I promise I’m not trying to start a fight.
Unfortunately, we have personally had to reevaluate health care options for our family. I say unfortunately mostly due to our circumstances but it’s also because the whole ball of medical-wax is a headache-inducing mess. I’ve gone to the exchange and wasted my hours. I’ve gone to individual insurance companies websites that inevitably just tell me to go to the exchange. I’ve called and talked to my insurance company. I’m pretty sure they wanted to strangle people with me.
Our country is at an impasse. Maybe that is not the right word because hopefully, something will happen, but what? We ended up with the Affordable Care Act (ACA) so the uninsured could be insured (let’s not discuss the mandate). However, from what I’ve seen repeated over and over is that it has just caused everyone’s premiums to skyrocket so fast they are being priced out of being able to afford even a very basic family policy. Which, in turn, is leading to more and more people to take the penalty and drop their insurance.
It seems like we have traded one group of uninsured for another. I don’t propose to know the
solution. I can’t imagine having a child with a pre-existing condition or being a cancer survivor and not being able to afford care or be insurable anywhere. On the other hand, it’s absurd to require maternity care to be included for everyone when many will never have children (that’s you men), don’t want to have children and are protecting themselves against it, or are simply past the time of that being a possibility.
I remember when I was between children I could get a non-maternity health care plan for myself and my child for around $300 (the plans including maternity were few and expensive, around $800, but there were some available). That is impossible now.
Currently, we were paying around $850 per month on a high-deductible plan, for a family of four (my husband’s employer paid his portion, so that was just for me and our two children). As we have parted ways we were offered COBRA for around $1130, plus another $65 for dental). I called our current insurance company to see what our non-COBRA options were and was told a similar plan would be a Silver level (go to the exchange to see samples, the options are tiered to Gold, Silver, and Bronze – but you’re not winning the health care game) and it would be $1270 per month. WHAT?! Remember when COBRA was astronomical?! Well, it still is, but so is everything else.
One of the main problems with insurance is that the public mindset has been reshaped from expecting insurance to be just that. Insurance against something catastrophic. We have gotten lackadaisical. Somehow it became the norm to see a doctor and pay nothing or maybe just $35. When this simple care is what we should have been paying for out of pocket all along. Insurance should be there to catch you when you’re falling – or after your kid falls out of a tree. Unless you are under 30 you cannot get a plan that is just that (often called catastrophic plans).
What’s a family to do?
What Are Your Options?*
As it stands now, according to the government, you are mandated to purchase insurance for your family, claim an exemption, or pay a penalty. That’s about it. However, when it comes to healthcare in the US, there are some less obvious options.
1. Insurance through an Employer
If you are fortunate enough to have this option many people just go with it. It’s easy. It’s there. You don’t have to compare much. Some employers are still paying for the employee so it may be a financially viable option if you only have to pay for your family.
Also, employers and groups are getting the best options. Currently, I am not aware of a single PPO option for individuals. Everything available is in the form of an HMO, meaning you will need to work within chosen providers or pay a premium.
2. Individual Insurance
My rebellious streak wants to tell you to bypass the exchange (I’ll do what I want!), but for the most part, at some point on any insurance hunt you will end up here or be directed here. Even if you go through an individual company’s website they will usually ask if you are eligible for subsidies or discounts and those are authorized through the exchange.
If you are trying to insure a child, student, Veteran, and/or are low income you have other options:
- Medicaid – largely determined by location, income, and household size. The income cutoff for a family of four is $33,465.
- Children’s Health Insurance Program (CHIP) – for families that earn too much to be on Medicaid
- Student Health Plans – Many colleges and Universities have a basic and very affordable health plan available. Often times there is a walk-in clinic on campus. Check with your individual university for details.
- Veterans & Service Members – VA Programs are available for those who served in the active military and were separated under any condition other than dishonorable. Tricare is available for service members and their families. Unfortunately, even these more “stable” options are also about to see rate hikes.
You can choose to go without. You will be penalized unless you qualify for an exemption. You may qualify for an exemption if any of the following relate to your situation:
- The lowest-priced coverage available to you, through either a Marketplace or job-based plan, would cost more than 8.16% of your household income.
- You don’t have to file a tax return because your income does not meet the tax filing requirement.
- You had a financial hardship or other circumstances that prevented you from getting health insurance
- You were uninsured for no more than 2 consecutive months of the year
- You lived in a state that didn’t expand its Medicaid program and your household income was below 138% of the federal poverty level.
- You’re a member of a federally recognized tribe or eligible for services through an Indian Health Services provider.
- You’re a member of a recognized health care sharing ministry.
- You’re a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare.
- You’re incarcerated
- You’re a U.S. citizen living abroad, a certain type of non-citizen, or not lawfully present.
- A member of your tax household was born or adopted during the year
- A member of your tax household died during the year.
The current penalty for not carrying Minimum Essential Coverage (MEC) is calculated 2 different ways – as a percentage of your household income (2.5%) and per person ($695 per adult and $347.50 per child – maximum payment is $2,085). You’ll pay whichever is higher. The fee rises with inflation.
If you choose to not pay the fee the IRS will hold back the amount from any future tax refunds. There are no associated liens, levies, or criminal penalties.
4. Health Care Sharing Ministry (Medi-Share)
“A health care sharing ministry is a tax-exempt organization whose members: share a common set of ethical or religious beliefs, AND share medical expenses in accordance with those beliefs…”
The organizations are often called Medi-Share though it is not technically correct because Medi-Share actually refers to a specific organization within the group, Christian Care Ministry (CCM). If the ministry has been around and sharing since December 31, 1999, then it qualifies members for the ACA exemption (Form 8965, enter code “D” in Part III, column (c)).
Due to the nature of these organizations, you may not qualify based on your religious affiliation. Also, because they are private they do not have to cover your pre-existing conditions, maternity, or stupidity. Some charge a premium if you are not within given healthy parameters (e.g. overweight, high blood pressure, etc.). Most have options if your pre-existing condition can be cured or a large prayer pool where members can help those with exorbitant medical costs that would not be part of the normal share “pool.”
However, if you do qualify and subscribe to like beliefs then these can be a really great option. They are very affordable. Particularly for large families. Most are purchased based on a unit or share system. Each adult would be an individual share and all the children in the family would be one share. The costs for a family of could be as low as $135 per month, though the average is probably more akin to $350-550.
These plans tend to run like insurance was meant to – you cover your incidentals, regular doctors visits, wellness check-ups, etc. up a certain amount and then anything over your designated threshold is eligible to be shared. If you are on a high-deductible plan not much will change.
Their setups vary on how you get reimbursed and your level of involvement in your bill. Some are set up like a regular insurance company where your doctor bills to them. Some you pay up front and try to negotiate your bill down and then submit “claims.” Some you directly write a check to another member some go through escrow and the company disburses payments.
If you are more interested in these options check out our Guide to Health Care Sharing Ministries.
5. No Insurance/ Self Pay Options
Healthcare is available to those who opt out of traditional insurance. You are now called “Self Pay.”
- Community health centers, schools, various non-profits throughout the year offer low/no cost options, it may be based on your income. You can receive services such are prenatal care, baby shots, general care, referrals to specialized care. Needy Meds also has a search for medical clinics and dental clinics. Another resources is FreeClinics.com.
- Direct Primary Care – A practice that charges a periodic fee (i.e. $70/ montly), will not bill third parties (i.e. insurance companies). It’s like a membership to a doctor’s office. These also go by the terms Cash-Only Clinics and Concierge-Based Medicine.
- Urgent Care Facilities – check with one nearby most offer cash patients discount and some offer a family package for basic exams
- Discount Programs
- Prescription Drugs – Check with your pharmacy and keep a copy of their $4 drug program. If your needs aren’t covered there look into a prescription program like FamilyWize, Needy Meds, Partnership for Prescription Assistance, RXHope, RXOutreach. Also, check with the manufacturer (Pfizer, Merck, etc.) they often have a plan for those without insurance.
- HeaLfundr – Owned and operated by NeedyMeds, a 501(c)(3) non-profit information resource devoted to helping people in need of assistance of affording their medications and costs to health care via crowdfunding.
- Foundations – Many foundations offer support for specific diseases. You should search according to your specific need.
Good luck and I hope you find something that works for you and your family. If you know of any options I missed please let us know in the comments.
*This article is my personal health care experience and research. I am not a tax attorney or insurance professional. To the best of my knowledge, all of the information presented in this article is accurate and factual as of the time of publishing. Please consult your own professionals and independently confirm options.