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That 27k bill will come out of your estate. So if you have a house, it will be sold to pay that bill before your children can inherit it, if they, for whatever reason, can't cover it.
Private Healthcare in this country is a nightmare. And with Covid slowly disabling everyone, it's only going to get worse. Saving the NHS is worth it.
$7200 annually in $300 bi-weekly installments.
Before I have even seen a doctor or used my "benefits" in any way.
on the one hand - my wife and i didn't have insurance when my oldest was born, as i was doing contractor work overseas. Between one thing and another over the course of that year, we paid like $8k in medical expenses, including all the obgyn visits and the actual delivery, plus a hernia repair for me. The hospital was very easy to work with. Our income was very high so it was not exactly a burden. (8k was about 2% of total salary)
on the other hand - this year, with insurance we're going to pay about $6k in insurance premiums and $8k in medical expenses before we hit our deductible (~7% of total salary)
on the gripping hand - last year we had really excellent insurance. we paid a total of $1200 for the year in premiums, $50/pay period, and our deductible was only $2k. (~1% of total salary)
So it definitely varies a lot
n the other hand - this year, with insurance we’re going to pay about $6k in insurance premiums and $8k in medical expenses before we hit our deductible (~7% of total salary)
First world countries spend like $6,000 - $8,000 per person on care for better outcomes. The US pays more in employer subsidies and premiums than other countries pay altogether for medical care, and they don't have to worry about it at the point of service.
I had a surgery that ended up costing a few thousand dollars after insurance and we have ok insurance at work.
You're fucked if you don't have insurance, which is common for a lot of the working class.
A lot of people simply don't because they can't. It's absurdly expensive because the system isn't designed for people to pay for it out of pocket. If someone doesn't have insurance, they'll either beg the hospital for mercy or ignore the medical debt because it doesn't count against your credit score. Even if they do have insurance, it often doesn't cover a portion of the cost, the insurance is extremely expensive, or both. The people with quality insurance through their employer have it good, but the system expects everyone to have that privilege.
TL;DR: mine is $660/month for health, $42/month for dental
Most folks in the US aren’t aware of how much they pay for health insurance. I live in California, where law requires full time employees (>30 hrs a week, >130 hrs month) be provided some amount of health insurance. The type of coverage varies not just from job to job, but also within the same job the employee must often choose their own plan from several company selected options at varying price tiers and types/amount of coverage. Usually the employee only sees the amount of the monthly cost that THEY are responsible for, which is then automatically removed from their paycheck. What most folks are unaware of is that the employer is also paying some of the cost (which is the part that the law makes them do). The part that makes it extra frustrating to deal with an already broken and overly expensive system, is that the rate paid by employers is negotiated in bulk with the insurance providers. Larger employers (national corporations with hundreds of thousands of employees) are paying much less than an individual or small employer would. This is the one of the largest reasons becoming unemployed is so dangerous in the US. In addition to not having income for food or housing, people often forego health insurance due to the expense. If you lose (or leave) your job you’re eligible to keep your current insurance plan for 18-36 months with COBRA (Consolidated Omnibus Budget Reconciliation Act, which is such a ridiculous backronym that I had to google it just now). This is often the only time people realize the true cost of their insurance as the entirety of it is then passed on to them directly (at the employer negotiated rate) and it shows up as a new monthly bill.
I recently left my employer to start my own business and discovered that my true cost of insurance is ~$700/month ($660 Health/$42 Dental). Keep in mind, this doesn’t mean that I have zero medical bills should I actually visit a doctor or hospital. This is pretty good health insurance, but I still have to pay $5,000 out pocket (annually) before it kicks in at the full coverage amount. Since I had ear surgery earlier in the year and hit that limit, and wanted to be able to continue seeing the same doctors I had for already scheduled follow ups, I decided to keep the same insurance. That $5,000 isn’t the only expense that landed on my shoulders, there’s a bunch of rules that I honestly don’t fully understand and I’ve probably ended up paying somewhere between $7,500-$10,000 for the surgery I had (in addition to the monthly premium).
The main reason I keep paying insurance (in addition to the fact that you’ll now be charged a penalty on your taxes if you go uninsured for a month), is my fear that you mentioned in the original post. Having a car hit me while I’m walking down the street and ending up with a $50,000 visit to the emergency room is a very real possibility without health insurance. California recently limited ambulance rides to a maximum cost of $1,200, so that’s… good?
My father has had two heart attacks. The first was a pretty standard one by heart attack standards, required a stint to be put in and two days at the hospital. The cost was ~$40k and after insurance we were left with I think a $4-5k deductible (pretty good county employee insurance). His second one luckily (ha) happened while on the job and required another stint to be put in (he got amazingly lucky, as it was a widow maker of a heart attack) and was covered under his works insurance.
For reference, I'm healthy and in my late 20s, I pay ~$250 a month through my employer's health plan, $25 for an office visit, $500 to walk through the doors of the ER, with a $3k in network deductible ($6k out of network). Believe me when I say you are amazingly lucky to have the NHS.
I had a two part visit, about 45 min each, to test to see if I had asthma. My out of pocket after insurance was about $1,200.
Currently, nothing.
If your income is low enough, you can get free insurance through the government. In my experience, the regular doctor checkups and stuff is covered, along with prescriptions and any emergency room visits. The dental portion only covers the worst dentist in town, and vision is non existent.
It's not great, but medically necessary things are covered without copay or arguing with an insurance company to get it paid for. It's good enough that I've known people who purposely kept their income low to continue to qualify for the free insurance.
Problem is you have to make so little that you can't live on it with more than 1 person to care for
I work for a public school district. We're signing up for insurance now to begin sept 1. These are our available plans. I always take the HD (high deductible) plan because i contribute to an HSA (health savings account- pretax money that you put into an account. They send you a card and you can use that to pay med expenses.)
ETA- forgot to finish my thought- I may switch to the higher plan because i see it's only $75 per month more but saves $2k in deductible and $1100 out of pocket max. I'm considering a knee surgery this year, so i would likely meet those. This is an area where you have to pay your bill if you want to ever go back. I still owe $700 to the anesthesiologist for the other knee surgery 3 years ago. I will have to pay that to schedule another. For emergencies, hospitals are required to treat. My son without insurance had an emergency appendectomy 5 years ago and has never paid a dollar of the $5k he owes. They continue to send bills and he continues to throw them away. If he had another emergency, he could show up at the ER and they would treat him and the cycle would continue forever until he needed a scheduled procedure with that hospital system. Then they would likely require that he pay a certain amount upfront. My other son has obamacare. He pays $250/mo for it because he sees a weekly therapist that's $75 without insurance or $20 with insurance. It's all a very complex game of which is cheaper, what are you getting, how much are you willing to risk/commit, and do you expect to get sick or have an accident. My husband cannot add me to his insurance because i have access to it through my work. I was on his dental insurance and they dropped me because we couldn't find our marriage certificate from 30 years ago. 30 years of tax records showing we filed as married were not sufficient. It's really just their way of getting spouses and families off the plan. It's all a scam.
As you mentioned there is a dance between insurance companies and care providers. You should never pay a bill on the spot or upon first receiving it. Always wait until it says final warning. Often by then the bill has been reduced significantly.
There are many ways for the system to suck. When my wife and I were working it was less expensive for me to be covered by my company's insurance and her by hers because adding a spouse to one policy was more expensive. This is because when you are working for a company that has a plan (not all provide this) the company usually pitches in on the cost of the insurance. The amount the company pays relative to the employee has typically been shrinking over the years. Combined the two of us paid about $500/month. Now that we are retired it is about $1500/month and the deductible has doubled to about $700 (which as I understand it isn't too bad). There is also something called a co-pay, which is a small amount you pay for normal office visits regardless of anything else. Ours was $25. Now it is $50.
Coverages were all over the place. For a while we paid more to both be in the same insurance because my wife's insurance would not cover alternative forms of birth control. My wife could not take the pill because it caused her to get blood clots. Ironically they would have paid (way more) for the birth of a child.
When my wife had a major issue, we found that ambulance services do not negotiate prices with insurance the same way as doctors, if at all. She was airlifted for a cost of $55k. Insurance paid $11k for some reason. The hospital stay (approx. 5 days) was $120k. Her max out-of-pocket was $16k, which we paid. Despite this, the air ambulance service was insisting that we pay the $44k and the insurance company was not budging on this. We had the same problem with the ground ambulance for $1600. This went on for like 2 years while my wife acted as intermediary trying to get the ambulance service to lower their price and the insurance company to raise theirs, figuring that having hit our maximum out-of-pocket meant we were off the hook. Not so. We were expected to pay this. Ultimately we were saved in the end when my wife's employer paid those bills.
After that, assuming that because we had hit our max, it would be good for me to get my colonoscopy, we wound up paying the whole co-pay and deductible because I was not considered family. Yup, I'm a spouse. Apparently family means children. Why didn't they say this? Probably to get people to do what I did.
So one of the biggest problems I think is when people don't have insurance or they do have insurance but no real savings to speak of, they avoid getting health care for fear of the high cost.
In New York a while back there was a viral video of a woman who had her leg trapped between the subway train and the platform and all of the people on the platform teamed up to tilt the entire train a bit to free her. It is an awesome video of humans being kind. What wasn't as viral was the fact that the woman had just prior to that, pleaded with the people on the platform NOT to call for help because she couldn't afford it. Very sad for a country with so many resources.
That is completely terrifying. You must be spending a large part of your life desperately dealing with medical bills and trying to juggle the unreasonable requirements of the various parties.
And of course, having health insurance through an employer binds you to that employer, so you are less free to switch even if the conditions are otherwise deplorable.
I have good insurance. I pay $20 per paycheck for my wife’s coverage. Our typical visit costs 20-35 depending. Our medications cost 10-20 per 3 month supply.
Most people don’t have insurance this good.
Back in 2007, I had just finished college and was traveling cross country to start a new job. I had to stop and get emergency surgery on the way there and ended up in the hospital for a few days. I ended up paying around $70,000 over the next few years and the hospital finally forgave the rest of the bill.
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.
It varies a lot for people, and the bills you actually pay depend on a lot of things. It’s complicated here.
I would say I’m the average “I have healthcare through work” person. But that’s not average for the population (many people have no healthcare).
I pay about $600 a month for a plan that lets me go to any doctor (called a ppo). If I wanted a cheaper monthly bill, I could get on board with the plan where you have to go to the doctors and facilities that are “in the insurers network”. I’ve had problems with these plans as they’ve become more and more run by the insurers than actual doctors - leading to shoddy care. So $600 a month for my family it is.
I did require major surgery about 10 years ago. I was in the hospital for a month and had a million office visits. The grand total “bill” was just over a half million dollars. My portion of that was about $10,000. It was crazy to look at the itemized bill though. Two Advils cost like $50. An X-ray? Like $1000. But that’s like this this fucky-fuck game insurers and providers play with each other. Sometimes people are flat broke, and the hospitals still have to care for them if they wander into the ER - and they get paid nothing. It’s a weird system.
If you don’t have health insurance-you’re kind of in trouble. Interestingly, those $1000 X-rays become $200 if you’re uninsured. Definitely more manageable-but you’d be screwed if you required major surgery. You’d be bankrupt.
Basically it’s very American-it works great for people doing well in life - screw everyone else less fortunate- get a job…
