Health care costs can add up fast and become a burden. What's more, many Americans struggle to pay their insurance premiums. For the uninsured, access to health care can be hard to come by.
The cost of health care has been on the rise for many years. It is estimated that between 2019 and 2028, health care costs will increase at a rate of 5.4% per year. Your health care costs will vary depending on whether you have health insurance or not and where you get your health insurance from. A healthy family of four spends an average of 12% of their total income per year on health care.
The chart below illustrates the percent change in health expenditures in the United States from 2007 to 2017.
Here's what you can expect for the average cost of health insurance, plus the typical prices for services such as wellness visits, ambulance service, and trips to the emergency room. Learn more about how to save on health care costs in this guide.
How Much Does Health Insurance Cost?
According to the Bureau of Labor Statistics, the amount that people spent on health insurance was $3,160 in 2016, $3,414 in 2017, and $3,405 in 2018. There was an 8% increase between 2016 and 2017, but a slight decrease between 2017 and 2018.
The cost of health insurance varies based on whether you qualify for a subsidy under the Affordable Care Act (ACA), what kind of coverage you choose, your deductible, and how much you must pay for out-of-pocket costs. The amount you pay also depends on whether your health insurance is a group plan or an individual plan. An employer may offer group plans, which can reduce your direct cost if the employer pays into your premium as part of your benefits.
What's the Price of a Check-Up or Wellness Visit?
If you have health insurance, the cost of a wellness exam could be included, so it may not cost you anything. According to the ACA, an annual exam is included in most ACA-compliant health plans.
In other cases, you may have a co-pay, deductible, and other costs, like lab tests, to think about. If you're insured, these extras may be partially or fully covered, depending on your plan. The price of your wellness check-up may also vary. For instance, you may be able to get basic tests or consultations at pharmacies, like CVS, which may cost less. CVS lists its prices for various health services so you can see what it'll cost before you go. For example, a basic health screening may be between $69 and $99.
What's the Cost of a Doctor's Visit Without Insurance?
The cost of a doctor's visit depends on whether you are an established patient or not. Most of the time, doctor's offices have different pricing for their current patients, so it is a good idea to have a primary care doctor.
According to a study by Johns Hopkins Bloomberg School of Public Health, the average cost of a primary care visit for a new, uninsured patient is around $160.
Comparing Costs of a Doctor's Visit
Digital technology provides options to also have a "doctor's visit" virtually. According to a study by the Sidney Kimmel Medical College at Thomas Jefferson University, a virtual doctor's visit saved people on average between $19 and $121 per visit.
You may have several choices for where you can visit a doctor, but the cost varies, so be sure to choose with care. Think about doing the research before you make your appointment. For instance, according to the same study, the same doctor's visit would cost different amounts depending on where you had the service:
- Between $84 and $131 at a doctor's office.
- Between $98 and $163 at an urgent care center.
- Between $358 and $1,595 at the ER.
- Between $66 and $89 at a retail clinic.
Shop around to find the best price for services such as lab tests. A virtual visit may also help you save money. For instance, Doctor on Demand offers a 15-minute medical consultation for a flat $75 fee to those without insurance.
What Is the Typical Cost of Ambulance Transport?
According to a poll by the American College of Emergency Physicians (ACEP), most Americans do not feel able to help in the event of a medical emergency. It is no wonder that when a medical crisis occurs, many people turn to an ambulance, despite the hefty costs that may result from the ride. The cost of transport may vary based on where you are at at the time of the issue, the distance traveled in the ride, and other factors. An ambulance ride could cost from a few hundred to a few thousand dollars. At times, patients are charged a flat fee plus a cost per mile.
The government does not have a say in how much ambulance companies charge. When you call for an ambulance, you may have no control over which type is sent. You may not get to choose which hospital you go to. This could lead to "surprise medical bills" or out-of-network costs.
For example, new patients transported in an ambulance in the Contra Costa County Fire Protection District in California may be charged $2,565 plus $62 per mile. There are also fees for getting oxygen and even for getting treatment but refusing transport.
Insurance may cover some of the ambulance costs, but it depends on your health plan and the insurance company. Most do offer a program for those who can't pay.
What's the Average Cost of an Emergency Room Visit?
Spending on ER visits increased by 23% between 2014 and 2018, according to the Health Care Cost Institute. In 2018, ER costs averaged about $2,096, up over 100% since 2008.
ER Pricing Is Not Consistent
ER visits account for 24% of all acute care visits in the U.S. An important factor in the cost of the ER visit is how the hospital sets its prices. A 2015 study by Gerard F. Anderson of Johns Hopkins Bloomberg School of Public Health and Ge Bai of Washington and Lee University found that there were quite a few U.S. hospitals that marked up prices of care by over 1,000%.
In 2018, Congress proposed a new law that requires hospitals to disclose their pricing. The law is a response to the variation of the cost paid by insurance and out of pocket by patients. This makes it hard for patients to fully understand what the bottom line will be.
When it comes to hospital costs, medical billing codes vary for different levels of severity of ER visits. Each one may have more costs that come along with it. The best way to get an idea of the cost is to do some research using the medical billing code to look up pricing and make sure you don't get billed for the wrong codes.
For instance, just one error in the last digit of an ER billing code could cost you a big change in your medical bill:
- Code 99285: ER visit, a problem with a significant threat to life or function.
- Code 99281: ER visit, self-limited or minor problem.
Look at using billing codes like these to research the cost of ER visits. You may be able to ask the hospital and call your insurance company for help.
What Do Prescriptions Cost?
According to the Organization for Economic Cooperation and Development (OECD), Americans spend over $1,200 on prescription drugs per capita per year. That's more than any other country. And when it comes down to it, drugs can vary in price depending on whether the drug is generic or name brand. The CDC National Center for Health Statistics found that around 70% of prescription drugs come with out-of-pocket costs. The report found that generic drugs cost around $6, while name-brand drugs cost about $30.
How Are Medical Costs Determined?
There is no one way to figure out how much a hospital, clinic, or health care provider will charge you. There are huge changes in the cost of the same services depending on where you get them. If you rely on your insurance to help keep your costs low, the prices you pay may greatly rely on:
- What your health insurance company has negotiated with providers.
- What percentage you will pay out of pocket (deductibles, co-pays, and maximums) and if you have a high deductible health plan.
- If you are using in-network or out-of-network services.
Among people who were insured and had problems paying their medical bills, 32% said they received care from an out-of-network provider that their insurance wouldn't cover. More than half didn't even know they were using "out-of-network" services. Always ask if the provider is in the network for your health plan before booking your appointment so you can avoid paying too much.
Ways to Save on Health Care Costs
Many doctor's offices or clinics may offer you reduced pricing if you pay in cash up front or within 30 days. More discount services are popping up, too, such as discounts for tests, services, and prescriptions. Many organizations are also looking to provide resources to people who want to know prices up front. You may be able to shop for the best prices by looking up your ZIP code and the treatment on websites like Clear Health Costs, Healthcare Bluebook, Fair Health Consumer, and MDSave.
Knowing how to shop around for the best price on health care costs will come in handy, especially if you are uninsured, have to use a specific network, or have to go out-of-network.
As of 2018, 45.8% of people with private health insurance under age 65 were enrolled in a high-deductible health plan (HDHP), with 20.4% of that group enrolled in a plan with a Health Savings Account (HSA). Consider using an HSA for paying medical bills out of pocket to save more money.
The Bottom Line
You can stay informed and do research to reduce costs that waste your money. And if you can find a way to get affordable health insurance, it may be well worth the cost, especially if you have regular medical visits, are on prescription drugs, or get diagnosed with an illness.