If you are living paycheck to paycheck, you may wonder if you really need health insurance. You’re young, you’re healthy, you don’t have any family history that concerns you.
When your employer gives you your options and you see how much will come out of your paycheck in healthcare premiums, you may be tempted to elect to skip the insurance.
You could use the money, right?
Obviously, if nothing happens and there’s no need for medical care, not paying for health insurance is cheaper.
But what about if you have a medical emergency? Even then, many health insurance companies don’t cover much. So, what do you do?
If you want to see how much health insurance is going to cost, start by comparing the cheapest health insurance options available to you wherever you live side-by-side.
The costs of health insurance
Kaiser Family Foundation reviews all healthcare providers and in 2020 reported the average health insurance premium is $462 per month.
Of course, when you add a family to the mix, the insurance premiums are even greater — and it continues to rise.
While employers will cover most of the premiums for single employees, they do not take on those costs when it comes to a spouse or children. The National Conference of State Legislators reported single employees paid 18% of the costs of insurance premium but for family coverage, the employees paid 29%.
Overview of the costs of treatment with and without health insurance
Type of care Insured Not insured
Primary care visit $10 to $40 copay $200 to $300
Emergency room visit $50 to $150 copay $1,016
Lab work $0 to $25 $5 to $150
Specialists $30 to $50 $160
Dental care (basic) $360 $360 to $1,650
Vision care $50 to $120 glasses
$50 to $1,500 contacts
$60 to $180 insurance
$50 to $100 exam
$50 to $1,500 contacts
Prescriptions $10 to $40 $89 to $129
Chronic illness Varies greatly
$10 to $40 copay
$10 to $40 prescriptions
Disability aides $16 to $300 wheelchairs;
$2,691 hearing aids;
$40 to $60 blood glucose monitors; $60 to $600 blood glucose testing strips
$80 to $1,500 wheelchairs;
$2,691 hearing aids;
$40 to $60 blood glucose meters; $1,533 to $4,380 blood glucose testing strips
When comparing the costs in this chart, remember you are paying an average of $462 per month for insurance premiums, which equates to $5,544 per year.
Let’s say you are a healthy individual without the need of seeing a doctor regularly. Your year may look something like this if you have insurance:
- Annual insurance premium = $5,544.
- PCP annual checkup = $0.
- Dentist, 2x a year = $360.
- Ophthalmologist, 1x a year = $60.
- Total: $5,964.
Now, without insurance, at minimum rates:
- Annual insurance premium = $0.
- PCP annual checkup = $200.
- Dentist, 2x a year = $360.
- Ophthalmologist, 1x a year = $50.
- Total: $610.
If you are healthy — and don’t wind up in the ER — your annual costs are nearly 10% lower, paying as you need services versus having insurance. That’s a huge savings!
If you have a chronic illness, impairment, or wind up in the emergency room, however, you need to review the chart to determine if you’ll save with insurance or not.
Primary care visits
Most insurance companies require participants to obtain their care through a primary care physician. These general practitioners are able to evaluate you for physicals, vaccinations, and ailments. If a more serious workup is needed, a PCP will refer you to a specialist.
How much does a primary care visit cost with health insurance?
Preventative care means insurance often covers 100% of your annual checkup at the doctor. Outside of that visit, the average cost of visiting a doctor for a checkup with health insurance is a $10 to $40 copay. The rest of your visit will be covered by insurance for which you are paying the average $462 per month.
This means it costs more than $5,500 a year to see a doctor just once and copays for additional visits. Some insurance has deductibles, meaning you will pay out-of-pocket until you reach the limit. For example, if you have a $1,000 deductible, you will pay copays and additional costs until you reach that limit. After that, all costs are covered by the insurance company.
How much does a primary care visit cost without health insurance?
If you choose to forgo health insurance, you will have to pay the full fees for doctor visits. Perhaps you are healthy and only need an annual checkup?
The average cost of visiting a doctor for a checkup without health insurance can cost between $200 and $300. A new patient office visit up to 30 minutes can cost upwards of $578, according to the Healthcare Blue Book.
While it’s much cheaper to skip health insurance when you are healthy, the reason for questioning the need for insurance is an emergency. How much can you expect to pay if you wind up in the emergency room (ER)?
How much does an emergency visit cost with health insurance?
The average ER visit cost $1,082 in 2019. With health insurance, a trip to the ER will cost $50 to $150, depending on the copay. If you need tests, you’ll pay additional fees. These may be a copay or a percentage of the price of the service. X-rays have been found to average $140 at hospitals and CT scans ranged from $442 to $1,146.
How much does an emergency visit cost without health insurance?
A trip to the emergency room (ER) will also cost $50 to $150 just to check-in without insurance. But this is where the big numbers come in: the tests and the doctors’ fees.
Your $50 to $150 goes to the hospital. The doctor you see may charge you another $100 to upwards of $1,000 for the level of service. And an ER visit may require CT scans, MRIs, or more, all with a price. Those X-rays at $140 and CT scans up to $1,146 are fully your responsibility. If you are admitted for an overnight stay, the hospital room and service will be additional, as well.
Healthcare Blue Book found an ER visit for a minor problem ranges from $431 to $1,343. The prices climb by the severity of the health issue with a very severe problem, pricing between $1,056 to $3,295.
Traditional annual exams do require various tests, but most are also affordable.
How much does lab work cost with health insurance?
Lab work performed within your PCP’s office is included with the office visit. If you are sent to a clinic for blood work, your insurance may cover all of the costs or you may have a small fee to pay, depending on your insurance and location.
How much does lab work cost without health insurance?
While some may cost as little as $5, the bigger the test, the bigger the cost. Basic tests most likely performed on younger adults include:
- Blood work – $5 to $50.
- Throat swabs – $30 to $50.
- Pap Smears – $18 to $88.
- Strep test – $20 to $40.
- Urine tests – $5 to $25.
- Vaccinations – $25 to $150.
Should you need a bigger test, expect to find prices in the hundreds. An ultrasound, for example, will cost $150 to $250 (on the low end) and a CAT Scan will run between $300 to $750 (again, on the low end).
A specialist is a doctor who, as the name implies, specializes in one area of medicine. A gynecologist or an allergist are examples.
How much does a specialist visit cost with health insurance?
Most insurance companies require you to begin your doctor visit with your PCP and obtain a referral to seek a specialist’s care. This is because specialists are more expensive and your insurance company wants to ensure your ailment isn’t something that your PCP cannot fix.
If the PCP refers you, then you will typically pay a copay from $30 to $50. However, some insurance companies do not provide out-of-network coverage, which means you’ll pay as if you do not have insurance should you see a specialist that’s not within your program.
How much does a specialist visit cost without health insurance?
Johns Hopkins Bloomberg School of Public Health found the average price of seeing a doctor without insurance was $160, with prices varying by location.
Dentists and ophthalmologists are specialists in oral and visual health but fall under different parameters. Regular insurance doesn’t include visits to these specialists and they require their own separate insurance.
It is recommended that people visit a dentist twice a year for cleanings and exams.
Of course, people who need glasses and contacts need to see an eye doctor annually while those with good vision under 30 may only need to see a doctor every couple of years.
How much does dental/vision care visit cost with health insurance?
Dental insurance is separate from traditional health insurance and comes with its own premium. The average is between $15 and $50 per month and this typically covers two annual cleanings and exams and one set of X-rays without a copay.
Should you need a filling or work done, a portion of the treatment is covered by insurance and you will have to pay the remaining costs. Insurance typically covers 50% to 70% of the costs. Cavity fillings can cost between $150 to $2,600 so you could pay $75 to $1,300 out of pocket.
Cosmetic work is not covered with dental insurance so any teeth whitening, veneers, and the like will be out of pocket and can climb into the thousands.
For vision care, an eye exam may be included once a year in your coverage plan with discounted pricing on glasses and contacts. You may find glasses covered with out-of-pocket ranges from $50 to $120. Contacts can range from $150 to $1,500 annually, with or without insurance. The good news is vision premiums are extremely low. You’ll only pay $5 to $15 per month.
How much does dental/vision care visit cost without health insurance?
40% of the population does not have dental coverage. This means they pay $50 to $350 for an office visit, with cleanings ranging from $70 to $200, X-rays between $20 and $250; and the dental exam costing $50 to $150.
If something goes wrong, such as a cavity must be filled, you need a root canal, or your wisdom teeth need to be extracted, the costs are high. To fill a cavity can cost up to $450 while a crown could take the price all the way to $3,000. If your wisdom teeth are impacted and you require surgery the cost is also as high as $3,000.
Without vision care, seeing an ophthalmologist can cost between $50 and $100 for an eye exam. Glasses including frames and lenses average $351 without insurance. Contacts can range from $150 to $1,500 annually, with or without insurance.
Read more: Is Dental Insurance Worth It?
Unfortunately, medications are not regulated and drug prices have risen year after year. Insurance may not cover all medications and may require a deductible to be met before covering them. In 2020, the average spend on pharmaceuticals was $1,200.
How much are prescriptions with health insurance?
If you have insurance you can expect to pay between $10 to $40 for medications.
However, some prescriptions can actually be more expensive with insurance because your carrier may not have brokered a good deal with your pharmacy or drug manufacturer. Diabetes medication, for instance, has been a source of contention with rising prescription drug costs, with Consumer Reports finding even with insurance one could pay $300 per month.
How much are prescriptions without health insurance?
Without insurance, prescription drugs could run between $89 to $129, so if you are someone who requires monthly medications, say for anxiety or migraines, you’ll have to pay out of pocket.
Managing chronic illnesses
Having a chronic illness is a completely different story when it comes to health insurance. Chronic conditions include diabetes, depression, cancer, obesity, and more. Having a chronic illness means you need lots more care than most people, including numerous doctor visits, medications, and tests.
How much does managing chronic illnesses cost with health insurance?
The Centers for Disease Control found chronic and mental health conditions take up 90% of healthcare spending. For example, the American Diabetes Association (ADA) finds the medical costs for a person with diabetes is $16,752 — 2.3 times higher than the expenses of a person without diabetes.
Having insurance doesn’t mean cut-and-dry coverage, however. Insurance companies vary greatly in how much they will cover for a chronic illness and while you may only need to pay a copay for doctors’ visits, different lab work, testing, medications, and more means shelling out more dough financially.
Chronic conditions may be subject to government insurance under Medicare, with premiums up to $458 per month for Part A, which doesn’t cover medications. For drugs, you will also need Medicare Part D, which averages $30 per month.
How much does managing chronic illnesses cost without health insurance?
Because it can be so expensive to manage a chronic illness, those without insurance have been found to seek treatment far less than those with insurance. The ADA, for example, found 60% fewer doctor visits and 52% fewer medications in people with diabetes without insurance. But that comes with a price: 168% more visits to the ER than a person with insurance.
For those suffering from depression, the costs are just behind diabetes as the second most costly condition, according to the American Psychological Association. Another 21% of medical expenses are directed toward obesity-related illnesses. As you can see, chronic illnesses can be expensive.
Aides for disabilities (hearing aids, wheelchairs, etc.)
Insurance alone does not often cover aides for various impairments. People with disabilities may be able to receive Medicare government insurance to help with these costs, as well.
How much do aides for disabilities cost with health insurance?
Medicare covers 80% of costs of wheelchairs for people with a disability. With patients paying 20%, these can range between $16 to $300. Power battery replacements will cost $14 to $90.
People with diabetes needing glucose meters and test strips to monitor blood sugar levels will pay $40 to $60 for the monitors and about $5 to $50 per month on strips as copays.
Insurance will not cover hearing aids, which Consumer Reports found averaged $2,691 out of pocket.
You can, however, get disability insurance, which may cover some of the costs associated with any disabilities. You can head over to Policygenius to compare disability insurance quotes and find one that may work for you.
How much do aides for disabilities cost without health insurance?
Here is a breakdown of some common aide prices:
- Basic wheelchairs: $80 to $250.
- Power wheelchairs: $1,500.
- Sports wheelchairs: start at $1,500.
- Power battery replacements: $70 to $450.
- Hearing aids: $2,691.
- Blood glucose meters: $40 to $60.
- Blood glucose testing strips: $1,533 to $4,380.
Ways to save
There are different companies and platforms available to help you save on your medical expenses, from finding you the best insurance rates to cheaper medications. Here’s how.
If you need to see a doctor for a few months or have lost your job and need coverage until you find a new job that will cost less than COBRA (Continuation Omnibus Budget Reconciliation Act), Agile Health provides temporary coverage starting at just $99 per month. In order to qualify, you must be in good health.
You can find the price of the medications you may need, receive coupons for those drugs, and find price comparisons based on pharmacies using RxSaver or GoodRx. Offering ways to save up to 80% on prescription drugs, these sites are extremely easy to use and provide you with coupons immediately.
Not all doctor’s visits are created equal. Walk-in clinics, such as CVS’ Minute Clinic or similar clinics in other pharmacies, can treat minor illnesses, injuries, and conditions. They can also administer vaccinations, and offer physicals. These visits can be up to 40% off traditional doctor prices.
Virtual doctor visits can also be cheaper, priced at $35 to $75 for a non-emergency visit. SteadyMD provides a flat subscription rate so you can get to know your doctor and have someone to talk to for less. Subscriptions are $99 for individuals and $169 for a family.
Mom and dad
Adult children can be insured through a parent’s health insurance until the age of 26. This includes children who live away from home and/or are married. A parent’s family plan may provide cheaper monthly premiums than single insurance as you’ll only pay your portion of the costs. Plus, a parent may have better insurance than your company, if you have an insurance option.
Health insurance is a big business and it’s expensive. If you are young, healthy, and just starting out in life on your own, it can be cheaper to go uninsured and pay for medical expenses as they are needed.
But if you have a pre-existing condition that must be chronically managed, insurance can help you keep your expenses down.
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