Introduction to the Cost of Medical Care
With the cost of health insurance set to rise, some Americans are asking a surprising question: Is it actually cheaper to get medical care without it? The short answer: Sometimes. But not often. And it may require a little — or a lot — of homework.
Understanding Self-Pay Discounts
Some hospitals and clinics offer self-pay or cash only discounts for patients who pay without insurance, skipping the paperwork and administrative fees that come with having coverage. Hospitals are required by federal law to make their discounted cash prices publicly available online. An allergy test or an X-ray, for example, may be a few hundred dollars cheaper this way, especially for people with high deductible plans. Nonprofit hospitals must provide charity care, which is free or discounted, to people who can’t afford it, even for those with insurance.
Risks of Paying Without Insurance
But paying outside of health insurance means that cost doesn’t count toward your deductible or out-of-pocket limit — and if you end up needing more medical visits than expected, you could wind up worse off financially. “You have to be really careful,” said Stacie Dusetzina, a health policy professor at Vanderbilt University in Nashville, Tennessee. “The price that you pay with cash, even if they give you some sort of advertised discount, can be more than what you might actually pay through health insurance overall.”
The Impact of Rising Premiums
The question of whether to opt out of insurance and pay in cash is surfacing as many Americans are expected to face higher premiums next year. Enhanced subsidies, which kept Affordable Care Act premiums lower for many middle-class people, are set to expire at the end of the year without action from Congress. Premiums for people who get their health insurance through their jobs or outside the ACA are also expected to rise next year.
Losing Benefits
Insurance Protections
Insurance, for all its frustrations, can provide crucial protections: caps on out-of-pocket costs, access to negotiated rates and free preventive care, such as cancer screenings, annual physicals and routine vaccinations. For non-emergency care, a doctor or hospital may require the patient who isn’t using insurance to pay the entire cost upfront or see a different provider, said Erin Duffy, director of research training at the USC Schaeffer Center for Health Policy and Economics.
Risks of Going Without Insurance
“It does seem risky,” Duffy said. “If you were thinking that you could keep going to the primary care doctor that you’d go to when you were insured, you might find that there’s different financial obstacles.” For those who are healthy, paying in cash can be a smart move for predictable, lower cost-services — such as an X-ray or CT scan, Dusetzina said.
Negotiating Care
Checking Federally Qualified Health Centers
Before people even think about negotiating care with a doctor or provider, they must first check if they have a federally qualified health center nearby. The health clinics receive federal grants to provide low-cost care to underserved populations, including the underinsured and the uninsured. “If you need primary care, you can often get primary care at a federally qualified health center,” Johnson said.
Getting an Estimate
If specialty care is needed, doctors may negotiate, but they often require people to pay the full amount upfront, Johnson said. If you want to get an idea of how much you could pay, websites like Turquoise Health show the average cash price hospitals may charge for certain medical procedures.
Conclusion
In conclusion, while paying for medical care without health insurance might seem like a cost-effective option, it’s crucial to weigh the risks and benefits. For healthy individuals with predictable, low-cost medical needs, self-pay discounts might be beneficial. However, for those with ongoing medical needs or facing unexpected emergencies, the financial risks can be significant. It’s essential to understand the potential consequences and explore all available options, including federally qualified health centers and negotiated rates, before making a decision.
FAQs
- Q: Is it always cheaper to pay for medical care without health insurance?
- A: No, it’s not always cheaper. While self-pay discounts can be beneficial for some services, the overall cost without insurance can be higher, especially for those with ongoing medical needs.
- Q: What are federally qualified health centers?
- A: Federally qualified health centers are clinics that receive federal grants to provide low-cost care to underserved populations, including the underinsured and the uninsured.
- Q: Can I negotiate the cost of medical care with my doctor or hospital?
- A: Yes, it’s possible to negotiate, but it may require paying the full amount upfront, and the process can be complex, involving multiple healthcare providers.
- Q: What is the Emergency Medical Treatment and Labor Act?
- A: The Emergency Medical Treatment and Labor Act is a federal law that requires Medicare-participating hospitals to provide care to anyone who comes to the emergency department, regardless of their ability to pay.
