BenefitsAll

Health Care Price Transparency Resources

BenefitsAll

Everyone can understand health insurance and health care better.
Imagine a grocery store with no price labels on food and other merchandise. People with grocery insurance scan their grocery card at the checkout and pay a small fee. They have no idea what their groceries actually cost. People without grocery insurance pay whatever the grocer charges them.

Now change the word groceries to health care, and you no longer have to imagine this scenario being true. The lack of health care price information is the norm. Granted, it is easier to price an apple than an appendectomy, but people have been paying for both for a long time. So, we know that health care price data is available, it’s just not generally shared with consumers. However, health insurers, Medicare, state governments, non-profits and technology companies are increasingly sharing some of their price data free of charge or for a fee.

Before accessing online health care price information, it is important to know that there are limitations to the data:
  • Data may not reflect the exact price you will pay
  • Data may be national or local
  • Data does not list prices for all procedures and drugs
  • Data may be a year or more old
  • Data may not include info about the quality of care
Health care price data are gathered from multiple sources, including government agencies, private and public organizations, insurers, doctors, hospitals, and individuals. Click the category to the right or scroll below to view a list of available price databases.

Health Insurers - Health care Price Tools

Large health insurers such as Aetna, Cigna, and UnitedHealthcare provide performance and cost estimator tools for its individual and group members, but not the public. A few of the programs include, but are not limited to:
  • Aetna Health Care Cost Transparency Tools (Medical Procedure by Facility Cost Tool)
  • Anthem BCBS (Connecticut) SmartShopper
  • BCBS Blue Links Medical Cost Comparison Tool
  • Capital Blue Cross MyCare Advisor
  • Cigna's Care Connections Hospital Comparison Tool and Cost of Care Estimator Tool
  • Highmark Care Cost Estimator
  • UnitedHealthcare Health Care Cost Estimator
If you are a member of one of these plans, you can access these tools online or by calling the phone number on your plan ID card.

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Private Industry - Health care Price Tools

Private companies, including technology companies are building databases for government, insurers and other groups to use, while also making this information available to the public.

Healthcare Blue Book – Similar to the Kelley Blue Book for cars, this popular tool provides an estimated price for health care services by zip code and service type. It produces a "fair price" value for all related services used in administering the care (physician, hospital and anesthesia, if applicable). The data is useful in negotiating rates before care is provided. New Choice Health offers a similar tool.

http://healthcarebluebook.com/
http://www.newchoicehealth.com/Home
https://www.spendwellhealth.com/swh/shoppers (check to see if your employer provides this service)

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Medicare - Health care Price Tools

In 2006, President G. W. Bush signed an executive order to increase the quality and transparency of health care pricing information that led to the posting of Medicare price information online. The Hospital and Nursing Home Compare tools provide quality and payment information at Medicare-certified hospitals. The tool will tell you if Medicare pays more, less, or the same on average at a particular facility. In addition, it provides patient responses about the care they received, readmission rates, and more.

http://www.hospitalcompare.hhs.gov/hospital-search.aspx

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State Governments - Health care Price Tools

State governments are working to bring healthcare price information to consumers via executive order or resolution. In 2007, the governor of California signed an executive order to create health care quality and price transparency databases for its citizens. There are similar initiatives taking place in other states (e.g., New Hampshire), but these efforts are in the beginning stages of development. Search your state government web site for health care quality and price transparency information, or call to see if data is available.

http://archive.hhs.gov/valuedriven/goverment/index.html

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Nonprofits - Health care Price Tools

Nonprofits are using existing databases and other resources to bring health care price transparency to consumers.

FAIR Health – Uses its national database of billions of billed medical and dental services to power a free web site that enables consumers to estimate and plan their medical and dental expenditures.

http://fairhealthconsumer.org/
http://www.guroo.com/#! (Health Care Cost Institute or HCCI gets pricing information from Aetna, Assurant Health, Humana and UnitedHealth)

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Prescription Drug Price Tools

Stand at any retail pharmacy counter for a few minutes and you will see people act pleasantly surprised at how little their prescription drugs cost. It may be safe to say that these people have prescription drug insurance coverage and have no idea of the true cost of these drugs. At this counter, you will also encounter a few people without prescription drug insurance coverage. They too will express surprise at the cost of their drugs, but not in a positive way.

Whether or not you have insurance, you do not have to be caught off guard when filling a prescription.

Insurance Coverage

Most major insurance companies and Medicare maintain prescription drug cost databases that are available to members. A few are listed below. Check your insurer's web site for more information.
  • Aetna Prescription Drug Cost Estimator
  • BCBS Drug Cost Estimator Tools
  • Cigna Prescription Drug Price Quote Tool
  • UnitedHealthcare Price a Medication Tool
  • Medicare.gov's Medicare Prescription Drug Plan Cost Estimator
  • AARP Prescription Discount Program web site
No Insurance Coverage

Price comparison tool websites for the uninsured:
States like Florida, New York, and Pennsylvania, provide online prescription drug cost calculators too. Check your state's Health Care Administration website for more information.

For assistance paying for prescriptions, check out these site (there are many others too):
To participate in these programs you must meet certain income requirements. In addition, you cannot participate in a private or public prescription drug insurance program. There are also prescription assistance programs that help with copays and premiums.

Mobile Apps

Some groups offer free mobile apps to go along with their web sites. Two of the most popular are listed below. There are other prescription drug price apps.
  • GoodRx (iPhone)
  • LowestMed (iPhone and Android)
Prescription Discount Programs

There is no shortage of prescription discount programs. Some of these programs charge an annual fee, but most are free. Online cost calculators are available to members.

In addition to comparing prescription drug prices: use generics, asks for a discount, or buy double the normal dosage and split pills in half. Before buying a generic or splitting pills, consult your doctor…

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No Internet Access?

If you cannot access the Internet, online health care price databases are not the answer. However, you can still receive price information by calling the Customer Service unit of your health insurer. If you do not have insurance, call the doctor’s office, pharmacy, or hospital whose services you plan to use (contact several to compare prices). Walk-in Clinics are more likely to provide upfront pricing information than traditional doctor’s offices and hospitals. And finally, let your voice be heard—contact your local representatives and demand that more health care price information be made available and not just online.

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March 2015

This information will be updated continuously as additional healthcare price information becomes available.