New ways to cut the cost of your insurance and medications
By Hallie Levine
Once you get to 65, Medicare is a big help. Still, even with that coverage, older Americans have more difficulty affording medical care than their counterparts elsewhere, according to a December 2024 survey from the nonprofit Commonwealth Fund. It found that nearly 1 in 4 older adults in the U.S. spent at least $2,000 out of pocket on medical care last year—over and above their Medicare premiums.
The result: “Older Americans are more likely than seniors in other countries to put off visiting doctors, skip medical tests, treatment, or recommended follow-up, and not fill prescriptions because of concerns about cost,” says Gretchen Jacobson, vice president for Medicare at the Commonwealth Fund.
Postponing needed care can cause a snowball effect. A health condition may worsen as you wait, which ultimately can lead to even higher medical bills.
But you can take steps to cut costs and get the most out of what you do spend. Here’s how.
Do an Insurance Checkup
Each year during open enrollment (Oct. 15 to Dec. 7 for traditional Medicare and Jan. 1 to March 31 for Medicare Advantage plans), take a look at the options for the next year. Make sure that they’re in your price range; your doctors, hospitals, and pharmacies are in-network; and your meds are covered.
“Ideally, you want a plan where most—if not all—of your drugs are in the lowest tier,” says Adria Gross, president of MedWise Insurance Advocacy, a nonprofit in Monroe, N.Y.
For Medicare Advantage plans, look closely at dental and vision benefits. A 2021 report from the nonprofit health policy organization KFF found that while 94 percent of Advantage enrollees had access to dental coverage, it was often paltry. “More than half—59 percent—of enrollees were in a plan with a maximum dental benefit of $1,000 or less,” says Tricia Neuman, ScD, senior vice president and executive director for the Program on Medicare Policy at KFF.
You can also see whether you’re eligible for a Medicare Savings Plan, which can help with premiums, deductibles, and copays. Eligibility differs by state; you apply through your state’s Medicaid office. Another option is the federal Extra Help program. If you qualify, your monthly Part D (medication) premiums are free, and you won’t pay more than $4.90 for generic drug prescriptions and no more than $12.15 for brand-name drugs.
Check Bills for Errors
About 1 in 5 people said they had recently received a medical bill they disagreed with or couldn’t afford, according to a 2024 study in JAMA Health Forum. But most of those who reached out to their doctor’s billing office said they got payment help or had their bill corrected.
So each time you get a bill, make sure your name, the service date, the provider’s name and address, and description of services are correct. Then check it against your explanation of benefits (EOB). This letter from your insurance company lists the costs of your care, how much your health insurance has or will pay for it, and what you owe.
“Never pay any medical bill—ever—without getting the EOB and comparing it to your original bill,” says Caitlin Donovan, senior director of the Patient Advocate Foundation. If there’s any discrepancy, contact both your provider and your insurance company.
Dial Down Drug Costs
As of this year, people on Medicare will pay no more than $2,000 annually for out-of-pocket prescription drugs. “This will provide enormous protection for people who take very expensive drugs,” Neuman says.
Having your doctor or regular pharmacist review all of your meds may also help. “If they go over your medications and find a couple that you no longer need, or a generic version of a brand drug you’re taking, you’ll most likely save money,” says Claudia Cometa, PharmD, a healthcare advocate in Clearwater, Fla.
For medications you take regularly, paying cash is sometimes cheaper, so check with a couple of local pharmacies. Websites like GoodRx, whose coupons can save you 80 percent off the list price of some drugs, Walmart’s low-cost prescription program, and Mark Cuban’s Cost Plus Drugs may also net you some savings.
Finally, consider contacting a drugmaker’s pharmaceutical assistance program or nonprofits like the Patient Advocate Foundation, which offers a copay relief program. Your state’s pharmaceutical assistance program may also cover some drug costs.
Don’t Take No for an Answer
If you have Medicare Advantage, you’ll need to get prior authorization for services like hospital and skilled nursing facility stays and chemotherapy. In 2023, only 11.7 percent of people whose prior authorization requests were turned down appealed that decision, the KFF says. “Most appeals—over 80 percent—get overturned, so it’s absolutely worth it to file one,” Neuman says.
No matter what kind of insurance you have, if you’re denied coverage for a healthcare service, you can push back. First, make sure your doctor sends a letter to your insurance company explaining your health condition and the need for a test or treatment, Gross says.
If you’re still turned down, you can ask for an external review by an independent third party. This means your insurer won’t get the final say about whether or not to cover the service.
You can file a request for such a review through the federal government. Need help with it? Contact your state’s department of insurance.
Watch Out for Ambulance Bills
Thanks to 2022’s No Surprises Act, if you have a medical emergency and call 911, you no longer have to worry about being taken to an out-of-network hospital emergency department. You’ll now be billed in-network for all services, including ancillary ones like imaging, says Caitlin Donovan, a patient advocate.
With ambulance use, though, it’s more complicated. Medicare generally covers about 80 percent of the cost of emergency ambulance rides. But that’s only for true emergencies like chest pain. If you break an ankle, Medicare might not consider it an emergency. In these situations, the ambulance company will usually ask you to sign an Advance Beneficiary Notice of Noncoverage. This means you’ll be on the hook if Medicare doesn’t cover it, Donovan says, and the median surprise bill for a ground ambulance is more than $700. But you can appeal this. It may help to ask the doctor who treated you for documentation that you needed an ambulance.
Take Advantage of Freebies
Medicare covers a host of no-cost preventive and screening services that can help you stay healthier. They include:
• A yearly wellness appointment with a doctor, which is similar to—but less extensive than—an annual physical exam.
• The recommended vaccines for illnesses such as shingles, the flu, COVID-19, and respiratory syncytial virus.
• Depending on your age, mammograms and screenings for colorectal cancer.
• Nutritional consults with a registered dietitian if you have a chronic condition such as type 2 diabetes or kidney disease.
• The Medicare Diabetes Prevention Program, which provides 16 weekly group sessions that help those who are at a higher risk for the condition make dietary changes. Ask your doctor for a referral. People with prediabetes who participated in a similar program saved more than $5,000 in medical costs over two years.
Editor’s Note: This article also appeared in the May 2025 issue of Consumer Reports On Health.
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