MONEY Medicare

How to Make Sure Medicare Really Covers Your Hospital Stay

hospital patient in bed
Masterfile—Radius Images

Many Medicare patients are surprised to learn they weren’t officially admitted to the hospital—and they face big bills. Here's how to avoid the problem.

If you’re on Medicare and you have to be admitted to the hospital, don’t make the mistake of assuming your costs are covered. Find out whether your visit is being treated as an inpatient admission or a so-called observational stay. The distinction could cost you a lot of money—and it may even limit your access to a skilled nursing facility if you need follow-up care.

There’s a growing likelihood that you may be given observational status—a kind of Medicare limbo that is akin to being an outpatient. Observational hospital visits soared 90% between 2006 and 2012, according to federal data.

The reasons for the shift are partly driven by Medicare’s efforts to restrain increases in health care spending, which include financial penalties for hospitals and doctors if they readmit too many patients. Classifying patient visits as observational helps to limit those readmission penalties—and in some cases, it may reduce costs. Medicare research in 2013 found savings to both Medicare and patients from observational stays vs inpatient stays lasting fewer than two nights.

Still, whether you see any cost savings will depend on your health care needs. Observational and inpatient stays are paid for by different parts of Medicare, even if the services provided are identical. Out-of-pocket costs for observational stays may be much higher, though patients and their doctors may be unaware of this until the bills are presented. Medicare does not require that patients be informed how their stay is classified, so some consumers have been hit with unexpected charges after being discharged.

Observational status may also limit your coverage for follow-up care in a skilled nursing facility. That’s because Medicare coverage kicks in only after you spend at least three days as an admitted hospital patient. If your stay is classified as observational, it won’t count toward this total. For many seniors, that rule has limited access to skilled nursing care.

A recent AARP report, based on an analysis of Medicare hospital visits in 2009, found that most visitors placed under observation required only outpatient services. But 10% of observational patients wound up with larger health care bills than they would have had if they had been admitted as inpatients. These patients were also likely to face higher costs for follow-up care.

So how do you know which category is really best for your finances? You don’t. As the AARP report noted, inpatient status may mean lower costs if you need nursing care later. But for some short stays, your unreimbursed expenses may be lower with observational status. “Few Medicare patients will be able to anticipate into which group they are likely to fall,” the report said. “If they guess wrong, they are likely to face higher out-of-pocket costs.”

AARP advocates changing the rules for Medicare hospital stays, including capping out-of-pocket costs for observational stays and allowing that time to be credited toward skilled nursing care. Reforms are supported by several Medicare advocacy groups and the Medicare Payment Advisory Commission, which advises Congress on Medicare issues. Legislation to amend hospital stay rules is also pending.

Still, it may be years before any rule changes take place. So if you or your family members are on Medicare now, here are three guidelines for reducing the risks of observational status:

  • Find out your status. Demand that the doctors and hospital clarify how your stay is being classified. If you disagree with the decision, bring it up with your doctor right away. This is especially important if the patient is likely to need follow-up care at a nursing facility after their hospital visit.
  • Understand what’s covered. Check out the differences in Medicare payment rules between inpatient expenses (covered by Medicare Part A) and observational or outpatient expenses (covered by Medicare Part B). You can find some of this information here and here.
  • Ask to use your own meds. Many hospitals do not allow use of medications brought from home. But if yours does, you’ll be able to sidestep the steep costs of hospital dispensaries.

Philip Moeller is an expert on retirement, aging, and health. He is co-author of The New York Times bestseller, “Get What’s Yours: The Secrets to Maxing Out Your Social Security,” and is working on a companion book about Medicare. Reach him at moeller.philip@gmail.com or @PhilMoeller on Twitter.

Read next: Here’s What You’re Really Going to Spend on Health Care in Retirement

MONEY Health Care

How to Cushion the Costs of Long-Term-Care Insurance

box with styrofoam peanuts
Victoria Snowber—Getty Images

Policies that help pay for nursing care can be costly. Here's what you can do to keep down the price.

A lengthy stay in a nursing home could wipe out your savings—the national average for a shared room in a nursing home is $77,380 a year. Long-term-care insurance can protect you and your family, but the policies are increasingly expensive and not always needed.

The decision to buy a policy—something I’m grappling with now—comes down to many factors, including what assets you have to protect, whether or not you want to leave behind an estate, your ability to pay premiums for decades, and your odds of needing care in the first place. But if you end up on the side of buying insurance, you have options to keep down costs.

How to Insure Yourself for Less

Buy just enough coverage to provide a cushion. “We advise insuring for a core amount and planning on using other sources if that runs out,” says Claude Thau, a long-term-care expert at Target Insurance Services in Overland Park, Kans. It’s like the peace of mind you get from having a fixed annuity in retirement. You lock into enough income to cover your housing and utilities, say, and fund travel and entertainment with other savings. Even modest long-term-care insurance will cut down your out-of-pocket costs.

The cushion approach appeals to me. The Department of Health and Human Services projects that the average 65-year-old will need three years of long-term care, but about two-thirds of that time will be spent at home, with the rest in either a nursing home or assisted-living facility.

I’m leaning toward insuring for that level of coverage, knowing that if my wife or I need more care, we have sufficient assets to pay our way. That would come out of our financial legacy. But so would excess premium payments over 30 years for coverage we didn’t need. I’m comfortable with that tradeoff.

Keep long-term affordability in mind. These policies have been around for decades, but only in the past five years have buyers filed claims in big numbers—exposing an underwriting disaster. MetLife, Unum, and Prudential are among dozens of insurers that have quit the long-term-care business. Others, including industry leader Genworth, have absorbed huge losses and won state approval to boost premiums on older policies to stay afloat.

New policies incorporate more realistic assumptions—and prices reflect that. “These policies have gone up so dramatically it makes them hard to recommend,” says Clarissa Hobson, a financial planner in Colorado Springs.

Can you be sure double-digit premium hikes are over? Long-term-care experts say the industry is on firmer actuarial footing. “By far, the worst is behind,” says Michael Kitces, director of research at Pinnacle Advisory Group.

Yet others are skeptical. “The baby boomers aren’t even there yet,” says Jane Gross, author of A Bittersweet Season: Caring for Our Aging Parents—and Ourselves. “What’s going to happen when boomers start making claims?” Gross, 67, bought a policy in her fifties and began to regret it soon after.

Think hard about how much you need. When you shop for a policy, the variables include the daily benefit (often $100 to $200), how much the benefit goes up for inflation (3% or 5%), how long payments last, from a few years to no cap, and the so-called elimination period, or how long before insurance kicks in.

A 90- to 100-day elimination period is virtually standard (92% of policies). You can adjust the daily benefit to save, but since nursing-home costs vary widely, first check local prices to get a sense of what you might face.

Inflation protection is an important lever. For years experts recommended policies with benefits that grow 5% a year to keep pace with medical inflation, and to be safe most still do. But that option costs about two-thirds more than a 3% adjustment.

Going with 3% may be fine, says David Wolf, a long-term-care insurance planner in Spokane. The cost of in-home care and assisted living is rising less than 2% a year, he says. Nursing-home rates are going up 5% a year, but stays are shorter than they once were.

Note that while premiums are tax-deductible, the write-off is capped based on age ($1,430 in 2015 for ages 51 to 60). And they are deductible only to the extent that they, along with other medical expenses, exceed 10% of your income (7.5% if you’re 65 or older).

Money

Buy a little flexibility. Three years is the most popular benefit period. As a couple, odds are only one of you might spend more time in a nursing home. A shared benefit can help you insure against that financial catastrophe.

Rather than five years of coverage each, you buy 10 years to be split as needed—five and five, say, or two and eight. A 60-year-old couple can expect to pay about 15% more for a shared policy with six years of total benefits than for a joint policy with three years of benefits each, says Wolf, but in exchange you have a better shot at covering a single long stay in a facility.

Don’t wait too long to shop. The average age of a buyer is now 57, down from 67 a dozen years ago, and it’s easy to see why. Premiums go up modestly before age 55. The curve steepens after that, with the sharp turn at 65, when prices begin to rise about 8% a year, says Jesse Slome, director of the American Association for Long-Term Care.

What’s more, you are fast approaching an age when your health can lead to higher premiums, if it does not render you ineligible altogether. “By 65, almost everybody has some kind of medical condition,” Slome says. Once you reach your sixties, the average denial rate jumps from 17% to 25%.

Gather multiple quotes. For the same coverage, the highest-cost policies can cost twice as much as the cheapest ones, Slome says. Go with a broker who sells coverage from at least five insurers and specializes in the field. Search for an agent at aaltci.org.

Know what it takes to collect. Stalling and claims denials sometimes command frightful headlines, but just 1% of denials are without merit, the federal government reports. Still, make sure you know exactly when your claim will qualify. One common hang-up is home care. Especially with an old plan, your policy might require a licensed home health aide when all you need is less-skilled (and less costly) help with simple chores.

The Alternatives to Insurance

If you decide against a traditional long-term-care policy—or are turned down—you have other insurance options. None provide as much coverage for care. But they have the advantage of guaranteeing you cash in old age or a legacy for your heirs.

How other policies can help. Hobson likes hybrid life insurance policies, which let you draw on the death benefit to pay for long-term care, or leave it to your heirs if none is needed. But the upfront cost is steep, and the premiums are not tax-deductible.

A deferred annuity is another option. For a single premium now, you lock in guaranteed income for life at age 82 or 85, which can go toward long-term care or anything else. Or if you can afford to self-insure and want to preserve money for your heirs, you can buy a whole life policy with a death benefit equal to your assets.

The bottom line (for one). I’ll probably end up in a shared policy with six or eight years of care. My wife is younger than I am. She may be able to help me if that time comes. So I will need less coverage, leaving her with more, assuming she outlives me. And by then she can sell the house if need be.

But I’m not quite sold on this either. If I invest at 8% the $7,500 a year I would spend on reasonably complete coverage, I could amass $343,214 in 20 years. That would be taxable and amount to less than half the benefit I’d enjoy with a long-term-care policy. But it would be mine no matter what. What I am sure of: I will keep weighing the options until we’re settled on a plan. I won’t leave either our care as we get older or our kids’ inheritance to fate.

Previous: Do I Really Need a Long-Term Insurance Plan?

MONEY Health Care

Do You Really Need a Long-Term Care Plan?

Shout

Doing the math on long-term care insurance is no easy chore. Here's how to navigate this high-stakes decision.

Millions of boomers are wondering how to prepare for the possibility of needing costly care some day. Count me as one of them. At age 58, I am in the sweet spot for buying long-term care insurance—assuming I want it at all. After weeks of research, I still haven’t decided. But I have sorted out the moving parts.

What I’ve found is that the rising cost of both care and the insurance that pays for it is only one piece of the puzzle. New types of insurance give me more options to mull over. And recent research calls into question how common lengthy nursing-home stays really are, leaving me to think harder about the odds of needing coverage.

What’s more, I have to be concerned about the health of an industry that I would need to rely on for the next three decades. Insurers badly miscalculated how many policyholders would make claims, leading to a mass exodus of big players from the business in recent years.

The upshot: drastic price hikes from the insurers who remain. A typical long-term-care policy written 10 years ago has seen annual premiums rise about 70%, says Michael Kitces, director of research at Pinnacle Advisory Group. Even so, those old policies are cheaper by half than what a person nearing 70 has to pay for the same coverage today.

That’s because the insurers that have stayed in the business have jacked up the price of new policies. Those premiums rose an average of 8.6% last year alone, reports the American Association for Long-Term Care Insurance. For some, the price hikes are even worse. Today, for example, a healthy 55-year-old man would pay $2,075 a year for comprehensive single coverage—up 17% from last year.

All in all, the answer to the question Do you need long-term-care insurance? is a personal one—and far from easy. Here’s how to think through the decision.

The Promise of Insurance

Long-term care is something you hope you never need. Or at least you hope that when and if you aren’t entirely self-sufficient, your spouse or another family member can pitch in. But when you need more of a hand with daily activities than a lay helper can provide, or around-the-clock or more expert medical care becomes a must, you’ll have to pay for a professional.

The national average for a shared room in a nursing home is $77,380 a year, according to the Genworth 2014 Cost of Care Survey, but the tab can go much higher—$120,000 is typical in Massachusetts, for example. Even assisted living, where you get just some one-on-one help and basic medical care, averages $42,000 a year.

Medicare covers 100 days in a nursing home if you are recovering from an illness or injury and showing improvement, but it offers no help at assisted living or in your home. Medicaid picks up the tab for a nursing home and some in-home help only after you have all but exhausted your savings (in some states, the program helps with assisted living too).

Enter long-term-care insurance, which reimburses you for at least a portion of the cost of a nursing home, assisted-living facility, adult day care, or in-home help. To qualify for benefits, you must be unable to perform two of these six day-to-day activities—bathing, dressing, moving from bed to chair, using the toilet, eating, and maintaining continence—and a medical pro must expect your disability to last at least 90 days.

How to Decide If You’re a Candidate

You may figure you’ll roll the dice and fund your care out of savings. In fact, sales of long-term-care policies fell by 24% in 2014 and are down 65% from 2004 levels, reports LIMRA, an insurance industry trade group. Just 13% of people 65 and older have a policy, according to estimates by Anthony Webb, a senior economist at the Center for Retirement Research at Boston College. Here’s how to make the call.

Start with what you’re worth. The rule of thumb is that you’re a candidate to buy long-term-care insurance if you have between $200,000 and $2 million in assets. With less, you can’t swing the premiums and don’t have enough to protect. Medicaid will cover most of the costs of care after you whittle your savings down to as little as $2,000 if you’re single. With $2 million, you can reasonably plan on paying your own way. But even in that doughnut hole, the answer isn’t always clear.

Understand the true odds. You may have heard figures that make rolling the dice seem like a foolish bet. One frequently cited stat is that 70% of Americans who reach 65 will eventually need some sort of long-term care.

But a recent paper from the Center for Retirement Research paints a less alarming picture. As the graphic below shows, a high number of people will need nursing-home care at or after 65, but only a small portion will remain long enough to run up big bills. Half of men and 39% of women stay less than 90 days, before most long-term-care policies even kick in. The average stay for a man is less than a year; for a woman, a year and a half.

Previous studies had estimated that a long-term-care policy made financial sense for 30% to 40% of 65-year-olds. The CRR pegged that number around 20%. “We’re getting more people going into care for a shorter period of time,” says Webb. “That’s what’s driving down the value of insurance.”

Money

Ask yourself what you’re insuring. At its root, long-term-care insurance is about protecting your estate. A desire to preserve a legacy for their three adult children is why Craig and Jan Klaas, both 60, bought a soup-to-nuts policy. Last year Jan’s mother died after eight years in a facility. Her father had spent two years in a nursing home. “I’ve seen people get wiped out,” says Craig, a financial planner in Rockford, Ill. “I do not want my estate at risk.”

Without coverage, you’ll still get care, funded by savings and Medicaid, if needed. But paying for it could deny your children an inheritance.

See if you even have a choice. Insurers have stepped up medical screening. Overall, 30% to 40% of applicants are turned down for health reasons, says Jesse Slome, director of the American Association for Long-Term Care. Your chances are better when you’re younger. Still, 17% of 50- to 59-year-olds are disqualified, up from 14% in 2009. Common reasons include chronic health problems like diabetes and arthritis, or any condition that can leave you incapacitated. A denial from one insurer, adds Slome, will often lead to automatic denials from others.

Check your family tree. It’s not just your health that counts. Since last year, Genworth has also been considering your parents’ health when you apply for a policy. With early-onset dementia or coronary artery disease in the family, you might not qualify for the best rate.

You should take your family history into consideration too. Half of all claims are triggered by care associated with dementia. On the other hand, says Howard Gleckman, senior fellow at the Urban Institute, a history of cancer may argue for less or no coverage because patients usually have a decent quality of life until just a few months from the end. That’s a cold calculation, but one you shouldn’t ignore.

Next: If you’re ready to explore your options, here’s how to keep down the costs of long-term-care insurance.

TIME Health Care

Inside Nepal’s Next Challenge: Overflowing Hospitals

The country's health care system is under enormous pressure after a deadly earthquake

Hospitals throughout Nepal are flooded with patients, with thousands in need of care for acute injuries after a massive earthquake that the country’s leader said may have killed up to 10,000.

“Most public and private hospitals sent all of their pertinent staff surgeons to Kathmandu Teaching Hospital, which is the trauma center, and it’s so overrun that they are treating people in the streets,” says Cindy Aliza Stein, director of global programs at Real Medicine Foundation (RMF), who is helping coordinate the response. Other hospitals in the area are doing the same, partially because of high numbers of patients and partially because of structural damage and trepidation among many to be inside buildings amid the risk for aftershocks.

Even the weather has become a roadblock to care. “It’s monsoon season, so the rain has started,” Stein says, stressing that hospitals need more tents and tarps to do medical care and triage effectively and to prevent survivors from being exposed to the elements. Many physicians working the crisis have slept very little since the earthquake struck Saturday.

MORE: Medics Race Against Time to Save Nepal’s Quake Survivors

“There are very complicated fractures and not enough medical personnel to actually handle them,” says Dr. Martina Fuchs, the CEO of RMF. “Often in these situations there are more amputations than actually needed. That’s really sad and means longer-term rehabilitation. Being handicapped in a developing country is really difficult.”

If patients are not immediately attended to, the fear is that injuries can become infected, result in long-term complications or even prove fatal. And medical responders are struggling to access people in rural areas. “There are areas in villages where they are saying up to 80% or more of structures are demolished,” Stein says. “Over the next few days that’s the focus.”

Aid groups are also trying to care for survivors with pre-existing conditions, like cancer or diabetes, who may need special medical attention or medication. “The impact of the earthquake has dramatically reduced the capacity of the health system to resume the delivery of health services, as well as other services such as water and sanitation,” says Jim Catampongan, an Asia-Pacific health coordinator for the International Federation of Red Cross and Red Crescent Societies.

MORE: 6 More Ways to Give to Nepal Earthquake Relief

Overcrowding issues are not only reserved to trauma centers. Bottlenecks of volunteers at the Kathmandu Airport have also caused some organizational headaches. “The vast majority of organizations have not registered beforehand through the ministry’s process and they are arriving with a lot of staff and large amounts of supplies,” Stein says. “When they hit the airport, the import of goods that were unsolicited has actually caused a bunch of logistic problems. We are trying to prevent that by coming by land and trying to procure things as local as possible.”

Catampongan adds that Nepal has made significant health gains in the past 10 years despite being a poor country with weak health infrastructures. “The risk is that many of these gains could be lost,” he says. “We could see resurgence in epidemic-prone diseases likes malaria and cholera, which Nepal has worked hard to control. Spikes in malnutrition is a major issue in the country especially for pregnant women and children. We could also see a drop in services for issues like noncommunicable disease, HIV and tuberculosis.”

TIME Health Care

Medics Race Against Time to Save Nepal’s Quake Survivors

Short-term and long-term medical risks are numerous

Medical emergency responders are continuing to rush into Nepal as the country recovers from the immense earthquake that took thousands of lives. While the final death toll remains unknown—the Nepali Prime Minister said today some 10,000 may have died—medical aid groups say the timeframe is tight to save lives.

“There’s a very narrow window of opportunity for people suffering from major traumatic injuries to receive the care they need. It’s vital that people start to receive that kind of care within the first 10 to 14 days of the emergency,” says Paul Garwood, a communications officer at the World Health Organization. “The general rule is that for every one person killed in a disaster like this, some three people are suffering from major trauma injuries.” As time goes on, the risk they die from their injuries increases, he says.

Medical responders tell TIME that survivors’ injuries range from broken bones to head trauma to spinal injuries, and they require intensive and rapid medical treatment and many will require surgical interventions. “These are the major injuries we are seeing now and expect to be seeing in the thousands,” says Garwood.

Responders are also trying to get care to people in the rural affected areas that are still isolated. “We are extremely concerned about people in villages that we can’t reach. The people can’t get out by their own means,” says Patrick Fuller an International Federation of Red Cross and Red Crescent Societies (IFRC) spokesman currently in Kathmandu. “There are thousands of people who have lost everything.”

At the same time, other health challenges don’t go away just because there’s been a major earthquake. Doctors need to maintain routine medical care for people with preexisting conditions or pregnant mothers who may be giving birth. The WHO says it’s working to ensure the right quantities of medicine are available to treat people who require care for diabetes, cancer and heart disease, for example.

Dr. Poonam Khetrapal Singh, WHO regional director for South-East Asia says her teams are trying to anticipate public health needs before they present themselves. She has team members preparing for the possibility of a measles outbreak and an increased need for mental health care among survivors. “Even now I find that people are traumatized,” she says. “At the moment the devastation is just so much.”

Teams from Doctors Without Borders/Médecins Sans Frontières (MSF) have has arrived in Nepal and are currently assessing medical needs and sending surgical teams throughout the affected areas. An 11-member surgical team was sent to Kathmandu with a “rapid intervention surgical kit,” allowing the responders to start performing operations within 72 hours after the earthquake.

In a natural disaster, there’s additional environmental factors that can jeopardize human recovery. Supply systems like roads can become disrupted and access to food can become an issue. Loss of water and sanitation systems can create risks for communicable diseases. Fuller says many shops and markets are closed and food is becoming quite scarce. “In the aftermath of the earthquake, there is the danger of epidemics breaking out, including cholera, malaria and typhoid fever. Landslides and heavy rains pose a risk to people forced to sleep out in the open,” MSF said in a statement.

“We understand that monsoonal rain has come early in Nepal, so excess amounts of water and displaced populations accentuate the risk of communicable disease outbreaks,” added Garwood. The WHO says its sending medicines to deal with diarrheal disease outbreaks. The hope is that if such infectious disease arise, as they have in past emergencies, they can be contained.

“The greatest concern is speed,” says IFRC’s Fuller. “We have to reach them as quickly as possible.”

TIME Health Care

U.S. Lowers Recommended Fluoride Levels in Drinking Water

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Getty Images

The new, lower recommendations are the first in over 50 years

For the first time in over 50 years, the U.S. has lowered its recommendation on fluoride levels in drinking water to prevent tooth decay.

On Monday, the U.S. Department of Health and Human Services (HHS) released its recommendation for an optimal concentration of fluoride at 0.7 mg per liter of water. The previous recommendations, released in 1962, allowed for 0.7 to 1.2 mg per liter.

U.S. states and cities began adding fluoride to water supplies in the 1940s to aid dental care and today, 3 in 4 Americans with access to public water systems get fluoridated water. But an excess of fluoride can cause white spots on teeth.

The HHS says Americans today have many other sources of fluoride, including toothpaste and mouthwash. The agency says the new recommended level will maintain the positive effects fluoride has on tooth decay but reduce the risk of Americans getting too much exposure.

Also on Monday, the U.S. Food and Drug Administration sent an industry letter recommending that bottled-water manufacturers, distributors and importers limit the amount of fluoride they add to bottled water to no greater than 0.7 mg per liter.

“Community water fluoridation is effective, inexpensive and does not depend on access or availability of professional services. It has been the basis for the primary prevention of tooth decay for nearly 70 years,” said U.S. Deputy Surgeon General Rear Admiral Dr. Boris D. Lushniak in a statement.

MONEY Health Care

How to Survive This Awful Allergy Season

pollen written on windshield covered in pollen
Joseph De Sciose—Getty Images/Aurora Creative

Lingering winter cold means pollen levels could rise quickly—and so could your medical costs.

Grab your tissue box. We’re in for a terrible spring allergy season. Experts say that the long winter may cause early-blooming trees to pollinate late this year, which means more trees pollinating at the same time.

About one in five Americans suffer from some kind of allergy, with seasonal allergies the most common, according to the Asthma and Allergy Foundation of America. While not as severe as food and insect allergies, hay fever can put a real damper on your life—seasonal allergies are responsible for some 4 million missed or lost workdays every year, the National Academy on an Aging Society estimates.

The upside is that if you take your allergies seriously this year, you might feel better and save money. True story: My entire childhood, I had “seasonal” allergies that lasted almost year-round. (For some reason, no one thought this was weird.) As an adult, I finally got tested. I was allergic to my cat. Part of me wishes I didn’t know that, but I don’t have to buy as much Claritin now.

Here’s what allergies could cost you—and how you can save.

Over-the-counter antihistamines: 10¢ to 67¢ a pill

With hay fever, you can burn money on boxes upon boxes of over-the-counter allergy relief like Claritin, Allegra, and Zyrtec. But you can save a ton if you just compare prices online, says Elizabeth Davis, editor-in-chief of GoodRx blog, a prescription savings blog.

“One thing that tends to be worthwhile is going for the non-name brand version,” Davis says. “It looks like you can get [generic Claritin] for as low as $10 for 100 tablets, but I’m generally seeing about $20 or so for a regular box of brand-name Claritin, which has 30 tablets.”

So shop online, save 85%.

Another medication to consider: nasal spray. Nasacort and Flonase were both recently approved for over-the-counter sale, where they cost between $17 and $25 a bottle, Davis says.

Prescription antihistamines: 50¢ to $1.60 a pill

Sometimes, over-the-counter medications won’t be enough to alleviate your symptoms. If you’re still suffering, or if you find yourself relying on Benadryl on a daily basis, it’s time to see an allergist.

While prescription allergy meds are usually more expensive—as low as $15 but as much as $40 or $50 for 30 tablets, Davis estimates—what you pay will depend on your health plan. Doctor visits, tests, and prescriptions are typically covered by health insurance, with a co-payment or co-insurance, after you meet your deductible.

The higher dosages in prescription meds might be what you need to kick your symptoms. A doctor might double, triple, or even quadruple your dose, or advise you to take a combination of antihistamines and decongestants, says Neil Kao, an allergist in Greenville-Spartanburg, S.C.

“When you go the doctor, you might say, ‘Well, I took Claritin, and it didn’t work,'” Kao says. “The doctor might say you need two—one in the morning, one at night. You might say, ‘The box says one.’ Well, that’s why I went to medical school!”

Also, while prescription generic Nasacort nasal spray costs more—typically $50 to $75 a bottle—and prescription generic Flonase costs less—usually $12 to $17—the prescription versions could be a better deal than over-the-counter versions if you have a low co-pay, Davis says. Talk to your doctor and check your plan.

Allergy testing: $30 to $275

Once you’ve spent serious money on allergy medicine, you may want to know if you’re on the right track, Kao says. Are you sneezing because there’s pollen in the air, or because you have a cold, or because your cat is shedding his winter coat? With a simple skin test, an allergist can determine what, if anything, you are allergic to.

According to HealthSparq, a health costs transparency firm, an office visit with an allergist typically runs $200 to $300 before insurance. Those estimates are based on insurer-negotiated prices on claims filed in Oregon, Washington, Utah, and Idaho.

From there, the cost of the allergy tests can vary from $30 to $275, and even as high as $4,000, depending on the type and number of tests given, according to HealthSparq. Pro tip: 77% of large employers offer a price transparency tool, according to Mercer, so you can get your own individualized price estimate.

Immunotherapy: $15 to $20 a session

After you know what you’re allergic to, allergy shots are another treatment option. Here’s how it works: Your allergist uses a skin test to decide which allergens to put in your shots, which slowly expose you to your allergens to get your immune tolerance back up to normal, Kao explains.

Kao recommends shots for sufferers with moderate to severe allergies who either do not get enough relief from medications or who do not want to take medications any longer. “Statistically, [shots] help about 90% of well-selected people,” Kao says.

HealthSparq estimates that it typically costs $15 to $20 a visit before insurance kicks in, but could be as high as $170 a visit, depending on your course of treatment.

However, Kao says that in the long term, allergy shots pay for themselves. Think of the money you won’t be spending on over-the-counter medications, prescriptions, antibiotics for sinus infections, and doctor’s visits. “That’s all money saved,” Kao says.

EpiPens: $450 to $500 for a two-pack

Pollen means something else for people with bee sting allergies: It’s time to carry an EpiPen again. EpiPens—or epipnephrine auto-injectors—provide immediate relief to anyone suffering from anaphylaxis, a potentially fatal allergic reaction. The pen is inserted into the middle of the thigh while a patient awaits professional medical attention.

Unfortunately, the price of EpiPens have increased significantly in the past several years. Davis of GoodRX Blog estimates a two-pack could run about $450 to $500 before insurance.

Coupons can help. At EpiPen.com you can apply for discounted epinephrine pens. Many patients with private health insurance can get the EpiPen two-pack for free, and everyone else can get $100 off, says Davis.

Alternately, you can get a generic epinephrine pen for $250 to $300, but you’ll need to ask your doctor to write a prescription specifically for the generic, Davis says.

Update: This article was updated to indicate the correct use of an EpiPen.

MONEY Health Care

The Danger Lurking in Your Medical Bills

Claire Benoist

Medical billing errors are more common—and more costly—than you might think. Here's how to give your bills a checkup.

Odds are, there’s a mistake in the medical bill that’s in your mailbox. A recent NerdWallet analysis of 2013 hospital audits by Medicare found that an average 49% of bills contained errors, and that some medical centers messed up on more than 80% of claims to Medicare.

Such errors now matter more than ever to consumers: Greater health insurance cost sharing means that a mistake can take serious money out of your pocket. “If you’re responsible for the first $5,000 or $10,000 of your care, you’re going to want to be more attentive,” says Stephen Parente, a professor at the University of Minnesota’s Carlson School of Management who studies health finance.

But billing errors can be tough to spot, and tougher to remedy. Disputes can go on for months, and if you don’t take the right steps, your account could be put into collections in the meantime—a recent report by the Consumer Financial Protection Bureau found that a whopping 52% of all debt on credit reports is due to medical bills. Follow these steps to ensure a clean bill of health:

Understand your bill

Step one is knowing exactly what you’re being charged for. Can’t tell from the bill? Ask the provider for an itemized statement, says Pat Palmer, CEO of Medical Billing Advocates of America, a professional organization that assists individuals and companies with medical costs and disputes. Doctors use standardized numerical “CPT” codes to categorize treatments, and you can Google the numbers to find out what they stand for.

Question discrepancies

If the price strikes you as high for the services rendered, “follow your gut and investigate,” says Mark Rukavina, principal at Community Health Advisors, a hospital consultancy. Your insurer may offer an online price transparency tool. If not, try Guroo.com, a website that shows the average cost by area for 70 non-emergency diagnoses and procedures. A big discrepancy suggests that you should start asking questions.

Next, compare the bill to the explanation of benefits you get from your insurer. If these differ on the amount you owe, that can be another red flag, says Erin Singleton, chief of mission delivery at the nonprofit Patient Advocate Foundation.

Source: Consumer Financial Protection Bureau

Diagnose errors

Even if you don’t have sticker shock, give your invoice a close read. Some common mistakes can be easy to spot. They include services that weren’t performed, tests that were canceled, and duplicate charges, says Kevin Flynn, president of HealthCare Advocates.

Palmer says one of the more frequent errors she sees is providers charging patients separately for things that are supposed to be under one umbrella, such as a tonsillectomy and adenoid removal. Ask your provider about this if you are billed item by item for something that might be one procedure.

Remedy the problem

When you spot an error, ask the billing department to start a formal dispute. Put your concerns in writing. Include any documentation you have and request that the provider support its claim as well, says Palmer. Also, notify your insurer, which can be a good ally if the company will be on the hook for part of the charge.

Typically you don’t have to pay disputed charges until the investigation is complete, but do pay the rest of the bill. And always respond promptly to billing communications so that charges aren’t sent to collections. That’s a very real risk; one in five credit reports is married by medical debt, with an average of $579 in collections. Fortunately, relief is on the way—the three major credit agencies recently agreed to institute within the next few years a 180-day grace period before adding medical debt to credit reports (now there is no official grace period) and to remove debt from a report if the insurer pays the bill.

Rukavina says that, with persistence, you should be able to resolve most disputes on your own. But if you’ve been fighting to no avail for more than a month or so, consider hiring a medical billing advocate to work on your behalf. Find one via billadvocates.com or claims.org. You’ll likely pay an hourly rate starting at around $50 or a fee of about 30% of what you’ll save. But that could be pocket change compared with what you’d owe otherwise, not to mention what a ding to your credit score could cost you.

Read Next: The Debt You Don’t Know You Have

MONEY Health Care

You May Still Have Time To Avoid the Health Law’s Tax Penalties

The tax-filing deadline may have passed, but it's not necessarily too late to get around the penalty for going without health insurance last year.

Even though the April 15 tax filing deadline has passed, you might be eligible for some health law-related changes that may save you money down the road.

•If you owed a penalty for not having health insurance last year and didn’t buy a plan for 2015, you may still be able to sign up for a marketplace plan, even though the open enrollment period ended Feb. 15. Many people who didn’t have insurance and didn’t realize that coverage is required under the law are eligible for a special enrollment period to buy a plan by April 30. If you sign up now, you’ll have coverage and avoid the 2015 penalty, which will be the greater of $325 or 2% of your household income.

•If you paid the penalty for not having insurance for some or all of last year and didn’t carefully check to see if you might have qualified for an exemption, it’s not too late. You can still apply for an exemption from the requirement by amending your 2014 tax return. It’s worth looking into since the list of exemptions is a long one. For example, if your 2014 income is below the filing threshold of $10,150—or $20,300 for a married couple—you don’t owe a penalty for not having coverage. Likewise if insurance would cost more than 8% of your income or if you’ve suffered financial hardships like eviction or bankruptcy.

•In February, the Centers for Medicare & Medicaid Services announced that 800,000 tax filers who received a federal subsidy to help pay their insurance premium and used the federal health insurance marketplace received incorrect 1095-A tax forms. These forms reported details about the advance premium tax credit amounts that were paid to insurers based on the consumers’ estimates of income. They were then used to reconcile those payments against how much consumers should have received.

If you filed your taxes based on information that was incorrectly reported by the government on the form, you generally don’t have to file an amended tax return even IF you would owe more tax. But you may want to at least recalculate your return, says Tara Straw, a health policy analyst at the Center on Budget and Policy Priorities.

“You have the option to amend if it helps you,” she says. Unfortunately, the only way to figure that out may be to do the math on the tax form 8962 that you use to reconcile your income.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

MONEY Health Care

You Can Now Use a Yelp-Like Star System to Check Out a Hospital

hotel sign with stars
Agencja Fotograficzna Caro—Alamy

The federal government's new ratings show you how satisfied patients have been with their care.

In an effort to make comparing hospitals more like shopping for refrigerators and restaurants, the federal government has awarded its first star ratings to hospitals based on patients’ appraisals.

Many of the nation’s leading hospitals received middling ratings, while comparatively obscure local hospitals and others that specialized in lucrative surgeries frequently received the most stars.

Evaluating hospitals is becoming increasingly important as more insurance plans offer patients limited choices. Medicare already uses stars to rate nursing homes, dialysis centers, and private Medicare Advantage insurance plans. While Medicare publishes more than 100 quality measures about hospitals on its Hospital Compare website, many are hard to decipher, and there is little evidence consumers use the site very much.

Many in the hospital industry fear Medicare’s five-star scale won’t accurately reflect quality and may place too much weight on patient reviews, which are just one measurement of hospital quality. Medicare also reports the results of hospital care, such as how many died or got infections during their stay, but those are not yet assigned stars.

“There’s a risk of oversimplifying the complexity of quality care or misinterpreting what is important to a particular patient, especially since patients seek care for many different reasons,” the American Hospital Association said in a statement.

Medicare’s new summary star rating, posted Thursday on its Hospital Compare website, is based on 11 facets of patient experience, including how well doctors and nurses communicated, how well patients believed their pain was addressed, and whether they would recommend the hospital to others. Hospitals collect the reviews by randomly surveying adult patients–not just those on Medicare—after they leave the facility.

In assigning stars, Medicare compared hospital against each other, essentially grading on a curve. It noted on its Hospital Compare website that “a 1-star rating does not mean that you will receive poor care from a hospital” and that “we suggest that you use the star rating along with other quality information when making decisions about choosing a hospital.”

Nationally, Medicare awarded the top rating of five stars to 251 hospitals, about 7% of all the hospitals Medicare judged, a Kaiser Health News analysis found. Many are small specialty hospitals that focus on lucrative elective operations such as spine, heart or knee surgeries. They have traditionally received more positive patient reviews than have general hospitals, where a diversity of sicknesses and chaotic emergency rooms make it more likely patients will have a bad experience.

A few five-star hospitals are part of well-respected systems, such as the Mayo Clinic’s hospitals in Phoenix, Jacksonville, Fla., and New Prague, Minn. Mayo’s flagship hospital in Rochester, Minn., received four stars.

Medicare awarded three stars to some of the nation’s most esteemed hospitals, including Cedars-Sinai Medical Center in Los Angeles, NewYork-Presbyterian Hospital in Manhattan, and Northwestern Memorial Hospital in Chicago. The government gave its lowest rating of one star to 101 hospitals, or 3%.

On average, hospitals scored highest in Maine, Nebraska, South Dakota, Wisconsin, and Minnesota, KHN found. Thirty-four states had zero one-star hospitals.

Hospitals in Maryland, Nevada, New York, New Jersey, Florida, California, and the District of Columbia scored lowest on average. Thirteen states and the District of Columbia did not have a single five-star hospital.

In total, Medicare assigned star ratings to 3,553 hospitals based on the experiences of patients who were admitted between July 2013 and June 2014. Medicare gave out four stars to 1,205 hospitals, or 34% of those it evaluated. Another 1,414 hospitals—40%— received three stars, and 582 hospitals, or 16%, received two stars. Medicare did not assign stars to 1,102 hospitals, primarily because not enough patients completed surveys during that period.

While the stars are new, the results of the patient satisfaction surveys are not. They are presented on Hospital Compare as percentages, such as the percentage of patients who said their room was always quiet at night. Often, hospitals can differ by just a percentage point or two, and until now Medicare did not indicate what differences it considered significant. The Centers for Medicare & Medicaid Services (CMS) also uses patient reviews in doling out bonuses or penalties to hospitals based on their quality each year.

Some groups that do their own efforts to evaluate hospital quality questioned whether the new star ratings would help consumers. Evan Marks, an executive at Healthgrades, which publishes lists of top hospitals, said it was unlikely consumers would flock to the government’s rating without an aggressive effort to make them aware of it.

“It’s nice they’re going to trying to be more consumer friendly,” he said. “I don’t see that the new star rating itself is going to drive consumer adoption. Ultimately, you can put the best content up on the Web, but consumers aren’t going to just wake up one day and go to it.”

Jean Chenoweth, an executive at Truven Health Analytics, which also publishes its own list of top hospitals, said she feared hospital marketing departments would oversell the meaning of the stars. “It would be very unfortunate and misleading if a hospital marketing department could claim to be a CMS five-star hospital and fail to mention it only reflected a patients’ perception of care,” she said.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

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