Average Health Care Costs and Ways to Save

Be prepared by understanding what you might pay

Female patient paying insurance copayment to nurse with credit card at clinic check-in counter
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Health care costs can add up quickly and become a burden. Many Americans struggle to meet premium payments in order to be insured, which is a huge issue. And for the uninsured, access to health care may be challenging.

The cost of health care has been on the rise for several years, and in 2018, the average consumer spent $4,968 on health care. Depending on whether you have health insurance or not, and where you get your health insurance from, your health care costs may vary. Out-of-pocket spending on health insurance increased consistently from 2007 to 2017, with the average cost increasing over 50% from $435 to $662.

Here’s what you can expect for the average cost of health insurance, plus the typical prices for different services like wellness visits, ambulance transports, and trips to the emergency room (ER). This guide will help you understand the information you need to save on your health care costs.

Cost of Health Care: Highlights

  • People spent an average of $4,968 on health care in 2018
  • The cost of a single service could vary widely by where you receive it and what your insurance covers
  • Americans spend more on prescription drugs than any other country: $1,200 per capita per year

How Much Does Health Insurance Cost?

According to the Bureau of Labor Statistics, the average spend by consumers on the cost of 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 are expected to pay for out-of-pocket expenses. There is also a difference in how much you will pay for insurance based on whether your health insurance is a group plan or an individual plan. Group plans may be sponsored by an employer, which can reduce your direct cost if the employer pays into your premium as part of your employee 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 additional services, 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 depending on where you go to have it done. For example, 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 $59 and $69.

What’s the Cost of a Doctor’s Visit Without Insurance?

The cost of a doctor’s visit may vary depending on whether you have a relationship with a doctor already or not. Oftentimes, doctor’s offices have different pricing for their established patients, so it is a good idea to have a primary care physician.

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, virtual doctor’s visits 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 carefully. Consider doing research before you make your appointment. 

For example, according to the same study, the same doctor’s visit would cost different amounts depending on where you obtained 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

If you have to have lab tests or screenings done, shop around to find the best price for these services. A virtual visit may also help you save money. For example, 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 an October 2019 poll by the American College of Emergency Physicians (ACEP), most Americans feel unprepared to help in the event of a medical emergency. So it is no wonder that when a medical emergency occurs, many people turn to an ambulance, despite the hefty costs that may result from the transport. The cost of ambulance transport may vary based on your location, distance traveled in the ride, and other factors. An ambulance ride could cost anywhere from a few hundred to a few thousand dollars. Oftentimes, patients are charged a flat fee, plus a cost per mile.

The government does not regulate private ambulance fees. In addition, when you call for an ambulance you may have no control over which type of ambulance is dispatched, and 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 $2,312.76, plus $55.17 per mile. There are also fees for oxygen administration and for refusing transportation.

Insurance may cover some of these costs, but it depends on your health plan and insurance company. 

What’s the Average Cost of an Emergency Room Visit?

Spending on ER visits increased 36% between 2013 and 2017, according to the Health Care Cost Institute. In 2017, ER costs averaged about $1,389, up 176% since 2008.

Different ER’s Also Charge Different Prices

ER visits account for 28% 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 several 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 for procedures. The law is a response to the many variations of cost paid by insurance and out of pocket by patients. This can feel almost impossible for a consumer 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, and each one may have additional costs associated 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 example, just one error in the last digit of an ER billing code could cost you a significant difference on your medical bill:

  • Code 99285: Emergency department visit, problem with significant threat to life or function 
  • Code 99281: Emergency department visit, self-limited or minor problem

Consider using medical billing codes like these to research the cost of different ER visits. You may be able to ask the hospital and call your insurance company for more information.

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, prescriptions can vary in price depending on whether the drug is generic or name-brand. According to a report from the CDC National Center for Health Statistics, approximately 70% of prescription drugs come with out-of-pocket costs. The report found that generic prescriptions cost an average of $6, while name-brand prescription drugs cost about $30.

How Are Medical Costs Determined?

There is no one formula to figure out how much a hospital, clinic, or health care provider will charge you. There are huge discrepancies in the cost of similar procedures depending on where you get them. If you rely on your insurance to help keep your costs affordable, the prices you pay may greatly rely on:

A Kaiser Family Foundation study found that among people who were insured and had problems with their medical bills, 32% said they received care from an out-of-network provider that their insurance wouldn’t cover. In fact, 69% of them 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 these surprises.

Ways to Save on Health Care Costs  

Many doctor’s offices or clinics may offer you reduced pricing if you pay cash up front or within 30 days. More discounted services are popping up, too, such as discount coupons for tests, services, and prescriptions. Many organizations are also looking to provide resources to people for price transparency. You may be able to “shop” for the best price by looking up your zip code and procedure 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, limited to 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

Health care spending is projected to grow at an average rate of 5.5% per year between 2018 and 2027. Consumers can stay informed and do research to reduce unnecessary costs. 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 if you get diagnosed with an illness.

Article Sources

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  7. The American Journal of Emergency Medicine. "On-demand Synchronous Audio Video Telemedicine Visits are Cost Effective," Accessed Nov. 14, 2019

  8. American College of Emergency Physicians. "Poll: Majority of Americans Unprepared to Help in a Major Emergency, But 90 Percent Would Be More Willing After Until Help Arrives Training," Accessed Nov. 14, 2019.

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