When you’re living paycheck to paycheck and every expense feels like a burden, you may constantly wonder if you really need health insurance. And when your employer gives you your options and you see how much will come out of your paycheck in healthcare premiums, it’s a tempting expense to skip.
You could use the money, right?
Obviously, if nothing happens and there’s no need for medical care, not paying for health insurance is cheaper.
But what if you have a one-time medical emergency? Even then your out-of-pocket costs might be less than what you would pay for insurance. Long-term conditions with regular medical costs, on the other hand, can make insurance a financial necessity.
What’s Ahead:
Average cost of health insurance
The average ACA Marketplace premium is $386 per month for a 27-year-old, with premiums varying significantly depending on the type of health insurance carried.
Of course, when you add a family to the mix, premiums are even greater — and continue to rise.
While employers will cover most of the premiums for single employees, they do not take on the same portion of those costs when it comes to a spouse or children. KFF reports the average single employee paid about 22% of the costs of their insurance premium in 2021, but for family coverage, the average employee paid about 29%.
If you want to see how much health insurance is going to cost, you can start by comparing the cheapest health insurance options available to you wherever you live, side-by-side.
Overview of health insurance vs. no health insurance
Type of care Insured Uninsured
Annual checkup $0 $150 to $300
Emergency room visit $50 to $150 copay $1,220
Lab work $0 to $25 $6 to $379
Specialists $30 to $50 copay $300+
Dental care $240 to $600 for basic annual premiums $290 to $790 for basic annual care
Vision care $60 to $180 in annual premiums
About $120 for glasses
$170 to $200 per exam
$351 for glasses
Prescriptions $10 to $40 $10 to $300
Disability aids $100 to $300 wheelchairs;
$40 to $60 blood glucose meters; $5 to $50 per month for blood glucose testing strips
$500 to $1,500 wheelchairs;
$40 to $60 blood glucose meters; $100 per month for blood glucose testing strips
When comparing the costs in this chart, remember you are paying an average of $386 per month for insurance premiums, which equates to $4,632 per year.
Let’s say you are a healthy individual without the need to see a doctor regularly. Your year may look something like this if you have insurance (at minimum rates):
- Annual insurance premium = $4,632
- PCP annual checkup = $0
- Dentist, 2x a year = $240
- Ophthalmologist, 1x a year = $60
- Total: $4,932
Now, without insurance, at minimum rates:
- Annual insurance premium = $0
- PCP annual checkup = $150
- Dentist, 2x a year = $290
- Ophthalmologist, 1x a year = $170
- Total: $610
If you’re generally healthy, your annual uninsured costs might be dramatically lower than what you would pay for insured medical care.
But if you have a chronic illness, impairment, or wind up in the emergency room, what you end up paying out of pocket for insurance could be worthwhile.
Primary care visits
Most insurance companies require participants to obtain their care through a primary care provider (PCP). These general practitioners are able to evaluate you for physicals, vaccinations, and ailments. If a more serious checkup is needed, a PCP will refer you to a specialist.
How much does a primary care visit cost with health insurance?
Preventative care means insurance often covers 100% of your annual checkup at the doctor. Outside of that visit, the average cost of visiting a doctor for a checkup with health insurance is a $15 to $25 copay. The rest of your visit will be covered by insurance for which you are paying the average $386 per month.
This means it costs more than $4,500 a year to see a doctor just once, along with copays for additional visits. Some insurance has deductibles, meaning you will pay out-of-pocket until you reach the limit. For example, if you have a $1,000 deductible, you will pay copays and additional costs until you reach that limit. After that, all costs are covered by the insurance company.
Read more: Common health insurance terms you need to know
How much does a primary care visit cost without health insurance?
If you choose to forgo health insurance, you will have to pay the full fees for doctor visits. Perhaps you are healthy and only need an annual checkup?
The average cost of visiting a doctor for a checkup without health insurance can cost between $150 to $300.
Emergency visits
While it’s much cheaper to skip health insurance when you are healthy, the reason for questioning the need for insurance is an emergency. How much can you expect to pay if you wind up in the emergency room (ER)?
How much does an emergency visit cost with health insurance?
With health insurance, a trip to the ER will likely cost $50 to $150, depending on the copay. If you need tests, you’ll pay additional fees. These may be a copay or a percentage of the price of the service.
How much does an emergency visit cost without health insurance?
An uninsured trip to the emergency room (ER) might also cost $50 to $150 just to check-in without insurance. But tests and doctors’ fees pile on expenses from there.
Your $50 to $150 goes to the hospital. The doctor you see may charge you another $100 to upwards of $1,000 for the level of service. And an ER visit may require CT scans, MRIs, or more, all with a price. If you are admitted for an overnight stay, the hospital room and service will be additional, as well.
All in all, Consumer Health Ratings reports that the average uninsured ER visit cost $1,220 in 2019.
Lab work
Traditional annual exams do require various tests, but most are also affordable.
How much does lab work cost with health insurance?
Lab work performed within your PCP’s office is included with the office visit. If you are sent to a clinic for blood work, your insurance may cover all of the costs or you may have a small fee to pay, depending on your insurance and location.
How much does lab work cost without health insurance?
While some tests may cost as little as $5, the bigger the test, the bigger the cost. Basic tests most likely performed on younger adults include:
- Blood work — $6 to $73 per test
- Pap smears — $50 to $150
- Strep test — $60 to $299
- STD tests — $29 to $379
Should you need a bigger test, expect to consistently find prices in the hundreds. An ultrasound, for example, will cost around $365 minimum.
Specialist visits
A specialist is a doctor who, as the name implies, specializes in one area of medicine. A gynecologist or an allergist are examples.
How much does a specialist visit cost with health insurance?
Most insurance companies require you to begin your doctor visit with your PCP and obtain a referral to seek a specialist’s care. This is because specialists are more expensive and your insurance company wants to ensure your ailment isn’t something that your PCP can treat.
If the PCP refers you, then you will typically pay a copay from $30 to $50. However, some insurance companies do not provide out-of-network coverage, which means you’ll pay as if you do not have insurance, should you see a specialist that’s not within your program.
How much does a specialist visit cost without health insurance?
The price of visiting a specialist can vary widely, and it’s difficult to provide a reliable average visit cost. But given that specialists tend to be more expensive than PCPs, the cost of visiting a specialist without insurance could exceed $300.
Dental/vision visits
Dentists and ophthalmologists are specialists in oral and visual health but fall under different parameters. Regular insurance doesn’t include visits to these specialists and they require their own separate insurance.
It is recommended that people visit a dentist twice a year for cleanings and exams.
Of course, people who need glasses and contacts need to see an eye doctor annually while those with good vision under 30 may only need to see a doctor every couple of years.
How much does dental/vision care cost with health insurance?
Dental insurance is separate from traditional health insurance and comes with its own premium. The average is between $20 and $50 per month, and this typically covers two annual cleanings and exams and one set of X-rays without a copay.
Should you need a filling or work done, a portion of the treatment is covered by insurance and you will have to pay the remaining costs. Insurance typically covers 50% to 80% of the costs, depending on the extent of the procedure. Cavity fillings typically cost around $200 to $600, so you could pay anywhere from $40 to $300 out of pocket.
Cosmetic work is not covered with dental insurance, so any teeth whitening, veneers, and the like will be out of pocket and can climb into the thousands.
For vision care, an eye exam may be included once a year in your coverage plan with discounted pricing on glasses and contacts. You may find prescription glasses covered with an out-of-pocket cost of $120 or so. Contacts average about $200 to $500 annually with insurance. The good news is vision premiums are extremely low. You’ll only pay around $5 to $15 per month.
How much does dental/vision care cost without health insurance?
Nearly 34% of adults ages 19 to 64 have no dental benefits of any kind. This means they pay around $60 to $120 for a dental exam, $75 to $200 for routine cleanings, and between $20 and $150 for X-rays.
If something goes wrong — such as a cavity filling, a root canal, or your wisdom teeth need to be extracted — the costs are high without insurance. To fill a cavity costs around $200, while a crown could take the price all the way to $3,000. If you need your wisdom teeth removed the cost can also be around $3,000 for all four wisdom teeth.
Read more: Is dental insurance worth it?
Without vision care, seeing an ophthalmologist can cost between $170 to $200 for an eye exam. Glasses, including frames and lenses, average $351 without insurance.
Prescriptions
Unfortunately, medication prices are unregulated and drug prices have risen year after year. Insurance may not cover all medications and may require a deductible to be met before covering them. In 2021, the average spend on prescription drugs was $1,011.
How much are prescriptions with health insurance?
If you have insurance you can expect to pay between $10 to $40 for medications.
However, some prescriptions can actually be more expensive with insurance because your carrier may not have brokered a good deal with your pharmacy or drug manufacturer. Diabetes medication costs, for instance, have been a source of contention, with Consumer Reports finding even with insurance one could pay $300 per month.
How much are prescriptions without health insurance?
Without insurance, generic prescription drugs could run between $10 to $300, so if you are someone who requires monthly medications, say for anxiety or migraines, you’ll have to pay out of pocket.
Managing chronic illnesses
Having a chronic illness is a completely different story when it comes to health insurance. Chronic conditions include diabetes, depression, cancer, obesity, and more. Having a chronic illness means you need a lot more care than most people, including numerous doctor visits, medications, and tests.
How much does managing chronic illnesses cost with health insurance?
The Centers for Disease Control and Prevention found chronic and mental health conditions take up 90% of healthcare spending. For example, the American Diabetes Association (ADA) finds the combined annual medical expenditures for a person with diabetes are $16,752 — 2.3 times higher than the expenses of a person without diabetes.
Having insurance doesn’t mean cut-and-dry coverage, however. Insurance companies vary greatly in how much they will cover for a chronic illness. And while you may only need to pay a copay for doctors’ visits, different lab work, testing, medications, and more means shelling out more dough.
Chronic conditions may be subject to government insurance under Medicare, with premiums up to $499 per month for Part A, which doesn’t cover medications.
How much does managing chronic illnesses cost without health insurance?
Because it can be so expensive to manage a chronic illness, those without insurance have been found to seek treatment far less than those with insurance. The ADA, for example, found 60% fewer doctor visits and 52% fewer medications in people with diabetes without insurance. But that comes with a price: 168% more visits to the ER than a person with insurance.
Aids for disabilities (hearing aids, wheelchairs, etc.)
Insurance alone does not often cover aids for various impairments. That said, people with disabilities may be able to receive Medicare government insurance to help with these costs.
How much do aids for disabilities cost with health insurance?
Medicare covers 80% of a wheelchair’s cost after you meet your annual Part B deductible. With patients paying the remaining 20%, this means most wheelchairs will cost between $100 to $300 out of pocket.
People with diabetes will pay $40 to $60 for glucose meters and about $5 to $50 per month on test strips as copays.
Read more: Why disability insurance is the most important financial product you didn’t realize you needed
How much do aids for disabilities cost without health insurance or Medicare?
Here is a breakdown of some common aid prices:
- Wheelchairs: $500 to 1,000
- Power battery replacements: $70 to $450
- Hearing aids: <$1,000 to >$4,000
- Blood glucose meters: $40 to $60
- Blood glucose testing strips: about $100 per month
Ways to save
There are different companies and platforms available to help you save on your medical expenses, from finding you the best insurance rates to cheaper medications.
Short-term insurance
If you need to see a doctor for a few months or have lost your job and need coverage until you find a new job, Agile Health provides temporary coverage starting at less than $99 per month. In order to qualify, you must be in good health.
RxSaver
You can find price comparisons of the medications you may need and receive coupons for those drugs at RxSaver or GoodRx. Offering ways to save up to 80% on prescription drugs, these sites are extremely easy to use and provide you with coupons immediately.
Alternative doctors
Not all doctor’s visits are created equal. Walk-in clinics, such as the CVS Minute Clinic or similar clinics in other pharmacies, can treat minor illnesses, injuries, and conditions. They can also administer vaccinations and offer physicals. These visits can cost 40% less than traditional urgent care clinics.
Virtual doctor visits can also be cheaper than in-person visits to a clinic. SteadyMD provides a flat subscription rate so you can get to know your doctor and have someone to talk to for less. Monthly subscriptions are $99 for individuals.
Mom and dad
Adult children can be insured through a parent’s health insurance until the age of 26. This includes children who live away from home and/or are married. A parent’s family plan may provide cheaper monthly premiums than single insurance as you’ll only pay your portion of the costs. Plus, a parent may have better insurance than your company, if you have an insurance option.
Summary
Health insurance is a big business and it’s expensive. If you are young, healthy, and just starting out in life on your own, it can be cheaper to go uninsured and pay for medical expenses as they are needed.
But if you have a pre-existing condition that needs long-term management, insurance can help you keep your expenses down.
Featured image: Scott Hales/Shutterstock.com
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