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Is health insurance worth it? Here’s the math.



Health care costs drives premiums. Here’s what you’d pay without insurance.

Health insurance is expensive, and we’ve all asked ourselves, “Is it really worth what I am paying?” This can be a nagging question for the young, or those who are in generally good health, and may not feel they need much more than an annual check-up and flu shot.

But the simple answer to the question is “yes”—unless you are financially able to pay health care bills of tens or hundreds of thousands of dollars should your health take an unexpected turn for the worse. Even a quick, unplanned visit to an urgent care facility can quickly add up to more than $1,000.

Can you afford to pay $73,000?

Millions of perfectly healthy people spend more time worrying about the health of their household budgets than budgeting for their health. But medical issues happen. No one expects to have an accident or to get diagnosed with a serious illness. If the conditions are serious, serious medical bills can arise, and some could easily wipe out an individual’s or family’s savings.

Consider the case of John, the typical New Jersey man who thinks he’s fighting a cold or flu, but realizes it's more serious when his usual home treatments don’t work and he wakes up in the middle of the night with a 102-degree fever and trouble breathing. He visits his local Emergency Room and is diagnosed with pneumonia.

When John is billed for that ER visit, he could expect to see a charge for $1900that’s the average for an ER visit at a New Jersey hospital.  That doesn’t include what the ER doctor will charge John for any tests, like an X-ray or bloodwork that will be performed.

If John is admitted to the hospital, his costs increase considerably. Time spent in the hospital varies based on the patient, but the average in-patient hospital stay in New Jersey racks up $75,380 in charges.

Insurance  The Right Medicine

A trip to the pharmacy can serve as a welcome reminder of how important prescription drug coverage is to Horizon® members. Prescription drug costs are the fastest-rising health expense and are growing at a faster pace than wages and inflation.

Prescription medications vary dramatically in price, depending on whether they’re offered by a specific pharmaceutical company (“brand name”), are a “generic” version (same active ingredients of a brand name drug) or are a “specialty” drug for which few treatment options are available.

When you look at the ten brand-name medications most frequently used by Horizon members, the average cost is $703 per prescription. If your condition requires—and your doctor recommends—that you go on a specialty drug, those charges add up quickly. The ten most frequently utilized specialty drugs among Horizon members range from $201 per prescription to $22,481—with the average cost per prescription being $6,613.

Without health insurance, those charges are 100% yours.

Value Defined: Peace of Mind, Health and Wellness

An insurance card in your wallet means you are protected from the possibly catastrophic financial costs of being sick. But just as important is knowing what the coverage can do to help you stay well. Health plans start with “essential benefits” (which come with every Affordable Care Act –“Obamacare” – policy), and they include ten elements:

  • Ambulatory patient services (care that doesn’t require an overnight stay)
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment such as counseling
  • Prescription drugs
  • Rehabilitative services and devices that help patients acquire, maintain, or improve skills necessary for daily functioning
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

For a full view of what your Horizon coverage offers you and your family, log into Member Online Services or the Horizon Blue App.

 All data concerning charges are based on claims submitted in 2022  to Horizon.

All pharmacy data based on 2022 Fully Insured Horizon claims, blended retail and mail order.