May 2009
The real cost of illness can be staggering…
Few Americans realize how much care costs. Coverage gaps can leave you in debt.
| Condition | Treatment | Total Cost |
|---|---|---|
| Late-stage colon cancer | 124 weeks of treatment, including two surgeries, three types of chemotherapy, imaging, prescription drugs, hospice care. | $285,946 |
| Heart attack | 56 weeks of treatment, including ambulance, ER workup, angioplasty with stent, bypass surgery, cardiac rehabilitation, counseling for depression, prescription drugs. | $110,405 |
| Breast cancer | 87 weeks of treatment, including lumpectomy, drugs, lab and imaging tests, chemotherapy and radiation therapy, mental-health counseling, and prosthesis. | $104,535 |
| Type 2 diabetes | One year of maintenance care, including insulin and other prescription drugs, glucose test strips, syringes and other supplies, quarterly physician visits and lab, annual eye exam. | $5,949 |
…and out-of-pocket expenses can vary widely
| Massachusetts plan | California plan | |
|---|---|---|
| With its lower premium and deductible, the California plan at right would seem the better deal. But because California, unlike Massachusetts, allows the sale of plans with large coverage gaps, a patient there will pay far more than a Massachusetts patient for the same breast cancer treatments, as the breakdown below shows. | Monthly premium for any 55-year-old: $399 Annual deductible: $2,200 Co-pays: $25 office visit, $250 outpatient surgery after deductible, $10 for generic drugs, $25 for nonpreferred generic and brand name, $45 for nonpreferred brand name Co-insurance: 20% for some services Out-of-pocket maximum: $5,000, includes deductible, co-insurance, and all co-payments Exclusions and limits: Cap of 24 mental-health visits,$3,000 cap on equipment Lifetime benefits: Unlimited |
Monthly premium for a healthy 55-year-old: $246 Annual deductible: $1,000 Co-pays: $25 preventive care office visits Co-insurance: 20% for most covered services Out-of-pocket maximum: $2,500, includes hospital and surgical co-insurance only Exclusions and limits: Prescription drugs, most mental-health care, and wigs for chemotherapy patients not covered. Outpatient care not covered until out-of-pocket maximum satisfied from hospital/surgical co-insurance Lifetime benefits: $5 million |
| Service and total cost | Patient pays | Patient pays |
| Hospital | $0 | $705 |
| Surgery | 981 | 1,136 |
| Office visits and procedures | 1,833 | 2,010 |
| Prescription drugs | 1,108 | 5,985 |
| Laboratory and imaging tests | 808 | 3,772 |
| Chemotherapy and radiation therapy | 1,987 | 21,113 |
| Mental-health care | 950 | 2,700 |
| Prosthesis | 0 | 350 |
| TOTAL $104,535 | $7,668 | $37,767 |
