Health Insurance prices are expected to surge in 2026. Millions of Americans will no longer be able to afford health insurance. They need alternatives that don't rely on government. There are a variety of options, including one secret weapon that people still aren't talking about.

Why are health insurance prices spiking?

Multiple factors are combining during the next year, and will cause a dramatic spike in health insurance prices in 2026 . The federal government has estimated at least 16 million people will become un-insured:

• A tax credit, a subsidy, and an income cap are all expiring December 31, 2025. These American Rescue Plan Act (2021) benefits for ACA marketplace insurance all expire on December 31, 2025. KFF estimates ACA marketplace enrollees will pay an average of 75% more in health insurance premiums. The Congressional Budget Office estimated this would reduce the number of insured by 5.1 million people.
• A work requirement on Medicaid eligibility take effect after June 1, 2026. The One Big Beautiful Bill Act (2025) dictates this must be implemented no later than January 1, 2027. As explained by the American Medical Association, the Act "creates new administrative requirements and conditions on eligibility (including work requirements) for patients seeking to enroll in or maintain Medicaid coverage and restricts states’ ability to use provider taxes to finance their Medicaid programs." The Congressional Budget office estimated this would reduce the number of insured by 10.9 million people.
• Tariffs (taxes) that were substantially increased in 2025 will have made their way through the supply chain. These will particularly impact lower-margin products like generic drugs and common medical supplies. Health system expenses are expected to increase 10-15% across the board. In turn, this is forcing health insurers to increase prices.
• New demand has also put upward pressure on prices, in particular with semaglutide weight-loss drugs like Ozempic. In turn, this is putting upward pressure on health insurer prices.
• Adverse selection will put further upward pressure on prices on an ongoing basis. The spike in prices in 2026 will cause many healthier people to drop their health insurance simply because the high cost will become so detached from the modest benefit. Plus, the ACA penalty has been removed, so they are no longer required to have insurance. As healthier people drop out of the insurance pool, insurers will increase premiums to cover the higher average cost per insured.

What should you do if you can't afford health insurance anymore?

If you expect your health insurance to become unaffordable in 2026, you have a few options.

If you need short-term care for free, even if there are very long wait times:

• Emergency room. Hospitals that accept Medicaid are required to stabilize anyone in an emergency, as dictated by EMTALA.
• Community Health Centers. Federally Qualified Health Centers (FQHCs) may be able to provide some primary and preventive care.
• Charity care. Local hospitals and churches may be able to help provide you with medical care. Reach out to ask.

However, millions of people will be leaning on those resources, so expect long waits if you can get care at all.

If you want longer-term solutions that you can rely on:

• Catastrophic health insurance. Covers only expensive/extreme cases. (This is what insurance should be.)
• Health sharing ministry. "Health shares" are not insurance, because they are not obligated to pay, but they can help with your medical bills.
• Medical cost sharing groups. Similar to a health sharing ministry, but non-religious.

The secret weapon

The most affordable healthcare can only be unlocked through the "self-pay" strategy. It means you pay out of pocket, but you get the lowest possible prices. This approach is usually much less expensive than health insurance.

You can become a "self-pay patient" by asking about self-pay discounts yourself, or by using a service like Pocketero to do it for you.

Further reading

• Washington Post on tariffs and Ozempic
• Time on ACA marketplace price increases

Kroger has announced it is terminating the Kroger Health Savings Club. It has sent members the following notice:

We regret to inform you that Kroger Health Savings Club will be ending, and your membership will not be renewed on 3/23/25. This decision was not made lightly, and we deeply value the trust you’ve placed in us to support your healthcare needs.

Redditors are commenting this is simply because no other grocer has a similar plan, so it was an opportunity to increase revenue by matching competitors. Regardless, this represents yet more upward pressure on healthcare prices.

If you're looking for an alternative to the Kroger Health Savings Club that is designed for patients who pay out-of-pocket, you might be interested in Pocketero.

Healthcare providers often struggle to decide how much a procedure will cost, especially for insured patients. Out-of-pocket patients will ask about a specific price only to be told, "we don't know the price until the end of your visit." This is obviously dysfunctional. Patients can't be expected to sign a blank check for every healthcare encounter.

But the problem isn't too little price information. In fact, it's the opposite – there is far too much. Turquoise Health writes:

Since July 2022, health insurance companies have been required to publish how much they pay healthcare providers for nearly all health care services. ... Insurance companies are posting in total about a petabyte per month of price data. ... A petabyte is a truly astronomical amount of information — many hundreds of trillions of numbers. With only 66% of Americans covered by commercial health insurance, how is it that we need trillions of numbers to represent health care prices for only 220 million people?

Incredibly, Turquoise Health is successfully crunching all that data every month. But even the reduced data "is still a challenge for traditional database systems." And this data doesn't help individual healthcare practices provide exact quotes beforehand. Even using the crunched data, patients can only get estimated prices.

If you're an out-of-pocket patient (most Americans are), you can solve the pricing problem by joining Pocketero. Pocketero members are entitled to price quotes before their appointment. That way you aren't signing a blank check – if you know what you need, you know what you'll pay.

The Washington Post reports "denials of health-insurance claims are rising — and getting weirder". They go on:

[health insurance] companies appear increasingly likely to employ computer algorithms or people with little relevant experience to issue rapid-fire denials of claims — sometimes bundles at a time — without even reviewing the patient’s medical chart ... It’s a handy way for insurers to keep revenue high ...

A recent study by the Kaiser Family Foundation (KFF) of plans on the Affordable Care Act marketplace found that even when patients received care from in-network physicians — doctors and hospitals approved by these same insurers — the companies in 2021 nonetheless denied, on average, 17 percent of claims. One insurer denied 49 percent of claims in 2021; another’s turndowns hit an astonishing 80 percent in 2020.

How will rising denials affect the healthcare system?

The more claims health insurance companies deny arbitrarily, the more we will see the following.

• Healthcare providers will be less likely to accept insurance. Instead, they will encourage patients to pay out of pocket.
• Patients will be less likely to use health insurance, because it can so easily lead to paperwork nightmares, and because their healthcare providers are encouraging them to pay out of pocket. Plus, for patients who are members of Pocketero, paying out of pocket gets the best price.

Health insurers were already incredibly difficult to work with because of arcane billing requirements and unreasonable denials. As they become increasingly impossible, the market will have no choice but to revert back to the way it used to be. As recently as the 1960s, "Americans used to pay for things like medicine almost entirely out-of-pocket". The challenge will be paying today's prevailing prices for healthcare, which are much higher than the 1960s. That's why Pocketero is such an important tool in a healthcare economy where health insurance companies are largely unusable.

Medical debts of less than $500 are now being ignored by the credit reporting agencies, apparently at the behest of the Biden administration. People with debts like this have already seen their credit scores rise as a result. However, lower-income people will now find it harder to get medical care. In the long run, this change probably benefits medical practices more than patients. If so, it's another unintended consequence of intervention in the healthcare market.

What changed with credit reporting?

The big three credit reporting agencies will no longer track medical debts under $500. The Federal government's Consumer Financial Protection Bureau (CFPB) just announced:

The three nationwide consumer reporting companies announced the removal of medical collections under $500 from consumer credit reports on April 11, 2023. We estimate that this reporting change removed at least one medical collection from the credit reports of 22.8 million people and removed all medical collections from the credit reports of approximately 15.6 million people.

While that's good for these people, this change will have other consequences.

What will be the consequences of the change?

Now that medical practices have lost their leverage for collecting small medical debts, they will be more discriminating in who they provide service to. We should expect medical practices to demand payment before service for total bills of $500-$1,000 or less. If you can't pay up front, you will be less likely to receive medical care. This will affect millions of Americans.

The majority of medical encounters cost less than $1,000. That means the majority of medical encounters could require payment up front. Yet 56% of American households can't cover a $1,000 emergency expense with savings. These households need the flexibility of paying later. So if medical practices respond the way we expect, and require payment up front, that puts a majority of American households in a position where they're less able to get medical care.

Who does this change benefit?

Clearly the credit reporting change immediately benefitted anyone who had small medical debts on their credit report. And it will continue to benefit people who incur small medical debts and can't pay them. But again, medical practices will become stricter about who they provide services to, favoring patients that pay up front.

Ultimately, this change probably benefits medical practices more than patients. It gives medical practices a motivation to be stricter about who they provide service to, and a viable reason to refuse service to lower-income patients.

What is the best way to pay up front?

If you must pay up front for medical care, understand you will get the worst prices unless you're part of a network. Unfortunately, it's notoriously expensive to join a health insurance network. If health insurance is not affordable, try Pocketero. It's a non-insurance network for people who pay out of pocket for healthcare. As a Pocketero member, you're guaranteed the best prices. And it's extremely affordable. Try it now.

Many healthcare providers offer a discount to financially vulnerable patients. These go by various names:

• Self-pay discount
• Cash-pay discount
• Prompt-pay discount

These discounts have good intentions. Unfortunately, they create some fairly serious dangers for both providers and patients. There is probably only one viable way to address these dangers, which is through a non-insurance network.

Breaching insurance contracts

Insurance contracts usually specify reimbursements as a percentage of the provider's "reasonable and customary" prices. For example, "Insurer's reimbursements shall be made at 50% of the provider's reasonable and customary fees." This language makes self-pay discounts dangerous.

If a provider offers a discount to anyone who walks in the door, then the discounted prices are effectively the "usual and customary" prices. Especially if a provider offers a discount without patients requesting, the discounted price is clearly the "customary" price. Yet most providers will continue billing insurers at full chargemaster prices. This is a violation of their insurance contract. While it might not be intentional, providers can easily lose a lawsuit for breach of contract.

Misleading patients

A patient without health insurance might reasonably assume a "self-pay discount" would make their healthcare affordable. That's not correct.

Let's face it, chargemaster prices are deliberately inflated. Every provider does it. Most patients are insured, so insured prices must be near market prices or providers would go bankrupt. But inflated chargemaster prices put financially vulnerable patients in impossible situations.

For financially vulnerable patients, chargemaster prices don't become viable after the typical 20% self-pay discount. Chargemaster prices are too high for anything close to be viable. Even a 50% discount off chargemaster prices, which is rare, is probably not enough. That is still around market price. Most financially vulnerable patients only meaningfully benefit from a below-market price. Otherwise they're likely to be sent to collections.

Basically, offering financially vulnerable patients anything but below-market prices could mislead them into financial ruin.

Resolving the dangers

Providers need a safe way to substantially discount prices for financially vulnerable patients. To avoid violating their insurance contracts, providers can only discount their prices to patients in a network. Because insurance networks are expensive, only a non-insurance network is viable.

Pocketero is a non-insurance network for financially vulnerable patients. It allows providers to offer their best price to financially vulnerable payments, without any risk of violating their insurance contracts. Please join our network now – it's free and easy.

Yes, most Americans pay entirely out of pocket for their healthcare in each given year. That might be surprising, considering that most Americans have health insurance. But most health insurance policies do not prevent you from paying out of pocket.

Before we get into explaining why most patients pay for healthcare out of pocket, let's look at what approaches patients use to pay for healthcare.

How do people pay for healthcare?

Americans pay for healthcare in one of 3 primary ways.  Here is how healthcare was paid for in 2021 (approximately):

• 80% through health insurance
• 10% through other payers like healthshares
• 10% directly

In other words, 90% of people paid through some sort of third-party payer, and only 10% paid directly.  However, that does not mean only 10% paid for healthcare out of pocket.  In fact, the majority paid out of pocket. That's because even patients with third-party payers are subject to deductibles.

Deductibles mean paying out of pocket

Most health insurance and healthshare policies have deductibles. A deductible is the annual amount the patient must pay out of pocket before insurance will start contributing. Most patients don't reach their deductible in a given year. That is largely because most patients have high deductibles, even extremely high deductibles, and deductibles are rising every year.

American Action Forum explains the individual insurance market:

But how many people actually use their insurance benefits? In the individual market, the answer is not most. Aside from a few preventative services, the majority of individuals will not incur medical expenses that exceed their annual deductible. ... In any given year, more than 80 percent of non-chronically ill individuals spend less than the average deductible for a Silver plan in the Health Insurance Marketplace.

The story is similar for the employer insurance market. Most employees have high-deductible health plans. ValuePenguin says: "52.9% of American private-sector workers were enrolled in HDHPs" (meaning high deductible health plans), and notes "HDHP enrollment is on the rise". According to Kaiser Family Foundation, the average annual deductible is $1,945 for an individual and $3,722 for a family on an employer plan. Again, most non-chronically ill patients spend less than the average deductible.

Conclusion

If you don't have health insurance or a healthshare, you will pay out of pocket for all your healthcare. You will pay the highest prices.

If you do have health insurance or a healthshare, you will pay out of pocket up to your deductible. Statistically, you probably won't spend enough on healthcare this year to reach your deductible. That means all of your spending will be out of your own pocket. You will pay mediocre prices at best, because insurers and healthshares aren't motivated to negotiate very hard, and some don't negotiate at all.

If you want to minimize how much you pay out of pocket, and have protection against the notoriously high prices in the United States, visit Pocketero. It is the only network for patients who pay out of pocket. You get the best prices when paying out of pocket for healthcare. It's so affordable that it generally pays for itself with only a single healthcare visit per year. Try it now!

No, private health insurance prices are not the best prices on medical care. In fact, private health insurance prices are generally normal market prices. If you want the best prices you must be part of a non-insurance network.

You may have heard that insurance companies negotiate big discounts on healthcare prices. That's true, but it's not as impressive as it sounds. In fact, insurance companies are simply negotiating down to normal market prices. That's because of the strange game they play with healthcare providers.

Around 90% of healthcare is paid by third-party payers, primarily health insurers. These third-party payers demand discounted prices, so they can advertise "we get you discounts".  Obviously healthcare providers can't discount 90% of their work, so they've found a way both sides can win.  Specifically, healthcare providers deliberately inflate their "chargemaster" prices by around double. This allows third-party payers to get "discounts" of around half. The result is that it looks like the third-party payer got a huge discount, when the healthcare provider is still getting paid what is effectively the market price.

In other words, third-party prices aren't really discounted. They're just normal prices – mediocre prices. So who gets the best prices?

There are two categories of patient who get the best prices:

• Patients with Medicare or Medicaid, because the federal government can throw enough weight around to get real discounts.
• Patients in a non-insurance network, because they are leveraging the full power of paying directly.

In fact, these two categories of patients usually get the same prices – the lowest that healthcare providers are willing to offer. Where most healthcare prices are exorbitant, these rock-bottom prices are far more reasonable and are probably the only prices that are affordable when paying out of pocket.

Which of these two categories could you be part of?  If you aren't in your old age, you aren't eligible for Medicare. If you aren't in poverty, you aren't eligible for Medicaid. That leaves you with only one option for getting the best prices, which is a non-insurance network.

Currently there is only one non-insurance network for patients who pay out of pocket, it's called Pocketero. It only costs $10/month, so very affordable. In fact, many people with health insurance also join Pocketero to get the best prices when they pay out of pocket before reaching their deductible.

How much better are rock-bottom prices than insurance prices? They're around half. Yes, you understood that correctly – the truly discounted prices are around half of the prices "negotiated" by health insurance companies.

• Kaiser Family Foundation says: "Private insurers paid nearly double Medicare rates for all hospital services."
• Rand Corporation says: "Large price discrepancies".

Basically, private health insurance prices are generally mediocre at best. If you want real discounts, you need Medicare, Medicaid, or membership in a non-insurance network like Pocketero.

Unfortunately it's true, most health insurance is effectively non-insurance. That's because most people can't afford their deductible.

Most people with health insurance have a high deductible plan. That means they are paying a relatively low premium in exchange for a relatively high deductible. Around half can't afford their deductible. That means they are effectively blocked from using their insurance for its primary purpose, covering their healthcare expenses.

Here's how Dr Eric Bricker of AHealthcareZ explains it:

People will use the term "under-insured," but arguably most health insurance, the way it's set up today, is essentially non-insurance.

I mean, specifically let's say you didn't have health insurance at all. So you basically would be trying to not drown in 100 feet of water. Okay, and someone comes along and says we're going to give you health insurance and instead of treading water in 100 feet of water, you only have to tread water in 17 feet of water. Well shoot, that might not be very helpful. Especially when 36% of people will drown in just 4 feet of water. So if 36% of people are going to drown in 4 feet of water, going from 100 feet of water to 17 feet of water doesn't help too much. ... You're still going to drown.

In this analogy, feet of water actually represents hundreds of dollars. Specifically, 17 feet of water represents a deductible of $1,700.  Statistics indicate 36% of people can't afford a deductible of $400, so a deductible of $1,700 makes insurance effectively useless.

The term "non-insurance" seems accurate here. If there is no chance your health insurance will cover any medical expenses, then it is basically a medical discount plan. And medical discount plans are not insurance.

If you are paying for insurance you can't actually use, consider joining Pocketero. You still pay out of pocket, but you get the best prices instead of mediocre insurance prices.

If a healthcare provider fails to file an insurance claim on your behalf, files it incorrectly, or fails to pursue a denial, who is on the hook?  It turns out you are, dear unsuspecting patient.

Patients worry that insurance claims aren't being filed properly

It's fairly common for patients to fear becoming responsible for huge medical bills because of mistakes made by others.  In particular, they worry their healthcare provider will screw up the insurance claim, or the insurer will refuse to pay it:

• Reddit user melonchollyrain asks, "Will I be on the hook for thousands since [my provider] didn't file [valid claims with my insurance]? What if they filed wrong?"
• Reddit user theophilus1988 asks, "I got a procedure done for an endoscopy almost a year ago today and I still haven't received a bill in the mail yet. ... Should I be concerned and what's going on?"
• Reddit user QuicaDeek says, "I’m being charged $8800 because my doctors never sent pre-certifications".

The answer is rather shocking.  As discovered by Reddit users like bobbyo23 and Spectrachic311311, providers can and will circle back years later to collect payment – even if they failed to collect it because of their own mistake.

Is it legal for a provider to bill you years later?

Yes, it's generally legal for a healthcare provider to send you a legitimate bill even if they do it years later.  They would argue they provided service and deserve to get paid.  They might even argue you should thank them for not charging interest!  Regardless, it's legal for them to send a legitimate bill in hopes that you will pay.  The question is whether the bill is legally enforceable.

Is a bill legally enforceable years later?

Bills are not legally enforceable forever.  How long a debt remains valid, especially if there is no attempt to collect it, is a legal question.  The answer varies between 3 years and 15 years, depending on the "statute of limitation" laws in your jurisdiction.

To learn about the statute of limitations in your state, visit the BetterCreditBlog post about medical debt and scroll down to "Statutes of Limitations for Each State".  Keep in mind that laws can change over time, so you might want to do your own Google search to confirm what you find.

For most people, their medical bills are still legally enforceable even if sent a year or two late. So don't ignore them, because most healthcare providers don't hesitate to send bills to collections agencies.  And as soon as a collections agency gets your bill, your credit score will take a hit.

You are responsible

Patients are responsible for making sure their healthcare providers get paid, not anyone else.

Yes, it might seem like a patient's health insurer should be responsible. And in specific, contractually-specified circumstances, they are.  But even in those circumstances they may not pay due to a mistake of their own, or a mistake of the healthcare provider's.  This is what seems unfair – when other people make mistakes with a process the patient isn't involved in, somehow the patient is responsible.  But that is the practical reality.

The fact that patients are ultimately responsible for mistakes made by others leads many patients to pay out of pocket, and avoid the risk.  If you're considering paying out of pocket for healthcare, you should look into Pocketero.  It empowers you with the best prices when paying out of pocket.

Many people have come to believe health insurance is a predatory scam.  While that might not be fair, it is totally fair to be frustrated because you aren't getting value for your money.

People pay for health insurance in exchange for two main benefits:

1. Covered healthcare expenses
2. Discounted prices

It turns out health insurance isn't very good at providing either of these benefits.  For most people, it won't cover their expenses.  And generally, it doesn't secure special prices.  It isn't a scam, because it's definitely useful in cases of catastrophic illness or injury.  But for most people, there is a much better option.

You usually have to pay out of pocket, even with insurance

Your health insurance won't help cover your healthcare expenses until you've reached your deductible.  But most insured people don't reach their deductible.  (In fact, most insured people can't afford their deductible.)  So most insured people pay out of pocket for all their healthcare.

Plus, there are many other circumstances where you will pay out of pocket even with health insurance:

• You want to use an out-of-network provider.
• You want a non-covered medication or service.
• You want a service more frequently than is covered (like a weekly mental health appointment).
• You exceeded your annual or all-time coverage limit.

When you are paying out of pocket, prices matter.  You want the lowest prices you can get.  Health insurers usually claim they have negotiated hugely discounted prices for your benefit.  But are these negotiated prices your best option?

Insurance prices are not good prices

Healthcare providers and insurers like to play a game.  Healthcare providers win by getting huge price increases, because they want to bring in more revenue.  Insurers win by getting huge discounts, because they want to make their product more valuable.  And year after year, both sides win.  So what's their trick?  It's actually very simple: healthcare providers deliberately inflate their "chargemaster" prices far beyond what is commonly paid.

Massively inflated list prices allow plenty of room for healthcare providers to raise prices and for insurers to "negotiate" huge discounts.  They both get to win.  The funny part is, the hugely discounted prices aren't very good prices.  They are usually what is commonly paid.

Insurers aren't actually special – they are the status quo.  Around 90% of healthcare is priced at payer-negotiated rates.  These payers tend to be similar, and tend to get approximately the same discounts off the inflated "chargemaster" prices.  So the vast majority of the market is paying these same "discounted" prices.  By definition, that means they aren't truly discounted prices – they are ordinary market prices.

This all assumes your health insurance plan is attached to a network of providers with discounted prices.  Unfortunately, "some plans don’t have networks at all".  Further, health insurance plans generally don't cover all services – and anything not covered has "usually not" been negotiated.  So there are circumstances where insured people aren't even entitled to ordinary market prices – they are exposed to the inflated prices.

There is only one way to consistently pay below-market prices, and that requires paying without the "help" of an insurer.

How to get below-market prices on healthcare

To get different results, you must take different action.  When 90% of healthcare is paid with the involvement of a third-party payer, the way to be different is to pay without one.  That might sound crazy because prices are so high.  But by paying out of pocket, you can negotiate real discounts – prices that are substantially lower than market rates.

Incredibly, paying out of pocket gives you more negotiating power than a big insurance company.  That's because paying out of pocket is much simpler than paying through insurance.  Healthcare providers hate the insurance hassles of codes, claims, denials, delays, etc.  They love getting paid directly and immediately.  In exchange, they are generally willing to offer their best price.  But there is a catch.  You can't just ask for their best price.

Most healthcare providers offer a standard discount for people who pay out of pocket, and it's not very good.  It's usually around 15% off chargemaster prices.  Insurers get around 50% off chargemaster prices, meaning they do much better in spite of being much more difficult to work with.  If you want to get truly competitive prices, you can't just walk in off the street.  You need to be part of a network that has already secured them for you.

Pocketero is a non-insurance network for patients who pay out of pocket for healthcare.  It ensures you get a provider's best price when paying out of pocket.  For everyone paying out of pocket for healthcare – and most people are – Pocketero is the best way to keep your money in your pocket.

Most people paying for healthcare are paying out of pocket.  Naturally, they want the best prices to minimize the cost.  While health insurers usually negotiate modest discounts, you can get much better prices by paying directly, without insurance being involved.  This is called paying "cash," although it might actually be by credit card, bank account, Venmo, etc.  Patients often ask: do these "cash" payments count toward your deductible?

Yes, usually payments you make directly to your provider can still apply toward your deductible.  It depends on your health insurance plan, so you should check with your insurer first.  But assuming your plan allows it, submitting invoices to your insurer is fairly simple.

How to efficiently submit invoices toward your deductible

How to handle every healthcare visit

Let's say your doctor charges $400 for a consultation.  Let's also say you have health insurance, but haven't reached your annual deductible yet.  Let's assume your insurer has negotiated a price of $200.  Let's also assume you're a Pocketero member, and you have invited this provider to join the Pocketero network and found their Pocketero price is only $100.  Obviously you would rather pay the Pocketero price.  However, you still want your payment to be applied to your deductible.  You shouldn't have to suffer because you got a better price than your insurer.  You should be able to submit your $100 invoice to your insurance company on your own, to be applied to your deductible.

The key is to get an "itemized" invoice from your healthcare provider that has a separate line for each service you received, which shows the price for that service.  (Pocketero network providers should always provide an itemized invoice, so you shouldn't need to ask.)  Also, if the invoice is not marked as "paid" or something similar, you should ask for a receipt showing the total you paid.  This documentation is what you will need to prove to your health insurer that this payment should be applied to your deductible.

After every healthcare visit, use the invoice to update your annual spreadsheet totaling how much you have paid for the year.  You can compare the total against your plan's deductible to know how close you are to reaching your deductible for the year.  Note that not every service is considered a "covered service" by your insurer – and only covered services count toward your deductible.  When in doubt about whether a service is covered, contact your insurer.

When to submit invoices

You typically need to submit your documentation to your insurer yourself.  That can be time-consuming.  Rather than invest that time every time, you can take a "middle ground" approach.  You can always gather the necessary documentation after each healthcare visit, but you can wait to submit it until you believe you're going to reach your deductible.  After all, your insurer doesn't care how much you have paid toward your deductible until you have reached it, and statistically you probably won't reach it.  Most likely, you won't need to submit anything to your insurer.  But you will be prepared if you do.

How to submit invoices

If you do decide to submit your documentation to your insurer, contact them to ask how they prefer to receive it.  They might want you to email or upload digital copies, or mail paper copies – it depends on the insurer.

Be sure your submission only contains invoices for "covered" services.  If your health insurance doesn't cover something, then they don't care how much you paid for it – it doesn't apply to your deductible.

Always include some sort of "cover letter" with your documentation.  It should include these elements:

1. Identify: This submission is in regard to Policy Number ___.
2. Explain: This submission contains documentation of health expenses paid by the policyholder directly to healthcare providers.  Although these expenses are for covered services, the policyholder chose to pay directly in exchange for a lower price.
3. Defuse: This is is not a request for reimbursement.
4. Request: Please apply these documented expenses toward this policy's deductible.
5. Invite: Please email me at ___.

How to handle further communication

You should prefer written communication (email or letters) for everything related to this submission.  You may choose to call your insurer if you don't hear back, but only to prompt them to take action.  Do not accept any statements from your insurer that are not in writing.  You provided documentation to them, they should do the same you.

If all goes as planned, your insurer should notify you the invoiced amounts have been applied to your deductible.  The most common problem is when the insurer rejects some of the amounts as being for "non-covered" services.  Those you will need to consider on a case-by-case basis based on your policy.  Another common problem is when the insurer rejects the entire submission as unacceptable.  Again, you will need to refer back to your policy to confirm that direct payments can be applied toward your deductible.  Critically, if your insurer does not refer to exact language from your policy, you should ask them to.  Again, you are referring to language from your policy, they should do the same for you.

Remember that a documentation-oriented approach is the only effective approach.  Your policy is your contract with your insurer, and your invoices are your proof of covered expenses.  Contracts and proof help things go smoothly, because it's hard to argue with them.  Do yourself a favor and base all your communication around these two things.

Additional reading about submitting invoices to count toward your deductible

• Sidecar Health on "Should I submit itemized medical bills, or “medical invoices,” even when I have an outstanding deductible amount?"
• StackExchange Money post on "Does paying a medical provider in cash count toward one's insurance deductible?"
• Kiplinger says: "Payments you make in cash may count toward your deductible".
• Cash Healthcare says: "The drawback to paying cash for medical services is that by not submitting your claims, medical bills won’t count toward your deductible." [Unless you submit your documentation.]
• Pinnacle III says: "If the patient opts to seek care under a self-pay arrangement, an insurance claim will not be filed.  This means the amount they remit under the self-pay arrangements is not credited to (applied against) their deductible. ... If the patient were to file a claim on their own, there is no guarantee it will apply towards their deductible."  [You should check your policy first.]
• ClearHealthCosts says: "Does this cash payment apply to my deductible? Probably not. You should check with your plan documents to be sure, but if by paying cash you are effectively declaring yourself uninsured, there’s no reason for it to apply to your deductible."  [This seems to be incorrect, and is included here to reflect there is some misinformation out there.]

Reddit user PearlLo writes:

Basically until you meet your [health insurance] deductible it's a medical discount plan.

Is that true?  Basically, yes.  Until you have paid out of pocket up to your annual deductible amount, health insurance is simply a way to get discounts from list prices – but not necessarily impressive discounts.  If you don't plan to reach your deductible for the year, there is a much better way to pay for healthcare.

What is a health insurance deductible?

Most health insurance policies have an annual deductible.  This is the amount you must pay out of pocket before your insurer starts helping with your medical bills.  For example, a common deductible is $5,000.  Let's say you got healthcare for a sinus infection in January, and a cut that needed stitches in July.  Let's say the total cost came to $2,700.  Your insurance wouldn't help with your medical bills, because you're still $2,300 short of reaching your annual deductible.

The deductible is an important part of an insurance policy.  Without a deductible, people could use their insurance policy to pay for everything, like a sort of credit card.  That would put insurers out of business.  So the deductible acts as a way of proving you really need help paying your bills.  This is what insurance exists for – the particularly difficult times.

Before reaching your deductible

Until you reach your deductible, you pay out of pocket for your healthcare.  However, sometimes you will pay prices that have been negotiated by your insurer, meaning they are better than the healthcare provider's list prices.  This is why it's fair to say health insurance is "just a medical discount plan" until you reach your deductible.

Interestingly, the prices negotiated by insurers are not necessarily the best prices.  While insurers do tend to receive big discounts from list prices, those list prices are deliberately inflated to allow for those big discounts.  In effect, the insurer prices are the normal market prices.  After all, insurers have little incentive to play hardball in negotiations – if they can't get a discount they simply raise their premiums.  You can get much better prices being a member of the Pocketero network, which has a best-price commitment.

After reaching your deductible

After reaching your deductible, your insurer will generally cover the majority of your medical bills.  You might still be liable for a small coinsurance (like 10%) or copay (like $25), but it is generally negligible in comparison to the amount covered.  This is the sweet spot with insurance – the part where you're getting clear value from the policy you pay for every month.

There is a twist.  The amount you have paid toward your deductible resets every year.  So the clock is ticking on your heavily subsidized healthcare.  Unsurprisingly, this dynamic leads many people into a healthcare frenzy after reaching their deductible, seeking healthcare they wouldn't otherwise.  This lasts until they are finished or the insurance year ends and the amount paid toward the deductible resets at zero.  That may seem dysfunctional, but it is a common dynamic of insurance and one reason insurers charge so much more than we might expect.

Is health insurance worth the cost?

Health insurance won't help before reaching the deductible, encourages a feeding frenzy after reaching the deductible, and offers negotiated prices aren't necessarily very good.  Why bother with it?  Because it has the power to protect you from financial catastrophe.  If you get very sick or injured (like cancer or car crash), health insurance can protect you from much of the financial harm.  That catastrophic protection is what insurance is good at.  It isn't particularly good at anything else.

If you don't expect to reach your deductible for the year, you will be paying out of pocket for your healthcare.  In that case, you don't want to rely on your health insurers negotiated prices.  You're better off using Pocketero to get the best prices on your healthcare when paying out of pocket.

Is it possible to get healthcare anonymously, without revealing your name, address, or social security number?  Yes, it is.  We'll show you how to arrange an appointment, pay for your care, and even get the best possible price.

What kind of patients want healthcare anonymously?

People might want to receive healthcare anonymously for various reasons, but generally they want privacy around sensitive health topics.  Common topics include:

• Sexually transmitted disease
• Pregnancy
• Mental health
• Domestic abuse

How to prepare

Before getting started, prepare yourself for some slightly awkward conversations.  Anonymous healthcare is legitimate, but rare.  Not everyone has encountered a patient who wants to remain anonymous.  You may need to repeat what you want.  Just remember, you're not doing anything wrong.  You want healthcare, and your provider wants to get paid for providing healthcare.  Both of those things are going to happen – just without you giving your identifying information.

To get started, you need to choose a healthcare provider to visit.  Maybe you must schedule an appointment in advance, or maybe you can walk in at your convenience.  Regardless, you should probably choose a healthcare provider who is not already familiar with you (possibly using reviews on Yelp, Google, etc. to guide your choice).  If you already have a good relationship with a particular healthcare provider, and feel strongly you would get the best care from that provider, you could contact them and ask them about doing something anonymously.  But even if they allow it, it's easier for someone who knows you to accidentally create a paper trail with your name.  Exercise your own judgment in choosing the best healthcare provider.

The next consideration is price.  Healthcare is notoriously expensive, so paying without the help of health insurance can seem daunting.  But don't worry.  Most healthcare providers offer something they call a "cash-pay discount" or "self-pay discount" that make it more affordable (especially for tests).  Feel free to call around and ask for the "cash-pay price" for the service you need.  For example, you might ask, "What's your cash-pay price for your comprehensive STD test?"  Obviously you need to know what you want, so do your homework before calling around.  For example, maybe you don't want a comprehensive test, only a test for HPV specifically.  Of course, it's possible you don't know what you want beforehand – maybe you're visiting a healthcare provider to find out.  That's okay, just ask for the price for an "office visit" – that's the price of getting in the door and speaking to a healthcare provider.

How to handle the visit

Once you've found the right healthcare provider, it's time to schedule an appointment or walk in to the clinic.  Many people wonder, "What should I say when they ask me my name?"  That's easy – give them a fake name.  Many people use common placeholder names like "John Doe" or "Jane Doe".  But don't pretend this placeholder is your real name, because that would be lying.  Remember, you're not doing anything wrong and you shouldn't lie.  Say something like, "I'd like to receive service anonymously, because I'm uncomfortable sharing my identity.  Please enter my name as John Doe."

Even after learning you want to remain anonymous, they might still ask identifying questions (when they shouldn't).  For example, they might ask for your address or social security number.  This is usually because they are inexperienced and still following their standard checklist in spite of the special circumstances.  For any identifying questions, answer with something like, "You won't need that information because I'd like to receive service anonymously and I will be paying cash."  Don't forget the part about paying cash, it's important.

They key to getting healthcare anonymously is paying cash – yes, the green paper kind.  Cash is truly anonymous, unlike the other payment options your healthcare provider might accept.  Don't pay by credit card, debit card, or bank account.  And certainly don't pay through your health insurance company.  All of these payments create a paper trail, one which may never be deleted.  Pay with cash to stay anonymous.

At the same time, paying with cash means your healthcare provider doesn't need any identifying information from you.  They don't need to bill you, or your insurance, because your transaction will be complete by the time you walk out the door.  If they are ever in doubt about working with you, remind them you will be paying cash during your visit.  Cash tends to cure all worries.

Special circumstances to be prepared for

In very rare circumstances, a healthcare provider will stubbornly insist they need identifying information from you even if you are paying cash.  For example, one dentist in Austin insists she needs identifying information from all patients "in case they die in a fire and need to be identified by dental records" (seriously).  This is probably an ethics violation, because a physician should not refuse a patient simply because the individual wants to remain anonymous for the sake of their physical safety and/or mental health.  But it's probably not worth arguing.  If you can't change someone's mind in one of these rare circumstances, just move on to the next-best candidate on your list.

During your visit, watch out for anything that might cost more money.  For example, after you asked for that HPV test, you might hear, "Great, now we'll send this off for a comprehensive STD test."  Stop them and tell them that's not what you expected. For any potential deviation from your plan, ask questions about how it will be valuable to you and, without a doubt, ask for the "cash-pay price".  Don't allow careless healthcare providers to lead you into financial difficulty.  They may not warn you about a higher pricetag, but they will try to hold you accountable for it.  It feels like a bait-and-switch, but it is just business as usual – they are thinking about providing you the best care, not minimizing your cost.  So let them focus on your care, while you focus on the cost.

On that note, it's a good idea to bring more cash than you think you need.  It's not uncommon for a healthcare provider to suggest something extra, with an excellent justification.  Do you really want to come all the way back for another visit after a trip to the ATM?  No, one anonymous visit is probably enough.  If you can, bring extra cash to protect yourself from the hassle of running short.

There's one other thing to remember: some offices will ask you to pay up front, before receiving service.  That's fairly normal for cash-pay patients, so don't let it worry you too much.  You're still entitled to top-quality service regardless of whether you pay at the beginning or the end.

You're ready to get healthcare anonymously

Now you're equipped to go out and get healthcare anonymously.  It might be an unusual approach, but sometimes the best solutions are.  You should do what is best for you and your health.  Be confident that you deserve healthcare you are willing to pay for, regardless of your name.

For many Americans, health insurance is a major recurring expense.  The price is often heavily influenced by whether they are married or not.  In some cases it is much cheaper for a couple to be married.  In other cases, it is much more expensive for a couple to be married.  These situations are causing some Americans to get married early, get married out of necessity, and even not get married at all – simply so they can afford health insurance.

Some regret getting married

Reddit user Stellarperallax writes:

Adding my wife to [my company provided health insurance] plan makes things go crazy. The company only puts an additional $100 towards the plan bringing the health insurance monthly premium I pay to $706.12 and dental at $57.81. That's just over 8 times the cost. Or, almost 11% of my monthly income...  If I had known this before we probably wouldn't have gotten married.

Some get married early

On the flip side, some people are getting married early purely for the sake of health insurance.  Reddit user Past_Temperature7995 writes:

So my real wedding is next year… but we got legally married yesterday so i can get my now husband some health insurance.

There are similar stories from BigDiggy, thxfortheinfo, and drylolly.  Reddit user pitofkwikzand even got married in virtual reality chat for insurance purposes.

Some get married when they don't want to

There are also stories of people getting married who otherwise wouldn't.  Reddit user MikGusta writes:

My best friend and I are not in a romantic relationship, and never will be as far as I’m concerned. We’ve been besties for 8 years now and I can’t fathom being anything more than friends. For the next few months I will still be on my dad’s Humana military / Tricare insurance. When I turn 21 I will lose it. I have chronic illnesses and I’m on a handful of medication that I can’t pay for without insurance. I also don’t have a job that provides health insurance ... My friend has a factory job with amazing health insurance and he offered to marry me so I can be on his insurance. I feel bad taking advantage of him like that but it seems like my best option right?

So desperate it's comical

The absurdity of these marriage arrangements has sparked some entertaining thought experiments.  PepperDoesStuff suggests: "Why don't all the people who are single and have health insurance marry all the people who are sick and really need health insurance?"  Another user goes further: "We should all go to a state where polygamy is legal and every American should get married to every other American so that we’re all covered in each other’s insurance from work".  While these might be ridiculous ideas, they underscore that people are desperate for change.

The way forward

Ultimately, health insurance is part of the problem with American healthcare, not the solution.  Health insurance tends to increase demand and also tends to make patients less price-sensitive, both of which tend to increase prices for everyone.  That's why things keep getting worse in spite of more insurance subsidies, broader coverage, and around 80% of healthcare paid through insurance.

If you worry about healthcare prices, consider joining Pocketero.  We are a non-insurance network for patients who pay out of pocket.  We are reshaping American healthcare by making it possible to get affordable healthcare without insurance.