Healthcare is the expense where frugality advice usually goes quiet, because the honest answer is complicated and nobody wants to be the person who told you to skip a doctor. None of what follows is about going without care. It is about paying a third of the price for the same care, from people who are better supervised than most private practices.

The specific San Francisco options are unusually good, and almost nobody uses them.

Dental: the school route #

UCSF School of Dentistry runs a clinic where dental students, supervised by faculty, treat the public at substantially reduced rates. Depending on the procedure, you are looking at a third to half of private practice pricing, and for some services considerably less.

You go through a screening appointment where they assess whether your case is appropriate for a student. Straightforward work usually is. Complicated work sometimes gets referred out or handled by the postgraduate clinics, which cost more than the student clinic and still less than private practice.

The tradeoffs are real. It takes much longer: a cleaning that runs forty minutes in private practice might take two hours, and a crown might be three or four appointments instead of two, because the student is learning and the faculty member checks the work at multiple points. Scheduling is slower, with waits for an initial appointment running weeks or months. And it follows the academic calendar, so your student graduates and you get reassigned.

The upside nobody mentions is that the work is checked by a faculty dentist at every stage. In a private practice, one person does the work and one person checks it, and they are the same person. A student clinic has more eyes on your mouth than you will get anywhere else.

City College of San Francisco also runs a dental hygiene program with very low cost cleanings. For a routine cleaning and X-rays this is the cheapest legitimate option in the city, often under fifty dollars for work that runs two hundred to three hundred in private practice.

Dental insurance is usually a bad deal #

Run the numbers before you buy a plan. A typical individual dental plan is thirty to fifty dollars a month, so four hundred to six hundred a year, with an annual maximum benefit of around fifteen hundred dollars that has barely moved since the 1970s, plus deductibles, waiting periods, and coverage percentages that drop sharply for major work.

If you need two cleanings a year and nothing else, you are paying five hundred dollars for something that would cost you three hundred out of pocket. If you need a major procedure, the plan caps out before it covers much of it.

Dental insurance makes sense mostly when your employer pays for it. Buying it individually is, for most people, a way to prepay for cleanings at a markup.

Dental discount plans are a different product, usually a hundred to two hundred a year for negotiated rates at participating dentists, with no annual maximum and no waiting period. Sometimes a better deal than insurance, and worth comparing.

Vision #

This is the clearest case of paying for a brand rather than a product.

The exam and the glasses are separate purchases and you should treat them that way. Get the eye exam wherever it is cheapest or covered, then ask for a copy of your prescription, including your pupillary distance. They are required to give you the prescription. The PD they will sometimes be cagey about, and you can measure it yourself with a ruler and a mirror, or a phone app.

Then buy the glasses online. Zenni, EyeBuyDirect, and 39DollarGlasses sell complete prescription glasses starting around twenty to forty dollars. Warby Parker is around ninety five to a hundred and fifty, with a nicer experience and better frames. Costco Optical is genuinely good value if you have a membership, and their exams are reasonably priced.

A pair of glasses at a mall optical shop runs three hundred to five hundred dollars. The same prescription in a similar frame from Zenni is thirty five. I have bought glasses both ways and the cheap ones are not meaningfully worse. The lens is a piece of shaped polycarbonate and the market for it is competitive.

One caveat: if you have a strong prescription, progressives, or unusual requirements, spend more and get them fit properly. Cheap progressives from an online vendor are a real gamble.

UC Berkeley School of Optometry runs a public clinic on the same student-clinic model as the dental school, if you want a thorough exam at a reduced rate and do not mind the drive.

If you are uninsured #

Healthy San Francisco is a city program that provides access to health services for uninsured San Francisco residents who do not qualify for other coverage. It is not insurance, which matters. It covers care within a network of San Francisco providers and does not travel with you. Fees are on a sliding scale based on income, and for the lowest income tier there is no participation fee.

Covered California, the state marketplace, offers premium subsidies that a lot of people dramatically underestimate. If your income is modest, the subsidized premium can be very low, and California has additional state subsidies on top of the federal ones. Run your numbers on the site rather than assuming you cannot afford a plan.

Medi-Cal covers people below the income threshold, and California expanded eligibility substantially. Many people who qualify never apply because they assume they earn too much.

San Francisco Community Clinic Consortium members and federally qualified health centers throughout the city offer sliding-scale primary care regardless of insurance status.

Check current eligibility rules directly with each program, because they change with state and federal policy and I am not going to pretend a blog post is a reliable source on that.

Prescriptions #

GoodRx and similar discount cards frequently beat the insurance copay. Check both prices every time. It is common for the cash price with a coupon to be less than what you would pay with coverage, which tells you something about drug pricing.

Costco pharmacy is open to non-members in most states, including California, and is consistently among the cheapest cash prices.

Ask for the ninety day supply, which is usually cheaper per dose than three thirty-day fills. And ask if there is a generic. Obvious, and people still do not.

Where I would not cut #

Being useful here means saying where the frugal answer is wrong.

Do not skip a real problem. Delayed dental work becomes a root canal. Delayed medical care becomes an emergency room visit, which is the single most expensive way to receive healthcare in the United States.

Do not go uninsured to save money if you can get subsidized coverage. A hospitalization without insurance is a life-altering bill, and that is a category of risk you cannot absorb.

Do not buy contact lenses without a current prescription from sketchy overseas sellers. The eye is not the place to find out a vendor was cutting corners.

Do not choose a student clinic for something urgent. The scheduling does not support it. Use them for planned, routine work.

The point of frugality is to spend deliberately, and health is the clearest case where spending is correct. What is not correct is paying four hundred dollars for glasses that cost thirty five to make, or paying five hundred a year for dental insurance that covers three hundred dollars of cleanings.

The pattern here runs through all of Frugal SF: find where the price and the actual cost of delivery have come apart, and buy from the side of that gap where they have not. Same as utility bills, same as groceries in Chinatown.