Matthew Botos

To understand one of the problems with health care in the US, see if you can answer the following questions:

• How much do you and your employer pay in total premiums for health insurance?
• What does a doctor’s visit or medical procedure cost you, and what additional amount does insurance pay?
• What would the same visit or procedure cost without insurance?

Those simple questions are often difficult to answer because there’s little information or transparency when it comes to health care costs. Employers often don’t disclose the majority share of the premiums they pay, and after your copay most costs occur behind the convoluted curtain of the insurance industry.

Here’s an idea of those costs:

• “Family coverage can cost on average about $1,000 a month, according to Families USA, a national nonprofit. The average monthly COBRA premium for individual coverage is $388.” (ajc.com)
• My last regular office visit was a $10 copay, plus an additional $46 paid by insurance.
• Without insurance, the same office visit would’ve been $80. Over the years, regular services I’ve received under insurance averaged a 60% discount from standard rates.

Two groups should be interested in increasing cost transparency: employers and insurers. Both pay significant amounts on behalf of the insured, and should be eager to quantify those benefits.

Aetna is off to a good start; their website allows you to view claims and see the amount billed and those actually paid by yourself and your insurance. They are also starting to take the next step by providing cost estimates before you go to the doctor.

With more information like this, we would have a better understanding of the true costs of healthcare and be able to plan & save accordingly.