Ways to Save on Your Health Care

Household budgets are tight for many Vermonters and saving money is more important than ever. That includes finding ways to reduce out-of-pocket health care costs.

In some situations, you can pay less for your care by choosing an independent facility instead of a hospital. Independent (freestanding) facilities often offer services such as surgery and diagnostic imaging tests at lower prices. At such facilities you can still get quality care and may save hundreds of dollars on your out-of-pocket costs, such as deductibles and coinsurance.

For example, an MRI may cost much more at a hospital than at an independent facility – $4,000 at a hospital, and less than $2,000 at an independent facility. If you choose a non-hospital location, you could save a significant amount of money, especially if you haven’t reached your health plan’s out-of-pocket limit, which is the most you pay for covered care during the year. Even if you have met your annual health plan limits, choosing a lower-cost provider can still save you money in the future, by reducing the need for additional premium increases.

Finding more affordable care options can be easy. Using our online tool helps members compare the cost of procedures at in-network locations. Keep reading to learn how to use our tool to find high-quality, affordable care near you.

What Services Are Available?

Not all health care services can be done at an independent facility. Some procedures are more complex and need the extra support that a hospital provides. However, many other procedures can safely be done at independent facilities. Be sure to check your health plan benefits to understand coverage options and costs.

In Vermont, available procedures may include:

• Diagnostic imaging: magnetic resonance imaging (MRI), computed tomography (CT) scans, X-rays, dual energy X-ray absorptiometry (DEXA) for osteoporosis screening, ultrasound imaging
• Laboratory: testing for oncology, genetics, toxicology, pathology, cardiology, fertility. There are also several independent full-service labs serving the state.
• Ophthalmology: repair of retinal detachment, cataract removal and artificial lens implantation, cornea surgery
• Gastroenterology: colonoscopy, upper gastrointestinal endoscopy
• General surgery: breast biopsy, mastectomy and other breast cancer surgery, laparoscopic and open hernia repair, hemorrhoidectomy, lesion excision, laparoscopic cholecystectomy to remove gallbladder
• Gynecology: laparoscopy in the abdomen and pelvis to remove abnormal tissue or lesions, hysteroscopy to diagnose and treat uterine disorders, dilation and curettage, myomectomy to remove uterine fibroids, pelvic prolapse to reinforce walls of the bladder and vagina, bladder sling to relieve symptoms of urinary stress incontinence
• Orthopedic surgery: carpal tunnel release, trigger finger release, removal of ganglion cysts, hand and wrist arthritis procedures, hand and wrist tendonitis procedures
• Podiatry: bunionectomy, hallux rigidus procedures to relieve big toe pain, hammertoe correction, removal of warts and cysts

This list does not include all services offered outside of hospitals in Vermont, but it gives you an idea of what may be available. You can use the enhanced cost estimate tool in the Member Resource Center to do a more detailed search.

To check if a service is covered by your health plan, review your Outline of Coverage and Certificate of Coverage. To learn how to use your Outline of Coverage, check out our blog.

Comparing Costs  

To locate independent facilities and compare costs for a procedure using our cost tool,  follow these steps:  

1. Register for or log in to our Member Resource Center.
2. Navigate to the “My Providers” menu and choose the “Estimate Costs” option.
3. Click on the tile that says “Procedure Costs” to browse for common terms, such as MRIs or colonoscopy. You can also search for a procedure by name.  

After choosing a service or procedure, you’ll see a list of in-network providers and facilities near you. Each listing shows the total estimated cost for each.

Select a provider or facility to see a detailed cost breakdown. This shows how much your health plan is expected to pay and how much you may need to pay. Please keep in mind that these are estimates only. Your final costs may be different based on factors such as how the provider or facility bills for the procedure.

• Tip: Most independent facilities are located in Chittenden County, so be sure to adjust the distance filter to include those facilities in the results.

In addition to our cost tool, some hospitals and independent facilities have price transparency tools available to understand the costs of their available services. To learn more, visit vtaffordablecare.com.