This article is by staff writer Lisa Aberle.
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 planâ€¦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 complicatedâ€¦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: