A fractured wrist from a slip on the ice. That pesky high blood pressure you’re keeping tabs on. The “text-neck” you’re nursing from spending too many hours glued to your cell.
At any given time, there are probably a slew of health-related problems you may be dealing with—and there may be more than a few medical bills that follow.
If you ever feel overwhelmed by your health care costs, you’re not alone: 39% of people say they worry about their ability to pay their medical bills for even “normal” health care, according to a 2014 Gallup poll.
The good news, however, is that the percentage of Americans who put off getting medical care because of cost-related reasons fell to 36% in 2014, from 43% in 2012, according to a study by the Commonwealth Fund.
That difference translates to 14 million people—and the study credits the statistical improvement to expanded health insurance coverage.
Get started with a free financial assessment.
Get started with a free financial assessment.
But what does the “right” coverage look like? There’s no one-size-fits-all answer, and how much you can potentially save really depends on your lifestyle, health and budget needs.
To get a sense of how people across the country are using their coverage to capture cost benefits, we asked three everyday Americans to estimate how much they save through their health plans.
From a fitness buff to a woman who recounts her journey with IVF, their stories show how budget-friendly it can be to find a plan that’s a good personal fit.
“I Get Reimbursed for Staying Fit”
Who: Brandon Gentile, 30, a registered nurse and case manager, Wooster, Mass.
Cost savings: $400 a year.
How my insurance helps save me money: "My insurance company offers a number of incentives to motivate people to adopt healthy habits. They'll reimburse me up to $200 for any number of qualifying fitness-related activities, including gym memberships, yoga classes and ski lift passes.
When I heard about the reimbursement program, I was already pretty active. I typically go to the gym several times a week, but I'm always interested in exploring new ways to stay in shape.
Last year I had been hearing a lot about CrossFit—an intense strength and conditioning program—and was curious to check it out. The CrossFit gym near me cost anywhere from $60 to $120 a month, depending on how frequently you go.
"I'm thinking about new ways to use this insurance perk. I might go skiing more often or buy home gym equipment—it's nice to have extra motivation to branch out."
I didn't want to put my own money on the line in case I didn't like it, but I figured there was little risk because I could use my insurance plan’s reimbursement program.
I essentially ended up getting a few months for free. It was a good move, and I decided to stay with that gym for several more months.
I'm now thinking about new ways to use this health insurance perk in 2015. I might go skiing more often or even buy some home gym equipment, like kettlebells—it's nice to have a little extra motivation to branch out.
In addition to the $200 reimbursement, I get another bonus: If you fill out an annual survey about the current status of your health, the insurance company gives you another $150.
And if you're already in good shape, you automatically get $50, which I am eligible for. (If you’re not, they direct you to a free health-coaching program, and after you complete it, you get the $50.) So basically I get $400 in checks cut to me each year just for taking good care of myself!"
“Insurance Covered My Fertility Costs”
Who: Lydia Fine, 34, associate marketing director, Iowa City, Iowa
Cost savings: At least $19,000.
How my insurance helps save me money: "When my husband, Nathan, and I got married five years ago, we knew we wanted to have kids pretty soon.
When we started trying to get pregnant, I was only 30, but signs showed that I wasn't ovulating—so we quickly realized that we'd probably need medical assistance. Six months later, we sought the help of a fertility specialist.
We are lucky to live in a city that has a leading research hospital, so we had some of the country's top experts in our backyard.
Because many health insurance companies can be vague about what they cover when it comes to fertility treatments, the clinic employs someone whose sole job it is to advise patients about expected costs. That person also tells you what the full out-of-pocket cost could be if your insurance doesn't provide any coverage—and those numbers are really scary.
"Another friend of mine did multiple cycles of IVF while uninsured—she calls her child 'the $52,000 baby.'"
I'm so grateful I had good coverage through my employer. The plan offers a lifetime $25,000 infertility benefit, and [associated] medications are covered at 80%.
My doctor started by prescribing medication to encourage ovulation, and after trying a few different fertility treatments, we eventually moved on to in vitro fertilization (IVF).
Fortunately, IVF was successful—we now have a daughter and a son—but it required a total of one fresh round of IVF and two frozen cycles, which requires using embryos frozen during the fresh cycle.
If I hadn't had insurance coverage, we likely would have paid $15,000 for that first cycle and $2,000 for each of the frozen cycles. That's $19,000!
We're actually donating our unused embryos to a couple who does not have IVF insurance coverage. The woman has had to take a part-time job, in addition to her normal work, to try to raise money for the treatments.
Another friend of mine did multiple cycles of IVF while uninsured—she calls her child "the $52,000 baby." She and her husband will be paying their lenders for a long time.
That shows just how expensive fertility treatments are, and how quickly the costs can mount up. I know not everyone is as lucky as we were to have that kind of coverage."
"I Save by Sticking With Only the Coverage I Need”
Who: Joey Gochnour, 29, nutritionist and personal trainer, Austin, Tex.
Cost savings: Between $360–$3,120 a year.
How my insurance helps save me money: "I'm not eligible for health insurance through an employer, which means I've had to shop for insurance on my own through the marketplace—but I actually think that's a good thing.
I have the freedom to choose minimal coverage, rather than pay for services I don't plan on using.
Because I'm young, healthy and rarely go to the doctor, I opt for a catastrophic health insurance plan, which I had last year too.
The plan covers three doctor's visits a year. After that, I have to pay out-of-pocket until reaching my deductible, which is $6,600 this year. But then my plan will pay 100% of costs, so if I were to get into a really bad accident, I’d be O.K.
So far I have only paid minimal out-of-pocket costs. In fact, I only went to the doctor once last year—and that was because I figured I might as well get a baseline checkup.
So far I have only paid minimal out-of-pocket costs. In fact, I only went to the doctor once last year—and that was because I figured I might as well get a baseline checkup. And I don't take any medications on a regular basis.
My monthly premiums are now about $140. Over the course of the year, that will add up to $1,680, which is less than what I'd pay if I had chosen a non-catastrophic plan. The other options I qualified for ranged from about $170 to $400 a month.
The price varies with the benefits each plan provides, but it really pays to do your homework. Some of the bronze-level plans have deductibles that are nearly as high as they are with my catastrophic plan. If I’d chosen one of them, I would have had to pay a higher monthly premium for no reason.
Of course silver, gold and platinum plans in the marketplace offer more benefits, but I don't need them right now. I rarely get sick and I take care of my body by eating well, sleeping enough and staying active.
For me, the insurance is there just in case something really bad happens unexpectedly."
LearnVest Planning Services is a registered investment adviser and subsidiary of LearnVest, Inc., that provides financial plans for its clients. Information shown is for illustrative purposes only and is not intended as investment, legal or tax planning advice. Please consult a financial adviser, attorney or tax specialist for advice specific to your financial situation. Unless specifically identified as such, the individuals interviewed or quoted in this piece are neither clients, employees nor affiliates of LearnVest Planning Services, and the views expressed are their own. LearnVest Planning Services and any third parties listed, linked to or otherwise appearing in this message are separate and unaffiliated and are not responsible for each other’s products, services or policies.