WITH The cost of health insurance will increaseSome Americans are asking a surprising question: Is it really cheaper to get health care without it?
Short answer: Sometimes. But not often. And that may require a little or a lot of homework.
Some hospitals and clinics offer self-pay or cash discounts for patients who pay without insurance, bypassing the paperwork and administrative fees associated with having insurance. Hospitals required by federal law make your cash discount prices publicly available online. For example, an allergy test or x-ray may be several hundred dollars cheaper, especially for people with high-deductible plans. Nonprofit hospitals must provide charity care (free or discounted) to people who cannot afford it, even those with insurance.
But paying outside of your health insurance means the costs don't count toward your deductible or out-of-pocket limit—and if you end up needing more doctor visits than expected, you could end up in a worse financial situation.
“You have to be very careful,” said Stacy Dusetsina, a professor of health policy at Vanderbilt University in Nashville, Tennessee. “The out-of-pocket price you pay, even if you get some kind of advertised discount, may be more than you actually pay for health insurance overall.”
The question of whether to give up insurance and pay cash arises for many Americans. they are expected to have to pay higher premiums next year. Expanded subsidiesThe Affordable Care Act, which lowered Affordable Care Act premiums for many in the middle class, is set to expire at the end of the year without any action from Congress. Awards for people who get health insurance through your job or outside of the ACA is also expected to rise next year.
Some ACA members are discussing whether to completely abandon their coverage — a decision that experts warn could leave them facing large medical bills if an unforeseen emergency occurs.
“If you like Russian roulette, you'll like approaching health care the same way,” said Michelle Johnson, executive director of the Tennessee Justice Center, a law firm and nonprofit advocacy group that helps people challenge medical bills.
Johnson said that “part of the misconception is that we as American consumers constantly ask ourselves, 'How can I get the best deal?'
“Healthcare is not like that,” she said. “If you're healthy, you're essentially putting all your chips on the table in hopes that you'll be mostly healthy.”
Loss of benefits
Insurance, for all its frustrations, can provide crucial protection: limiting out-of-pocket costs, access to negotiated rates and free preventionsuch as cancer screenings, annual physicals, and routine vaccinations.
“For non-emergency care, a doctor or hospital may require a patient who does not have insurance to pay the entire cost in advance or go to another provider,” said Erin Duffy, director of research training at the USC Schaeffer Center for Health Policy and Economics.
“It does seem risky,” Duffy said. “If you thought you could continue to see the primary care doctor you would have seen when you were insured, you might find that there are other financial barriers.”
For those who are healthy, paying cash can be a smart move to get predictable and cheaper services such as X-rays or CT scans, Dusetsina said.
“It arises all the time in the world of prescription drugs“,” Dusetsina said. “People often purchase generics out of pocket because in some cases it costs them less than paying for health insurance.”
But patients won't have access to their insurer's negotiated rate — the amount an insurance company agrees to pay for a medical service, Dusetsina said. Even if people don't reach their deductible, they still get a negotiated rate, which can be cheaper than paying cash. And whatever they pay won't go toward their deductible or out-of-pocket limit.
“Historically, if you went to a medical center and wanted to pay cash, the price they started at was often double or more than the price of health insurance,” she said. “So you lose the benefit of having a negotiated rate without health insurance.”
Savings of a person can disappear quickly if something unexpected happens– said Johnson. Emergency room visits, hospital stays or surgeries—even at discounted prices—can cost tens of thousands of dollars. Uninsured patients will be billed for the full amount. It's typically not possible to sign up for health insurance after an emergency has already occurred, she said. There is also a narrow period for registration; Most states enroll in the ACA from November 1st to January 15th. Open enrollment for people who get health insurance through their job usually happens around the same time.
“This is the only time you can sign up until next year, so you're essentially left on-hand not only for emergency visits, but for all follow-up care,” she said.
Johnson said before people even think about talking about health care with a doctor or health care provider, they should first check to see if there is a federally qualified health center nearby. Health clinics receive federal grants to provide low-cost care to low-income populations, including the underinsured and uninsured.
“If you need primary care, you can often get it at a federally qualified health center,” she said.
If specialized care is needed, doctors can negotiate, but they often require people to pay the full amount up front, Johnson said. If you want to get an idea of what you might pay, sites like Turquoise Health show the average price hospitals can charge for certain medical procedures.
If you get a lower rate from a doctor, the process may not end there, Johnson said. Depending on how complex the medical procedure is, you may need agreement with the entire medical team involved.
“Even if you have a doctor who says, 'I'll do this for you,' then somehow you need the anesthesiologist to do it, and you need the labs to do it, and you also need the nurses to do it,” she said.
Duffy advised calling the billing office and “asking really specific questions about when you'll have to pay, what the full range of options for both assistance and payment plans are that may be helpful for those who are uninsured or low income or just faced with a bill that you may not be able to pay all at once.”
For those who need emergency care or hospital treatment, Duffy noted, there is a federal law—the Emergency Medical Services and Labor Act—that requires hospitals that participate in the Medicare program to provide care to anyone who goes to the emergency room, regardless of their ability to pay.
The person can then make arrangements with the hospital or health care provider or obtain a payment plan.
Neither strategy is particularly helpful for people who are not healthy and are likely to seek medical care frequently, said Lawrence Gostin, director of the O'Neill Institute for National and Global Health Law at Georgetown University.
“The self-pay option will be most attractive to healthy and affluent patients who may forego adequate health insurance,” he said.
