In 2018, many American adults are split into two camps— those with a high deductible health plan (40 percent) and those with no health insurance at all (11.3 percent). With these two circumstances so common, it’s no wonder more people than ever can’t afford the healthcare they need.
Whether you have health insurance and a high deductible or no insurance at all, a simple medical procedure could cost you thousands of dollars out-of-pocket. If you can’t afford your medical bill, you could end up going into debt to pay for it—or going without the care you need. Neither is a great solution.
This brings up an important question: who pays more for healthcare—people with health insurance or without? Below, we explore the difference in cost between insured patients and uninsured patients and options for patients who need help paying for medical procedures.
The cost difference between insured and uninsured patients
The answer to “who pays more for healthcare—people with health insurance or without?” is neither succinct nor exact. For each person, a unique combination of factors such as personal health, financial situation, type of health plan, and medical condition influences what the “right” answer is.
It would be virtually impossible to definitively say whether any one individual should or should not have health insurance. However, by attempting to answer the question, you can better understand the ins and outs of health insurance coverage. Using this information, you can then decide what the best solution is…for you.
Why are so many Americans going without health insurance?
There are many reasons why a person may not have health insurance. According to a report by the Henry J. Kaiser Family Foundation, “45 percent of uninsured adults said they remained uninsured because the cost of coverage was too high.”
Other reasons include the loss of a job or change of employer, the loss of Medicaid coverage, or an employer not offering health insurance (or being ineligible for the health insurance that is offered). Hispanic people, black people, adults, and people with low incomes go without health insurance most often.
What’s the deal with high deductible health plans?
Over the last ten years, high deductible health plans have become increasingly popular. These health plans usually have lower premiums (monthly payments), in exchange for having high deductibles (the amount you have to pay for care before your insurance kicks in).
Each year, the federal government determines what the minimum deductibles are for high deductible health plans. For 2018, these minimum amounts are:
- Family plan: $2,700
- Individual plan: $1,350
People with high deductible health plans pay lower monthly premiums but more for out-of-pocket care. For many, these high deductibles can be barriers to getting care. If you can’t afford to pay $1,350 for a medical procedure, you may find yourself in the same situation as someone who is uninsured: going without the care you need because you can’t afford it.
The true cost of going without health insurance
When a person who does not have health insurance gets sick or injured, their options for healthcare are incredibly limited. Many choose a visit to the emergency room because both public and private hospitals are required by law to treat anyone who comes in with an emergency medical concern. They will still receive a bill but they won’t be required to pay for treatment upfront, which means they can get the care they need.
Without health insurance, a trip to the emergency room could cost anywhere from $150 to $3,000 or more. If you need a surgery or intensive care, your bill could be tens of thousands. The final price depends on many factors including:
- The severity of the condition for which you’re being treated
- Which diagnostic tests are performed
- Which treatment(s) you’re given
- Whether you need a surgery
- Whether critical care is needed
- The fees of the doctor(s) who treat you
- If you need to ride in an ambulance (this alone could cost $1,200 or more)
This scenario is based on a visit to the emergency room. When you need an emergency medical treatment, it may be worth incurring a costly bill if it means saving your life.
However, if you need an important but non-emergency medical procedure like a colonoscopy or a hernia repair surgery, the ER isn’t an option. These procedures typically require pre-scheduling and pre-payment. Unfortunately, for people who are uninsured, this often means going without the care they need. When necessary healthcare is put off, more health problems tend to arise. In the long-run, this increases the cost of care—or the cost of illness—exponentially:
- Tangible costs of not getting a medical procedure when you need it include more medication, more doctors appointments, and more time off work. Even if they seem like far less than the cost of the procedure you need, over time they add up and often cost even more.
- Not all of the costs of going without care can be measured in dollars, either; the quality of your life is also impacted. When you’re not healthy, you can’t live life in the way you want. This can cause a further negative impact on your physical health, as well as your mental health and emotional wellbeing.
The cost (and savings) of having health insurance
As you can see, whether you have a high deductible health plan or no insurance at all, the cost of healthcare can prevent you from getting the care you need. When you’re uninsured, you are essentially responsible for 100 percent of the cost of your care. On the other hand, having health insurance can offset these costs in two ways:
- Your insurance company has negotiated a discounted rate with a network of providers. If you stay in-network, you reap the benefits and pay significantly less than you would if you went out-of-network or had no insurance at all.
- Your health plan picks up at least a portion of the cost of your care. This means that after you’ve met your annual deductible, you’ll only be responsible for copays and coinsurance amounts.
Having health insurance often means creating a budget for care is easier. The costs you need to factor in include:
- Your deductible
- Your monthly premium
- Your co-pay amounts
- Your co-insurance amounts
What your costs are for each of these will depend on your health plan. If you’re unsure, you can check directly with your insurance company.
Unfortunately, being able to identify how much a medical procedure will cost beforehand doesn’t always mean you’ll be able to afford to pay for it. Still, in the long run, having health insurance tends to be far less expensive than paying for healthcare on your own. Again, this depends on your individual health and financial situation.
Insured vs. uninsured cost comparison example
Still unsure how having insurance versus not having insurance affects your wallet? Below, you’ll find an illustrative example for both scenarios based on gallbladder surgery. We’ve also included our program Patient Assist in the cost comparison.
|With insurance (HDP)||Without insurance||With Patient Assist|
|Medical procedure charges (list price)||$18,500||$18,500||$18,500|
|Medical procedure discounted cost||$13,000||$15,000**||$6,500|
|Health plan pays||$5,200||N/A||N/A|
* = Assumes $350/m premium, $6,500 individual deductible, 20% co-insurance, and an $8,000 out-of-pocket max.
** = While some providers offer discounts for Self-Pay patients, the majority will bill Self-Pay patients the full “Charge” or list price.
How can I get help paying for my medical procedure?
You may be wondering what all of this means for you, as a patient. The high cost of healthcare is somewhat of a catch-22. If you can’t afford to pay for health insurance and need a medical procedure, you’re faced with choosing between a high medical bill that you also can’t afford or going without care. Similarly, if you do have health insurance but can’t afford the cost of your deductible, you may face the same choice.
What’s the solution? For some people who need help affording their medical procedure, New Choice Health’s Patient Assist program is an option. Patients who qualify are offered access to a private network of high-quality healthcare providers at a discounted, all-inclusive rate. If you still need help, you can apply for interest-free financing through our partner CareCredit. Learn more about Patient Assist!