Usually for hospital visits, your plan either has an annual deductible that must be met (e.g. $5,000) before insurance contributes, or on a better plan you have a co-pay where insurance will cover 60% while you cover 40% up to a different annual deductible (“Maximum out of pocket”).

The shitty thing is the insurance companies make deals with the providers along the lines of “We’ll pay $X or 20% of the sticker price for Y procedure, whichever is lower”, so the hospitals increase their price to 5 times the insurance rate to maximize their income. The do this so it’s financially ruinous not to have insurance.

So the patient on the good plans get charged double the insurance company’s rate (that the insurance companies only pay after you’ve reached maximum out of pocket), while the insurance company doesn’t actually pay anything on their “60%” co-pay.

And you and your employer end up paying the insurance company like $1200/month combined for this service.

And if you get really sick, you lose your job and therefore your insurance.

It’s a truly fucked system.