Most Americans get their health insurance through employers. According to KFF Research, 155 million employees had health insurance through employers in 2021. The average yearly premiums were $1,299 for single coverage and $5,969 for family coverage. The average family premium had increased 22% over the prior five years and 47% over the prior ten years. However, employees’ wages had increased only 5% and inflation increased at least 1.9%.

Most plans require a yearly deducible before health insurance kicks in. Most also require either a co-pay or coinsurance for even for a routine doctor’s visit. The average 2021 co-payment was $25 for primary care and $42 for specialty care. The average coinsurance was 19% for primary care and 20% for specialty care. Many had co-pays and coinsurance for hospital admissions or outpatient surgeries.

Virtually all plans limited employee out-of-pocket costs for in-network services, although the limits vary widely. In 2021, 13% had maximums less than $2,000, while 27% had maximums of $6,000—or more.

Most Americans over age 65 are covered by Medicare for their medical services; but Medicare pays only 80% of covered services, with patients responsible for the other 20%, which can be considerable when expensive procedures are involved.

Many on Medicare therefore purchase a Medicare Advantage plan, run by private companies, to pay what regular Medicare does not. Everyone in the multitude of MAs must continue paying the monthly Medicare premium, plus whatever fees and co-pays their particular plan requires. All MAs are required to provide all traditional Medicare services. Most, though, offer additional services like vision, hearing, and dental services, and discounts on over-the-counter drugs that Medicare Part D does not cover.  However, to control costs, most MAs use the in network - out of network payment systems, require prior approval for some, especially very expensive, procedures and limit their geographical coverage. Before enrolling in any MA, determine what you will have pay, if your preferred medical providers are in-network, and if it covers everywhere you normally travel away from home.

Another option to pay the 20% is purchasing a supplemental health insurance policy from a private insurance company. As with MAs, there are a plethora of these. Unlike MAs, private policies are not officially connected to Medicare. Normally, however, all these pay whatever Medicare does not. However, if Medicare does not cover a procedure, some policies will pay 20% and some will not. Some policies provide only local or regional coverage and some provide nationwide coverage. Premiums vary from $0 to much more. Before purchasing a private policy, know what is covered by the various premiums from each company you consult, and is their coverage the same wherever you travel.

This is the option we chose and it has served us well. For instance, two weeks ago my oncologist gave me this note along with a huge smile: “No evidence of residual or recurrent lymphoma.” It was the result of a PET scan done a week earlier after the conclusion of six monthly chemo treatments.

According to my Medicare and supplemental insurance statements, each two-day session cost over $100,000. That sounds excessive. However, considering the several very experienced and very caring medical professionals involved, plus procedures and medications, it may not be so excessive.

Of course the result was priceless to us, in more ways than one: because of our supplemental insurance, we have not paid one cent out-of-pocket. Our policy is not cheap but we are fortunate to be able to afford it. And the amounts it and Medicare paid cover the premiums for each for the next few years.

In this wealthiest country on earth, too many Americans cannot afford such health insurance. And too many have none at all. This should be a national embarrassment. Unfortunately it is not.

Steve Wintermute is a journalist and history student. Contact him at stevewintermute1@gmail.com.