You didn’t want to get ill and you certainly didn’t intend to, but we all know that illness or injury could strike at any time. In fact, two out of every three American adults have one or two chronic health conditions. When you’re young, perhaps one of the furthest things from your mind is your health. Doctors, medications, and health care aren’t usually at the top of your agenda, but after this read, it could be.
Though we don’t hesitate to insure things that can be replaced such as a house or a car, it’s surprising that over 27.9 million Americans do not have health care insurance. It might be helpful to start off with a few staggering statistics.
- In 1960, the American healthcare industry was worth $24.7 million. Now it’s worth around $3.5 trillion.
- Every year, around 805,000 Americans have a heart attack. Receiving treatment for a heart attack will cost an average of around $27,246 and this is not including any sort of heart operation. One in four people in the USA died from a heart attack.
- 1.4 million Americans travel abroad for medical care because of lower costs.
Why Are There Uninsured People?
People in the low-income bracket constitute the largest group of people who are not insured. These families will have at least one worker and will cite expensive coverage as the main reason for not having it. Many uninsured people cannot get coverage through their jobs and others are not eligible for financial assistance or coverage.
The Effects of Being Uninsured
It used to be that you would be fined under the Affordable Care Act (ACA) which required you to have insurance. The fine paid was called Shared Responsibility Payment. Since 2019, that fine is no longer enforced by the federal government. But depending on which state you live in; you might be required to pay a fee on your tax returns.
Those who are not insured are subject to having limited access to medical care. One in five people without medical health care will not get the care they need at the time they need it.
In addition, uninsured people are twice as likely to not be able to pay medical bills. This amounts to a huge unpayable debt.
Why You Need Healthcare
There are a lot reasons than not to receive health care.
Less Expensive: If you cite that coverage is too expensive, it is still cheaper than hospital stays, treatments, operations, and medications. The monthly premiums can seem a lot more practical and affordable compared to how much you would be paying for medical treatments without insurance.
Going back to the statistic of heart attacks. Around 85% of Americans aged 65 and over have cardiovascular diseases (CVD) compared to 50% for those aged 45—64. The estimated calculation of an open heart surgery will cost you around $324,000. Add that expense to medications and other treatments, not to mention your average monthly bill of all the other corresponding essentials.
There is a growing connection between out-of-pocket medical expenses and chronic illnesses.
A chronic illness is defined as a condition that lasts 12 months or longer that affects your physical activity. People over age sixty-five with multiple chronic conditions spend an average of $1,292 per person, per year for drugs. This accounts for more money spent than any other age group and is more than five times greater than their spending on doctor office visits.
One study shows that overall, out-of-pocket spending increased by 39.4% per person over a ten-year period of the study. It also showed that one of the groups most at risk of spending on chronic illnesses were non-elderly uninsured people starting at the age of 45.
Why there is an increase in chronic illness of non-elderly individuals is beyond the scope of this read though we know that unhealthy lifestyles contribute greatly. But it does show you that from a relatively young age, you are prone to spending more than you expect at your health. And without health care, this money will be coming out of your pocket.
A quick overview can show you the average cost of common surgeries:
- Heart valve replacement: $170,000
- Heart bypass: $123,000
- Spinal fusion $110,000
- Hip replacement: $40,364
- Knee replacement: $35,000
- Hip resurfacing: $28,000
- Gastric bypass: $25,000
- Cornea: $17,500
- Cast: $7,500
This is just half the story. These numbers don’t even cover hospital stays, medications, and other expenses. There are still other costs that we’ll talk about next.
The above numbers don’t add up to the actual cost of what you can pay as an inpatient. Actual costs can differ in a variety of things, such as the cost of an ICU room vs a regular room. You can’t find two hospitals that will charge you the exact same amount.
But we do know that people underestimate the amount of money that can be spent on their healthcare. It can have a huge impact on your retirement income, and it’s estimated that a retired couple of 65 years of age can spend up to $399,000 annually on medical expenses. That number doesn’t account for long-term care.
The following will show you the average out of pocket costs you may pay for some things:
- Flu vaccination: $15 to $30
- Doctor visit: $28 to $234
- X-rays: $100 to $1000 (varies according to which part of the body is being X-rayed. Specialized X-rays such as ones for various arteries, veins or ducts in the body, can reach $20,000 to $30,000.)
- MRI: $2,600
- ER visit: $1000 to $20,000
As long as you’re not sick, you probably might not realize the importance of having health care. Yet, once an urgent medical emergency arises, you will see how it does not just affect you, but everyone around you. Out of many things in the field of health, a medical emergency is often the most expensive.
Usually, a medical emergency can put you out of work for a while. The duration could be anywhere from a few days to weeks or months. Some cases might not allow you to work again. With no income or a reduced income, the normal outcome will be mounting bills of all kinds. Especially when we talk about medical bills, they can accumulate very quickly.
When you have a health care system in place, you’re going to use it and not let any premiums you pay for coverage go to waste. Since you’ll be keeping your health in check that means protecting yourself from certain diseases or illnesses by having possible early detection. As always with health, prevention is easier than cure. Regular medical checkups and diagnosis can catch the possible onset of diseases early on.
In an article in The Economist, it states that people who have health care are actually healthier. Obviously, with a healthcare plan in place, you are more likely to have regular checkups, which are considered as a type of preventive measure. You’d also remove the worry of not being able to pay medical bills. The article also states that it’s estimated that lack of health insurance causes 44,789 excess deaths annually.
Healthcare plans vary and can often be complicated to understand. A typical health care plan can pay for some of your expenses, but the coverage is usually limited. Then there are private companies offering their plans. People might be familiar with some plans, but not all, while there are other options you might be less familiar with.
Below are some types of plans that you can consider.
Traditional Indemnity Plan: This plan is the original healthcare insurance that most people are familiar with. In exchange for going to any doctor, specialist, or hospital, you will probably pay a lot of out-of-pocket costs and have a deductible.
Health Share Ministry Plan: One of the lesser-known options, but growing in popularity is Christian healthcare sharing, which works by way of Ministries that are based on health cost-sharing. Typically, a ministry shares eligible bills through members’ contributions. Each month, members contribute their monthly amounts, which are used to share each towards others healthcare costs.
The program offers you different coverage, which may range from catastrophic only programs to other programs that cover affordable consult fees of doctor visits, preventive care, urgent care, and emergency room admissions.
Unlike traditional insurance plans, technically it’s not an insurance plan. Also, Christian health care sharing has an all-year open enrollment. With other plans, you are limited in the time in which you can sign up. Over and above, you would be dealing with like-minded people who support each other as a community. In essence, monthly contributions mean that each individual is watching out for the other, therefore creating a strong community of faith and help.
The system of other health care insurance plans might not align with your religious and personal values, which is one of the reasons why this system is attractive to many people across the USA.
Managed Care Plans: These include Preferred Provider Organizations (PPOs), Point-of-Service (POS), and Health Maintenance Organizations (HMOs). These plans only work when the physician or facility is involved in one of the plans that you too are involved in. That means they work in a closed network. In exchange, patients pay lower premiums and have lower or no copays. PPOs are the cheapest options, but do not pay for any services outside of the network.
High-Deductible Plans: These are known as catastrophic plans which cost less than other types of plans. As the name implies, you pay a large deductible at the beginning, then the insurance will pay the rest.
Choosing a Health Plan
Healthcare isn’t a luxury. This is clear from the average costs, we have provided you with about various procedures and other expenses. While it’s tempting to skip out on a health care plan, that would be a serious mistake.
To have a plan that suits you, you can consider some of these factors.
Your Current Health: If you engage in risky behavior such as extreme sports or exercise, or if your current workplace engages in risky practices, your current health, even if good, can be compromised.
Amount of Doctor Visits: If you have to pay several visits to a doctor throughout any given year, this is an important factor to consider. Besides calculating your average cost of the visit, you need to also calculate medication, lab tests, etc.
Prescription Drugs: If you are on a prescribed drug, you need to know if a certain plan covers that. Plans vary greatly when it comes to what and what is not covered in terms of medications. If you’re already on a drug, it won’t be difficult to find out, but you might have to look beyond today and know that many elders and retirement age people are often on one type of medication or another to manage chronic ailments.
Specialists: Depending on your health condition, you might need a specialist to attend to your needs. You need to review the details of your health plan to see if this is viable. Different health plans may not allow you to go to a specialist without a referral first.
Your Priorities: If you need to see a doctor often, you would probably want a plan with low copays and deductibles. If that isn’t the case, it wouldn’t be practical or cost-effective to pay high monthly premiums.
Coverage: Ultimately, you have to decide the type of coverage that you need. You need to check the details of a plan that you feel might suit you. You are purchasing a coverage for your health, so no matter how tempting a cheap policy can be, it might not be your best choice. You want your money to pay off nicely in the long run and get the most value out of it with proper healthcare, doctors, hospitals, and other facilities.
Not having a healthcare plan can lead to financial disaster, something you can’t afford now or later. Contrary to popular belief, there is a lot more to pay financially and otherwise when there is no health care in place. There’s no reason to delay the decision of getting enrolled in a plan that will help you today and tomorrow and all the coming years.