The Moment Most People Never Have
At some point, you probably sat down to figure out why your paycheck felt smaller than it should. You added up the rent, the groceries, the car payment, and then there was that line item.
The one that kept going up every year. Health insurance.
Maybe you shrugged and left it alone because that's just how it works. Everyone pays it. You're supposed to.
Here is what most of us were never taught to do:
Add up the whole number. Not just the premium. The premium, the deductible, the co-pays, and the bills insurance declined.
The actual number is what you really spent last year to have and use your insurance.
For many Americans, that number is between $5,000 and $15,000. And that is before a single major health event.
This issue is for the person who has started to suspect the math doesn't add up, and wants to see it laid out plainly.
What Insurance Is Actually Costing You
Let's start with the number you know: your premium.
In 2025, the average annual premium for single coverage was $9,325.
For a family, $26,939.
As an employee, your share of that was approximately $1,440 per year for single coverage and $6,850 for a family, taken directly from your paycheck before you ever see a doctor.
Then comes the deductible.
The average employer plan deductible for a single adult in 2025 was $1,886.
If you purchased coverage through the ACA Marketplace, the 2026 bronze plan deductible was $7,476.
That is the amount you pay entirely out of pocket before insurance covers anything at all.
In other words:
You are a cash-paying customer until you hit that number.
Most people never do.
Add your premium, your deductible, your co-pays for office visits, and any bills insurance declined. That is your real healthcare spend for the year. Most Americans who run this exercise find they paid thousands for care they barely used, or paid for and still didn't get the answers they needed.
That's the starting point for this conversation.
What Cash-Based Healthcare Costs by Specialty
The following numbers come from the 2024–2025 industry reporting. These are real averages, not best-case scenarios, not outliers.
Direct Primary Care (DPC) DPC practices operate on a monthly membership model with no co-pays, no insurance billing, and no per-visit charges. Appointments run 30–60 minutes. Same-day or next-day access is standard.
Individual adult: $50–$150/month (most common: around $100)
Children: $20–$75/month
Family of four: $250–$400/month
What's included: unlimited visits (in-person or virtual), preventive care and physicals, chronic disease management, and wholesale lab pricing.
Cash-Based Physical Therapy
With insurance, if you haven't met your deductible, you pay the full insurance-negotiated rate: typically $150–$180 per session. A standard course of 6–12 sessions can run $1,000–$2,000 before insurance contributes anything.
Cash-based physical therapy averages $75–$165 per session. The highest end of the cash price is still below the average insurance-negotiated rate. Sessions run 45–60 minutes. No prior authorization required. No session caps.
Cash-Based Mental Health Therapy
In-network therapists are often full or not accepting new patients. Many people search and simply give up, not because care doesn't exist, but because searching within insurance networks leads to dead ends.
Cash-based mental health therapy removes the in-network requirement entirely. You choose your provider. You know the price before you schedule. Many therapists offer sliding-scale fees based on income.
Licensed counselors: $90–$160/session
Psychologists: $150–$250/session
Telehealth platforms: $65–$95/week
Cash-Based Chiropractic
Cash-only chiropractic averages $57/session versus $70/session at insurance-billing practices. Lower overhead, no-insurance middleman, and package pricing options that further bring the per-visit cost down.
Functional Medicine
Functional medicine operates almost entirely outside insurance, and for a reason: it is built around extended consultations and root-cause lab testing. Neither is reimbursable under most insurance models, which are structured around symptoms, prescriptions, and defined treatment protocols.
Initial consultation (60–120 minutes): $200–$500
Follow-ups (45–60 minutes): $150–$300
Labs often available at direct-pay rates, below hospital pricing
The comparison worth sitting with: if you pay a $50 co-pay and see your doctor ten times ($500 total) without resolving the underlying issue, you've spent what a single functional medicine consultation costs, and you still don't have an answer. For people who have been managing symptoms for years, that reframe tends to land hard.
In Reality
Here is one scenario:
A relatively healthy single adult runs straight through both systems.
Insurance (ACA Bronze, 2025):
Annual premium: $4,560
Deductible before coverage activates: $7,476
Two sick visits, pre-deductible: $300
Total before insurance contributed anything: nearly $12,000
Cash-based healthcare equivalent:
Direct primary care membership: $1,200/year
Catastrophic emergency plan: $1,200–$1,800/year
Total: $2,400–$3,000
Estimated savings: up to $8,900, for the same year of care, with longer appointments and same-day access.
Find a Practitioner
If any of the specialties covered in this issue are relevant to your health goals:
Primary care
Physical Therapy
Mental Health
Functional Medicine
Cash-based and hybrid practitioners across the United States are listed in the Centered Care Directory.
Every practitioner in the directory has been reviewed and approved. These are not random listings. This is a curated directory of providers who prioritize your outcomes.
One Thing to Do This Month
Pull out last year's healthcare spending. Add up:
Your annual premium (your portion, not your employer's).
Your deductible, how much did you actually pay before coverage kicked in?
Your co-pays for office visits.
Any bills that insurance declined or only partially covered.
That total is your real number. Then ask:
What did I get for it?
Once you have that number, search the directory for one specialty that's relevant to your health right now. See what cash-based healthcare options exist near you.
Start here → Search the Directory
You walked into that appointment hoping someone would actually help you figure it out. That feeling was telling you something. There are practitioners who practice exactly that way, and now you know what to call it.
More next time.
— Suzy
Health Over Wealth in the US is published monthly on Beehiiv. This newsletter is for educational purposes only and does not constitute medical or financial advice. Always consult a qualified healthcare professional for your individual situation.
To search for a cash-based or hybrid practitioner by location and specialty, visit the Centered Care Directory.
For more examples, watch “What Americans Are Really Paying for Health Insurance vs. Cash-Based Healthcare.”
Sources
All figures referenced in this issue are drawn from the following sources. Links are included for your own research.
KFF Employer Health Benefits Survey — Premiums and Deductibles: Updated to the 2025 Annual Survey Full Report which details that family premiums reached $26,993 and average single deductibles are $1,886.
Health Affairs 2025 Data: Updated to the National Health Expenditure Projections, 2024: https://www.healthaffairs.org/doi/10.1377/hlthaff.2025.00545
2026 ACA Deductible and OOPM Data: Updated to the Official HealthCare.gov Glossary and CMS Fact Sheet, confirming the 2026 out-of-pocket limit is $10,600 for individuals and $21,200 for families.
AAFP Direct Primary Care (DPC) Pricing: Updated to the AAFP Family Practice Management (FPM) Journal and DPC Policy Paper, which cite monthly adult fees typically ranging from $50 to $75.
Therapy Costs by State: Updated to the Octave 2025 Therapy Cost Guide, which provides estimated ranges of $100 to $250 per session across different US regions.
Physical Therapy Cost Comparison: Updated to the Sword Health 2025 Cost Analysis, which compares typical $30 copays against $125+ cash-pay rates.
Chiropractic Pricing: Updated to the Veeva Clinics Chiropractic Cost Guide, documenting national out-of-pocket averages between $75 and $100 per visit.
DPC Lab Savings: Updated to Mosaic Med's DPC Savings Overview, illustrating how direct-contracting models can reduce lab costs by up to 90% compared to insurance-billed rates.
