Not all employers take on the responsibility of paying for insurance for their employees.
Therefore, it is quite common for U.S. residents to purchase their own insurance “packages”.
- The cost of insurance depends on marital status and family composition. It costs a little more for singles.
- The cost of insurance is determined by income: the more you earn, the more you pay. If your income is less than $24,000 for two people, the family gets free insurance, paid for by the government.
- The cost of insurance depends on age: the younger you are, the cheaper it is. Also, retirees have free insurance.
- The chosen insurance plan assumes that a person will be treated “in-network”, i.e. by doctors who accept this insurance. If the doctor you want to interact with is “out of network,” you will have to pay all the bills yourself.
This is how U.S. residents pay for their insurance each month. It is considered normal if insurance costs do not exceed 10% of income. But that is not the total cost.
Depending on the plan chosen, patients will still pay for medical services in addition to what falls on their shoulders in the form of monthly premiums. Although there are some very expensive insurance plans (well, very expensive) that don’t require extra spending anymore.
The general pattern is simple – the more expensive the insurance, the less you have to pay extra.
Let’s check how insurance works, using the example of a single New Yorker who bought a silver plan from MetroPlus.
The insurance begins Jan. 1. But new immigrants can buy it any day.
So, our single New Yorker pays $648.72 (Premium) each month. That’s the first important amount. And, unfortunately, not the last.
When he enters the doctor’s office, he has already paid a $50 co-payment. Co-payment is a fixed amount (usually $10-20-30-50) that you pay yourself when you go to the doctor. It is listed on your insurance card.
The next important amount is Deductible – $1,875. Deductible is the initial uncovered amount that you pay yourself out of pocket until the insurance kicks in. Let’s say our hero went to the doctor on January 2. Any bills he gets from the doctor up to $1,875 will be paid out of his own pocket. Anything on top of that is the company’s insurance.
After the visit, the doctor billed the insurance company $5,000. The insurance company laughed at him and reduced it to $500. And that’s just the $500 our bachelor would have to pay.
But that’s not all. During the doctor’s visit, he had tests taken. The lab billed the insurance company $8,000, and the insurance reduced it to $1,000.
Our patient also had an ultrasound. The insurance company lowered the bill by $1100 to $175.
Question: how much should the patient pay?
Do the math. Upon entering the doctor’s office, the patient has already paid $50. Plus $500 for the doctor’s appointment, $1,000 for tests and $175 for the ultrasound. That’s a total of $1,725. And that’s in addition to the fact that he also pays $648.72 each month. In February, our bachelor went to another doctor who billed him $800.
How much do you think he ended up paying?
Taking Deductible $1,875 and subtracting the $1,725 he already spent last month, we get $150. And never mind that the doctor billed the insurance company for $800.
Several months have passed. Our hero is out of luck. He needs surgery, which costs $30,000. How much do you think he’ll pay for it? Look at Out of pocket (the maximum amount the insured can pay). So our hero’s surgery will cost no more than $8500 minus the $1,725 and $150 already spent. The insurance company will pay the rest of the money.
That’s about how it works. There are, of course, also nuances. For example, X-rays for our hero will cost $75 each time after he “opts out” of the deductible. And the Emergency Room will cost $300. Medical organizations charge huge amounts, knowing already that the insurance companies will cut them down many times, if not dozens of times. Besides, in the United States you can always and everywhere bargain. If you are not satisfied with the doctor’s bill, you can always call and argue. Often doctors charge more in the hope that the patient will not understand and will not look into it. And if the patient does not keep quiet and calls, they usually meet and lower the bill.
Health insurance in the U.S. is more of a disadvantage to the young and healthy. If our bachelor didn’t need surgery, he would pay $648.72 a month all year, and he would be Deductible.
When you see different doctors regularly, insurance pays off.If you’ve been told stories about how the insurance company billed several tens of thousands of dollars, know that the patient didn’t have insurance.
The question is why? If a person makes little money, they are entitled to free insurance. If they just don’t want to waste money, they risk ending up with bills that are tens of times the amount of insurance payments.
To consider yourself smarter than others and not to buy insurance, risking your health and wallet, or to engage in fascinating medical accounting, it is up to each person to decide.