Healthcare costs in the USA are out of control – it’s something our nation discusses constantly – and I am joining the conversation by sharing real figures from my annual medical charges as a chronically ill person. And I’m starting with an outrageous one.
My family’s total healthcare cost in 2018 was $73,123. Our portion of that bill was $20,018.
The total cost is much higher than the median US salary (which sits around $44,500). It’s approximately half the cost of our three bedroom house. It could cover rather luxurious world travel for years.
To be clear, $73,123 represents what was charged for our care – not what was actually paid for it. Why? Because of plan discounts. The bulk of the $73K comes from $20,838 in insurance premiums for three people and $51,570 for the amount billed for medical services. Now, in case you don’t know, we typically don’t pay the actual amount billed for medical services in the USA.
So $51K was the price charged for care, but our United Healthcare (UHC) insurance plan negotiated discounts to the tune of $17,934. Which begs the question, why is that much money so easily discounted? Was it truly necessary? Discounting over a third of the original cost because of what insurance plan I have only adds to the ridiculous nature of our healthcare situation. People with different plans would have different discounts, and uninsured people or those choosing to pay in cash may receive an automatic discount or have to negotiate for themselves.
After discounts the medical charges came to $33,636. Using that discounted price plus the cost of premiums and other various expenses brings us to a total of $55,189 for our 2018 healthcare cost. In this post, I’m going to break down these costs in detail and explain how my chronic illness impacted it all.
My Healthcare Costs as a Person with a Chronic Illness.
To give you some background, I was diagnosed with lupus in 2017 after several years of symptoms. (I was also diagnosed with fibromyalgia in 2015 and early onset osteoarthritis in 2014, but I believe both were the result of misunderstood lupus symptoms.) Additionally, I have chronic high blood pressure, which I suspect is from lupus complications as well as untreated chronic pain. These are my main issues that consistently lead to increased healthcare costs. Another large expense was that I had a baby last year; I needed lots of extra monitoring because of my lupus and high blood pressure.
Insurance premiums.
Our insurance premiums cost $20,838 last year. They were high because my husband, Mr. Meena, was working for a small company. In the USA, most large companies subsidize the health insurance premiums at around 71% for a family plan like the one we had. This results in significant savings for employees.
The company that Mr. Meena was working for in 2018 subsidized the family plan at 33% post baby (it was 50% before baby), which is much lower than the national average of 62% for small companies. They were subsidizing the plan by simply paying for Mr. Meena’s portion of the premium. This was not something we fully realized when Mr. Meena accepted the job offer and the lack of competitive benefits was more of a financial hardship than we expected.
We had a low deductible United Healthcare plan, as it was the only option available with the company, and the premium was $645 per person per month. With most insurance plans, the cost for adding a baby is around half compared to an adult, so we were expecting around a $300 increase to our premiums once our baby was born. We discussed estimates in detail with the company HR as well as HealthCare.gov representatives, as we were considering switching to a plan outside of his employer. We decided to renew the UHC plan but were upset as they charged us the full price of $645 for Baby Meena’s premium, which was a breaking point for us financially. Here are the charges:
January to May: $1290 monthly premium for two people; $645 was paid by the company.
May to December: $1935 monthly premium for three people; $645 was paid by the company.
Those are just the medical premiums. Our plan did not cover dental, so we took a dental plan out for the two of us due to my past dental issues and an abundance of caution. Our dental premiums cost $69 monthly for the first 11 months and $78 for the last month of 2018.
This brings us to a total insurance premium cost of $20,838, with $13,103 paid by us. Furthermore, these costs were all paid out of Mr. Meena’s salary after taxes. For perspective, he has since started a new job at a large company with more standard subsidized healthcare through Blue Cross Blue Shield (BCBS) and our monthly premium is currently $217 monthly ($2,604 annually) for our family of three. This premium includes dental and is paid before taxes; we also have an HSA so we can pay all of our medical bills before taxes as well.
So we are now paying $10,500 less a year – a drastic difference – for our healthcare coverage solely because Mr. Meena switched employers. While Mr. Meena loves his job, many people in the USA are stuck in jobs they don’t like because they need good insurance. During a job search it’s not guaranteed that the employer will discuss benefits until there is an official job offer, and even then we have experienced companies be less than willing – even annoyed – when asked to share more details concerning benefits.
Having insurance being tied to an employer is not ideal in my opinion (this has caused us issues several times over the years). Even though our total premium costs reached $2,013 just for the month of December, that’s not an unusual amount for a family in the USA to pay. We also would have paid nearly that much with a healthcare marketplace plan. I’ve spoken with many families who pay that much or more per month. And my question is: who can afford that? We certainly could not. The only way for us to have affordable(ish) healthcare is to get a job with an employer that offers quality, subsidized coverage.
Our expensive little family. Photo by Leslie Mason Photography.
Amount billed for medical coverage.
Now that I’ve discussed how much it cost us to be insured, let’s move on to how much it cost to use our insurance last year. Below is a breakdown of our medical insurance charges; the first number is the total for our family, the second number is my portion of the costs, and the last number is my percentage of the total cost:
Amount billed: $51,570 / Me – $43,517 (84%)
Plan discount: $17,934 / Me – $15,289 (85%)
Amount paid by insurance: $27,384 / Me – $22,027 (80%)
Amount we paid out of pocket: $6,200 / Me – $6,200 (100%)
Additionally, our dental bills were $299 for the year – $275 for me and $23 for my husband. That puts me at 91% of the cost; we both had two cleanings but I also had two fillings.
As you can see, I am the most medically expensive person in my family. When it comes to using your health insurance, my husband had one wellness visit and our son had five wellness visits throughout 2018. Wellness visits are completely covered by insurance. Though Baby Meena received a lot of medical care in the hospital during the first two days of his life, those costs were also completely covered as we had already met our deductible with his birth. That is why the entire out of pocket cost falls into my category. Unlike my husband and son, I had 34 appointments throughout 2018 – and only one was a wellness visit. I’m going to break down my appointment costs and other medical charges in the next sections.
Rheumatologist.
I saw my new rheumatologist five times and my old rheumatologist twice (I switched doctors in February). I also saw my rheumatologist’s physician assistant on an emergency basis in December because my knees stopped working. At each visit I paid $100 for my specialist copay – this always made the staff cringe and each time they pointed out it was an unusually high copay. Moreover, the copay did not count towards my deductible, which meant I’d have to keep paying it for every appointment unless we met our $12,000 out of pocket maximum. This did discourage me from going to the doctor at times. I’m not entirely sure which doctors are considered specialists by the insurance, but I had to pay the specialist copay every time I saw someone other than my primary doctor.
My eight rheumatologist appointments resulted in $4,895 in medical bills. After $3,524 in discounts, $667 was paid by insurance and $765 was paid by me. Now, it should have been $800 paid by me according to my copay amounts, but my first rheumatologist only cost $82 per appointment after my plan discount. I received refunds from his office since the appointment charge was less than my copay.
Primary physician.
I saw my primary physician six times – once for a physical, four times for blood pressure monitoring (although I used those appointments to bring up other issues and thus reduce the amount of times I had to come in), and once for my chronic muscle pain.
Those appointments resulted in $1,429 in medical bills. After $358 in discounts, $920 was paid by the insurance and was $150 paid by me. Now, it should have been $250 paid by me because my regular copay was $50 (for each appointment aside from the physical) but twice the copay was refunded and we don’t know why. We call it the case of the mysterious copay. I’m sure there must be some reason why they decided I didn’t need to pay, but the insurance plan is baffling and inconsistent and we didn’t have the time (or desire) to find out why we were refunded.
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Eye doctor.
I saw my eye doctor four times, and to be clear, this was only my medical eye doctor – not my vision provider. I actually skipped my vision in 2018 due to complications with the terrible vision insurance included with our plan, which would not have covered a large part of the vision exam, and because I was so fed up with how much money we had spent already on medical care. Instead I ordered another years’ worth of contacts right before my prescription expired. This is another case of the cost of healthcare discouraging me from seeking proper medical treatment.
Anyway, I saw my medical eye doctor three times to have eye plugs inserted because chronic dry eye is painful (and likely caused by my lupus but we can’t prove it) and once for my annual plaquenil eye exam to check for damage. Plaquenil is a common lupus medication that can cause permanent damage to your eyes and any rheumatologist worth their salt will require annual evaluations.
Those appointments cost $2,784 in medical bills. After $1,861 in discounts, $194 was paid by insurance and $728 paid by me. I paid $400 in copays and then $328 for the eye plugs as having them put in was technically considered a surgical procedure. I found that strange, as it definitely didn’t seem like surgery and took approximately five minutes.
Prenatal care.
I saw my various OB/GYNs 14 times – I say various because I went to an office that has you rotate through all their doctors during pregnancy. I was happy with that because it gave me several different perspectives and towards the end of my pregnancy I was able to attend the high risk clinic and have three doctors meet and evaluate my case each week. You can read more about that in my post about my third trimester.
Twelve of the OB/GYN appointments were for high risk pregnancy care, which cost me zero dollars. This was one large advantage of the plan – prenatal care was covered 100%. Even though we spent a crazy amount on premiums, a different plan without complete prenatal coverage probably would have cost more overall. The other two OB/GYN appointments were my postpartum check (also covered) and a tubal ligation consult requiring the $100 specialist copay.
My OB/GYN charged $1,822 in medical bills. After $428 in discounts, $1,340 was paid by insurance and $100 paid by me. Honestly, I’m surprised these numbers are so small because I had around eleven non-stress tests (they were $107 a pop). Although, I was four months pregnant at the start of 2018 so these charges don’t represent my entire pregnancy.
You might think this is the end of my medical appointments, but it’s not. I also saw a maternal fetal specialist throughout my pregnancy thanks to my high risk status. I saw him twice in 2018 which cost $668 in medical bills. After $135 in discounts, $533 was paid by insurance and I paid nothing. I’m also surprised these numbers are so low, because I had an anatomy scan at one of those appointments and I know the charges for our second ultrasound with him in 2017 were $1,620 (of which my plan paid $838 and we paid $82 – and it was the same plan). That’s a huge inconsistency in charges, considering the less expensive 2018 appointments were more thorough and required more testing.
Lastly, part of the medical charges weren’t for an appointment but for my hospital stay. As you might imagine, it was the largest part of the charges. The doctor’s charge for delivery was $4,427 in medical bills. After $496 in discounts, the insurance paid $2,470 and I paid $1,460, which was the remainder of our deductible ($2,000) at the time of birth in May. The hospital charges were $17,548, and after a whopping $7,383 in discounts the insurance paid $10,066 and I paid nothing. So having a baby resulted in nearly $24K of medical charges. And that was with a relatively simple birth; I was induced but otherwise I had him naturally and without an epidural (which would have resulted in separate charges from the anesthesiologist).
Of course, I looked at the EOB (explanation of benefits) because I wanted to know exactly what was charged. And guess what I found? Over $13K in miscellaneous services.
How is it possible to charge that much money in miscellaneous charges? Also, being charged $3,339 for a three night stay is definitely the highest we’ve seen out of all our travels – especially considering that my husband had to sleep on a couch. At least we had good views.
Lab and other medical charges.
There were $1,326 worth of lab and imaging charges; these were largely from my lupus related lab tests but I also had an abdominal ultrasound and a few x-rays. After $1,004 in discounts my plan paid $321 and I paid nothing.
After I switched rheumatologists I stopped receiving separate lab charges, because the new office has an in house lab for standard tests, so this isn’t really representative of the exact cost of my labs. I have blood drawn every three months for lupus panels and the occasional urine test to check for protein, so there are significant lab costs but they now fall within the rheumatologist visit cost so it’s not easy to differentiate them. (I could go through all the EOBs but I’m not quite that Type A. Yet.)
Other charges include the $120 for my breast pump and $20 for my flu shot, which were both paid for by insurance.
Prescriptions.
Even though I was diagnosed with lupus over two years ago, my prescriptions have not yet stabilized. This is fairly normal – it takes a long time to figure out the right treatment plan after diagnosis. On an average month last year I would take two prescription medications for my lupus, one for my blood pressure, one for my dry eyes, one for acid reflux, and five different pain medications (each pain med has a different purpose). So prescriptions account for a lot of my healthcare costs.
I had 74 prescriptions filled last year and they cost $8,415. For this category there were no discounts; my plan paid $5,368 and I paid $3,046. I don’t know why UHC did not provide discounts, although it’s possible they have already negotiated set prices. I do know that the exact same medications all cost less with my current health insurance plan, so clearly BCBS has negotiated better prices. Why should drugs vary in price according to insurance plans?
Like my copay, my prescriptions didn’t count towards my deductible; I had to pay whatever they copay was for each prescription unless we met our $12,000 out of pocket maximum. This did at times discourage me from wanting to fill my scripts. I always filled them and complied with taking my meds, but I could easily see how someone struggling financially might not have the extra money each month just for prescriptions and choose to skip one. (In fact, diabetics have been doing just that.) And for people with lupus, not taking medication as prescribed is dangerous and largely contributes to organ damage and deadly complications. In fact, lupus patients not taking their meds is a huge part of why they go downhill. (This isn’t always because they can’t afford it, however, sometimes it’s because the patient doesn’t want to accept that they need the meds or they forget).
I will also mention there were a couple times that my insurance would require me to pay the full amount for a medication instead of offering a reasonable copay and when that happened I usually didn’t fill it. One instance is when my rheumatologist prescribed Colcrys for my pleurisy and my insurance refused to let me fill it as Colcrys – it could only be filled as mitigare because of their medication tiers (medications on their preferred tiers have good coverage, but meds on the nonpreferred tiers tend not to be covered). The mitigare would have cost around $300. That was too much money to pay for a drug that I didn’t know would work and that I only needed occasionally. My rheumatologist told me about the Colcrys copay program which would have made the medication affordable, but I wasn’t allowed to use the copay program unless the insurance would allow the script to go through as Colcrys, which they would not do. Isn’t that ridiculous? We spent a lot of time on the phone with the insurance and the pharmacy and never made any progress or filled the script. It was very frustrating.
Healthcare costs paid outside of health insurance.
There are several items needed for my chronic illness that were not covered by health insurance. These are things like my vitamin D3 supplements (I can’t be in the sun because of my lupus), ibuprofen, eye drops, and the heat wraps I use for my chronic neck pain when I’m not at home, just to list a few. I recorded those kinds of purchases and they totaled $407.
We also chose to pay for our contacts outside of insurance, due to our poor vision insurance, and that cost $308. I could go even further here, and include our contact lens solution – which cost almost $60 in 2018. Or include the gas for driving to each medical visit and to the pharmacy so often, but I didn’t keep track of it in detail (I did keep track of it in 2017 for tax purposes and it was around 400 miles). My point is that the true cost of our healthcare goes even further and has more of an impact than we may realize.
2018 summary.
In this post I emphasized the disparities between what was charged for medical services and what was paid for them because the difference is absurd in many cases. There is a lot of discussion about skyrocketing medical costs and out of control premiums in the USA, and I hope that sharing actual numbers from my medical history this has added to the conversation. Analyzing my medical costs has led to a lot of questions, skepticism, and even disgust.
To recap, we spent $20,018 on healthcare last year. That comes from $13,103 for our portion of the premiums, $6,200 in out of pocket insurance charges, and $715 in healthcare related costs that were not covered by insurance. (If we had experienced any other health issues or emergencies and reached our out of pocket maximum of $12,000 then we would have been on the hook for $25,818 last year.)
It’s hard to figure out exactly what portion of our 2018 healthcare cost is due to my chronic illness, but I feel comfortable saying that 100% of the rheumatologist visits, eye doctors visits, non-wellness primary doctors’ visits, and maternal fetal specialist visits were solely a result of my chronic illness. I also feel that all of my prescriptions were also due to my chronic illness. So those costs account for around 41% of the amount billed, 34% of what the insurance paid, and 75% of what I paid for medical care. I expect that in 2019 these numbers will be much closer to 100% since there will be no prenatal care.
As far as OB/GYN care and the birth costs, I have no way to estimate how much less the cost would be but I know that I would not have needed nearly as much testing for a normal, healthy pregnancy. It’s also unlikely I would have needed an induction (which added an extra night in the hospital) without my chronic illness or that my son would have needed extra monitoring for neonatal heart block (from my lupus) and blood sugar issues (from one of my medications).
I am grateful that my insurance paid for a lot of the costs, including 100% of the prenatal visits. I will also say I did not have to fight UHC about coverage (except for a few prescriptions), which was a first for me. They never refused to cover a procedure. Yet it’s still hard to be appreciative when we spent a third of our take home pay on healthcare in 2018.
I plan to do these healthcare costs each year when I’m able as well as share some of our past healthcare costs (You can read a bit about our healthcare costs in Germany in this post). I hope to inspire Americans to track their own healthcare costs, remain educated about their situation, and help us move towards more reasonable healthcare prices in the future.
Please share your unreasonable healthcare costs or any questions you have about this post in the comment section.
My 2018 Healthcare Costs as a Chronically Ill Person in the USA. #ChronicIllness Click To Tweet
Hi Ava. The cost of healthcare in this country is beyond out of control. I was diagnosed with multiple fibroids and had blood pressure spikes this year, and my total cost of healthcare was in the $20,000 range. The doctors charge for every minuscule test and treatment, and it really feels scary to get sick. I can't imagine living with a chronic illness, and I think you are very strong! Congrats on your new family 🙂
I’m sorry to hear that. I think many people don’t calculate what their total expenses would be if they had some sort or medical emergency. And the costs add up so fast! We still had almost $6,000 left before we’d have hit our out of pocket maximum so if I’d had another issue we could have hit $26K last year. We’ve started calculating our total potential cost (worst case scenario) each year so that we are prepared (hospitalizations are common with lupus).
I hope your health issues have been resolved and don’t pop up again. And thanks so much for that, I really appreciate it! 🙂
Medical costs are crazy. What you were paying a month for premiums – many people don't even make that much money from their job. Due to my low income I'm on premium assistance for medical care, I don't pay a monthly premium, and a lot of medical procedures are covered. This is doctor visits, including emergency room at the hospital, and if a stay at the hospital is needed. It doesn't cover medicine, dentist, eye doctor, or any medical equipment a person might need, say crutches or walking boot. Having benefits at work is huge and I did have them until recently because they cover prescription drugs and some dental and eye visits plus other specialists. Unfortunately that was a contract job and after a year and a half they no longer needed me. New job has no benefits, which is not unusual for most employers, but a job is a job. Many Canadians get their prescription drugs filled in the US to save money, and many of us fly to other countries to get surgery or dental work done. Either can't afford it here or the waitlist times are horrendous. People die while they're waiting for surgery. One of my friends also has lupus and she's been on disability for around 10 years. I don't know how much she makes but it's my guess around $1000/month and her prescription drugs costs thousands a month. She has an insurance carrier and I think it's like $300/month she pays but she needs it to cover her medicine. Many people have to decide between paying the rent or the light bill or their prescription meds. Your post is a real eye opener.
Cheryl, yes – I know several people that have paychecks equal or less than the cost of our monthly premiums. We could have supported another household with our healthcare costs! I’m glad to hear you have assistance but also sad that it doesn’t cover some essential things like medication and dental. 🙁 So many jobs don’t offer healthcare or they don’t offer affordable healthcare and that is so discouraging because everyone needs a basic level of healthcare each year – even if it’s just the wellness exams. I have considered getting prescriptions from Canada as well. It’s just a terrible situation. Even when I lived in Germany with great coverage I had issues getting into see the doctors and getting the doctors to give me “real” medications. So hard to find a balance these days. Thanks for reading and for your thoughtful comment.
Thanks for sharing, Ava. Always insightful to know. I too have such a post written about my country that’s been sitting in my drafts for years, heh. I think you’ve just given me the motivation to clean it up and maybe publish it, too 🙂 Hopefully healthcare costs becom more affordable arounr the globe and wishing you improved health!
So glad it was helpful, Sheryl. And I’d love to read your post about how it works in Singapore! I have to admit I do get jealous sometimes when I read similar posts from England, Canada, Australia, etc. Thanks so much! And you too. 🙂
this is such an eye opening post! i didn't really know how it all worked living in the UK! $600 a month for health care! Does it depend on your income, like a percentage of it? That would be like 50% of wages for some people I know!
No, health insurance doesn’t factor in our income. There is a program called Medicaid for very low-income people or people that meet certain requirements, such as having a child under 18 or being disabled. But it’s not a great program, it’s more of a last resort. For most people you get whatever plan is offered through your employer, and my husbands last employer only offered a plan that was $645 per person – period. We could have gotten insurance outside of the employer through the Healthcare Marketplace but it would have been around the same price. A lot of people in the USA are facing this dilemma and absolutely can’t afford any type of coverage so they just go without treatment. It’s awful. It’s part of the reason why my husband changed jobs because his new employer has a better insurance plan.
I discovered your awesome blog after you visited mine. You have a great story and outstanding writing. I enjoyed reading this post and a little about you. I loved the idea of a "start here" page… that is a great idea!! Keep writing and telling your unique lupus story, what I like to call an adventure. I am one of those people with great benefits, and have been with my employer for 30 years. There have been years that my self-insured government employer paid out an amount equal to my salary, or double it, and I am a manager, so do the math!! I look forward to reading more about your journey! Thank you!
Thank you so much! I found your blog because I was doing research on lupus symbols, and I so enjoyed your post comparing the wolf and the butterfly. I really appreciate your kind comments and encouragement! Yes, it can definitely be an adventure. Wow, I can only imagine what that sum is, especially if you add it up over the years!! So nice to “meet” you in the blogging world. Look forward to reading about you as well. 🙂