How much do Americans actually pay for healthcare?
How much do Americans actually pay for healthcare?
Hey all, I'm British so I don't really know the ins and outs of the US healthcare system. Apologies for asking what is probably a rather simple question.
So like most of you, I see many posts and gofundmes about people having astronomically high medical bills. Most recently, someone having a $27k bill even after his death.
However, I have an American friend who is quick to point out that apparently nobody actually pays those bills. They're just some elaborate dance between insurance companies and hospitals. If you don't have insurance, the cost is lower or removed entirely. Supposedly.
So I'm just asking... How accurate is that? Consider someone without insurance, a minor physical ailment, a neurodivergent mind and no interest in fighting off harassing people for the rest of their life.
How much would such a person expect to pay, out of their own pocket, for things like check ups, x rays, meds, counselling and so on?
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I pay $30 per doctor's visit and $40 if the visit is for a specialist. I also pay $0 for a yearly checkup and $0 for telehealth. For any hospital visits, I pay 20% of whatever the actual bill is after a $300 copay (basically a down payment), which came out to a total of $600 when I went to the ER. Lastly, my prescription drugs are capped at $10 per month for generics and $150 for some brand-name drugs.
I use a ton of healthcare and the costs have been super manageable, but affordability is going to vary wildly between people. A ton of insurance plans don't start working until you hit an out-of-pocket minimum of several thousand dollars, and others work like mine except with way higher copays.
Lastly, insurance often doesn't cover certain drugs or procedures. As someone with really good insurance with good customer service, it's still an issue every so often, and the solution is either to find an alternative, try to find a manufacturer's coupon and pay up, or suck it up and move on. There are insurance companies that use shady tactics to get them out of paying for certain expensive drugs that they're supposed to cover.
This is almost exactly the same as my experience as well. My premiums are pretty high (like $500/month out of my paycheck) but when the time comes for the procedures it’s usually not too bad. One caveat, we have not had any large medical expenses except for a relatively minor outpatient surgery that my wife needed last year, bill was over $1000 but the hospital had an interest-free payment plan that let us break it up over the next 12 months with no early payment penalty, so we took advantage of that.
As another poster pointed out, the big issue is the emotional and mental toll of trying to sort things out if the slightest little thing goes wrong. You basically have to do their job for them in that case and can be exhausting.
Edit to add: as you can see in this thread, people’s expenses can vary wildly depending on a lot of factors. For my plan, even if we don’t hit our caps, there is typically still a ‘discount’ and ‘allowed charge’ that the insurance has worked out with the providers, so we still didn’t have to pay the ‘full’ amount of that surgery even though we didn’t hit our deductible or out of pocket. We’ve also been to the ER a couple times for our 7-year old and it’s typically been about $600 a pop for each. It is insanely complicated and I barely understand it all but just thankful the plan my employer offers seems decent.
everything you've listed is what you pay at the point of service. are your premiums covered 100% by your employer, or what?