Gana Mukhtar: Insured, Employed, and Still Guessing at the Bill

For Gana Mukhtar, a 23-year-old from New Jersey, getting health insurance through her first full-time job was supposed to provide security. Instead, it introduced her to a challenge she had never experienced before: trying to understand and afford health care costs.

Growing up, Gana was covered by Medicaid through her family and never received a medical bill of her own. “Everything was free,” she said. “I didn’t even know at that point how expensive health care was.”

Everything changed when she graduated from college and entered the workforce. Because her income made her ineligible for Medicaid, Gana transitioned to health insurance through her employer for the first time.

At first, she felt fortunate to have coverage through her job. Her employer covered most of the premium, leaving her responsible for about $30 per month. She selected a PPO plan and contributed to a health savings account to prepare for future expenses.

But having health insurance did not mean affordable care. Although Gana had coverage and planned ahead for medical expenses, she quickly learned that the amount she would owe was often unclear until the bill arrived.

Gana’s first medical bill came after a routine annual checkup, a visit she scheduled because she wanted to prioritize preventive care. Despite having insurance, the visit resulted in an unexpected bill of about $600. “I was in front of the doctor for 5 to 10 minutes,” Gana said. “I was truly surprised.” For Gana, the challenge was not expecting health care to be free, but not knowing ahead of time what a visit would cost.

After receiving the bill, Gana contacted the billing office to ask questions about the charge and was able to reduce the amount she owed to $400. The experience showed her that managing health care costs often requires patients to advocate for themselves and ask questions they may not know they are supposed to ask.

As Gana needed additional medical care, she saw how difficult it could be to predict those costs. She began experiencing breathing issues in college and though she has not received an official diagnosis, she needs care when her symptoms worsen, including breathing treatments or a nebulizer.

One visit to a specialist resulted in an initial bill of about $1,000. Although insurance covered a portion of the cost, Gana was still responsible for hundreds of dollars out of pocket. After contacting the billing office and negotiating the charge, she reduced the amount she owed to $684 by agreeing to pay immediately.

The uncertainty around medical costs has also influenced the care Gana chooses to pursue. After a provider noticed a spot on her chest during an annual checkup and recommended a follow-up chest X-ray, Gana has not yet completed the additional imaging because the initial X-ray cost her several hundred dollars.

For Gana, the challenge is not only the amount of individual bills but also the uncertainty of what care will cost ahead of time. “Medical bills are the only expense in your life that you can’t really plan for,” she said. “I’m a big planner, and the fact that I don’t know how much a doctor visit is going to be until after the fact is very bothersome to me.”

That uncertainty has affected how Gana manages her finances. Although she has savings and funds available in her health savings account, she chooses to preserve those resources for long-term financial goals. Instead, unexpected health care costs often mean adjusting her monthly budget. “If I have a random medical bill, I limit how much money I plan on putting in my savings account that month,” she said.

Despite her concerns about health care costs, Gana has prioritized paying her bills and avoiding debt. “There are a lot of people that will say just go to collections, it’s not that big of a deal, but I’m really big on no debt,” she said. “So, I paid it.”

After experiencing the challenges of navigating health care costs with insurance, Gana faced another major transition: losing her employer-sponsored coverage. She recently left her job to pursue opportunities in film and content creation, which meant she would no longer have access to her employer’s health plan. She was offered COBRA continuation coverage but was surprised by the cost. “I was really shocked,” she said. “This whole time, I thought that your employer only paid the other half of your premium, so I thought I would pay $60 per month, which I definitely would have done to have medical insurance. But finding out that they pay over $700 a month for health insurance really surprised me.”

For now, Gana has decided not to enroll in COBRA because of the cost and plans to explore other coverage options if needed. Her biggest concern is what could happen in an emergency. “My mind automatically goes to drastic things, like if I got into an accident or anything like that,” she said. “I can’t even imagine how much money I’d have to end up paying.”

Her experiences have made her think about how difficult health care costs can be for people who need frequent care or experience major health events. “I always ask myself, ‘How are people giving birth in this country? How are people who have to routinely go to the doctor and deal with all this stuff affording it?’ It’s really expensive,” Gana said.

Gana recognizes that she is fortunate to be young and generally healthy, but she also understands that health can change unexpectedly. As she begins building her career and financial independence, she worries about how an unexpected health event could affect her future. Looking ahead, Gana hopes her next job will include health benefits.

Gana’s experience reflects a broader challenge facing millions of people across the country: health insurance does not always translate into affordable health care. Even people who have coverage and some financial resources can find themselves uncertain about costs, delaying care, or changing how they manage their finances because of medical expenses. “You can still have health insurance and have very unaffordable health care,” Gana said. “Without Medicaid and Medicare, I have never come across affordable health care in the U.S.”