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?
You must log in or register to comment.
On average they actually spend $12.500 per year (total, PPP adjusted, at leat that’s the number for 2022)
https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita
You as a Brit spend $5.500 (also adjusted) (And as a bonus, at the same time you’re also expected to live 2.8 years longer than the average American.)
I spend more than that just for insurance for two. Actually using it costs far more. Strep? $250. Video call a random person when I’m in bed after puking my brains out? $100 for a five minute call where they tell me to drink water. Minor surgery? Thousands of dollars in bills sent between two months and two years after the surgery.
I really wish you people that it’ll become better one day. It’s just a rip-off and and a way to funnel money from normal people to the rich. Looking at other countries, you could do away with the scary bills. And on top have an extra free $5.000 each year. Per person. And I think it’s extra cruel to rip off people with their health.
Plus the Brit coverage is universal while the US has a significant number of uninsured. We pay double on average including for those that aren’t covered at all. Even though the long lines myths are overblown for countries with universal care, it is important to remember that in the US a lot of people never get the care and we still have massively long wait lines unless we can afford to be first in line. The wealthy have a fast pass.
it is important to remember that in the US a lot of people never get the care and we still have massively long wait lines unless we can afford to be first in line
This is really important for non-Americans to understand. Yeah there are waits to see specialists and so forth in countries with a public system. We also have waits…but it’s for people who can’t afford the procedure. They have to wait until they can afford it, and if they can’t they simply have to live with their condition indefinitely or until it’s bad enough that they go to the emergency room. People who are uninsured go to the emergency room for everything because, legally speaking, they can’t turn you away. They have to at least diagnose and stabilize you. Because these people are broke, they generally end up not paying the bill, which means everyone else’s costs go up.
You couldn’t devise a worse system if you tried.
deleted by creator
The United Kingdom provides public healthcare to all permanent residents, about 58 million people. Healthcare coverage is free at the point of need, and is paid for by general taxation. About 18% of a citizen’s income tax goes towards healthcare, which is about 4.5% of the average citizen’s income. Overall, around 8.4 percent of the UK’s gross domestic product is spent on healthcare (an amount of around 0.18984 trillion GBP). UK also has a
growing private healthcare sector that is still much smaller than the public sector.( http://assets.ce.columbia.edu/pdf/actu/actu-uk.pdf )
So it should be more like £1.200 for you?!
And I think the study I linked is total healthcare expenditure. So it also covers the extra private insurance and the medication you buy that isn’t covered at all. I’m not 100% sure.
But yeah, that’s how statistics works. For everyone who pays less than the average, there has to be someone who pays more than the average. And I also think it should work with solidarity. Rich people can afford to pay more.
deleted by creator
Was that pre ACA? When we had our kid, we only paid a $175 hospital stay copay. Granted… we’re very lucky with the insurance coverage provided by my employer, but we were under the understanding that the reason we didn’t have OBGYN copays and otherwise throughout the pregnancy was because the ACA made sure it was covered.
deleted by creator
On top of your premiums, any insurance through a job means the job is paying thousands of dollars a year to insurance instead of paying you on top of what you paid.
deleted by creator
I think you may have read that backwards.(didn’t see edit till I finished posting so I’m keeping the rest)If the plan is ‘good’, then the part the employee ‘pays’ each month is low and could be in the hundreds each year before paying for any care they actually receive. But the employer is shouldering the rest of the costs behind the scene as part of the cost to employ. That means whatever they spend on insurance is money not going to your income so it really doesn’t matter if it is paid directly by the employer or employee, that is all smoke an mirrors.
As an example for state employee plans from 2020:
While health insurance premiums varied greatly across the states, the average per-employee per-month premium was $959; states paid an average of $805 (nearly 84 percent) toward premium contributions.
This means the insurance company is collecting $959 dollars per state employee per month just to have them on the plan ($11,508 /yr) -The state is paying $808 per month ($9,696 /yr) -The employee is paying $154 per month ($1848 /yr)
This is all before office copays, medicine, emergency room copays, hospital bills, care clinic visits, and any service where you pay something to access service. This is generally decent to good insurance in the US and we pay well over the cost per person in other countries just to be insured.
To drive home that this is not an outlier, this is the cost that each country spends on health care per person United States $12,555 Switzerland $8,049 Germany $8,011 Norway $7,898 Netherlands $7,358 Austria $7,275 Belgium $6,600 Australia $6,597 France $6,517 Sweden $6,438
Everyone in Sweden is covered for healthcare, they don’t need to pay at the point of service, and they spend about half of what the US does on average including the uninsured.
My employer’s insurance plan, which is REALLY good mind you, takes $2800 annually in premiums, then actually starts to cover your expenses after you’ve spent $1600 on health care. That is, unless you’re “out of network”, AKA the hospital/office doesn’t have a contract with your insurance company, in which case it kicks in after $3200. So basically, minimum of $4400, max of $6000, and that’s for like the top 1% best insurance available, assuming you’re only doing things your insurance covers.
I wonder how this compares to my Canadian tax contribution to healthcare
It doesn’t, since govt. subsidies still go to healthcare in America, so I’m paying for this privilege in taxes and insurance premiums.
The portion per capita that Americans pay for Medicare and Medicaid is about the same as Canadians pay for our Healthcare. Then they get the privilege of paying insurers and others for the coverage they have if they don’t qualify for those two programs.
that’d be $4400 and $6000
I shouldn’t write Lemmy posts while driving, my math becomes silly 💀
you uh… probably should not be on your phone while driving. stay safe, friend.
Different ask lemmy thread about crazy stuff seen while driving is leaking.
That’s so useless. I had 3 surgeries and multiple visits to doctors last year. I paid the equivalent of $150 for that. I love Sweden.
My insurance costs several times that but I still have plan where everything is a small copay (except of course dental)
I have insurance. Just to give you perspective. I had a video call for some mental health diagnosis. I now have a bill of $568 dollars. Reminder, this is WITH insurance. I have to pay that out of pocket. And I even have to set up additional appointments. Which will be probably around the same price.
I also have an inhaler. I had a doctor’s appointment to get a refill on my medication because I don’t have to use the inhaler too much (meaning I don’t have to refill often). I try to stay healthy and workout and only have to use it when working out/exercising. $300 dollars for the appointment. Another $212 for the actual medication that I picked up. In the last 30 days I have blown over a grand on medical. And I’m not even sick/unhealthy.
My wife on the other hand has very expensive monthly medication for a rare disease. She hits her max out of pocket every year which is 5k. Which we just have to pay forever. If I was on her healthcare plan, we would end up paying 10k every year just for healthcare.
I would say on a regular year. We pay around 7k in healthcare costs with our insurance (depending on how healthy I am throughout the year). On a light year 5.5k.
Is it possible to get health insurance with no copay at all in the US? My insurance in Berlin is about 1500€ per month, for which my employer pays half. If I lose my job, the unemployment office pays it and the price drops to 100€. The same happens if my salary drops, because the insurance cost is a percentage from my salary.
But if I came to the US, what kind of insurance would I get with $1500 per month?
Yeah if you make less than 10k/yr or something, sometimes you can get state health insurance and it covered everything for me.
When I was on welfare, I got Medicaid. (Free health insurance from the government.) I chose the plan with no copays or deductibles. It was nice.
They had another plan where the copay was $3. I had it before I moved to the no copay plan. It’s fine, but being on welfare at the time, every dollar counted.
Now I have my employer plan and my copays range from $15 - $50, depending on the type of appointment I see. I pay about $1k/month in premiums.
Typically you have a choice between public Medicare/Medicaid, high deductible health care plan through work. Or co pay plan through work. And as for per month. It really depends on the job. Everything depends on where you work. If you work at a company with good healthcare you will probably pay more. But have a lower max out of pocket.
If you want I could look up what I pay on a monthly basis for my healthcare and get back to you.
Like the whole stress of needing to pay anything if needing medical help… If I would avoid that, it is worth even a bigger monthly pay.
Like, in Berlin I can just walk to a doctor, to a hospital or to a pharmacy, plug my insurance card to a machine and it is all settled. I never see any money changing hands, or at maximum 10 euros copay if getting expensive prescription drugs.
Completely removing the stress of having a huge bill suddenly is worth the money I put into the insurance every month.
Oh totally agree with you. Our system is sooooo dumb. Plus, this is all just the payments for the actual healthcare and how it interacts with my insurance. This does not include the insurance premiums I pay every paycheck.
I spend all of this on top of my insurance premiums.
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.
You’re exactly right and it gets so much worse. I had a friend who needed a new lens in his eye. There were 3 options. For lack of a better explanation, it was, normal, better and best. His insurance only covered normal. So unless he could cough up more money, he only had the one choice.
My sister-in-law got very sick. She was in the hospital for almost a month. In the end, she died. My brother-in-law who was the executor of her will told me he saw the bill. It was $3.2M. You can’t force a dead person to pay and he was not responsible for her bills so it was pretty much just written off. But holy cow!
I think people in this country who think we have the greatest health care in the world, simply haven’t used it.
yes, that’s about right.
Consider that most Americans are pay 2x to 5x more in insurance premiums each month than folks in the 32 other developed nations with national healthcare coverage pay monthly in taxes for health care. Consider that Americans still pay deductibles and copays. Consider that insurance won’t cover pre-existing conditions (which are many). Consider the insurance frequently denies claims and requests for further tests and specialists. Consider that most insurance only works within the limited network of the insurance companies designated healthcare providers.
I work a multinational company that has moved staff from Japan, Canada, and the UK to the USA for periods of work. All of these folks were shocked and horrified by the American insurance system.
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.
If you are and remain healthy it is very expensive. If you get sick or injured or ill
It costs more than you have
You essentially gamble a little bit. Most people get insurance through work (or they are part of a family plan). Generally, you’ll have a few plans to choose from. If you are older, or have recurring issues, you might pick a plan that’s a little more expensive, but covers more costs. If you are young and healthy, you might pick a cheap plan, essentially betting that you won’t really need healthcare other than your yearly checkup and some vaccines.
The biggest thing with healthcare in the US is that it’s very complex. Even if you have insurance that should cover something, it can be hard to find a doctor that’s part of your insurance, so people often put off going to the doctor, which is part of the reason why costs are high. Teeth and eyes have separate insurance cause they are optional, apparently.
You basically have “premiums” that are your monthly payment. If you get your insurance through work, they cover a percentage of that; generally a pretty hefty amount of it. They usually don’t outright tell you what percentage, though, so many people think insurance is cheap, and get a rude awakening when they lose a job, and suddenly can’t afford $1000 a month when they used to be paying $100. Those premiums are taken out of your paycheck pre-tax, too, which gives you even more of a benefit if you have a job.
Depending on the “style” of the plans, they cover things differently. They all (I think) cover “preventative care” completely, which includes your yearly checkup, vaccines, and birth control for women. After that, some plans have “co-pays”, which are set costs for a few things, like $25 for a normal doctors visit, $50 for a specialist, $100 for an emergency room visit. Some just cover a percentage of those costs, and some don’t pay anything until you hit a limit (the deductible). Finally, there’s an “out of pocket” limit. That’s most you’ll have to pay in a year, after which point the insurance covers everything.
All together, I pay less than $1000 a year for healthcare, but if I got really sick, and needed a bunch of expensive healthcare, I would quickly hit my out of pocket maximum, which I think is like $6,000. I could cover that, but many people cannot cover an expense like that on short notice.
The number on bills is very misleading. The hospitals know that insurance will negotiate down, so they start high, and then after the negotiations, insurance will pay some or all of the remainder. If you don’t have insurance, you typically don’t pay that whole number on the bill, either, cause the hospitals recognize that they dont have to adjust it up for the negotiation. You can still negotiate on your own, though.
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.
Prescriptions are all over the place: I just paid $1.60 for one while a 30 day supply of something for my wife was over $200.00
deleted by creator
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 quit even responding to them. After two or three years I’ll get sued for a very small amount. It will be some radiologist who looked over a xray who has sold his debt to some bottom feeders. I wait until I’m served then I pay it. Within six months some other bottom feeder will serve me again for the same debt. When I go to court showing it was paid I can generally get my money back from the second bottom feeder. I’ve done this three times and got paid twice. The third time cost me nothing but time. Its long drawn out and stupid but its the shit sandwich we are forced to eat to live in the Home of the fee.
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
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 $300. Depends on the medication, how new it is, are there cheaper alternatives?
What if I get sick long enough where I lose my job? I might lose my insurance as well, and then have to apply for government assistance, that might make other medical bills different.
And not to forget that sometimes cheaper but equally effective drugs aren’t available under the insurance plan. Like auto insurance and their prefered shops and stuff.
Oh plus that FSA must run out really quick when private hospitals charge bug money for an aspirin because they trying to gouge the insurance company who probably doesn’t even care for other twisted reasons.
Not always. There’s still a max annual out of pocket expense, which is what is covered by the FSA. A single event, or an illness or accident that only requires care for a single year or two, regardless of how expensive, would not deplete the FSA. It’s only a chronic condition that requires hitting the max out of pocket for multiple consecutive years that would start to deplete that buffer.
That’s all assuming that I can continue to work, and don’t have any other non-medical expenses during the recovery.
I assume you need to have health insurance? As in, you mention paying 0$ if you break your arm. But do you have to pay monthly premiums for it to be 0 at the hospital ?
And I have no idea but - presumably you would claim on the insurance for the broken arm, does that then impact your monthly premiums or coverage afterwards?
deleted by creator
I don’t contribute to the FSA, that’s an automatic part of my health insurance.
Some people contribute separately to an FSA or an HSA depending on their insurance, but that’s not an option for my situation.
deleted by creator
It’s understandable, the people I work with get them mixed up all the time.
The nice thing about an FSA is that I don’t pay any extra for it. The bad thing is that if I cancel insurance with this company, or change jobs, I lose that built up money and need to start over.
An HSA stays with me, but it requires extra deposits, and more work on the back end to get reimbursed for expenses.
As part of our employment, our employer has negotiated that we pay $400 a month for my family to have insurance under these terms.
If I had a different employer, those terms could be wildly different. I would have no choice.
It is EXTREMELY complicated, and extremely different for everyone in the country, and depends heavily on how your employer sets up the benefits. This is a major benefit for large corporations, and a major burden for smaller businesses.
If you buy insurance through the private market, it is usually far more expensive, but often subsidized by the government, since you often only buy from the market if you are unemployed or low income.
you often only buy from the market if you are unemployed or low income.
Don’t forget self employed or at a workplace with workplace insurance so bad it’s actually cheaper to go through private (so basically low income)
I know multiple small business owners who also have a regular corporate job JUST so they have insurance. The whole second job has nothing to do with salary, only health insurance.
Every family farm I know, the husband works the farm while the wife works a normal job for insurance and stable base income to help keep everything afloat
If you have insurance through your employer, then no the insurance company can’t raise your rates. And part of the reason for the Affordable Care Act (ACA, sometimes called Obamacare) was to make it so people who are getting the insurance themselves also can’t have their rates raised or get turned down for insurance because they have pre-existing conditions. However insurance companies can raise everyone’s rates when the insurance is up for renewal each year.
Most insurance plans have several different costs: 1. The monthly premium you pay to have insurance coverage. Some employers pay this themselves, otherwise it gets taken out of every pay check.
-
Co-pay: Usually a set amount ($30, for example) you pay to see a doctor for office appointments that aren’t an annual check-up*. So say I get an ear infection and see my primary doctor to get it treated, I’d pay the co-pay for that visit. Sometimes things like x-rays, blood work, CTs can be a set amount, other times it’s something like insurance will cover 65% of the cost. For some plans, co-pays are included when figuring out if you’ve reached your deductible.
-
Deductible: The amount you have to pay before “co-insurance” kicks in. Co-insurance being the percent of your bill insurance will pay (for us it’s 75% after we pay $3500 in a calendar year).
-
Out of pocket max: When you’ve spent this amount in a calendar year after that insurance covers 100%. Often plans have both individual and family maximums, with the family amount being higher.
Usually the more you pay in monthly premiums, the lower your deductible and out of pocket maximums will be. So each year people have to try and decide what they think their health bills will be next year when picking their plan (you can’t change plans mid-year unless something happens like changing job, getting married/divorced, having a kid). If you’re pretty healthy you might pick a lower monthly plan with higher out of pocket amounts because you don’t expect to have to pay much out of pocket. If you’re someone with a chronic condition or you’re expecting to need surgery or a costly treatment you might go with the higher monthly plan so you don’t have as high of out of pocket amounts.
For example, my spouse had to go to the ER a few years ago for what turned out to be a collapsed lung. They didn’t have to stay in the hospital overnight. I forget the total bill (or I’ve just blocked it from my memory), but our part ended up being about $5,000. Insurance kicked in after the bill got to $3,500, and they covered 75% of everything that was over $3,500. The most we would’ve paid was $6,000 (the individual out of pocket max), however we would still have to pay bills for myself and our kid up to $12,000 (family out of pocket max).
*Another part of the ACA was to make annual preventative screenings (like annual physical, mammogram for women over a certain age, prostate screening for men, etc) free.
-
I posted a tad about costs with my son undergoing cancer treatment:
I hope your son stays clear for the rest of his life and that the insurance CEOs’ yachts and houses burn to the ground.
It’d be wonderful to see them struggle to get their yachts/houses covered by insurance…
