Health Care Knock Out Punch

5 Health Care Options for When Premiums Make You Cry

Insurance.

Sigh.

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 is 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 want to strangle people with me.

currently

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. However, a common major side effect is that premiums are skyrocketing so fast people 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 deciding 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 not 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, do not 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.

rising costs

At the time of this writing, 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 no longer expects insurance to be just that. Insurance against something catastrophic. We are 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 Are Your Health Care Options?*

As it stands now, according to the government, there is not a mandate to purchase insurance (as you were prior to 2019) for your family, claim an exemption, or pay a penalty. However, we still need it, so when it comes to health care in the US there are some obvious and less obvious options.

1. Insurance through an Employer

If you are fortunate enough to have this option many people just go with it. It is easy. It is there. You do not have to compare as 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 sent there. Even if you go through an individual company’s website they will usually ask if you are eligible for subsidies or discounts and they authorize those through the exchange.

If you are trying to insure a child, student, Veteran, and/or are low income you have other options:

  • Healthcare.gov – This option is the “exchange.” It is only be accessible during the annual open enrollment window (Feb. 15 to May 15) or if you have had a special life changing event – like marriage or having a baby.
  • Medicaid – largely determined by location, income, and household size. The income cutoff for a family of four in Texas $52,470.
  • 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.

3. Opt-Out

You can choose to go without. There is no longer a penalization or need an exemption (as of 2019). You may qualify for an exemption if any of the following relate to your situation:

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) – as the mandates are no longer law, this is no longer necessary.

How to Qualify

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 purchase 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.

The Process

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 reimbursement policies 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, and 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

Health care is available to those who opt out of traditional insurance. You are now a “Self Pay” patient.

Community health centers

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

Direct Primary Care – A practice that charges a periodic fee (i.e. $70/monthly), 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

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. Many have a $4 drug program – simply keep a copy of their options handy for when you visit the doctor. Should they need to prescribe something show them the list and see if anything on it is a good alternative. If your meds are not on the list look into a prescription program like:
  • Discount Dental plans – these are through Careington and Aetna
  • Discount Vision Exams – EyeCare America, Vision USA

Healfundr

  • 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

  • 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.

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