an investment advisor representative with Global Financial Private Capital and is also a licensed life and health insurance professional.

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