Is health insurance actually just a big scam? Several people seem to think that might be the case after having unexpected encounters with the American healthcare system.
Healthcare costs are known to typically run much higher in the U.S. than in other countries, and having good insurance is often presented as the solution to that problem. Unfortunately, many people face barriers to accessing quality health insurance plans, but one man who was in that position is now questioning why it’s worth it to pay for insurance at all.
A man realized that he actually paid less money for an emergency room trip because he wasn’t insured.
Content creator Clarkson Lawson shared his confusion after finding out the hospital was giving him a deep discount for his two-night ER stay because he didn’t have health insurance. Lawson explained that he is in that uncomfortable in-between spot where he can’t get insurance through an employer, but also makes too much money to qualify for Medicaid.
This leaves him with no choice but to “pay a monthly fee,” which most likely means he has gotten coverage through the Affordable Care Act in the past. When he tried to renew his plan at the start of the year, he found out his monthly bill would cost $800 to $900, in addition to the cost of his deductible. Since he’s young and healthy, he decided to take a risk and go without it.
Lawson said that after spending two nights in the ER recently, he found out the hospital was charging $24,000 for his care. But, with the discount the hospital provides for patients who don’t have insurance, he’s only responsible for paying $2,478.74.
Lawson made it clear that he was not recommending everyone cancel their health insurance, but the situation did leave him with some questions. “Are they overcharging insurance companies, or does it actually cost $24,000 to take care of me for two days?” he asked.
: Millions Of Americans Are Canceling Health Insurance Because They’re Paying Thousands Before Coverage Even Starts
Lawson isn’t the only one who was shocked by the difference in costs for uninsured versus insured medical care.
A mom named Megan shared a similar story in a TikTok post of her own. After their deductible and out-of-pocket costs increased at the beginning of the year, she decided to cancel the health insurance she and her son received through her corporate job.
Jonathan Borba | Pexels
Megan had a few prescriptions to refill, which she used to pay about $50 for with her insurance coverage. She estimated that the cost without insurance would be close to $250. Instead, by using GoodRx coupons, she got it down to $8.
“What my new out-of-pocket cost would have been, just to have insurance, just for me and my son … was going to be almost $1,000 a month,” she said. “That does not include out-of-pocket expenses. That does not include the new deductible that was added. That is just basic coverage, what is coming out of my paycheck.”
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Self-pay may be a good option in some cases, but it’s not a solution to a broken system.
8% of the country doesn’t have health insurance, which means self-pay options like this, where the patient is given a discount, can be a good thing. Medical facilities are able to offer the discount because they don’t have to deal with all of the administrative work and fees required by insurance companies.
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However, there are a lot of risks. An NBC News report noted that going the self-pay route might limit the number of providers you can see, and you wouldn’t be able to use your insurance company’s negotiated rate, or what they’ve agreed to pay for a certain service, which is sometimes even cheaper.
Plus, health is not permanent. Lawson estimated he would have spent $12,000 to $15,000 on insurance alone this year, but it’s a worthy trade-off for some people. If you have a serious illness or chronic condition, the cost of your care will well exceed that amount. If you just need one or two ER trips a year, it’s fine, but you never know what could happen.
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Mary-Faith Martinez is a writer with a bachelor’s degree in English and Journalism who covers news, psychology, lifestyle, and human interest topics.
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