Are You Prepared for Costs Your Health Insurance Doesn’t Cover?

Laura Cave
August 31, 2021

If you have health insurance, you’re protected from major medical bills—but having health insurance in the U.S. doesn’t mean all your healthcare is free. People are often surprised by the number of bills they receive after getting care for a health issue. These can put a dent in your savings or end up on a credit card, adding financial stress to your recovery.

So I’m going to ask you an important question that most people would rather not think about:  

Are you aware of what a health issue could cost you? 

Understanding your potential costs is the first step toward making sure you’re prepared if you or a loved one gets sick or injured this year. 

Here are a few questions to ask yourself to start identifying potential costs that could come with common health issues—

What out-of-pocket costs would your health insurance require you to pay?

Most health insurance plans require some form of cost-sharing, where you pay certain costs up front for your medical care. These are called “out-of-pocket costs.” In case you’re a little fuzzy about the basics, here’s how most health insurance works. 

Let’s start with the deductible. Most plans require you to pay for your own medical bills until your spending reaches your deductible, and some plans have a separate pharmacy deductible specifically for medications. 

After you meet your deductible, your health insurance plan will start to pay for some of your costs, but you’re often still responsible for a flat fee, called a copay, or a percentage of the bill, which is called coinsurance. This goes on until your spending reaches your out-of-pocket maximum. After that, your health plan pays 100% of covered services.

So, what does that mean? It means that an injury or illness that requires an Emergency Room visit, imaging like X-Rays or CT Scans, some medication, and follow-up care could mean that you’d have to pay hundreds or maybe even thousands of dollars in medical bills in a very short period of time. 

What would you need help with?

Another area of surprising costs that crop up when you or a loved one is in recovery is everyday expenses that are heightened because you’re not able to take care of all the things you usually do yourself around the house. Think of all the things you might need help with if you were in bed or on crutches for a period of time. What would fall through the cracks if you had to take care of a sick parent or child?  

Would you need extra childcare? Who would mow the lawn? What if you couldn’t drive and needed a ride to appointments? You might need items around the house to make your recovery more comfortable like a different kind of pillow or a chair for the shower. 

Your health insurance likely won’t cover all of these costs, so even if your medical bills are low, you should be prepared for the everyday expenses that might come up while you’re recovering.

Would you miss work and lose income?

Another source of financial strain while families are dealing with a health issue is lost income from limited ability to work. Your inability to earn your normal paycheck could be a major challenge if your job doesn’t offer paid leave. 

Health issues are financially challenging for most people, even when they have health insurance, because out-of-pocket medical bills, increased everyday expenses, and loss of income can really set you back. 

Steps you can take to prepare

The first step is to take an inventory of your potential costs by reviewing your health insurance cost-sharing numbers and estimating extra expenses and potential for lost income in advance. Knowing your deductible and out-of-pocket maximum will help ensure that medical bills are not a surprise. 

Next, take some steps to protect your finances. Savings is an obvious place to start if you can set money aside. However, it takes time to build up savings and once you have them, they’re worth protecting. 

Consider a supplemental health insurance plan like Brella. You’ll have a chance to enroll in Brella at work and you’ll pay an affordable monthly fee out of your paycheck. Then if you’re diagnosed with any of 13,000+ covered conditions from moderate issues like dehydration or stitches to more serious conditions like appendicitis or cancer, you can file a claim and receive cash benefits, typically within 72 hours of your completed claim. There are no restrictions on how you use your payout.

You can choose your Brella benefit amounts when you enroll to help offset your out-of-pocket medical bills, everyday expenses, or to help make up for lost income. It’s a good idea to choose your health insurance with Brella in mind. For a deeper dive on this, read more about how to choose your health insurance and learn more about how Brella’s plan works.