For the young and healthy, trips to the hospital are rare, but it is impossible to predict sudden injuries and illnesses. If you have to go to the emergency room, you could rack up large medical bills. Health costs that result from a trip to the ER can be a major financial setback, especially if you don't have health insurance to help pay for the care you receive.
Health Insurance Basics
If you have health insurance and go to the emergency room, you generally split the cost of the care you receive with your health insurance company. ER visits usually come with a flat fee you have to pay, called a co-payment. According to the Society for Human Resource Management, the average ER copay is $76. You may also have to pay an up-front cost called an annual deductible before your insurance company will cover costs. For instance, if your annual deductible is $500 and your co-payment is $100, you'd have to pay $600 for an ER visit and your insurance company would cover the rest.
Some health insurance plans include "coinsurance," which describes a cost that is shared between you and your insurance company at a certain percentage. If your health insurance plan requires coinsurance on ER visits, you'll have to pay for a portion of your total ER bill. For example, if your plan requires 20 percent coinsurance and your bill is $2,000 after paying any co-payment and deductible, you'd also have to pay 20 percent of the remaining $2,000, while your insurance company would cover 80 percent of the remaining bill.
Hospitals are required by law to accept anyone in need of urgent medical attention into the ER, even if they don't have insurance. Uninsured people who use the ER are responsible for paying medical bills themselves. As a result, if you don't have insurance, a trip to the ER could result in having to pay thousands of dollars out of your own pocket. If you can't afford to pay medical bills, it could force you to declare bankruptcy. According to CNBC, medical bills are the number one reason for bankruptcies in the United States.
Paying for the Uninsured
Since people who go without health insurance sometimes can't pay their medical bills, hospitals often end up absorbing the cost of ER visits made by uninsured people. When hospitals absorb these additional costs, they have to raise the prices of care to make sure they receive enough cash from paying patients to stay in business. Higher prices for medical care translate to higher insurance costs for those who do have insurance.
- Blue Cross Blue Shield of Michigan: How Do Deductibles, Coinsurance and Copays Work?
- LA Times: Trauma in the ER -- Who Covers The Uninsured?
- CNBC: Medical Bills Are the Biggest Cause of U.S. Bankruptcies
- CNN Money: 'We All Pay for the Uninsured'
- Society for Human Resource Management: Unnecessary ER Visits Linked to Low Co-Pays
- Healthcare.gov. "No Health Insurance? See If You'll Owe a Fee." Accessed Sept. 23, 2020.
Gregory Hamel has been a writer since September 2008 and has also authored three novels. He has a Bachelor of Arts in economics from St. Olaf College. Hamel maintains a blog focused on massive open online courses and computer programming.