One way to survive without health insurance

When I was considering leaving my full-time job, I had some concerns. My main concern? Health insurance. And it wasn't just me. Since my husband didn't have health insurance coverage through his job, he had been covered under my policy for years. Plus, we were going to be adding kids to our family, so we needed to think about them too.

First, we took care of my husband's needs. About a year ago, he started looking for a private health insurance plan — and since he is a healthy guy, he found an inexpensive one rather easily. And once we adopted the kids, they could also go on his plan with no problems.

So that left me. If I quit my job, I had a few options: 1. Find my own private health insurance plan 2. Go without insurance 3. COBRA 4. Find a non-insurance alternative.

A history of cancer, although it was a very minor case, eliminated finding my own private health insurance plan…at least for 2013. The Affordable Care Act would have eliminated that, of course, but not until 2014. Going without insurance seemed like a crazy choice, especially since medical bills are the number one cause of bankruptcy. For approximately $1,000 per month, I also could have gone on COBRA. I strongly considered using COBRA as a “bridge” to help me make it to the day when my preexisting condition would be covered. However, the last option, finding a non-insurance alternative, was the one I chose. Here is why, how it works, and what I think of it so far.

Although I do not have health insurance, what I do have is an eligible option under the Affordable Care Act. It's a medical cost-sharing plan that is available to Christians who follow certain guidelines including moderate use of alcohol, and no tobacco or illegal drug use. Although I was unable to find similar options available to people who weren't Christians, I think creating something like this would be amazing. Like, the vegetarian medical-cost-sharing plan, or the Paleo cost-sharing plan, or basically any overall healthy group. But I digress.

How It Works

When I signed up, I had to choose a level which determined the amount of money that I pay each month. The highest level requires the member to pay $500 per incident. An incident could include surgery, a broken bone, or pregnancy. For instance, if I needed to have my appendix removed, I would be responsible for the first $500 of all doctor/hospital/lab bills, but that's it. On the other hand, if I have an annual physical that costs $400 with associated labs and testing, I would pay for all of it because I didn't exceed $500 per incident. Ditto for the next incident. The other levels are less expensive, but require more member financial responsibility.

So each month, I send in my voluntary gift amount (not called a premium since this is not health insurance). This money gets sent to an escrow account, which is then distributed to other members, according to their eligible medical expenses. Certain medical expenses are not eligible, including more recent preexisting conditions. Each month, I get a newsletter that lists members who have ineligible expenses. If I want to, I can send extra money to be used for their expenses.

I'll be honest: After over a decade of having regular health insurance, this felt like a scary option. But I have seen it work. As I have mentioned several times, my father had terminal cancer years ago. He had multiple surgeries, chemotherapy, radiation therapy, visits to the Mayo Clinic, and many other tests. And he had the same medical-cost-sharing plan as well. His bills were paid, so I knew the plan worked for him. I just hoped that it would work for me.

What I Think so Far

Wouldn't you know, I had an incident about 10 weeks after signing up. I have paid almost $1,000 in bills so far with more to come, but I have submitted all my itemized bills to the organization, and I am waiting to be reimbursed for all my expenses, minus the first $500. (Just FYI, they do not recommend personally paying bills that are over $1,000. Instead, they recommend that these bills are submitted directly to the organization.) Additionally, I was not required to pay more than $500, but it can take 60 to 90 days for bills to be paid. Since we had the money in savings, I preferred to pay the bills and wait for reimbursements. But that's just me.)

Another marked difference is my role in my health care now. I didn't bother to shop around for my medical care before, because no matter which hospital or doctor I chose, I incurred the same costs. But now, I shop around. For instance, when I needed some lab testing, I could have chosen to go to my usual hospital lab or I could have gone to an independent lab, which was half the cost. I chose the independent lab.

Since I am officially a self-pay patient, I have also asked all my providers for discounts. Every time (except once), I did get a discount off my bill, all the way up to 20 percent off. I thought it would be awkward, since I hate negotiating, but it hasn't been a big deal at all. I just simply say, “Do you offer discounts for self-pay patients?” If they do, super. If not, I deal with it. I also don't feel bad about it, because insurance companies don't pay the full price either. In fact, my doctor's office is small and doesn't have a standard discount for self-pay patients, so they bill me at the Blue Cross/Blue Shield contract rates.

We were notified that my husband's and children's insurance costs are going to double effective January 1, 2014, so I am also considering signing them up too. Our monthly costs, should all of us be on this plan, would be about half of what it would be otherwise. Other than financial benefits, I feel like I am more involved in my health care, and it hasn't felt more complicated…yet. And this probably sounds really idiotic (like, why wouldn't I have done this anyway?), but since I am on the hook for more of my costs, I am trying to be more healthful in general so my costs stay down over time.

If interested, here are some medical-cost-sharing websites for further research:

www.samaritanministries.org

www.chministries.org

www.mychristiancare.org

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FI Pilgrim
FI Pilgrim
6 years ago

My parents have been using CCM for quite a while now, and have had pretty good coverage. They’re not going to cover everything that a full-on PPO plan does, but they don’t bill the same either. Thanks for the overview!

Snarkfinance
Snarkfinance
6 years ago

Wow, talk about options people don’t really know exist. Religious organizations of all make and creed have similar plans if you want to put the time in to find them (and of course personally match their requirements). Glad you have had a fair experience with them so far.

Matt YLBody
Matt YLBody
6 years ago

Good post. I never knew that these existed. I wonder if they’ll gain in popularity as medical costs continue to rise even with the ACA.

Jon @ MoneySmartGuides
Jon @ MoneySmartGuides
6 years ago

I never knew these types of things existed. The most interesting part of this post is how you now shop around for a good deal. I think this is the biggest flaw of health insurance. Since we have $20 co-pays, we go where ever, not concerned with the cost. But if we did shop around a little, we could easily find comparable service for less money. But, the only way people will do this is if there is a greater financial burden on themselves.

Lisa Aberle
Lisa Aberle
6 years ago

There are HUGE disparities between healthcare costs at different facilities, but it can be really hard to compare. With my blood test example, it was straightforward, but with other things, it can be more difficult. I wish I could say that I have always been cost-conscious so my health insurance plan could save money, but if I didn’t see the immediate payoff, I didn’t even think about a cheaper option. Now it’s different 🙂

New reader
New reader
6 years ago

Thanks for this blog! This scheme sounds like a good option for you at the moment. Although this is one of the reasons why I am so happy to live in Europe, where our tax money pays for healthcare. Of course there are differences between healthcare systems even within the EU countries – in the UK it is all free, for instance. I am living and working in Belgium, although I come originally from Scandinavia. At the moment my husband and I are registered at a medical centre 50 metres from our house, and we get doctors’, nurses’ and physio… Read more »

Andrew
Andrew
6 years ago
Reply to  New reader

Your healthcare isn’t “free” you dolt. It’s paid for by increased taxes.

How is this so hard to understand?

It drives me berserk when I hear people from other countries say it’s “free” when it’s basically prepaid by your increased taxes.

New reader
New reader
5 years ago
Reply to  Andrew

Well, of course someone has to pay for the costs of healthcare in every system. But did you know that the USA spend by far more money per capita for healthcare than any other country in the world? http://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_%28PPP%29_per_capita

I would rather pay taxes for good public services than live in fear that cancer or some other illness could make me and my family bankrupt.

Sarah Rice
Sarah Rice
1 year ago
Reply to  Andrew

I am all with New Reader. Even after paying income tax and all the Insurance Premium, the Cost of Healthcare still is expensive here in US. We all know that US is one of the countries that have the highest healthcare cost.
https://www.fool.com/investing/general/2013/06/15/7-countries-with-the-highest-health-care-costs.aspx

Lisa
Lisa
1 year ago
Reply to  New reader

You get what you pay for. That’s certainly why you see Saudi royalty conducting their medical tourism in the US and taking up wings in NY hospitals rather than in Europe or the UK. I’m a US citizen and have also lived abroad, and while there are some pros to the universal model as found in the UK, Europe and Canada, there are also some definite negatives that I’ve personally run into, and I’m always shocked at how quickly some citizens of those countries are to dismiss them, including: – waitlists for surgeries and even routine procedures that can become… Read more »

Neel Kumar
Neel Kumar
6 years ago

Author says: Just FYI, they do not recommend paying bills that are over $1,000.

So, who is going to pay those bills?

Lisa Aberle
Lisa Aberle
6 years ago
Reply to  Neel Kumar

I asked for a clarification edit, but I meant that they don’t recommend that I *personally* pay bills over $1000. Instead, those bills should be sent to the cost-sharing association and they would negotiate with the provider directly.

Bella
Bella
6 years ago

So, does having this alternative coverage ‘count’ under the ACA – or will you have to pay additionally the penalty for not having health insurance?

Lisa Aberle
Lisa Aberle
6 years ago
Reply to  Bella

These options do count. No penalty. But don’t just take my word for it…you can find the specific verbiage on each of the websites.

Daniel
Daniel
6 years ago
Reply to  Bella

I’m curious about this too. What I read on the websites seems a little sketchy WRT ACA. They don’t cite a specific regulation, etc. that states these plans “count”.

Lisa Aberle
Lisa Aberle
6 years ago
Reply to  Daniel

Daniel,
Hopefully this will help: http://www.chministries.org/downloads/ACAInsert.pdf

Eliza
Eliza
6 years ago

Thank you for sharing this option! This is a great idea I had never heard of before. My own experience without health insurance recently (sounds similar to yours — pre-existing condition meant no private insurance and other options were too expensive) caused me to learn about preventive care and first aid and basic health treatments, and as a result I completely changed my eating/health habits and have learned to treat certain minor conditions myself rather than going to the doctor, so that has helped me reduce healthcare costs greatly. Plus, I am healthier than I was 5 years ago, due… Read more »

Janice
Janice
6 years ago

Good for you!! A recent article in the New York Times highlighted the exhorbitant fees hospitals charge because they can because there is no transparency and the insurance companies just go along with paying their portion of those charges and…wait for it….pass that on to us!!! What a surprise. Hospital costs account for about 30% of rising insurance costs. One of the highlights of the article was the disparity between what one hospital/lab charges for procedures vs. another in the same area. You might think one hospital is consistently cheaper only to find out for one particular surgery/procedure they are… Read more »

spiralingsnails
spiralingsnails
6 years ago
Reply to  Janice

Unfortunately, I’m not so confident that the whole market will move towards cost transparency. While the cheapest providers will want to advertise their low rates (to attract budget-conscious patients), all the moderate and expensive providers will want to hide or obfuscate their rates instead.

Susan
Susan
6 years ago

Actually, if you have had insurance coverage and move to a new policy within 60 days, you can’t be deneid or made to wait for coverage of pre-existing conditions. This provision was part of the HIPAA legislation and I’ve changed jobs and purchaced individual insurance all without problems for my pre-existing conditions. You need to provide a certificate of creditable coverage from your last insurer and can’t have gone more than 63 days without coverage.

Lisa Aberle
Lisa Aberle
6 years ago
Reply to  Susan

This is good to know, but I wonder why I was denied when I was looking, especially since I had coverage while I was looking? Anyway, it no longer matters for me, but thank you for bringing up that point for the rest of the readers.

Tawnya Greene
Tawnya Greene
6 years ago

Same here. I never knew about these until I read this post. Thanks. Anyhow, I cannot imagine living without a health insurance as life can be very unpredictable. Keeping a part of your income for it can somehow give you an assurance that you’re covered if something ill happens. It’s one thing I am willing to save for but unwilling to make the most out of. Who wants to get sick, right?

Tyler Karaszewski
Tyler Karaszewski
6 years ago

This sounds way worse than just buying normal health insurance, especially post-obamacare when you *have* to be covered and it is effectively illegal not to be. And this *is* health insurance, they just don’t call it that. But I guess if you really like paying for insurance *and* paying for your own bills *and* negotiating your own healthcare rates *and* having lifestyle imitations set for you, cool, do this thing, then. I just can’t see any reason why anyone would actually pick it over a normal ACA health plan except religious fanaticism or something.

Lisa Aberle
Lisa Aberle
6 years ago

Tyler, I knew I could count on you to rain on my parade ;).

SAHMama
SAHMama
6 years ago

I agree with Tyler. My health issues are between my husband, doctor, insurance company and me. I don’t need any big network or people at church finding out about my health problems. Also, who’s to say that something isn’t going to be denied. Perhaps you caught HPV back in your younger days from your first and only partner before you met your spouse. And now, that HPV resulted in cervical cancer. A religious network could deny payment for that. Or perhaps you used to smoke, or used to be alcoholic, and now you’ve got COPD, or lung cancer, or cirrhosis.… Read more »

Lisa Aberle
Lisa Aberle
6 years ago
Reply to  SAHMama

Let me try to explain it better: For my particular organization, I send my monthly “premium” to the organization. They pay other members’ bills, so no one is depending on individuals sending them a check. I know that other organizations may do things differently. And no one individual will find out about any condition that I have unless I petition to have my need posted on the extra help page (the needs that may have been pre-existing or something like that). If so, then it would say something like Lisa Aberle, pancreatic cancer, still has $400 in unpaid bills or… Read more »

Tyler Karaszewski
Tyler Karaszewski
6 years ago
Reply to  Lisa Aberle

then it would say something like Lisa Aberle, pancreatic cancer, still has $400 in unpaid bills or something like that.

Oh man, I hope you never actually get cancer, but even more so if that’s what you think it’s going to be like from a cost perspective. Wait till you get a medical bill for $92,000 and you have to post on your group website about “needing more help to cover it”. I’d rather have real insurance that handles those bills for me.

Lisa Aberle
Lisa Aberle
6 years ago
Reply to  Lisa Aberle

Tyler, not sure why it won’t let me reply to your comment, but anyhoo… Whoa, I am doing a bad job of explaining. First, I actually have already had cancer, so I know that $400 is a couple of lab tests, or, like, 10% of a CT. Second, if I developed an unrelated cancer tomorrow with bills upwards of $100,000 (which as you know, unfortunately, is probably low), I would submit those bills to be paid. I wouldn’t go on the ineligible needs list that I mentioned. If, however, I had an umbilical hernia when I became part of this… Read more »

JayEll
JayEll
6 years ago
Reply to  Lisa Aberle

Lisa, it sounds to me like a Ponzi scheme. A friend of mine had a “plan” like this, and she was waiting and waiting to be reimbursed for the bills she had to pay out of pocket–and eventually the company told her that she would get paid when they got enough money to pay her. In other words, they had to have enough premiums come in before they could pay claims. It’s no wonder that the medical providers insisted on up-front payment. With the ACA, you can find real insurance from bona fide companies that is affordable. I hope you’ve… Read more »

Kristen
Kristen
6 years ago

The hair on the back of my neck stands on end whenever I hear of religious organizations getting involved in things like this. It’s just the principle of the whole thing. Churches get breaks – they don’t pay taxes – and they are allowed to discriminate against people based on whatever they like, so long as they claim it’s part of their religious tradition. What if the exclusion had to do with skin color, or sexual orientation, or use of birth control, rather than drinking, etc.? (and what about drinking? it’s a legal activity and alcohol can be used responsibly)… Read more »

Ramblin' Ma'am
Ramblin' Ma'am
6 years ago
Reply to  Kristen

“What if the exclusion had to do with skin color, or sexual orientation, or use of birth control, rather than drinking, etc.? (and what about drinking? it’s a legal activity and alcohol can be used responsibly)” Are we so sure that sexual orientation ISN’T excluded? Lisa’s post mentions “certain guidelines,” of which limited alcohol use is only one. Lisa, are there other guidelines about sexuality, marital status, etc? Could a cohabitating, unmarried straight couple qualify? I ask not because I think all Christians believe homosexuality is wrong, but because I wouldn’t be surprised if a company providing Christians-only health care… Read more »

Lisa Aberle
Lisa Aberle
6 years ago
Reply to  Ramblin' Ma'am

For one of the plans, this is taken from the initial application: “By signing below, I attest that the participating ADULT members included herein are Christians living by New Testament
principles, attend group worship regularly (health permitting), follow scriptural teaching with regard to alcohol, and do not
use tobacco or use drugs illegally. I also attest that all information provided herein is true to the best of my knowledge.”

Kristen
Kristen
6 years ago
Reply to  Ramblin' Ma'am

One more thing- if it looks like a duck, and it quacks like a duck… this is insurance. It ought to be subject to the law just like any other insurance provider.

BD
BD
6 years ago
Reply to  Kristen

@Kristen: And we feel precisely the same way when the government sticks its fingers into things like healthcare, and regulates it to the point where it makes religious people do things contrary to their religion (ie, the Catholic church being forced to supply birth control, even though it’s against their religion). For the record, no, I am not Catholic, and I am very much for birth control.

If only the government would stop trying to nanny every single detail of everyone’s lives.

Kristen
Kristen
6 years ago
Reply to  BD

BD- The government isn’t forcing anyone to take birth control. If an organization wants to offer health insurance, it needs to meet certain standard requirements. Period. Birth control is one of them. It is not my employer’s right to determine my access to birth control. It’s MY personal decision whether or not to use it. We’re not going to agree on this no matter what, I can tell…

James
James
6 years ago
Reply to  BD

Glad to find a liberal biggot with nothing to do but reply several times to a blog, aimed at giving honest alternatives to those without health insurance.

Kristen
Kristen
6 years ago
Reply to  BD

For some reason this won’t let me reply to James. Wow, James. Way to throw nameThat’s always a mature way to put forth a good argument. My suggestion was to make our cultural options, regardless of religious belief, better. I think everyone should have insurance. We should be able disagree about how to do what is best for people overall while preserving the most individual freedom for people without resorting to calling people names.

Andrea
Andrea
6 years ago

That’s one of the perks of being adopted, is that you don’t know anything about your health history, and therefore can’t be discriminated against. No one asks anything after you put “adopted” on the forms.

Andrea
Andrea
6 years ago

Which cost-sharing plan did you go with specifically Lisa?

Lisa Aberle
Lisa Aberle
6 years ago
Reply to  Andrea

I went with Christian Healthcare Ministries.

Stace
Stace
6 years ago

While I can see the benefits of using this as a bridge plan, I certainly wouldn’t want to use it long term or use this as coverage for children. It sounds like you have to pay for every single office visit out of pocket then (assuming office visits are under the $500 cap)and kids can generate a LOT of office visits. It also sounds like you have very little protection if they disband/decide not to pay.

Lisa Aberle
Lisa Aberle
6 years ago
Reply to  Stace

I understand your hesitation as it is a nontraditional option. As I mentioned in the article, my parents (and their 7 children) had this for years. For my parents, especially at that time, it was a much less expensive option, even considering paying out of pocket for office visits. Fortunately, we were rarely sick and I think only one of the kids had a surgery and two of us had stitches before the age of 18. I do wonder if we went to the doctor less because it would have cost us more? Not that my parents were neglectful, but… Read more »

stellamarina
stellamarina
6 years ago
Reply to  Stace

Can I just say here too that I think some parents take their kids way to much to the doctor!

Tie the Money Knot
Tie the Money Knot
6 years ago

That is a good point in the post regarding asking for a discount. In other areas outside of health care self-pay, in totally different situations altogether, it can be beneficial to ask. There is often very little to lose by simply asking, and the potential rewards in terms of savings can be substantial.

Cindy @ GrowingHerWorth
Cindy @ GrowingHerWorth
6 years ago

It does make a huge difference when you have some “skin in the game”. I have a great insurance plan, but ended up having a lot of medical expenses this year. I’d already met my deductible for the year and knew I’d be paying a 20% coinsurance when I needed an MRI for an ankle injury. I used my insurance’s website to compare costs between facilities. It wasn’t easy; there were numerous types of ankle MRI’s listed, and I wasn’t exactly sure which one was the one I needed. The list of facilities was extensive, and the price range was… Read more »

Jane
Jane
6 years ago

I find it highly unlikely that these plans would ever end up paying for major, catastrophic illnesses that reached into the hundreds of thousands or even millions of dollars. Color me skeptical, but wouldn’t they find a way to renege on it? If they are not bound by the ACA and the new caps on yearly maximums, what guarantee do you have at all that they would pay out? Take, for instance, a friend of mine who managed to rack up a million dollar hospital bill in five months. This might be improbable, but it is possible. She was in… Read more »

SAHMama
SAHMama
6 years ago
Reply to  Jane

In 1982, my sister was born at 23 1/2 weeks of gestation at a Catholic hospital with no doctor in the room. My mom had been hemorrhaging for a week, had been sent home only to return later in the day gushing blood. They thought she was having a stillbirth. She and my sister almost died. My sister was taken to the nearest high level NICU and had immediate open heart surgery to repair a heart defect. She was released from the ICU when she was 7 1/2 months old and finally weighed 6 pounds. She went home on oxygen… Read more »

Trace @ Independence Investor
Trace @ Independence Investor
6 years ago

Thank you for sharing this unique option. I was not aware of this offering.

My prior health insurance plan was a High Deductible HSA Plan. I also found myself negotiating with providers to keep costs low. If you are a self payer, it’s important to research what the Usual, Customary and Reasonable charge is for each procedure. This is the amount third-party payers use to determine how much will be paid. I would definitely not pay over UCR.

Petra
Petra
6 years ago

So while they don’t want to call it health insurance, it’s health insurance: you pay a certain amount of money each month, and when you get ill, you get a certain amount reimbursed.

The lenghts people will go to to call something something else…

Andrew
Andrew
6 years ago

I am a health insurance actuary who works on issues related to the solvency of insurance companies every day. If you plan to enroll in a health care sharing ministry (HCSM), like those described in this article, you need to do your due diligence to ascertain (1) whether the finances of the HCSM are sound, and (2) the extent to which your state regulates these entities. In many states, there may be very little regulation of these entites and virtually no protections against insolvency. In short, there is little guarantee that your claims will be paid if you or others… Read more »

Scott
Scott
6 years ago

Thanks for the interesting article. As I’m working in the medical field, I am interested in these issues as well as alternatives to Obamacare, which none of my colleagues like. I ran this idea of a faith-based “insurance” by my father, a retired physician. Here’s what he said: These are always interesting, sound good, and I refer to them as “co-op” plans. They are often “sponsored” by a group that sounds respectable, and make you believe that you belong to it. Some may actuality be valid, but they are unregulated, they are not insurance groups, and often have minimal money… Read more »

Diane C
Diane C
6 years ago

Before I was FIRE, I traveled on business and binged on hotel cable.

IIRC, the Duggar Family (19 Kids, etc…) utilizes such a program to cover their family’s medical needs. I know their last baby was very premature and ran up huge NICU expenses. Does anyone know if their plan covered them? (I don’t travel for work anymore, so I don’t know the “Rest of the Story”.)

Obgyn mountain view, ca
Obgyn mountain view, ca
6 years ago

Cool stuff well surviving with out health insurance is difficult now days.

talkcarinsurance
talkcarinsurance
6 years ago

It is a great story to show how insurance really work. You have formed a small insurance funds to pay for each others costs. The only difference is that you are not charged premium that is calculated based on your age and risk factor. Main determinant for how much you should pay seems to be deductible.

However, your plan is mainly based on trust that nobody will try to cheat the system. That is why it may be important that you are recommended or pass some sort of screening.

Shamim
Shamim
6 years ago

Is is affordable each people in every country to maintain health care (insurance fee)

Shiv Sharma
Shiv Sharma
6 years ago

My parents have a health insurance card and that making more support for them….I hope every people should have health insurance……

bellyfat
bellyfat
5 years ago

but since I am on the hook for more of my costs, I am trying to be more healthful in general so my costs stay down over time.

Ivan Washington
Ivan Washington
3 years ago

too bad it is not available to us heathens. 😐

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