By NextBestFitOut-of-pocket spending
Only non-covered items remain: over-the-counter products, cosmetic dental, premium eyewear and hearing aids, nursing-home room and board, non-formulary drugs.
Result
$197.3B
$556.6B → $197.3B
Per resident, per year
$578
÷ 341.1M people
Per household
$1,493
÷ 132.2M households
How it's calculated
| # | Step | Arithmetic | Value |
|---|---|---|---|
| 1 | 2024 amount (CMS NHE Tables 5-1 to 5-4) Sources: CMS Office of the Actuary (2025) | $556.6B | |
| 2 | Stays out of pocket: Other professional services (25% of $44.8B) | $11.2B | |
| 3 | Stays out of pocket: Dental services (20% of $72.5B) | $14.5B | |
| 4 | Stays out of pocket: Other health, residential & personal care (30% of $11.2B) | $3.4B | |
| 5 | Stays out of pocket: Home health care (20% of $30.4B) | $6.1B | |
| 6 | Stays out of pocket: Nursing facilities & continuing-care communities (45% of $48.7B) | $21.9B | |
| 7 | Stays out of pocket: Retail prescription drugs (5% of $55.0B) | $2.8B | |
| 8 | Stays out of pocket: Durable medical equipment (40% of $35.8B) | $14.3B | |
| 9 | Stays out of pocket: Other non-durable medical products (100% of $123.2B) | $123.2B | |
| 10 | Out-of-pocket under the plan | $197.3B | |
| 11 | Out-of-pocket eliminated | −$359.3B |
Trade-off: Continues as before.
Sources: CMS Office of the Actuary (2025)