Average family of four · then a knee
Nobody is sick yet. The job already took this. The deductible is still waiting on the other side of the door.
Kaiser Family Foundation 2025 averages. Not a $10k outlier. Then they need a knee, and the hospital has four prices for the same cut.
Family-of-four job plan, 2025 averages. Premiums are the subscription. The deductible is extra — you still owe it the day you use care.
Top right is the HDHP/HRA family deductible ($6,912— the ~$6,800). That is on top of the $6,850 you already pay in premiums. A true HSA-qualified family deductible averages $4,932. Deductible is not a premium. You pay both.
The median person on a job plan does not get $26,993 of care out. The plan paid about $1,369 for the middle privately insured adult (MEPS 2021). Four of those is still far below the family sticker. See invested premiums for job vs Medicaid vs Medicare, median vs mean, and the expensive 5% for why the tail is so large.
Four prices for the same cut. The hospital asks high. Insurance does not pay that. Cash is a fourth number — often below what insurance “negotiated.”
The hospital posts the chargemaster, then bills that same ask to the insurer. After the higher ask, the contracted total (you + plan together) is $29,737. Cash is Surgery Center of Oklahoma’s public menu. List and allowed are modeled typical US community hospital.
Plan pays the hospital about $18,260. You pay about $11,477. Premiums are not in this stack — they are added in the year totals below.
Deductible + 20% = you. You + plan = $29,737, which is the allowed amount — what actually gets paid for the replacement. The 20% is modeled. Deductible is the Kaiser Family Foundation average.
Without premiums is only this knee. With premiums is what got paid in all year: the family subscription plus this surgery.
$29,737 is the surgery. $26,993 is the year of premiums. Together $56,730 is what got paid in for coverage plus this knee. Your own checks are $18,327. Cash for the same knee is $17,679 with $0 premium.
Hospital list ~$41,632. They bill the insurer that list. After the ask, the contracted total (you + plan) is ~$29,737. On the average family deductible you pay ~$11,477 at the knee; the plan pays ~$18,260. Posted cash is $17,679.
Family deductible on a high-deductible plan averages $6,912 (HDHP/HRA, Kaiser Family Foundation 2025) — the ~$6,800. A true HSA-qualified family deductible averages $4,932. Deductible is on top of premiums, not instead of them.
PPO/HMO directory. Call the office. The PDF is often wrong.
You do not know. Transparency files exist. Humans cannot use them.
Pick PPO vs HDHP/HSA. You are buying a deductible and a network, not a price list.
Family of four, 2025 average $26,993: you $6,850, employer $20,143. That is before a single claim.
Average HDHP/HRA family deductible $6,912. The first dollars of a real claim are still you. The savings account is not the deductible.
Insurer portal → directory → call the surgeon’s office and the facility separately. Anesthesia is often a third TIN.
The chargemaster is the ask. The EOB is what insurance actually paid. Cash is a third number.
Premiums all year ($6,850), then ~$11,477 at the knee. Posted cash is $17,679 with $0 premium.
Eight stages, four payers. Job column is the average family deductible (~$6,900), not the $10k cliff. Medicare Part B year is $2,435.
| Stage | Cash | Medicaid | Medicare | Job (avg family) |
|---|---|---|---|---|
| How you got here | No plan. Or job that does not offer one. | Income / category eligibility. State decides. | Age 65+ or SSDI. Part A usually earned. | Employer offers ESI. You are 18–64. |
| Pay every month | $0 premium. You are the stop-loss. | $0 in most states. Taxes fund the plan. | Part B $202.90/mo (2026). Part A usually $0. | You $6,850/yr family. Employer $20,143. Kaiser Family Foundation 2025. |
| Deductible / HSA | No deductible. Full price at the door. | Usually $0–$4 copay. No $10k cliff. | Part A $1,736/benefit period. Part B $283 then 20%. | Average HDHP/HRA family deductible $6,912 — the ~$6,800. You still owe this when you use care. |
| Need a procedure | You shop or you walk into the emergency department. | You need a Medicaid-enrolled clinician. | Any provider who takes Medicare (Original). | PCP referral, prior auth, in-network or else. |
| Who is in network | Anyone who will take the card. | State directory. Many specialists will not. | Original: most hospitals. Medicare Advantage: a list. | Insurer directory. Often stale. Call the office anyway. |
| What will it cost | Only if you ask for the cash menu — not the chargemaster. | You usually do not need a price. $0 at the door. | You find out on the MSN/EOB. Lookup tools exist, unused. | Estimate tools lie. MRFs are unusable. EOB is the price. |
| At the door (knee) | $17,679 posted cash at Surgery Center of Oklahoma — or ~$44,652 rack. | Plan allowed ~$12,135. You: ~$0. | Allowed ~$15,558. You: Part A $1,736 if inpatient. | Hospital list ~$41,632. Insurer allowed ~$29,737. You pay ~$11,477 (avg family deductible + 20%). |
| The bill after | Receipt. Done — if it was a real cash quote. | Rare patient bill. Fight is access, not the EOB. | MSN. Then Medigap or Advantage theater. | EOB weeks later. Balance-bill risk if anyone was OON. |
Premiums, deductibles, cash menu sourced Chargemaster, billed, allowed, 20% coinsurance modeled See evidence. Shop the knee on Surgery / Knee.