Where to get affordable healthcare when you don't have insurance

[disneysteve]

I get that but there still has to be some level of being worth the benefit you're receiving.

If medical premiums are $15k/year, I'm not paying it. If I have a life threatening injury, I can't be refused medical care

You can't be refused at an emergency room. You can certainly be refused outside of that. No doctor is required to accept patients who can't afford to pay for their care. No pharmacy is required to dispense medications for free. If you land in the hospital, you might be able to do something about that bill but what about all of the care after discharge? Follow up visits, meds, physical therapy, home care, etc. Who is paying for that?

If you want to go uninsured, go right ahead, but you're taking a HUGE gamble that could easily bankrupt you.

My cousin was diagnosed with breast cancer when she was 19.
My former medical assistant got malignant melanoma in her 30s and a few years later got breast cancer.
"Young and healthy" sounds great, until you wake up one morning with a new lump under your arm that turns out to be cancerous or you slip going down the stairs and sustain a traumatic brain injury.

[riverwed070707]

You can't be refused at an emergency room. You can certainly be refused outside of that. No doctor is required to accept patients who can't afford to pay for their care. No pharmacy is required to dispense medications for free. If you land in the hospital, you might be able to do something about that bill but what about all of the care after discharge? Follow up visits, meds, physical therapy, home care, etc. Who is paying for that?

If you want to go uninsured, go right ahead, but you're taking a HUGE gamble that could easily bankrupt you.

My cousin was diagnosed with breast cancer when she was 19.
My former medical assistant got malignant melanoma in her 30s and a few years later got breast cancer.
"Young and healthy" sounds great, until you wake up one morning with a new lump under your arm that turns out to be cancerous or you slip going down the stairs and sustain a traumatic brain injury.

To be clear, I don't WANT to go without healthcare. I want the healthcare system fixed to be available and affordable for everyone. I don't agree with the "welp that's what it costs and you have to pay it" mentality - something needs to be done. I empathize with those that are in a position to have to choose whether or not they can afford it, and feel very fortunate that is not my situation currently. I do plan to retire early and I'm surely not going to let the cost of healthcare be the reason I continue to work an extra 20 years when I otherwise can afford to stop working.

[LivingAlmostLarge]

To be clear, I don't WANT to go without healthcare. I want the healthcare system fixed to be available and affordable for everyone. I don't agree with the "welp that's what it costs and you have to pay it" mentality - something needs to be done. I empathize with those that are in a position to have to choose whether or not they can afford it, and feel very fortunate that is not my situation currently. I do plan to retire early and I'm surely not going to let the cost of healthcare be the reason I continue to work an extra 20 years when I otherwise can afford to stop working.

this is the reason why I don't think if we go pay as you go we'll wreck people faster and honestly I sort of think we should do it. That will probably be the only way we'd ever get socialized system in place. Without having people actually experience a truly free market health care not tied to jobs and EVERYONE has to pay out of pocket, leveling the playing field and fully understanding how costs work we'll likely be the only 1st world country without socialized system. We need to let the market either go completely free market and fail or succeed. Either way if you have money and can afford concierge medicine without blinking now you'll be fine.. No insurance tied to job but companies pay more? Then those with good plans now will get more out of their companies. Those super poor will always be cared for, we have it now called medicaid. Those in the middle we'll that'll finally sway which way the us goes.

[Thrif-t]

I think WalMart is trying to change health care in America https://clark.com/insurance/health-i...h-care-clinic/

And Amazon is doing some thing too, but I don't have any links.

The private sector has to start the change, there are too many cronies making $$ off our current healthcare system so they don't want to change anything.

Maybe one of these WM clinics in GA is close to you OP? Although I realize that doesn't provide an answer for your insurance question.

[disneysteve]

I think WalMart is trying to change health care in America

A lot of this mirrors what CVS has done for years with their Minute Clinics. Some of it also mirrors what Urgent Care centers do. So it isn't all terribly new.

I do wonder about some of that pricing. For example, they are charging $60 for a Medicare Wellness Visit. Obviously, that means the patient has Medicare which pays for that service minus any deductible or copay, and if you have a secondary insurance, that may pickup the difference, so why are they charging $60. And why are most of the prices even numbers but a school physical is $23.37? That's rather odd. They're charging only $30 for an annual check up but $40 for a sick visit which is probably far less complex and shorter than the check up. Overall, though, I think the price transparency is great.

[Smallsteps]

Part of the issue we have in healthcare was created when we took the prices off the menu, I ASK for the costs for each treatment plan when being seen.
People do not know what things cost and so if their plan pays 80% and they are responsible for 20% it sounds ok. Even 20% adds up quickly in an expensive situation.
It creates a situation where "free" is not really true. If you and/or employer PAY premiums and they pay for the flu shot for example. People will tell you " i got a FREE shot" when in fact it was paid for when you paid the premiums.
When i hear the term " Surprise medical bills" i would like to see a breakdown of how many were because the patient disconnect.
Lets say people added up items thinking they had their deductible covered only to find "insurance math" is not easy to follow. Or perhaps they simply did not watch the bills add up and their % goes right up too.
I worked for years in the health insurance industry and have ZERO faith in most companies involved. The wasted dollars and cost of the administration is taking a huge chunk of money.

With that said I have read how bloated administration the system in the UK and other countries have as well. The more middle people the more cost............ with paying them and their benefits etc.

[kork13]

And why are most of the prices even numbers but a school physical is $23.37? That's rather odd. They're charging only $30 for an annual check up but $40 for a sick visit which is probably far less complex and shorter than the check up. Overall, though, I think the price transparency is great.

My immediate guess would be that it's not doctors/nurses who are setting the rates, with the experience to know what's involved. 99% guarantee their exact pricing (beyond known costs & profit margins) is driven mostly by marketing people. It's still pretty new, so they're almost certainly still feeling out their pricing structures.

[amastewa93]

Um delivery of my baby cost $100k+ looking at our bills. I was 30 and young and super healthy and had a couple of issues that cropped up. Early delivery, jaundice, hip dysplasia, heart murmur, vacuum, and DK got stuck wrong side up after being turned from being breech entire pregnancy. I had terrible tearing spent over 3 hours being seen to after. I ran a fever, delivered at 35 weeks and did not have for extra "test" that were supposed to be done. Did I mention I snowboarded, walked and ran 5 miles a day and perfect health. No problems. And then a bad delivery. With all her problems we were SOL for every buying private health insurance before the ACA. DK1 was "pre-existing condition" everything. Allergies she had as well, multiple ear infections, surgery to correct and put tubes in 2x the first by 6 months after 3 months of being on antibiotics which turns out she was allergic too. She also had a high palate and was we suspect tongue tied. Can I keep going? The aca was the only thing going that allowed us to quit DH's job and buy some crappy HDHP plan and we still didn't buy dental or vision. So I have a huge bone to pick with insurance companies and how it's tied to employment.
.

This is another HUGE reason we've been looking into private coverage. We are planning to start trying to have a child in another two years and having those costs covered will be key. There's no doubt we need coverage - especially once we start expanding our family, and we wouldn't start to try for child until we have insurance. But, right now, it is so hard to pay that $1,200 a month and be strapped to pay for it.

[amastewa93]

OP, you need to talk to an insurance broker who can go over options with you. Some good middle ground might be choosing a high deductible plan if you want to bet on good health. But then gives you more catastrophic coverage in a worst case situation. But a broker will be able to go over the risks and pros/cons of each, and will probably be able to find some more affordable options. The fact that no one has mentioned this to you shows how little people shop around for their healthcare.

OP, the best of luck. It is 1,000% an easier decision to pay this much for health insurance at this stage in our life when we do have significant assets to protect. & I have a spouse with a medical condition (something random and awful that popped up around age 30, but is very expensive). If I was a perfectly healthy 20-something, I can't say I'd agree to pay $1,200 per month for insurance. Or more. But just make sure you know what your options are before foregoing insurance entirely.

I certainly don't want to forego it entirely (not for long anyway). We are looking into chatting with an insurance broker - my husband just so happened to work on a broker's Porsche earlier this week so he got a card. With open enrollment coming up and chatting with him, we should be able to find something that fits our needs. But, like you said, as a healthy 26-year-old, it is SO hard to pay that much for insurance month-to-month. However, my husband is 30, and we do plan on trying to have a child in about two years' time, so insurance is going to be a necessity.

[disneysteve]

It's still pretty new, so they're almost certainly still feeling out their pricing structures.

It's certainly not a new thing though. Like I said, CVS has been doing it for years as has Walgreen's and other places so there are models they could follow.

I wonder if maybe they made the annual check up cheaper on purpose to encourage people to come for them. People are more willing to pay for care when they're sick so you can charge more for that.

[disneysteve]

Part of the issue we have in healthcare was created when we took the prices off the menu, I ASK for the costs for each treatment plan when being seen.

It is such a complex system. You can ask the price and there's a good chance they can't tell you. Every insurance company has it's own fee schedule so what you pay for a particular service may be different than what I would pay at the very same place. And you may have a 70/30 plan while I have an 80/20 plan and someone else has a 100% after deductible plan.

You're totally right about people misusing the word FREE. It isn't free. It is COVERED. Very different but that's how people think and not just about healthcare. I've posted about that before, like when hotels advertise free breakfast or free WiFi. It isn't free. It's included in the cost of the room. If it was actually free, I could just walk in off the street and eat breakfast.

[Smallsteps]

It is such a complex system. You can ask the price and there's a good chance they can't tell you. Every insurance company has it's own fee schedule so what you pay for a particular service may be different than what I would pay at the very same place. And you may have a 70/30 plan while I have an 80/20 plan and someone else has a 100% after deductible plan.
.

I never understand why people do not seem to want to deal with the "complex system". it is complex just accept it and look the other way ...
I have never had anyone not tell me costs using well it differs by this and that .
Some are ballpark figures that in general have been fairly accurate. My providers usually have been very upfront about items instead of pushing specific meds/ treatments. in fact many will tell me things we can try before writing a script etc. and i HAVE coverage. TOO many just up sell like they are on commission.

My point is how many patients will just take whatever meds or treatment by " that sounds ok" or told this is the newest thing never Knowing that one option was twice $$$ of another option until maybe they change insurance or had to pay out of pocket.

Look at when some upstart takes any other consumer item and finds a cheaper way to deliver.
It would force more transparency in a customer/ to supplier situation .........but with insurance the middle man just keeps every nickle not spent so ZERO savings for end user.
Perhaps that is why in auto insurance is more competitive.................... you can get an estimate without playing games like..." well with insurance X it is this much.... but with insurance Y it is this. so i cant tell you how much to fix your car" insurance is still involved just not using some murky equations saying" it is complex dear don't worry about it."

[disneysteve]

I have never had anyone not tell me costs using well it differs by this and that .

I work in Urgent Care. For the longest time, I could not get anybody to give me a price list for the services we provide. Most of our patients have insurance so it doesn't matter for them but we do have cash patients, too, and they would ask, "How much is this chest x-ray going to cost?" and I couldn't tell them. I asked my manager, our lead physician, our medical director, and a few other people and nobody could tell me. I finally gave up trying to get the info.

Now they changed our billing system and made a global fee for a visit that includes anything we do onsite like a strep throat test, a flu test, an x-ray, stitches, etc. That way a price list is no longer needed. Patients pay a flat fee to be seen and they're done.

I just never understood why nobody could give me an answer to my question. They were going to send the patient a bill but nobody could tell me how much that bill was going to be for. It was beyond frustrating.

[Smallsteps]

I work in Urgent Care. For the longest time, I could not get anybody to give me a price list for the services we provide. Most of our patients have insurance so it doesn't matter for them but we do have cash patients, too, and they would ask, "How much is this chest x-ray going to cost?" and I couldn't tell them. I asked my manager, our lead physician, our medical director, and a few other people and nobody could tell me. I finally gave up trying to get the info.

Now they changed our billing system and made a global fee for a visit that includes anything we do onsite like a strep throat test, a flu test, an x-ray, stitches, etc. That way a price list is no longer needed. Patients pay a flat fee to be seen and they're done.

I just never understood why nobody could give me an answer to my question. They were going to send the patient a bill but nobody could tell me how much that bill was going to be for. It was beyond frustrating.

That would be incredibly frustrating so the "surprise" medical bill is a surprise to you as a provider as well.
The one fee to cover most.... is simply cost shifting... so someone who needs very little services is partially covering someone who uses more then average time/ services?

Just see how that works at a buffet... people are often trying to get their moneys worth.

i understand each case would be different but general costs should be available. Just like experts advise people to look over detailed hospital charges to see if they were over charged for items/ treatment you did not receive but as you said people say "it does not matter insurance covers most" etc.... many people simply do not look any deeper.

What other service do people IGNORE the details like this? Without transparency and people wonder why there is fraud and room for so much abuse.

if a person had their car fixed and bill had a set of new tires or wipers and you never received those you would say something. not just" oh well it is on insurance"

[amastewa93]

I work in Urgent Care. For the longest time, I could not get anybody to give me a price list for the services we provide. Most of our patients have insurance so it doesn't matter for them but we do have cash patients, too, and they would ask, "How much is this chest x-ray going to cost?" and I couldn't tell them. I asked my manager, our lead physician, our medical director, and a few other people and nobody could tell me. I finally gave up trying to get the info.

Now they changed our billing system and made a global fee for a visit that includes anything we do onsite like a strep throat test, a flu test, an x-ray, stitches, etc. That way a price list is no longer needed. Patients pay a flat fee to be seen and they're done.

I just never understood why nobody could give me an answer to my question. They were going to send the patient a bill but nobody could tell me how much that bill was going to be for. It was beyond frustrating.

This is interesting because I never received a price beforehand when I was insured under my father's coverage. Probably because I never thought to ask. However, when I hit urgent care for my allergic reaction last week they said it was $155 for the visit. Before they administered any breathing treatment or shots they informed me of how much it would be (since I was paying cash). Steroid shots and one shot of Benadryl was $40. The breathing treatment was another $25. I was pleasantly surprised to find the pricing was so upfront.