Women Pay Billions More in Out-of-Pocket Health Costs a Year


Oct. 3, 2023 – Marielle Farina, a senior manager at consulting and accounting firm Deloitte, has spent her career helping health insurers design their benefits. 

But she was not prepared for the deluge of medical bills that arrived during the whirlwind of new motherhood.

“Becoming a new mom is very overwhelming – you have a couple days of hospital stay, and then you take this baby home and try to figure out how to survive,” Farina said. “I remember a few weeks after having him, getting bill after bill after bill, and just adds to the sleepless nights and the stress of it all.”

As it turns out, maternity care is only the tip of the iceberg – women face higher medical costs than men even without factoring in childbirth costs, according to a new report from Deloitte, co-authored by Farina. 

The report focused on working women, who analysts found pay as much as $15.4 billion more a year than men in out-of-pocket health care expenses. This spans age brackets, holding true for women 19 to 64.

Deloitte’s health team examined more than 16 million people under employer-sponsored coverage. The results were jarring – on average in 2021, women spent 20% more on out-of-pocket expenses, compared to men. Without maternity costs, it was still 18%, which translates to $266 more per year, on average.

While the exact reasons for the differences are unknown, the report offered some likely reasons. Women use health care more often, with 10% more in total health expenditures, relative to men. Women have a need for specific checkups that men do not, including gynecological examinations, menopause-related visits, and high-cost breast cancer imaging.  

Women also get less value for their dollars when it comes to health insurance, receiving about $1.3 billion less than men in the value of benefits among people with commercial insurance, the report says.

According authors, the heavier financial burden for health services can be considered part of the “pink tax” – the price on products designed for women, like menstrual products. It is an issue that’s compounded by the pay inequity between men and women, they say. 

Women – particularly Black, Native, and Latina women – make up nearly two-thirds of the nation’s workforce in low-paying jobs in industries like food service, retail, and housecleaning, according to a report from the National Women’s Law Center.  And these public-facing jobs came with especially high risk during the height of the COVID-19 pandemic. 

“Women, Black women in particular, are overrepresented in these low-pay, high-risk jobs ,” said Venicia Gray, senior manager for maternal and infant health for the National Partnership for Women & Families, a research and advocacy group. “To hear that men don’t pay as much is disheartening.”

There is research that points to lower-quality care for women in the doctor’s office. According to the 2022 Kaiser Family Foundation Women’s Health Survey, 29% of women ages 18-64 who have seen a health care provider in the past 2 years felt their doctors had dismissed their concerns.

Also, 15% reported that a provider did not believe they were telling the truth, and 19% said their doctor assumed something without asking.

This leads to less efficient and thorough medical care, forcing women to schedule extra appointments and spend more on out-of-pocket costs, said Malia Funk, founder of the POV, a women’s health advocacy platform.

Funk launched the POV in 2021, after it took eight doctor appointments over 3 years to have an out-of-place IUD removed that was causing pain, bleeding, and infections, she said. 

Like Farina, Funk had a background in the medical field, transitioning from pre-med studies to roles as a health care strategist and a private equity consultant. Despite her extensive experience, she wasn’t prepared for the hurdles and costs that came with addressing what should have been a straightforward medical issue, she said.

Her repeated appointments counted as “sick visits,” which she had to pay out-of-pocket toward her $4,000 deductible, she said. She was also charged $800 to rule out sexually transmitted infections, which she said was done without her knowledge during other testing. 

“As I was having these negative experiences, I was consulting some of the biggest health care companies,” Funk said. “I thought, ‘I know this space, and I still can’t figure out how to get good health care.’”

Kulleni Gebreyes, MD, an emergency medicine doctor and Deloitte’s chief health equity officer, said she hopes the report will encourage employers and insurers to take a harder look at coverage structure. Business leaders should work with providers to determine why these discrepancies exist, she said, and to redesign benefits and cost-sharing. 

“Women aren’t men with ovaries,” she said. “There are different medical needs, different burdens of disease, different behaviors. As we think about how to make health care more affordable, we need to make sure our health care benefit system takes that into consideration.”



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