Can You Afford a Broken Leg?

So you’re relatively young and healthy and don’t visit the doctor too often; does that mean a low-premium, high-deductible plan will be the right fit for your health insurance? Or perhaps you believe you can afford to skip premiums altogether and go without coverage? You could be tempting fate.

Stuff happens! The average emergency room visit cost $1,389 in 2017,¹ the most recent year available, according to the Health Care Cost Institute.  The daily cost of a hospital stay in the U.S. that same year averaged  $2,424 per day, the Kaiser Family Foundation reports.² 

Meanwhile, nearly 40 percent of Americans surveyed by Bankrate say they couldn’t cover a $1,000 emergency bill.³  So forgoing health insurance could be a risky business.

The young are over-represented in the ranks of the uninsured with about one in four of those ages 26 to 34 eschewing coverage, and one in five between ages 34 to 44. And more men than women forgo insurance, the U.S. Census reports.

If you’re young, the odds may still be in your favor when it comes to chronic and serious illness, but no one is immune. Car accidents, sports-related injuries and other mishaps account for millions of emergency room visits annually.

These injuries can be costly, even if they don’t result in a trip to the ER. Diagnostic testing, surgeries, physical therapy, and follow-up visits add up. According to the U.S. Consumer Product Safety Commission’s National Electronic Injury Surveillance System, the average charges for a fractured arm among 25 to 40 year olds is $7,666; a limb dislocation could set you back $4,757 and a simple sprain costs $3,175.⁴

It’s prudent to have coverage, and even if you do you may wind up paying a substantial portion of related medical bills, depending on your annual deductible and coinsurance amounts.

What to know about emergency care

Under the Affordable Care Act, emergency services are among the 10 essentials that all health insurance plans must include. Though specific emergency services benefits vary based on state benchmark plans, the following are required:

• Coverage for emergency department services will be provided without a pre-authorization requirement or limit to in-network providers; and
• When emergency services are received out-of-network, the cost-sharing requirement (i.e., copayment and coinsurance rate) is the same as it would be in-network.

This offers some peace of mind, whether you travel to compete, make sports part of your vacation, or simply become injured in the area where you live and are taken to an out-of-network hospital. However, be aware that you could still wind up paying more for out-of-network care. Read more in our recent post “What You Need to Know About Out-of-Network Emergency Care.”

You should still compare emergency services benefits from plan to plan (e.g., emergency transportation, urgent care, emergency room services), as copay and coinsurance amounts may vary widely. If you have specific concerns or questions about out-of-network emergency care, contact your health insurance carrier.

Think beyond the ER

But what if your injuries don’t send you to the emergency room? Some benefits you may want to look at closely when comparing plans include:

• X-rays and diagnostic testing
• Imaging (e.g., CT Scans, MRIs)
• Specialists
• Prescription drugs
• Inpatient and outpatient physician and surgical services
• Hospital stays (e.g., inpatient hospital services)
• Outpatient facility fees
• Rehabilitative services such as physical therapy
• Durable medical equipment
• Chiropractic care and other

Also, be aware that under the Affordable Care Act you can no longer be denied major medical health insurance coverage or charged more based on your health history. Furthermore, all ACA-compliant health insurance plans include certain free preventive services.

Save for injuries with an HSA

Whether you shop and purchase coverage on or away from a state or federal health insurance exchange, you may want to consider an HSA-compatible high-deductible health insurance plan and enroll in a health savings account. It can be a great combo if a low-premium, high-deductible plan makes sense, depending on your health and finances.

An HSA allows you to set aside pre-tax wages to be spent later on qualified medical expenses. The funds roll over year after year, meaning there are no use-it-or-lose-it requirements as with flexible spending accounts. It can be a helpful way to save for unexpected medical care you may need one year and not the next, such as a sports injury or a fall.

HSA-compatible high-deductible health plans are typically advertised as such. Many insurance companies that sell the plans also offer HSAs or can connect you with a partner who does. If yours does not, you may obtain an HSA through a financial institution.

Supplement your coverage

You may want to consider supplemental benefits that help lower out-of-pocket spending when you need medical care.

If you are part of a national club or are licensed in your sport through its governing body, you may have access to low-cost accident medical plans that are designed for active individuals and provide defined benefits upon accidental bodily injury and even emergency evacuation. If not, you may look into such products independently. Free and low-cost prescription drug cards are another supplemental product that can help save you money, at least for the short term. You may also want to consider dental insurance. So ask yourself, can you afford a broken leg or worse? And keep in mind that people who say, “That will never happen to me” are rushed to the ER every day. Protect yourself. You may be facing a double negative: Perhaps, you can’t afford not to have coverage.