The Cost of Care, With and Without Health Insurance

A major surgery, a routine screening, or a sudden fracture — countless reasons bring us to the doctor’s office or even the hospital. Whether you have health insurance or not, you can’t help but wonder, “What’s this going to cost?”

“The cost of any health situation can snowball quickly,” said Bria Gunderson, Customer Care Coordinator of Quality Assurance at Avera Health Plans.

When you’re covered by health insurance, health care out-of-pocket costs reach a cap. Without a cap you don’t know where that dollar amount will end.

Big Costs in Health Care

When you realize how big the cost of health care can be, it’s worth the cost of monthly premiums, especially if the health event is unexpected.

Look at these numbers of caring for common health events:

Hospitalization Costs for COVID-19

  • Uninsured: $30,000 and up to $233,000 for COVID-19 with complications (ICU care)
  • Insured: $6,000 maximum out-of-pocket

Hospitalization Costs for Broken Leg Requiring Surgery

  • Uninsured: $55,000
  • Insured: $6,000 maximum out-of-pocket

Hospitalization Costs for Pregnancy/Delivery with a C-Section

  • Uninsured: $20,000
  • Insured: $5,600

The insured cost supposes you have a plan with a $2,000 individual deductible, are in-network, and have 20% coinsurance, up to a maximum individual out-of-pocket of $6,000. Avera does offer charity care and financial assistance for uninsured or underinsured people at designated income levels who do not have the means to pay their health care bills.

Non-insured cost estimates are from FAIR Health Consumer, a national site that computes average health care costs for certain health events or procedures depending on where you live.

*Estimates based on national figures and do not apply to real patient care scenarios.

Get the Most from Your Health Insurance

If you’re paying a few hundred bucks in premiums every month, then make sure you’re getting the most from your health plan and benefits. Take advantage of every free exam and test available to you or your family.

Most health insurance plans cover preventive health services as recommended, such as women’s yearly mammograms, colonoscopy, immunizations and annual physicals.

Learn About Your Health Insurance Plan

“Facing any health situation without the financial protection of insurance can have a negative impact on your healing,” added Gunderson.

Contact Avera Health Plans with your health insurance questions, where they are passionate about helping members make the most of their health plan.

“Our member advocates are looking out for you and want to bring peace and grace to every person’s health situation,” said Gunderson. Turn to them for help, resources and guidance.

Avera Health Plans agents are also available to help you find a plan that fits your needs. Learn more about your options after a qualifying life event or during annual open enrollment.

Calculator, Paper and Stethoscope on table