Well water you pay every month. Some landlords will include hot water but they aren't obligated to. If you own your own home and pay for water(hot and cold), you'll get a quarterly bill for cold water and a monthly one for hot. Healthcare is grabbed during taxes at year end. So I pay into Healthcare and its geared to income, and pay for someone else to go to the doctor 'for free' cuz I only go see a doc for serious shit. Takes ages to see specialists, hard to find a new doctor let alone get a second opinion, forget a 3rd. But I won't walk out of the hospital with a $5000 bill for a broken arm, which is super nice.