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?
WILDLY depends. And it is never simple.
If I break an arm, and I go to the hospital, and there’s not much that’s done aside from a cast, and some PT at the end, I pay $0.
Now, what does that mean?
We have had our insurance for a long time, and as we pay our monthly premiums, a little money goes into an account called an FSA. This pays some of the co-pay, deductibles, etc. in the background for us.
What happens if I get cancer and need to have some care for 7 years? Eventually that FSA runs out. Every insurance has a deductible that you pay before they start paying for everything. So we might have to pay $5k out of pocket annually and then insurance pays the rest.
What if I need to travel to another city to talk to a specialist? There might be airfare, hotels, food, etc. that we pay that is “part of the treatment” but not paid for by insurance.
What if I need medication? Might be $25 every trip to the pharmacy. Might be $300. Depends on the medication, how new it is, are there cheaper alternatives?
What if I get sick long enough where I lose my job? I might lose my insurance as well, and then have to apply for government assistance, that might make other medical bills different.
And not to forget that sometimes cheaper but equally effective drugs aren’t available under the insurance plan. Like auto insurance and their prefered shops and stuff.
Oh plus that FSA must run out really quick when private hospitals charge bug money for an aspirin because they trying to gouge the insurance company who probably doesn’t even care for other twisted reasons.
Not always. There’s still a max annual out of pocket expense, which is what is covered by the FSA. A single event, or an illness or accident that only requires care for a single year or two, regardless of how expensive, would not deplete the FSA. It’s only a chronic condition that requires hitting the max out of pocket for multiple consecutive years that would start to deplete that buffer.
That’s all assuming that I can continue to work, and don’t have any other non-medical expenses during the recovery.