Health insurance

[colliehauler]

Anyone know who offers the best high deductible health insurance plan?

ACA coverage has gotten to expensive and I have a few years before medicare kicks in. In my case bronze coverage is $8700. With a $8000. deductible. I live in KS.

Please do not turn this political so I can get some answers without it being closed.

[gkainz]

Good discussion and timely for me as I begin to look at retirement plans and how to cover the health insurance gap between employer group coverage and Medicare. I've looked at co-op programs before and will look again, as they fit my belief system.

I was self-employed for 25 years before my current employment, so I have experience in both sides of providing and acquiring health care coverage.

Also looking into VA healthcare, but that doesn't help with spousal coverage and even though I have a good friend who is currently a doctor in the VA, navigating the paperwork mountain isn't easy.

[colliehauler]

When United pulled out of Kansas it only left BCBS. I had United for decade's. If there was some competition in the insurance companies I would be willing to bet the prices would come down. ACA gave insurance companies a monopoly. The other thing about insurance companies is the out of area penalty. I find that not conducive to RV travel.

[WTP-GC]

At some point, you have to make the determination as to who and/or what you're going to trust. Testimonials can be impactful to a certain extent. Virtually every RV related comment on this website is a form of a testimonial. Amazon has a zillion of them (many of which are very fake). And our health co-op provides them too. Based on my personal experiences with this co-op and the overriding faith-base that I subscribe to, I choose to believe that the program is truly effective. I've honestly seen more people get run through the ringer with their traditional insurance plan than I can even remember. Some of that is due to a lack of understanding of the policy parameters, but some is just because insurance companies can be an absolute pain to deal with. An "english-challenged" phone screener in Inida is a not what I want to hear when I have to make a call regarding my insurance policy.

FWIW, in this day and age, I don't think thre's any significant risk involved in choosing a health cost sharing co-op. If I learned that I had cancer and needed treatment, if there was any inclination I had that my co-op might give me trouble, I could switch to traditional insurance and not miss a beat. Even if there was a minor waiting period prior to coverage, I could figure out how to minimize cost during the wait (hopefully). Everything is a hypothetical. Even if I had traditional insurance, there's no guarantee they would provide coverage for the particular specialist that I may need at that given moment.

Really, though, much of this boils down to the availability of a competitive insurance market. There are only 2 health insurance companies available to me in my market. Note that I could choose from literally hundreds of insurers for auto, home, liability, etc. But United and BCBS are my only options. BCBS wouldn't write a policy for my company. So I'm stuck with United. Fortunately, they've been good to work with, but I can only imagine how costs might be more competitive if I could choose from more than 2 companies.

At the end of the day, making the choice to use a faith-based health cost sharing co-op is heavily philosophical in nature. For those who don't share the same beliefs, that concept may not make as much sense. Topics and discussion of religion are prohibited on this forum, but there is a Bible verse which explains exactly what I'm talking about that I'd be happy to share with any member via the PM function.

[2gypsies1]

Unless a testimony appears with contact information that I can contact myself I don't believe in them. Any company can write their own testimonies. In time of true need of medical insurance I'd want a company that I could rely on paying and not have to worry about it.

[westernrvparkow]

WTP-GC wrote:

winnietrey wrote:


You sound young, having a kid or a broken leg, is nothing, and for you, at this time in your life, cost sharing may be a great deal. But at my age when the costs can run into the many hundred of thousands, for cancer etc it would not be. ( and why I would not want my care subject to a non regulated entity) And why I would suggest folks read the fine print.

I initially wondered about how truly major medical events (cancer, cardiac, transplants, etc.) would be handled. As an admittedly healthy young buck, I don't worry too much about these things. But every monthly newsletter contains testimonials actual participants sharing their stories on just that...truly major events. Even for them, the system is working. There are others who came into the program with non-covered pre-existing conditions, and they share their stories of how members chip in a little extra to help cover those needs too.

It would be a little unfair for me to say that this is the only program I particpate in. We've seen a number of "concierge" type service providers pop up in our area. So we do pay a modest monthly fee for us and our children to participate in those programs too. I highly encourage folks to look into those programs. They can be very affordable, provide excellent care, and be far more personal.

Testimonials are not worth the paper (or the digital ink) they are printed on. I could put together entirely true testimonials from people who will tell you the best way to plan for retirement is to buy a winning lottery ticket. Trouble is, it leaves out all the people who buy losing lottery tickets.
I don't doubt that your plan (or Medi Share, or any other similar plan) is currently paying claims. But what happens if they get into financial trouble and stop paying all or part of the claims? True insurance plans have re-insurance spread across the insurance market through companies with hundreds of billions of assets. They are also regulated and backed by state governments. Your valid claims are going to be paid. Nothing similar backs the Medi Share type programs.
As a previous poster pointed out, the fine print in these cost sharing programs are scary. Mandatory arbitration with their in house arbitrator, behavior clauses, and certain exclusions make these type of plans untenable to me. What I also don't like is the fact that certain of these plans sell themselves as substitution for actual insurance, wrap it up in religious mumbo jumbo, and then relegate the differences and deficiencies to the fine print.

[winnietrey]

WTP-GC wrote:

winnietrey wrote:


You sound young, having a kid or a broken leg, is nothing, and for you, at this time in your life, cost sharing may be a great deal. But at my age when the costs can run into the many hundred of thousands, for cancer etc it would not be. ( and why I would not want my care subject to a non regulated entity) And why I would suggest folks read the fine print.

I initially wondered about how truly major medical events (cancer, cardiac, transplants, etc.) would be handled. As an admittedly healthy young buck, I don't worry too much about these things. But every monthly newsletter contains testimonials actual participants sharing their stories on just that...truly major events. Even for them, the system is working. There are others who came into the program with non-covered pre-existing conditions, and they share their stories of how members chip in a little extra to help cover those needs too.

It would be a little unfair for me to say that this is the only program I particpate in. We've seen a number of "concierge" type service providers pop up in our area. So we do pay a modest monthly fee for us and our children to particpate in those programs too. I highly encourage folks to look into those programs. They can be very affordable, provide excellent care, and be far more personal.

yeah Wtp, I am probable old senile and jaded, but I have been in the health care biz for a very long time..

My take, unless it is carved in stone, with 72 lawyers to back it up, don't believe the hype.

Seems like you are a smart guy, and on top of this. My only advise, poor as it maybe is, CYA, don't bet the family farm on what others say

I did get a bit of a chuckle out of your reference, to the news letter. It would kind of be poor PR on their part, to publish the not so good stuff, I trust the news letter, as far as I can through a Buick.

This is the big thing IMHO, you have no recourse or course of action if things go bad. If one accepts and knows what they are getting into, I say go for it.

On the flip side, I do not want to hear, and will have no compassion for someone who is just trying to be cheap and gets burned, because they did not do due diligence

[colliehauler]

msmith1199 wrote:
Is that for a single person or for your and your spouse? If it makes you feel any better, I was able to keep a plan from my former employer. It is a Cadillac plan with no deductible and just small co-pays. My annual expense is more than your annual premium and your deductible.

That is a single person amount. I could only keep my former employer insurance for one year.

[colliehauler]

Another thing to remember is their is a one year exclusion for cancer at Health share.

[WTP-GC]

winnietrey wrote:


You sound young, having a kid or a broken leg, is nothing, and for you, at this time in your life, cost sharing may be a great deal. But at my age when the costs can run into the many hundred of thousands, for cancer etc it would not be. ( and why I would not want my care subject to a non regulated entity) And why I would suggest folks read the fine print.

I initially wondered about how truly major medical events (cancer, cardiac, transplants, etc.) would be handled. As an admittedly healthy young buck, I don't worry too much about these things. But every monthly newsletter contains testimonials actual participants sharing their stories on just that...truly major events. Even for them, the system is working. There are others who came into the program with non-covered pre-existing conditions, and they share their stories of how members chip in a little extra to help cover those needs too.

It would be a little unfair for me to say that this is the only program I particpate in. We've seen a number of "concierge" type service providers pop up in our area. So we do pay a modest monthly fee for us and our children to particpate in those programs too. I highly encourage folks to look into those programs. They can be very affordable, provide excellent care, and be far more personal.

[msmith1199]

Is that for a single person or for your and your spouse? If it makes you feel any better, I was able to keep a plan from my former employer. It is a Cadillac plan with no deductible and just small co-pays. My annual expense is more than your annual premium and your deductible.

[winnietrey]

No not really, To use your example 10k procedure, Insurance allows say 5K, of that 5k. which would be applied your your deductible, because you belong to that ins, you will be charged at the allowed rate, for the remainder. Which just in general would say be a 2k cost to you, as the ins will reduce it to that rate, ( which, big surprise, hospitals have a nasty habit of not telling you that and hitting you for the whole cost, not the INS adjusted cost) And unless you call them on that, you will pay full freight

You sound young, having a kid or a broken leg, is nothing, and for you, at this time in your life, cost sharing may be a great deal. But at my age when the costs can run into the many hundred of thousands, for cancer etc it would not be. ( and why I would not want my care subject to a non regulated entity) And why I would suggest folks read the fine print.

Like I said, I have no dog in this fight, just make sure what you want is, what you are buying, and it works for you. And for the long term, if you get really sick concentrate on that, not the monthly premium

40 years in my own health care office, not the ultimate expert, but I do have a clue.

by the way, I really appreciated your post, you did not get defensive, and explained your point of view, something quite often lacking in todays world

[WTP-GC]

winnietrey wrote:
Read with great care, exactly what a health sharing co-op is. It is not an insurance plan, it is not subject, to the laws of your state. basically they do whatever they want.

Read about preexisting conditions exclusion, read about limited drug coverage. Read about their ability to deny coverage, for any reason, they deem fit. Read about how disputes are resolved. Through their in house arbitration, no third party

WTP, if someone did not read closely what you said, one might get the impression, that somehow the cost sharing plan helped you negotiate the cost down. I am sure you would agree, reason you got the cost down, was cash at time of service.

yes the provider may have billed 10K, of which they may have hoped to get 2500, so 2K cash for them is a great deal.

It is not about a few K medical bills, it is about medical bills that run into the hundreds of thousands. And put you in the poor house

Risk assessment, versus reward. Save a few bucks a month lose the house. Not me, not my call, not for me to judge.

I am not saying it is a bad deal, all I am saying is understand what it is, and if you choose to go forward, good for you.

Lastly Wtp, you state these programs, have insurance, to cover folks if the program goes bankrupt. I can find no evidence of that. Would you be so kind as to supply the name of any one company that reinsures programs, like this?

Its possible that there may not be any insurance or reinsurance provisions. I thought there was, but honestly I haven't reviewed their policies in several years. I do recall, though, that they are subject to a number of governmental regulations to help ensure fraud prevention and stability.

My statement regarding the reduced cost should be mostly inferred to be due to up-front cash payment. However, that doesn't apply to all medical procedures. We've had multiple procedures over the years that we were billed for, then had to go and submit a claim for reimbursement. During those times, we don't pay the bill until the dust settles and a final amount is determined. The very good folks at CHM have negotiated many medical bills down to a level lower than we could have ever imagined...prior to us paying them and thus receiving reimbursement. All I can say is that the system works.

When we had our first child, we had a typical insurance policy. The next child was with the co-op. For the first child, we hit the deductible and max out-of-pocket. For the second child, other than a few minor misc. costs, the entire pregnancy and birth was fully reimbursed.

If you're deductible is $8K and the procedure is $10K, under traditional insurance, you will pay the deductible. Using baseline generalizations, the insurer will pay the remaining $2K. However, they may not pay it at all if they can negotiate the cost down to $8K with the provider. So in effect, you've just paid the entire cost. With our co-op, we would have paid ZERO.

[winnietrey]

Read with great care, exactly what a health sharing co-op is. It is not an insurance plan, it is not subject, to the laws of your state. basically they do whatever they want.

Read about preexisting conditions exclusion, read about limited drug coverage. Read about their ability to deny coverage, for any reason, they deem fit. Read about how disputes are resolved. Through their in house arbitration, no third party

WTP, if someone did not read closely what you said, one might get the impression, that somehow the cost sharing plan helped you negotiate the cost down. I am sure you would agree, reason you got the cost down, was cash at time of service.

yes the provider may have billed 10K, of which they may have hoped to get 2500, so 2K cash for them is a great deal.

It is not about a few K medical bills, it is about medical bills that run into the hundreds of thousands. And put you in the poor house

Risk assessment, versus reward. Save a few bucks a month lose the house. Not me, not my call, not for me to judge.

I am not saying it is a bad deal, all I am saying is understand what it is, and if you choose to go forward, good for you.

Lastly Wtp, you state these programs, have insurance, to cover folks if the program goes bankrupt. I can find no evidence of that. Would you be so kind as to supply the name of any one company that reinsures programs, like this?

[WTP-GC]

mudhound wrote:

WTP-GC wrote:

westernrvparkowner wrote:
We have not been able to find anything better than what you are getting quoted. One possibility would be to manage your income so you do qualify for subsidies. It sounds kind of like cheating, but the government set up the system and if you use all the tools available you might be able to use the system to your advantage.
Things like contributing the max to all the potential retirement accounts to lower your taxable income. If self employed, stack your expenses so you have a low income year and get substantial subsidies one year to offset the unsubsidized income the following year.
If you are retired, invest in instruments that do not generate dividend or interest income and sell a combination of winners and losers to obtain a taxable gain income that qualifies for subsidies.
I don't like medishare for two reasons. First, it is not insurance, it is a cost sharing program. To me, that is one step short of a Ponzi scheme. I won't take chances with the potential of having catastrophic health expenses and being out in the cold if they run out of other peoples money.
Second, they have a bunch of gotchas in the fine print. Things like you must practice good Christian Behavior. I won't take a chance that somewhere there is a photo lurking of me drinking a beer at a football game that will disqualify me for coverage of a heart transplant.

As a business owner, we use a highly renowned CPA that advises us regarding taxes, retirement planning, etc. According to them, the tactic of income adjustment in order to change how you qualify for certain benefits and tax brackets is very useful for the ultra-wealthy and potentially momentarily useful for the poor. At the end of the day, most people find themselves going through hoops to move money around and play games merely to save a few bucks or nothing at all. In this case, unfortunately the lack of a competitive insurance market and age will play against the OP's favor.

Regarding Medishare, my family has participatd in a similar health cost sharing CO-Op for nearly 10 years. We pay cash at the doctor (ends up being just a few dollars more than the average Joe's co-pay) and our out-of-pocket cost for any medical event over $750 has been fully reimbursed. Spend a few hours in the ER and you'll be guaranteed to incur more cost than $750. The program we participate in is basically the same as Medishare, just has a different name. And while I can't speak for them, our co-op is nowhere close to a Ponzi scheme. Take for example a recent procedure we had to have. The cost for the procedure was over $10,000. This is what the medical provider was prepared to bill the insurance company. We paid around 80% less up front at the time of the procedure. We will be fully reimbursed for this. If the OP had the similar procedure and it was billed to insurance, this would have led to them hitting their deductible. The insurance company would have then negotiated the cost down to a point where their cost would be virtually nothing.

And you don't run out of other people's money. That's not how it works. The company will become rapidly insolvent long before that happens. Even these programs have be insured and re-insured.

In short, health sharing co-ops can be a smart move. There are a lot of them out there, so I'll stop short of saying that they're all good companies.

I too went away from normal health insurance. LOL! I happen to be an insurance agent!
I went to Christian Healthcare Ministries out of OH. I love being able to pick and choose where and when i go to the dr or hosp

That's the group we selected as well. We've been completely happy with it and recommend it frequently. The more we talk about it, the more we're surprised to learn that so many people also choose CHM or similar groups. I've never met anyone who switched back.

FWIW, as an employer, I provide actual health insurance to my employees through United Healthcare. In our market (FL), they were the most affordable and seem to offer pretty decent coverage. As for myself, I do not participate in the group plan that we offer LOL.