One of the harsh realities that we are facing in our early retirement is the loss of health insurance for us and for our children. I’m all too aware of how much it costs for my current employer (church) to insure my family and me. For 2016 it’s $14,000, plus another $6,000 they are paying into a Health Savings Account for my “high deductible” plan. It’s good insurance – great insurance even. But it all goes away on July 1, so I’ve been looking into our options.
My first stop was www.healthcare.gov, where I entered my anticipated income for 2017 and got the good news that you the taxpayer will subsidize my health plan to the tune of about $1,600/month. Thank you, taxpayers!
But, it seems that there are only two companies offering plans eligible for that subsidy in the state of New Jersey. One is Amerihealth, and the other is Horizon Blue Cross Blue Shield. And the premiums after the subsidy average about $500/month. Not bad! I was thinking that this ObamaCare stuff might work out for us after all. EXCEPT that every plan offered has ONLY IN-NETWORK coverage, and the networks cover ONLY NEW JERSEY and the Philadelphia area.
This doesn’t work very well for us since we’re expecting to spend part of every year on the road. “You caught pneumonia in Colorado? I’m sorry, if you want insurance to cover your claim you’ve got to travel back to New Jersey in order to see a doctor.”
When I started to look at the price of unsubsidized plans, panic began to set in. We are talking in the range of $2,000/month for coverage similar to what we have now. I’ll have just turned 60 when I retire, so that means five years before Medicare kicks in.
Fortunately, a friend suggested that I look into “Medical Cost Sharing,” in lieu of insurance. And what I discovered blew my mind.
Medical Cost Sharing:
Most medical cost sharing plans are faith-based, meaning that you have to share the religious beliefs of the group in order to participate. Kathy and I are Christians, so we first looked to Christian Health Sharing networks. The big three are Christian Medi-Share, Christian Healthcare Ministries, and Samaritan Ministries.
These plans make it quite clear that they are not insurance. They do, however, qualify under the Affordable Care Act with no
penalty as substitutes for insurance. Each requires that you live a healthy lifestyle in keeping with their understanding of biblical teaching. For instance, you can’t join if you smoke and must participate in the life of a local church. None cover abortion, sex-change operations, and the like. None will pay a claim for injuries sustained while you were drunk or high. You get the picture.
The result of these stringent requirements is that, overall, the members of these plans are likely to be healthy and health-conscious people. This means that they’ll typically have lower medical bills, and that means the plans can be offered at a much lower cost. Costs are comparable with the subsidized premiums under Obamacare.
I also discovered a fourth company, Liberty HealthShare, that is a little bit different. While the above three require statements of belief that are Christian, Liberty is far less stringent in its theological boundaries and has a statement of belief that would be acceptable to non-evangelical faiths such as Catholics and Mormons, and many other faiths as well. Otherwise, regarding lifestyle choices, the requirements are about the same.
None of these four plans cover preexisting conditions when you first enroll. Several will cover them in full or in part after a waiting period of one to three years. So, if you’re already sick, you’ve got to suck it up and go with Obamacare if you can. But, if you’re basically healthy and live a healthy lifestyle, these may be good alternatives.
At the moment we’re strongly leaning toward joining Liberty HealthShare. Their top plan (Gold) has a family “monthly share amount” (like a premium with insurance) of $449, plus annual dues of $75. Our “personal responsibility” (like a deductible) would be $1,500/year for the entire family, after which they cover 100% of “sharable” medical expenses, with a maximum of $1,000,000 per incident. (It is important to read and fully understand which expenses are “sharable” and which are not.) There is no coverage for preexisting conditions for the first twelve months, up to $25,000 the second year, up to $50,000 the third year, and then full coverage. They cover preventative care and some prescriptions, including, in some cases, alternative medicine. You can go to any doctor or hospital.
For a more in-depth look at these and some other options, particularly as they relate to RVers, check out this article by the RVer Insurance Exchange.
What do you think?
Are we missing some obvious problem? What else should we be asking before we make a final decision? Are you already part of a health-sharing network, and if so, how has your experience been so far? Please let us know in the comments section below. Thanks!
I think a very reasonable question you should ask is:
What will happen if your RV goes off the road and you and Kathy are in some emergency department in nowhere you’re familiar with? That’s kind of a definition of “catastrophic event”. A couple of days in an ED and ICU can easily run up a bill of a half a million dollars.
How much will you be out-of-pocket in each of these plans, including your ACA options?
Out of pocket is a bit hard to calculate because the different Health Sharing plans exclude different things. I’ve tried to make an “apples to apples” comparison between three of them for a family of five for their most comprehensive plan with similar “personal responsibilities” (Deductibles):
Monthly Share – $784
Personal Responsibility – $1000/member
No preexisting conditions covered for 36 months
Has a preferred provider network (PPO)
Maximum family annual expense for covered items, INCLUDING “Share” – $14,408
Monthly Share – $611
Personal Responsibility – $5000 (various levels are available at different costs)
No prescription medicine coverage
PPO but no difference for out of network reimbursement
Maximum family annual expense for covered items INCLUDING “Share” – $12,332
20% discount available for those with healthy cholesterol, weight, etc.
Preexisting conditions covered with percentage growing over three years, then 100%
Monthly Share – $449
Annual Dues – $75
Personal Responsibility – $1500/family
Preexisting conditions not covered first year, $25,000 second year, $50,000 third year, then 100%
Preventative care (eg colonoscopy) covered
Go to any doctor/hospital
Prescriptions covered 45 days before/after an incident
Maximum family annual expense for covered items INCLUDING “Share” – $6888
Maximum PER PERSON out of pocket AFTER premiums ranges from $3250 to $5700, or $16,250 to $68,400. Premiums after subsidy, $258 to $1222/month. No out of network coverage.
There’s a lot more to consider, but that’s a basic breakdown of the financials.
Jeff and Kathy,
Welcome to my world, the independently insured. I pay $900/mo for my daughter and I, with a $6000 deductible and basically pay for everything except hospital. That is pretty standard across plans I’ve looked into. And going up Jan 2017. I hope this blog turns up other options besides those you’ve mentioned.
I gather that you will have to pay out of pocket and submit the bills for reimbursement? What limitations and exclusions do they have? For example, are blood transfusions, medical devices, any out patient rehab allowed for submission? What about private nursing care if needed and for how long? Also is there a limitation on hospital stays? How much would they reimburse you? Yes, I am thinking about our recent experience. Lastly, are routine annual tests covered? Mammograms etc?
Just offering some other things to think about.
With Liberty you present an ID card and the doctor can bill Liberty directly. If the doctor won’t or can’t do that, you send the bill to Liberty for payment or reimbursement.
Some of the plans don’t cover routine annual tests, Liberty does. Those that don’t explain that this is NOT insurance, and that “sharing” is for large expenses, not for routine medical care. However they will help you negotiate for the greatest discounts available for those services.
Good questions on some of those other particulars. I’ll study up on them and get back later!