Affordable Care Act
A lot of people, when their parents forced them to eat vegetables as a kid, would say something like, “why?,” or, “I don’t want to!”
The Affordable Care Act’s mandate that requires most people to buy health insurance or pay a penalty tax can have a similar effect.
After all, if you’re being forced to buy something you probably want to know why.
Ask and you shall receive. eHealth compiled the “top three list” of ways people may benefit from having health insurance.
#1: Negotiated rates – In 2013, Steven Brill wrote an article for TIME Magazine that – among other things – highlighted some of the absurdly high prices that hospitals and doctors sometimes charge.
For example, Brill writes about hospitals charging $1.50 for one Tylenol (an entire bottle costs $1.49 on Amazon.com); $6 for a marker used once to mark their bodies before surgery; $77 for a box of gauze pads ($10.15 on Amazon); and $1,200 an hour for a nurse’s services.
The catch was that the costs mentioned above would be applicable to people who were uninsured. When you have health insurance, your insurance company has already negotiated the prices for you (and for themselves) and that usually changes the out-of-pocket costs for you.
Insurance companies are experts at negotiating with hospitals so if you go in network, or even outside of their network, the hospital has an incentive to come to an agreement with your insurance company on prices.
These negotiations between hospitals, doctors, and insurance companies are common and expected, and can lower the initial bill anywhere from 20 to 50 percent.*
#2: Avoiding the ER – Visiting the emergency room for a sprained ankle can cost you anywhere from $4 to $24,000, according to an NIH-funded study of 8,303 ER visits that occurred between 2006 and 2008. The study found that the average emergency room visit was $1,233.
If we assume ER visits have not become cheaper since 2008, the average cost of an ER visit would be at least 50 percent higher than the average month’s rent in the United States, which is $821 (according to the U.S. Census Bureau).
The good news is that, according to the Wellness Council of America, 40 percent of emergency room visits are unnecessary. Still, too many Americans (even those with health insurance) use the ER as an entry point as soon as they encounter a health issue.
The emergency room is intended for medical emergencies, and patients who seek help in an ER typically should know that:
With health insurance, you can go to a a primary care physician (or PCP) or even a specialist instead of the ER. And, in many cases your doctor can address minor health problems before they become major ones.
It’s also worth pointing out that many new insurance plans require a patient to pay for ER visits in full before they have reached their deductible. When we looked at a sampling of bronze plans coverage in 11 markets across the country, we found that the average deductible was $5,490. You could avoid paying the deductible, depending on your insurance plan, by visiting your doctor instead.
If your plan doesn’t cover anything before you reach the deductible, you may still be better off because doctor’s visits usually cost less than visits to the ER. Most plans cover doctor visits before the deductible, either in full or with a co-payment. Choosing to see a PCP or even a specialist for non-emergencies will save patients both money and stress.
#3: Preventive services – A key feature of Obamacare is that all qualified health insurance plans must cover the following list** of preventive services without charging a copayment or coinsurance. This applies even if a patient’s yearly deductible has not been met, but the services must be done by a provider within network.
*Statistic courtesy of Bills.com
**List courtesy of Healthcare.gov