Estimating Your Medical Costs

HealthCue co-founders Traci Richards and Stephen Schuster help you map out future medical costs, and answer your health insurance questions.

To decide which health insurance plan is best for you, you need to determine how much you will be spending on medical care in the future. There are two ways to estimate your future costs:

1) Starting from scratch and estimating how much you will probably spend using average costs for the medical procedures you think you’ll need.

2) Looking at your Explanation of Benefits (EOBs) from last year to see what medical coverage you required, and guessing that the next year will be similar.

If you’re starting from scratch, first list all the doctor visits, hospital visits (such as out-patient surgery), prescription drugs, laboratory tests, immunizations, x-rays, or other medical services you may seek in the next year. Then, multiply your expected number of visits, prescriptions, etc. by the average costs in the table below. (For quick explanations of terms like EOBs, co-pay, deductible, and co-insurance, check out our Health Insurance Glossary.)

  • Doctor Visits (co-pay) - $30 per visit

  • Prescription Drugs (co-pay) - $10 per prescription (generic), or $40 per prescription (name brand)

  • Prescription Drugs (out-of-pocket) - $40 per prescription

  • X-rays, CT Scans or MRIs - $300 per procedure

  • Laboratory Tests - $85 per test

  • Hospitalizations (average - 5 days) - $5,000 per hospitalization

  • Out-Patient Surgeries - $2,000 per surgery

While these estimates are general, they’ll give you a good idea of how much you might expect to spend in a generic health insurance plan.

If you have been enrolled in a health insurance plan for the past year, the second—and more accurate—way to estimate your medical costs is to examine your “EOBs,” or explanation of benefits. Whenever you receive medical service from a provider, your health insurer sends you an EOB explaining how much your insurer paid to the provider, and how much you must pay. EOBs contain five critical pieces of information that will help you accurately estimate your future expenses.

1. The Negotiated Amount - This is a column on each EOB that tells you what amount a health insurer has agreed to pay your medical provider for the medical service you received. Multiply the Negotiated Amount by the number of visits or services of that type you expect to receive. This gives you a more accurate estimate than using the average costs in the table above.

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