Having insurance doesn’t mean you don’t pay anything, or that health care bills aren’t a hassle.
In 2016, about 6% of working-age adults say they didn’t receive needed health care due to cost. The percentage is less for children and older adults. About 9% didn’t receive needed dental care due to cost (in 2015).
In 2016, the average annual premiums for employer-sponsored health insurance are $6,435 for single coverage and $18,142 for family coverage (your employer may pay a lot of this for you). Among covered workers with a general annual deductible, the average deductible amount for single coverage is $1,478. Workers or others with health savings accounts have to pay substantially more than this. Even after the deductible, most people have to pay something when they visit a provider; usually between $10 and $40. So, even with health insurance, you can pay a lot.
About a quarter of families with the say that they have had some trouble paying their medical bills. This had decreased from 2011 among people under age 66, from 21.3% to 16.2% (43.8 million) in the first 6 months of 2016. Medical debt has been among the leading causes of bankruptcy for the last several years.
For people who pay claims for each visit, it can also be confusing and irritating to figure out how much you owe and what is covered. For serious conditions and procedures you may pay out of pocket and then the insurance company rules whether the benefit is covered, which means you have to pay and then get reimbursed (maybe).
How much do you pay out of pocket? How much of a problem are these payments? Do you have problems getting reimbursed? Can you afford your health insurance premiums? Have you ever not received medical care you think you needed because you couldn’t afford it? We would love to hear some real-life examples of the problems medical care costs have caused for you.
Please comment or send an email (on the “contact” page).
How Does Health Care Matter to You? 
I’ve found that the two most (consistently) expensive out of pocket expenses I have are for dental care and mental health services. For dental care, I actually do have dental insurance, but that will only cover $1,000 a year (above the cost of two cleanings). Due to dental issues I’ve had for years, I’ve needed dental surgery and more recently, four crowns. One crown can typically cost around $800; if I wanted to get all four done with any expediency it would cost me over $2000 out of pocket. The only reason I have been able to get most of my crowns done within a year period and not wait and get one a year was because my dentist is a personal friend of mine. Dental insurance only really seems to cover cleanings; if people actually have more widespread dental problems the insurance is pretty unhelpful.
Mental health services have also been challenging to find within the insurance system. I’ve paid out of pocket for years to see a counselor, even though my HMO technically offers mental health coverage. When I initially tried to go through the system it was basically impossible to find the kind of services I wanted. All I wanted was so see someone once a week for relatively standard anxiety issues; nothing extreme. When I initially contacted my HMO I had to wait multiple weeks to get an appointment with someone that I chose from a list of only 3 or 4 options, and when I finally went for my appointment the person was not particularly helpful. It can take a few tries to find a therapist you click with, but I had essentially no options if the one I saw didn’t work out. The therapist also kept recommending that I go to group therapy sessions, which is not what I wanted and would have not been a good fit for the social anxiety issues that brought me to therapy in the first place. I found a counselor on my own who had in the past been able to take Kaiser (my HMO’s) insurance when Kaiser did not really offer mental health services and contracted outside the HMO. After seeing this new counselor and contacting Kaiser again, Kaiser made it clear that they would not refer outside the network for services they “provided,” so if I wanted to actually see a counselor that I chose from a list of more than five people that wasn’t a group session, I was out of luck. I’ve been paying out of pocket for services ever since.
One last comment related to dental services – the surgery I had was also entirely out of pocket, because for some reason it is often classified as a “cosmetic” procedure, even though the majority of people who need/have the surgery have it for decidedly non-cosmetic reasons. An HMO states up front that they won’t pay for it out of network, so finding someone you feel comfortable with breaking your jaw and resetting it would be an even greater challenge when you have to go in network in an HMO that may not have anyone who has even done this surgery before. When I contacted other insurance companies about the potential to pay for that particular surgery if I switched to their insurance, they all indicated that I would have to have the surgery and submit the claim to insurance after, so if my family couldn’t afford to pay out of pocket up-front or the costs were too exorbitant without insurance, I wouldn’t have been able to have the surgery, which dentists and orthodontists both agreed was in my medical best interest.
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