Modern medicine allows patients to receive comprehensive, life-saving treatments every day. However, advancements in healthcare come with a cost. Without health insurance, a serious medical procedure in a hospital can cost more than the average U.S. annual household income, which was $74,580 in 2022.
The Financial Burden of Hospital Procedures
The high cost of medical procedures can be overwhelming, especially for those without health insurance. According to a KFF report, 61% of uninsured Americans went without much-needed medical care in the past 12 months due to the cost.
Top 20 Most Expensive Hospital Procedures
Understanding the financial impact of hospital procedures is crucial. Here are the top 20 most expensive hospital procedures in the U.S., along with their average costs without health insurance:
- Exploratory Chest Surgery
- This expensive procedure is a pre-diagnostic surgery that physicians perform to better diagnose or treat an illness.
- Average Cost: $137,533
- Aortic Valve Replacement
- This open heart surgery treats problems with the heart’s aortic valve, which controls blood flow from the heart to the rest of the body.
- Average Cost: $135,984
- Partial Removal of the Esophagus
- Physicians may need to remove part of the esophagus to reach large tumors.
- Average Cost: $113,756
- Decompressive Craniotomy
- This major surgery relieves pressure in the skull while maintaining a bone flap so brain tissue isn’t completely exposed.
- Average Cost: $112,984
- Tracheostomy
- A tracheostomy involves creating an opening in the front of the neck so physicians can insert a breathing tube into the windpipe.
- Average Cost: $102,399
- Liver Transplant
- People need a liver transplant when their liver fails because of a disease or injury.
- Average Cost: $101,240
- Aortic Graft
- A graft is a synthetic tube inserted during surgery that repairs or replaces a diseased section of the aorta.
- Average Cost: $92,939
- Transcatheter Aortic Valve Replacement (TAVR)
- This surgery places a fully collapsible replacement valve in the heart with a catheter.
- Average Cost: $85,279
- Tricuspid Valve Replacement
- This procedure replaces the tricuspid value, one of the two main valves on the right side of the heart.
- Average Cost: $82,631
- Tricuspid Valve Repair
- This procedure repairs the tricuspid valve.
- Average Cost: $82,431
- Video EEG Monitoring
- Helps doctors properly diagnose epilepsy from other illnesses by monitoring brain waves with electrodes while video captures the patient’s movements and behavior.
- Average Cost: $77,664
- Carotid Artery Stent
- To treat blocked carotid arteries, physicians insert a mesh metal tube, or stent, into the artery so blood can safely flow to the brain.
- Average Cost: $77,529
- Coronary Artery Bypass Graft
- This surgery improves circulation by rerouting blood around a blocked or narrowed coronary artery.
- Average Cost: $77,177
- Lumbar Spine Surgery
- This invasive procedure is a surgery on the lower section of the spine.
- Average Cost: $75,361
- Mitral Valve Repair
- This surgery repairs the mitral valve, a valve on the left side of the heart.
- Average Cost: $74,144
- Laminectomy
- During a laminectomy, physicians remove the rear section of bone from one or more vertebrae.
- Average Cost: $73,363
- Mitral Valve Replacement
- This procedure replaces the mitral valve.
- Average Cost: $73,154
- Breast Reconstruction Surgery
- Recreates the breasts after mastectomy or lumpectomy, involving several expensive surgeries.
- Average Cost: $73,100
- Small Intestine Repair
- This complex procedure repairs the damaged or diseased portion of the small intestine.
- Average Cost: $72,757
- Vascular Bypass Graft
- Similar to a coronary artery graft, it redirects blood around damaged or narrow arteries using healthy blood vessels.
- Average Cost: $70,846
Understanding Healthcare Costs
Healthcare costs are influenced by various factors, including medical equipment, personnel, facility fees, and post-operative care. Chris McDermott, a certified advanced practice registered nurse, emphasizes the complexity of these costs.
How Health Insurance Can Help
Securing health insurance is your first step toward reducing your medical bills. Health insurance helps you pay for services and items that your plan covers, like doctor visits, hospital procedures, preventative care, prescription drugs, and annual screenings.
Employer-Sponsored Health Insurance
Employers typically offer group health insurance, which can be a cost-effective way to secure coverage. Federal health insurance programs like Medicare or Medicaid are also available for those who meet specific age or income requirements.
Individual Health Insurance Options
If employer-sponsored insurance isn’t available, you can enroll in individual health plans on public exchanges, like the federal Health Insurance Marketplace or state-based marketplaces. Private exchanges through brokers or directly from insurance companies offer more personalized experiences.
Enrollment Periods and Special Circumstances
You can enroll in a health plan during the annual open enrollment period or after a qualifying life event, triggering a special enrollment period. Health exchanges often provide customer service teams to help you compare and enroll in policies.
Advantages of Health Insurance
Health insurance provides coverage for emergencies and routine care, helping you manage medical expenses. In case of a surprise medical bill, health insurers can negotiate bills and potentially reduce costs.
Introduction to Health Reimbursement Arrangements (HRAs)
HRAs are customizable benefits that employers offer to help employees manage their medical costs. Unlike Health Savings Accounts (HSAs), HRAs are funded solely by employers.
Qualified Small Employer HRA (QSEHRA)
QSEHRA is ideal for small employers with fewer than 50 full-time equivalent employees. It reimburses employees for individual health plan premiums and qualified out-of-pocket medical expenses, with contribution limits set by the IRS.
Individual Coverage HRA (ICHRA)
ICHRA works for businesses of all sizes and has no maximum contribution limits. It allows employers to offer different allowance amounts to different employee classes and reimburses individual health plan premiums and qualified medical expenses.
Group Coverage HRA (GCHRA)
GCHRA, or integrated HRA, supplements traditional group health insurance by reimbursing out-of-pocket medical expenses that the group policy doesn’t fully cover. It requires enrollment in the employer’s group health coverage.
Using HRAs to Cover Medical Expenses
HRAs help reduce out-of-pocket costs for hospital procedures. By reimbursing deductibles and copays, HRAs provide financial relief and allow employees to make informed healthcare decisions.
Top 20 most expensive hospital proceduresConclusion
Medical procedures in the U.S. can be expensive, especially if you have a chronic disease or need multiple surgeries. It’s essential to research your options and potential hospital costs to make the best financial decisions for your family. Leveraging HRAs can significantly reduce the financial burden of out-of-pocket medical expenses.
FAQs
- What is the most expensive hospital procedure?
- Exploratory chest surgery, costing an average of $137,533.
- How can HRAs help with medical costs?
- HRAs reimburse employees for qualified out-of-pocket medical expenses, reducing financial burdens.
- What are the differences between QSEHRA, ICHRA, and GCHRA?
- QSEHRA is for small employers, ICHRA is for businesses of all sizes, and GCHRA supplements group health insurance.
- How do I know if my health insurance is affordable?
- Affordability is determined by comparing the cost of your premiums to your income and the federal guidelines.
- Can I use both an HRA and premium tax credits?
- You must choose between the HRA and premium tax credits based on the affordability of the HRA.