Hello, I decided to come back to the board after a long absence, due to offensive comments made by a few posters. We'll see how long my comeback will last. Judging by the discussions I have viewed as a lurker, probably not long, but I had some important updates on my medical insurance issue, so I thought I'd post this.
I have been dissatisfied with my health insurance for as long as Obamacare has existed and my last year...2017...was particularly onerous, with $800/mo premiums and an $8000 deductible. Oh, I am a healthy 62 year old female non-smoker with no conditions. I work out everyday... I am 5'7" and 125 lbs...and have been that weight for 15 years. I am an early retiree and do not qualify for any subsidies, so I feel the full brunt of any increases.
So, when the increases for 2018 were announced....$1000/month premium and $10,000/annual deductible...I started looking for alternatives and found Medishare, run by the Christian Care Ministries. I chose a middle-of-the road plan with a $5000 annual deductible and $360/month premium (although they have different terminology for those terms). I actually got a discount ($40/month) because my health and weight are excellent...so now my premium was down to $320/month!?!
I was a little nervous because it was taking a step into the unknown, but since I am healthy, what can go wrong, right?
Well, because of my impeccable timing, I have had two chronic medical issues since the beginning of the year and I have to say that Medishare has come through admirably with both. They negotiate discounts on my behalf and even though my out-of-pocket is more...I still have come out waaayyyy ahead than if I had continued with Obamacare. For example, although mammograms are not covered by Medishare, with the negotiated rate, my oop was $300...and I should know...I had to have 2 of them this year! My MRI was $350....and I didn't even shop around for a lower rate! I can go directly to a specialist WITHOUT having to go to my general physician first.
The Medishare customer service representatives have been particularly kind. One of my medical issues happened suddenly when I was vacationing in another state and they were incredible...even offering to pray for me while I recovered. Go ahead and make fun of that if you will, but when you are in distress, it is extremely comforting.
I don't pretend that this is for everyone, but for me, it has literally been a Godsend...if nothing else, it opened my eyes about the TRUE cost of healthcare. In my opinion, a good first step to solving this dilemma would be to PUBLISH PRICES of procedures, so people can make informed decisions. Oh, and have some out of pocket costs for diagnostic procedures...I'll bet the prices would come down even more...I'm due for a colonoscopy next year...I plan on shopping around and finding a good rate.,,I'll let you know what I come up with.
Comments
I'm very glad to hear you had a good option to turn to and can certainly understand how your experience with Obama care was not a good one. Obviously each state is different.
Interesting comment by @MikeM that pricing was absolutely the same (ACA policy vs non-exchange policy).
@little5bee, I believe a colonoscopy "screenings" are a covered cost (preventive care) with ACA plans, but then there is this:
(I write here about underestimating "insurer" risk just after having written about overestimating insurer risk of annuity policies. Infer from that what you will - that I am not posting consistently, or that I'm trying to be objective and there are real differences, or anything in between.)
This PBS Newshour piece does a good job of covering the bases. You are not alone:
1 million Americans pool money in religious ministries to pay for health care
https://www.pbs.org/newshour/health/1-million-americans-pool-money-in-religious-ministries-to-pay-for-health-careThey can effectively rescind the agreement. Insurance companies are generally barred from doing this. Basically, when faced with a large claim, health ministries can go back and find some loophole to void the agreement. As was the practice of insurers before the ACA.
See, e.g. https://www.huffingtonpost.com/entry/christian-health-ministry-obamacare_us_5a9d66fee4b0a0ba4ad6754b
There's usually no government oversight - this isn't insurance. So as well as added risk there's less help in case there is a problem. Still, these ministries do seem to work well for many people, and given the pricing, the potential savings may well outweigh the risks. I'm glad it's working out for you, and hope it continues to do so.
Regarding the colonoscopy, as @bee noted, it would be free under ACA, but classifications matter. Medicare also handles these differently depending on your level of risk and whether they are followups. (I'm not of that age, but at some time in the past I read up on this. I figure it's enough just to be aware of this now.)
On the other hand, in New York County (Manhattan), bronze plans generally have an out of pocket max of $7150, unless they're HSA plans for which the ACA legal max is $6550. The least expensive of these bronze plans costs $421.
To reduce the out of pocket max to $4500, one would need to buy a silver plan. Even at that level there's only one plan with a cap this low. Oscar offers a plan for $538/mo, but you'd have to pay all $4500 toward the deductible before getting any coverage outside of preventive care. That $4500 deductible applies to lab tests and even to generic drugs.
Remember too that a 24 year old would also be paying $538/mo for this plan.
States vary; so do counties. One reason to use the exchange in NY even if you don't qualify for subsidies is that this enables you to get separate dental insurance that isn't sold off-exchange. You can find plans costing about $20/month with decent networks, unlike the narrower ones that seem to be packaged with all-in-one health plans.
@Crash Same. My #1 pet peeve is "customer service representatives" who seem to hate people and don't really want to provide any service....enough to raise anyone's blood pressure...thus incurring a "pre-existing condition"....arrghhh!
@msf TBH, if I were subsidized by others, I probably wouldn't care about which risk pool I was in, either. But since it's MY skin in the game, I prefer to be in a risk pool with those with non-reckless behavior.
So while it might seem that they are taking advantage of a somewhat captive market, they can't, at least not directly. If they're paying out an average of, say $4800 per person, then they can't charge more than an average of $6000 per person ($500/mo). Admittedly they've little motivation to hold down the cost of health care. Their 20% share goes up as health care costs go up.
Still, the real problem is the cost of health care, not the price of insurance. Premiums (and deductibles, copays, etc.) simply reflect those costs. Insurance costs are what people see, so they're what people complain about. IMHO those are the wrong target.
Medi-Share Senior Assist is an alternative to Medicare supplemental plans ("Medigap"), not Part C Medicare Advantage. I think you'll find that the latter costs less. It often has zero premiums.
For example, in Naples, there are eight plans at zero cost. Humana and UnitedHealthcare (AARP-branded) both offer HMOs and PPOs, while Florida Blue offers an HMO at zero cost, and PPOs with various premiums. They all cover drugs, so you don't have to pay for a separate Part D plan as you would with Senior Assist or Medigap.
A resource that I have used a lot (unfortunately) this year is www.healthcarebluebook.com. Check it out...it's quite informative.
Now, if I could only find an easy way to deal with Comcast customer service........
>> TBH, if I were subsidized by others
Isn't that sort of what insurance is? Subsidy, partial, by group (= others)?
One other thing...because Medishare is not considered insurance, I am no longer able to contribute to my HSA...bummer, but definitely not enough of an incentive to stay with Obamacare.
Still, the real problem is the cost of health care, not the price of insurance. Premiums (and deductibles, copays, etc.) simply reflect those costs. Insurance costs are what people see, so they're what people complain about. IMHO those are the wrong target.
Agreed...and that is why Medishare works for me. Because many procedures are oop, I am incentivized to shop around. PCHS is actually the name of the provider that I use when I make an appointment. All of my doctors accept it, but I'm not sure if that's the case in other regions of the country. When I had my out-of-state medical emergency, though, there was no time to check to see if a facility was in network. When I felt better, I called Medishare's excellent, compassionate customer service department and they assisted me with the necessary paperwork that I needed to file for using an out-of-network clinic.
But, I have time to do the comparison shopping for routine appointments and it's been enlightening...I kinda enjoy it. I like having more control, unlike Florida Blue
Before you toss the coin, have I subsidized you? Have you subsidized me? We've each paid into the pot and gotten exactly the same value out - an even money chance of winning $2.
Stripped to its core, that's all insurance is.
Now let's rig the game. We'll weight the coin so that 3/4 of the time it comes up heads. So on average, you expect to come out with $1.50. But we'll continue having you ante up the same buck. Meanwhile, I'm also putting up a buck, but I only expect to get back 50¢. I'm paying in too much for what I'm getting (a 1/4 chance of winning $2), you're paying in too little. I'm subsidizing what youre getting - the expectation of making out like a bandit.
That's what happens when you pay in less than your expectation value. You're subsidized by those who pay in more than their expectation values. The game is rigged and they're paying for your expected gains.
So it's not insurance per se that creates any subsidies. It's only when it is rigged that some participants subsidize others.
Maybe this will help: http://worthwhile.typepad.com/worthwhile_canadian_initi/2011/11/what-does-actuarially-fair-mean.html
But I mean this politely, but utterly unfettered and truthfully: health insurance in this country is ALREADY a cluster-f***. Tax the ones with money. Tax the rest of us less. Everyone pays in, who's working. And everyone gets covered.
Oops, I forgot Vested Interests. How much will we owe THEM, before something SENSIBLE becomes possible?
https://mychristiancare.org/medi-share/what-is-medishare/how-medi-share-works/faqs/
so the christian w diabetes has a tough row to hoe, looks like. (maybe I am missing something.)
there are lots of private / affinity-group initiatives in the world, for all sorts of things (sharing). will be interesting to see what happens with success and increased enrollment.
wonder if there is a non-christian or nonreligious version of this yet.
fascinating:
'eligible medical bill is paid ... with funds received directly from another member'
no abortion 'sharing', can't find text re other reproductive care.
Also, AFAIK medical expense deductions are currently limited to anything over 7.5% AGI. For some, that's a pretty big number...and with tax reform, that is going away either this year or next.
@davidrmoran as I said in my original post....'I don't pretend that this is for everyone'...but it is an excellent option for ME. The medical sharing part is also nice...every month you receive a notification as to whom your share assisted. I have even received thank you notes from the recipients...although that's not required. I have also used the telemedicine feature.
You're in excellent shape, you have low risk. You're the one who will "win" the biased coin flip 1/4 of the time (getting a little money for medical costs). Say I'm in poor shape, so I'm the one who will "win" 3/4 of the time - my expected payoff is higher. So if we both wager $1, you're subsidizing me. The game is rigged.
To "unrig" the game, you'd need to pay less, commensurate with your long odds of "winning". Just as in a horse race, the worse the odds of your horse finishing first, the less money you have to put up to win the same amount.
If your horse is 10:1 (you are healthy), you put up $1 in order to win $10. But if my horse is even money (I'm in poor health) I have to put up $5 in order to win $10 (or $1 to win the $2 coin flip).
This goes to show that I was right about doing a poor job of explaining. (Though IMHO the example was simple but not simplistic). Thus the referenced page might help to provide more clarity. Still that doesn't change the fact that for some people, they can compare the cost of paying for this in after-tax dollars with the cost of paying insurance premiums in pre-tax dollars.
The tax reform act didn't sunset the medical expense deduction. In order to secure Susan Collins' support for the legislation, the floor for medical deductions was reduced from 10% to 7.5% of AGI for two years. After that, it just reverts to what it was originally.
https://mychristiancare.org/globalassets/media/medi-share/medi-share-guidelines.pdf
https://mychristiancare.org/medi-share/what-is-medishare/how-medi-share-works/medi-share-guidelinesThat's the way I read Chapter VI Section A:
"The cost of CMS or FDA approved testing, treatments, and up to six months of FDA approved prescription drugs per eligible condition will be considered for sharing."
See also Section J, "Medical Conditions and Services Not Eligible for Sharing":
- Ineligible services include "Diabetic Counseling".
- Ineligible "Non-prescription (over-the-counter) drugs and medical supplies/equipment" includes "Diabetic supplies."
These diabetic supplies and drugs (both prescription and OTC) are still eligible medical costs for HSA dollars you've got left over from HDHP-covered years.
https://www.irs.gov/newsroom/affordable-care-act-questions-and-answers-on-over-the-counter-medicines-and-drugs (See #5)
The idea is that the ministries are in effect providing catastrophic insurance for unexpected events. Hence preventive care is not covered. Chronic conditions are not unexpected and quite literally medical sharing ministries are not set up as charities. "All the ministries are Christian at this point, though Weldon says there’s an attempt to start a Jewish sharing ministry."
KHN, July 28, 2017, https://khn.org/news/leap-of-faith-will-health-care-ministries-cover-your-costs/ Which is a reason why the 'shares' that members pay are not considered tax deductible contributions There's a full Chapter VII on maternity care. Too long to quote, highlights include up to $125K for any single pregnancy event (including postpartum care), $25K for multiple births due to infertility treatment (but the fertility treatment isn't covered; see below), well-care up to age six (including routine checkups, but excluding vaccinations). Pregnancies of unwed mothers are covered in the case of rape, but only if reported to the police.
From Chapter VI Section J (medical conditions not eligible for sharing):
• Fertility/infertility care – including, but not limited to:
--Birth control procedures, such as IUD, and/or related supplies
--Infertility testing and treatment
--Sterilization or reversals (vasectomy and tubal ligation)
Also excluded from coverage are lactation counseling and breast feeding classes.
Since routine care is excluded as a matter of course, that exclusion extends to mammograms. As the exclusion of routine care is based only on a financial concept (that coverage is only for unexpected events), that does not preclude benefiting from negotiated rates for mammograms, as little5bee has already noted.
And thanks for finding that on the charitable deductions! That would have been the icing on the cake. I knew there was a reason I couldn't do that because I had asked my tax advisor prior to enrolling, but with my advancing age, I couldn't remember why. Since I was too lazy to look for the answer myself, I knew if I waited long enough, you would find the answer!
@davidrmoran are the health insurance pools for small business that Trump is touting similar to this? Don't know enough about them...or if someone not working is eligible to join. I guess I could do the research myself, but I'd rather go shopping and let someone else...probably @msf... do it!
https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_fund_report_2018_mar_lucia_state_regulation_alternative_coverage_options_rev.pdf Exhibit 5 (p. 9) is a map showing which 30 states explicitly exempt health sharing ministries from any state oversight. The accompanying text says that some of the other 20, while not providing safe harbors, nevertheless exercise little oversight.
https://www.mdsave.com/
https://www.politico.com/story/2018/07/28/trump-facts-policy-shop-administration-research-714353