When you have a health crisis, even if you have insurance, you still worry — and for good reason — that the bill will make you sick.

My daughter recently had a major health crisis. Her right lung collapsed and she spent nine days in the hospital. She had excellent care and is recovering now.

During this trying time, I wrote about the need to have a rainy-day fund to help when life happens. Savings allowed my husband and me to be with our daughter during her hospitalization without worrying about accumulating debt.


Soon after these columns, a number of readers expressed concern about the cost of our daughter’s care.

One person said one of the columns resulted in “a weary chuckle” when I wrote, “We won’t be bringing home any debt.”

“Your daughter, given the serious nature of her illness, (hope she is doing better) and length of hospitalization, will be left, most likely, with five-figures of hospital charges after insurance,” the reader emailed. “Most 20-somethings don’t have that type of money laying around, so you may have to step in. Either that or she depletes her savings and goes into debt. I would love to read an article that follows up with what you/your daughter experienced on the billing end.”

In a 2016 survey, the Kaiser Family Foundation and the New York Times found that 19 percent of working-age Americans 18 to 64 with health insurance through an employer had problems paying their medical bills. It was, of course, worse among people who are uninsured.

“While insurance provides financial protection, that protection can be incomplete for a number of reasons, including rising deductibles and other forms of cost-sharing, out-of-network charges, the growing complexity of insurance that can leave consumers with unexpected bills, and the fact that many people have only modest financial assets to cover medical expenses,” the survey report said.

In separate survey, released in September, Kaiser reported that the average annual cost of family health coverage among employer-sponsored plans was $20,576.

“And while employers shoulder most of the burden for family coverage, the $6,015 average employee contribution is 74% higher than it was 10 years ago,” reported Max Nisen for Bloomberg Opinion. “That’s far from trivial for low-income families, and doesn’t even cover all their costs.”

Nisen went on to point out from the Kaiser data, “Premiums are just the start, especially when people get sick. Deductibles — the set amount many insured people must pay before their coverage kicks in — have been rising even more rapidly than premiums. … Most workers that need care or prescription drugs have substantial co-payments or coinsurance to deal with as well. And remember, the Kaiser data reflect averages. Plenty of Americans with employer coverage are substantially worse off. Families that get coverage from smaller firms, for example, face higher premiums and deductibles.”

A day after my daughter was discharged from the hospital, she became worried about the cost of her hospital stay, so she called her health insurance company.

As she peppered a member representative with questions, my husband and I sat nearby listening to the exchange. She’s 24 and was offered health insurance through her work, a 12-month residential internship at a Houston nonprofit.

To be honest, I was disappointed that she didn’t know much about her insurance coverage. I had volunteered to review her policy. I also reminded her that she could keep her primary coverage under our family plan. Under the Affordable Care Act, plans and issuers that offer dependent child coverage must provide coverage until a child reaches 26. But, as part of my daughter’s effort to become more independent, she simply said, “I got this, Mom.”

Except she didn’t have it.

I needed to pick up her medication following her discharge from the hospital, so I asked about her prescription co-pay. She didn’t know how much it was. She was unsure about much of her coverage overall.

But to be fair, between the move across the country and taking care of small, vulnerable children, it’s understandable that she wasn’t focused on digging into the details of her health coverage. She was grateful she was even offered her own health insurance. Plus, she’s young and has always been covered as a dependent — meaning she didn’t have to worry about costs.

Many people don’t fully understand what their health insurance will cover. They are caught off guard by what’s left for them to pay. Even if you have health insurance, you have to account for deductibles and other out-of-pocket expenses.

So there we were with her feeling a bit better, although still in pain, trying to figure out how much she would end up paying for all the medication, multiple X-rays, surgery and physical therapy that she received.

I was scared for her. She’s a great money manager and saver, but she’s earning so very little in the internship program, a position she took for the experience.

Of course, it’s too soon to know how much the final bill will be, but my daughter was relieved to find out the hospital where she received treatment was in network so it appears she may only be responsible for a maximum $3,000 deductible before her insurance picks up the rest of the tab. She can manage that even without our help. Since she still has coverage under our family plan, it’s possible that any costs not handled by her primary insurance could still be covered. However, I’m still concerned there may be some unforeseen expenses that won’t be paid by either insurance company.

This experience has taught her a lot. And I won’t be so easily deterred from trying to get her to pay attention to her employer benefits.

Can I also make an appeal to the many of you who are probably going through open enrollment season right now?

Please take the time to review your benefit options. Pay close attention in particular to your deductibles and co-pays.

During open enrollment, you can change plans, so it’s the ideal time to review your health insurance options. Don’t wait until the last minute, either. Check when your open enrollment ends. It’s Dec. 7 for Medicare. The Obamacare marketplace open enrollment runs until Dec. 15.

Whatever your coverage, better to know what you may be expected to pay than be sickened later by an unexpected bill. The more you know, the better you can plan and save — as best you can — for what your policy doesn’t cover.

Read more:

Color of Money Question of the Week

Did your health insurance bill leave you in debt? Send your comments to colorofmoney@washpost.com. Please include your name, city and state. Put “Medical Debt” in the subject line.

Live Chat Today

Join me today at noon (Eastern time) for a live discussion about your money. My guest will be Myles Ma, a health care expert and managing editor at Policygenius Magazine. Ma will be taking questions about health insurance for both private plans and those purchased through the Obamacare exchange. Policygenius is an insurance comparison website.

To participate in this week’s discussion live or read the transcript after it’s over, click this link.

I’m live every Thursday from noon to 1 p.m. (Eastern time).

The cost of long-term care

I’ve written recently about the high cost of paying for long-term care.


Last week I asked: How are you paying for long-term care for yourself or a parent?

Laurel Nation of San Diego wrote, “We don’t need long term care yet, but when we do need assistance, our plan is to sell our house and move into a retirement facility with all levels of care. We are fortunate to live in a beach community in Southern California where home prices in our neighborhood continue to rise. We don’t have children to leave the house to, so we definitely want to spend our house. My only concern is what these facilities will cost in 15 years. If our house continues to increase in value, we should be fine.”

M. Blake wrote, “My spouse is now in a long term care residence in Manhattan which is referred to by the management as an independent living residence. The cost is $10,800 per month. We have long term care insurance but when that runs out in five years, I have no idea how we will pay for it.”

“My husband and I are 66 years old,” wrote Marsha Botts from Silver Spring, Md. “Given our genes, I enrolled us in a long term care plan shortly before our 50th birthdays. At one time, my former employer covered part of the premium, but ceased their contribution before I retired. My concern is the increasing cost to maintain the policy. Now that we are Social Security and pension dependent, the annual increase is frightening. Fortunately, we have Medicare, a prescription plan and a supplemental health insurance.”

Susan Lilly from Beverly, N.J., wrote, “I carry long term care insurance, which I pay for monthly. My policy was discontinued by the insurer but I’m grandfathered in as long as I pay. Premiums have risen 23% since I obtained the coverage about 11 years ago. The policy pays a pretty good set monthly amount, no matter where I receive care, including at home. The catch is, the coverage only lasts three years. So after that I can die, live with family and be a burden, or bankrupt myself and go on public assistance. I would rather die. Sad.”

Color of Money columns this week

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