Navigating our Current Healthcare Environment

I have been reading lately about the state of the US healthcare system and have come across some sobering statistics. Articles with titles like, "Accelerating Spending, Worsening Outcomes” do not build a lot of confidence in the “system.” I am writing this blog to shed some light on the state of healthcare and what Mountain Performance PT is doing in Twin Falls, Idaho to be part of the solution to this colossal problem.

Let’s start by defining some insurance jargon. (this is general information that can be found online, specific questions should go through an insurance agent)

• Insurance Premium: what a person pays per month for their insurance plan.
• Deductible: The amount the person is responsible for before insurance will start covering healthcare costs.
• Copay: some plans will require a person to pay a fixed amount for a covered service typically after the deductible is reached.
• Coinsurance: some plans require a person to pay a percentage of the cost of covered services after the deductible is reached.
• Out-of-Pocket Maximum: The total amount a person should expect to pay for covered healthcare expenses in a year.

The Kaiser Family Foundation (KFF) reported that,”The average annual health insurance premiums in 2024 are $8,951 for single coverage and $25,572 for family coverage.” That is a 52% increase in 10 years! 

eHealth reported that the overall average for deductibles for families in 2024 was $10,310 and deductibles for bronze plans through the insurance marketplace were $7,481 on average.

From healthinsurance.org: In “2025 the upper limits (for out of pocket maximums) are $9,200 for an individual, and $18,400 for multiple family members on the same plan.” The out of pocket maximums are expected to reach as high as $20,300 for families in 2026!

Let’s summarize those numbers in a different way. Say a person is looking for insurance for his family and finds an average plan where he pays $25,572/year* or $2131/month for his monthly premium. He would then be responsible to cover (on average) $7,481 before insurance would start to cover costs and up to $18,400 for any bigger medical costs like the birth of a baby or a surgery. The total cost burden for this family would be $43,972 for that year. They would still pay $25,572 for that year even if they didn’t see a healthcare provider a single time! As reported on healthinsurance.org and the KFF website these costs have been rising since 2014 and are expected to continue to increase. 

*Typically higher premiums will have lower deductibles and vice versa. We are looking at averages and trends as a whole.

Here is a personal example of insurance costs. My daughter was born in 2022 with a midwife which was not covered by insurance. We paid roughly $5500 in cash for the total birth experience which included hour-long visits with the midwife and in-home care following the birth. Contrast that with my daughter born in 2023 at the hospital where insurance “covered the birth” but we paid over $10,000 for an uncomplicated birth and 5-10 minute appointments with the OB-GYN. 

I am not suggesting that hospital or emergent care is not important, but the healthcare costs and poor care is a staggering reality of 2025.

The Common Wealth Fund has reported that, “...people in the United States experience the worst health outcomes overall of any high-income nation. Americans are more likely to die younger, and from avoidable causes, than residents of peer countries.” In physical therapy I have worked in high volume clinics where I might have seen 3 patients an hour which limited the time I could spend with my patients. Often these patients spent more time with the support staff than the therapist. Contrast this with other healthcare providers who may only spend 5-10 minutes with their patients and it’s no surprise why outcomes aren’t better. There are many factors contributing to patient outcomes, but one factor we are choosing to control at Mountain Performance PT is to spend 60 minutes with our patients and clients. This helps us make necessary changes immediately and adjust plans in the moment. Our patients enjoy a truly individualized experience almost unheard of in healthcare today.

We recognize the cost burden of healthcare on our patients and see where costs are trending. Our answer is to strive to provide the best care possible and set sensible rates where there are no added fees or questions about what is covered or not covered. Our patients may realize a perceived higher cost initially, but will save time and money in the long run. We take patient care seriously and commit to be part of the solution in Twin Falls, Idaho providing a sensible alternative option for physical therapy. Contact us today for clarification on specific questions you may have.