The Money Mustache Community
Learning, Sharing, and Teaching => Ask a Mustachian => Topic started by: boarder42 on January 14, 2017, 09:33:29 AM
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With all the talk of the ACA going belly up etc.
Why aren't more mustachians looking at health share
I know the big caveat with these is they don't take pre existing conditions. So lets not debate that here. Let's assume you have none
Another great thing is they don't accept obese or smokers.
http://www.medicalcostshare.com/liberty-healthshare-program-options.html
Anyone doing this ? Seems like a great option for catastrophic coverage. A family pays 449 per month plus the first 1500 out of pocket and the parent company does the negotiations for everyone including your initial 1500.
6888 per year for a family doesn't seem extreme
The operate as a non profit think insurance = bank - health share = credit union
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Anybody?
Comments?
Info?
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We have belonged to Samaritan Ministries since 5/15. It is the only one of the 4 Christian health sharing groups that has you pay other people directly. The office sends you (I'm signed up to do everything online) a notice to send this month's share to John Doe in Texas, and you mail him a check for your "premium" amount, $440 currently for me and DH. The last 2 months the needs have been less than the total that would have come in, so we paid less. The also have "special prayer needs" so you can voluntarily send money, usually $20 or $25, to people to cover preexisting conditions or other things like dental that aren't covered - we send this, too. If you don't pay your regular amount you are dropped (I've heard people say this can't work because nobody will pay). Their website has details on what's covered and the requirements for membership.
I was in the ER twice in December so have sent in my first bills. The hospital would not negotiate the price, so a third party negotiator is dealing with that part. I'm responsible for the first $300, if the bills are discounted at least $300 I pay nothing. I'll repost to update how things are working.
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awesome thanks for the information. looking forward to hearing how it goes.
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Awesome!
We need more choices like this. All the accursed regulation/legislation is limiting our choices! grrrr... 'Insurance' was originally just a group of people sharing risk. Fire insurance, crop insurance - they'd all pitch in a small amount, and when something bad happened, the victim was covered.
I hope we can go back to that model. Buy what you need, even if that's nothing at all. My grandparents had true 'catastrophic' insurance (something like $20k deductible) for around $200/yr for the 2 of them through their professional society. It came in handy for them once or twice. Good luck!
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I won't do it because it is not considered insurance which means even if you don't have any now, if you get one, no other insurance will cover you.
Also, the religious stuff bothers me, I already don't want someone telling me to live according to Christian values, I don't need my imitation insurance company doing the same.
And then we get to the lack of oversight and out right fraud with those ministries.
No thanks.
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I won't do it because it is not considered insurance which means even if you don't have any now, if you get one, no other insurance will cover you.
Also, the religious stuff bothers me, I already don't want someone telling me to live according to Christian values, I don't need my imitation insurance company doing the same.
And then we get to the lack of oversight and out right fraud with those ministries.
No thanks.
Sent from my SPH-L710 using Tapatalk
at its heart its litterally what insurance was when it started before it became a profiteering business.
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With current employer they would not cover my wife since she if eligible for insurance through her job. She is a teacher making $35,000/year and her insurance would have been $1,400/month to just cover her through her school's plan so we said no thank you. We moved her to Liberty in April but have not had any claims so cannot say much about it other than the cost is $199/month which is much better.
I've not heard the "it's not insurance" point before. I understood the ACA allows it to be used instead but did not understand it precludes you in anyway from getting covered again. Is this in reference to pre-existing conditions? Where can I read more about this?
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With current employer they would not cover my wife since she if eligible for insurance through her job. She is a teacher making $35,000/year and her insurance would have been $1,400/month to just cover her through her school's plan so we said no thank you. We moved her to Liberty in April but have not had any claims so cannot say much about it other than the cost is $199/month which is much better.
I've not heard the "it's not insurance" point before. I understood the ACA allows it to be used instead but did not understand it precludes you in anyway from getting covered again. Is this in reference to pre-existing conditions? Where can I read more about this?
i dont think it precludes you from ever being covered again. not the way the current ACA is written but who knows with a future one.
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I've read that these schemes are under no contractual obligation to provide any payment to members whatsoever, so if something happens that's too expensive they could just decide not to pay for it and you would have no recourse. I don't know how common this is in practice, but it would give me pause.
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I've read that these schemes are under no contractual obligation to provide any payment to members whatsoever, so if something happens that's too expensive they could just decide not to pay for it and you would have no recourse. I don't know how common this is in practice, but it would give me pause.
yes this is 100% true though most have never not paid a claim. and you can look all that up.
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I've read that these schemes are under no contractual obligation to provide any payment to members whatsoever, so if something happens that's too expensive they could just decide not to pay for it and you would have no recourse. I don't know how common this is in practice, but it would give me pause.
That is accurate, but the major three have consistently paid their claims. Since it is a pooling process when we looked that was a prime things we looked at was the total members, because if you have 30,000 members and you have $100,000 bill you can get that $3+ for each member who has paid, versus the smaller companies that have many fewer members and may not have the funds.
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With current employer they would not cover my wife since she if eligible for insurance through her job. She is a teacher making $35,000/year and her insurance would have been $1,400/month to just cover her through her school's plan so we said no thank you. We moved her to Liberty in April but have not had any claims so cannot say much about it other than the cost is $199/month which is much better.
I've not heard the "it's not insurance" point before. I understood the ACA allows it to be used instead but did not understand it precludes you in anyway from getting covered again. Is this in reference to pre-existing conditions? Where can I read more about this?
Here is a law journal article:
http://engagedscholarship.csuohio.edu/cgi/viewcontent.cgi?article=1341&context=jlh
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We signed up for Liberty this year. I'm a teacher and my health premium is only $70. However, my wife would raise the premium to $950, and family to $1300. This is with a $6000 deductable. Now, to make matters more interesting is two of my three children are covered by CHIP, but because my adopted / step daughter is a permanent resident and has been a PR less than five years (Permanent Residency is calculated by when it was approved, not when one landed in the country, she legally immigrated to the U.S. when she was six months, but USCIS didn't approve her application until three years later) she doesn't qualify for benefits in Texas. So, went to Liberty because to be frank, we cannot afford to devote a third of my salary to health insurance with a de facto catastrophic deductible. We haven't used it, but we also called many times beforehand to be clear what the riders and exceptions were. In addition, we also called the doctors and hospitals around to get their cost list and to explain the program to have an idea of which ones to use. Luckily all our doctors and preferred hospitals said they did not have a problem with it. One reason we went with Liberty over others was their allowance of ambulances and medical devices in home up to the 1 million limit.
Are we taking a risk? sure. Do I feel comfortable with it. After a lot of research, and understanding the limits and exceptions. Yes.
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With current employer they would not cover my wife since she if eligible for insurance through her job. She is a teacher making $35,000/year and her insurance would have been $1,400/month to just cover her through her school's plan so we said no thank you. We moved her to Liberty in April but have not had any claims so cannot say much about it other than the cost is $199/month which is much better.
I've not heard the "it's not insurance" point before. I understood the ACA allows it to be used instead but did not understand it precludes you in anyway from getting covered again. Is this in reference to pre-existing conditions? Where can I read more about this?
Here is a law journal article:
http://engagedscholarship.csuohio.edu/cgi/viewcontent.cgi?article=1341&context=jlh
anyone want to summarize the 67 pages of legal jargin.
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With current employer they would not cover my wife since she if eligible for insurance through her job. She is a teacher making $35,000/year and her insurance would have been $1,400/month to just cover her through her school's plan so we said no thank you. We moved her to Liberty in April but have not had any claims so cannot say much about it other than the cost is $199/month which is much better.
I've not heard the "it's not insurance" point before. I understood the ACA allows it to be used instead but did not understand it precludes you in anyway from getting covered again. Is this in reference to pre-existing conditions? Where can I read more about this?
Here is a law journal article:
http://engagedscholarship.csuohio.edu/cgi/viewcontent.cgi?article=1341&context=jlh
anyone want to summarize the 67 pages of legal jargin.
Not health insurance, they don't want to be health insurance because then they have to follow those rules. Some states want them to be considered health insurance, some don't. Some think even if it is, it should not have to follow the laws because religion. Then religion, religion, religion. How healthshares relate to ACA, and why those statements means states cannot treat them like insurance.
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With current employer they would not cover my wife since she if eligible for insurance through her job. She is a teacher making $35,000/year and her insurance would have been $1,400/month to just cover her through her school's plan so we said no thank you. We moved her to Liberty in April but have not had any claims so cannot say much about it other than the cost is $199/month which is much better.
I've not heard the "it's not insurance" point before. I understood the ACA allows it to be used instead but did not understand it precludes you in anyway from getting covered again. Is this in reference to pre-existing conditions? Where can I read more about this?
Here is a law journal article:
http://engagedscholarship.csuohio.edu/cgi/viewcontent.cgi?article=1341&context=jlh
anyone want to summarize the 67 pages of legal jargin.
Not health insurance, they don't want to be health insurance because then they have to follow those rules. Some states want them to be considered health insurance, some don't. Some think even if it is, it should not have to follow the laws because religion. Then religion, religion, religion. How healthshares relate to ACA, and why those statements means states cannot treat them like insurance.
My interest and concern is more about the claim that once you have this you cannot be covered under insurance again.
I understand it is not insurance, but nowhere have I ever seen a problem moving back to standard insurance if the opportunity presents itself.
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With current employer they would not cover my wife since she if eligible for insurance through her job. She is a teacher making $35,000/year and her insurance would have been $1,400/month to just cover her through her school's plan so we said no thank you. We moved her to Liberty in April but have not had any claims so cannot say much about it other than the cost is $199/month which is much better.
I've not heard the "it's not insurance" point before. I understood the ACA allows it to be used instead but did not understand it precludes you in anyway from getting covered again. Is this in reference to pre-existing conditions? Where can I read more about this?
Here is a law journal article:
http://engagedscholarship.csuohio.edu/cgi/viewcontent.cgi?article=1341&context=jlh
anyone want to summarize the 67 pages of legal jargin.
Not health insurance, they don't want to be health insurance because then they have to follow those rules. Some states want them to be considered health insurance, some don't. Some think even if it is, it should not have to follow the laws because religion. Then religion, religion, religion. How healthshares relate to ACA, and why those statements means states cannot treat them like insurance.
well yes that is their loop hole out of the ACA. I think there are reasonable risks with using one. and i'm not "religious" but many dont require that anymore. but thats what insurance is about mitigating risk for a price. is there a risk paying into this if they fold yes. If the law for insurance ever says you must have what we classify as insurance from age 2x on or you wont have any pre existing conditions covered i think the risk with using something like this increases. on the flip side i think the costs are much more reasonable and provdie a cap to the level of catastrophic coverage available. but i wont have to cross this bridge til i'm FIREd so we have 7 years to see what unfolds in the health coverage market place.
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With current employer they would not cover my wife since she if eligible for insurance through her job. She is a teacher making $35,000/year and her insurance would have been $1,400/month to just cover her through her school's plan so we said no thank you. We moved her to Liberty in April but have not had any claims so cannot say much about it other than the cost is $199/month which is much better.
I've not heard the "it's not insurance" point before. I understood the ACA allows it to be used instead but did not understand it precludes you in anyway from getting covered again. Is this in reference to pre-existing conditions? Where can I read more about this?
Here is a law journal article:
http://engagedscholarship.csuohio.edu/cgi/viewcontent.cgi?article=1341&context=jlh
anyone want to summarize the 67 pages of legal jargin.
Not health insurance, they don't want to be health insurance because then they have to follow those rules. Some states want them to be considered health insurance, some don't. Some think even if it is, it should not have to follow the laws because religion. Then religion, religion, religion. How healthshares relate to ACA, and why those statements means states cannot treat them like insurance.
My interest and concern is more about the claim that once you have this you cannot be covered under insurance again.
I understand it is not insurance, but nowhere have I ever seen a problem moving back to standard insurance if the opportunity presents itself.
correct. see my post i just made as you were posting this. thats my only real risk concern ... is IF you dont have "real insurance" coverage non stop with no gaps from age 2x on in your life you will not be covered under the pre existing conditions clause. or something to that effect.
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With current employer they would not cover my wife since she if eligible for insurance through her job. She is a teacher making $35,000/year and her insurance would have been $1,400/month to just cover her through her school's plan so we said no thank you. We moved her to Liberty in April but have not had any claims so cannot say much about it other than the cost is $199/month which is much better.
I've not heard the "it's not insurance" point before. I understood the ACA allows it to be used instead but did not understand it precludes you in anyway from getting covered again. Is this in reference to pre-existing conditions? Where can I read more about this?
Here is a law journal article:
http://engagedscholarship.csuohio.edu/cgi/viewcontent.cgi?article=1341&context=jlh
anyone want to summarize the 67 pages of legal jargin.
Not health insurance, they don't want to be health insurance because then they have to follow those rules. Some states want them to be considered health insurance, some don't. Some think even if it is, it should not have to follow the laws because religion. Then religion, religion, religion. How healthshares relate to ACA, and why those statements means states cannot treat them like insurance.
well yes that is their loop hole out of the ACA. I think there are reasonable risks with using one. and i'm not "religious" but many dont require that anymore. but thats what insurance is about mitigating risk for a price. is there a risk paying into this if they fold yes. If the law for insurance ever says you must have what we classify as insurance from age 2x on or you wont have any pre existing conditions covered i think the risk with using something like this increases. on the flip side i think the costs are much more reasonable and provdie a cap to the level of catastrophic coverage available. but i wont have to cross this bridge til i'm FIREd so we have 7 years to see what unfolds in the health coverage market place.
That I can understand. If the law CHANGES, from what it is now, and there is a pre-existing condition you'd be back in the same boat, but that's what the people now on ACA plans are worried about anyway. I get we need to monitor the rule changes and unless they are entirely irresponsible about how they go about making these changes, you would assume there will a grace period to re-establish traditional insurance coverage. I had understood that under current conditions there was something that forbade you from ever moving back to traditional insurance. I understand that is not the case now, which is what I had thought.
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With current employer they would not cover my wife since she if eligible for insurance through her job. She is a teacher making $35,000/year and her insurance would have been $1,400/month to just cover her through her school's plan so we said no thank you. We moved her to Liberty in April but have not had any claims so cannot say much about it other than the cost is $199/month which is much better.
I've not heard the "it's not insurance" point before. I understood the ACA allows it to be used instead but did not understand it precludes you in anyway from getting covered again. Is this in reference to pre-existing conditions? Where can I read more about this?
Here is a law journal article:
http://engagedscholarship.csuohio.edu/cgi/viewcontent.cgi?article=1341&context=jlh
anyone want to summarize the 67 pages of legal jargin.
Not health insurance, they don't want to be health insurance because then they have to follow those rules. Some states want them to be considered health insurance, some don't. Some think even if it is, it should not have to follow the laws because religion. Then religion, religion, religion. How healthshares relate to ACA, and why those statements means states cannot treat them like insurance.
well yes that is their loop hole out of the ACA. I think there are reasonable risks with using one. and i'm not "religious" but many dont require that anymore. but thats what insurance is about mitigating risk for a price. is there a risk paying into this if they fold yes. If the law for insurance ever says you must have what we classify as insurance from age 2x on or you wont have any pre existing conditions covered i think the risk with using something like this increases. on the flip side i think the costs are much more reasonable and provdie a cap to the level of catastrophic coverage available. but i wont have to cross this bridge til i'm FIREd so we have 7 years to see what unfolds in the health coverage market place.
That I can understand. If the law CHANGES, from what it is now, and there is a pre-existing condition you'd be back in the same boat, but that's what the people now on ACA plans are worried about anyway. I get we need to monitor the rule changes and unless they are entirely irresponsible about how they go about making these changes, you would assume there will a grace period to re-establish traditional insurance coverage. I had understood that under current conditions there was something that forbade you from ever moving back to traditional insurance. I understand that is not the case now, which is what I had thought.
The problem is that if you have a pre-existing condition and are on a heathshare there is no transitioning back on transitional insurance and having your condition covered if the law changes (which seems likely). I was unwilling to assume the law would never change which meant going without insurance was not an option for me. Being aware that because it is not insurance you don't have the same protection, as you make your choice, seems important to me.
Sent from my SPH-L710 using Tapatalk
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What's the yearly and lifetime limits for these plans? There's a reason that limits were banned under the ACA.
MAXIMUM: For Liberty Share℠ and Liberty Plus℠ $125,000 per incident
<or>
Liberty Complete℠ MAXIMUM: $1,000,000 per incident
Do these plans cover prescriptions and is there a limit?
Prescriptions 45 days before and after each related medical incident
If the illness lasts longer than 45 days, you're SOL?
Underwriting is allowed. What's their stated policy of kicking someone out if they get a chronic illness and send in $5000 bills each month?
These plans might be good for a minor to serious accident/illness. For a serious and chronic condition, you're better off with a regulated plan. It then becomes, like all insurance, a numbers game -- what are the odds I'll get a chronic illness?
With good underwriting, these plans can exclude the sick and going-to-be-sick and avoid a death spiral. Kinda like regulated plans did before the ACA.
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What's the yearly and lifetime limits for these plans? There's a reason that limits were banned under the ACA.
MAXIMUM: For Liberty Share℠ and Liberty Plus℠ $125,000 per incident
<or>
Liberty Complete℠ MAXIMUM: $1,000,000 per incident
Do these plans cover prescriptions and is there a limit?
Prescriptions 45 days before and after each related medical incident
If the illness lasts longer than 45 days, you're SOL?
Underwriting is allowed. What's their stated policy of kicking someone out if they get a chronic illness and send in $5000 bills each month?
These plans might be good for a minor to serious accident/illness. For a serious and chronic condition, you're better off with a regulated plan. It then becomes, like all insurance, a numbers game -- what are the odds I'll get a chronic illness?
With good underwriting, these plans can exclude the sick and going-to-be-sick and avoid a death spiral. Kinda like regulated plans did before the ACA.
well under the current system as it sits now you just go to an ACA plan. not saying that wont change but its really the only reason someone wouldnt use this right now is if you have a chronic illness. if you do jump over to the ACA as it sits right now the next open enrollment.
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well under the current system as it sits now you just go to an ACA plan. not saying that wont change but its really the only reason someone wouldnt use this right now is if you have a chronic illness. if you do jump over to the ACA as it sits right now the next open enrollment.
True but there could as long as an 10+ month gap, right? You'd get diagnosed with breast cancer on 2/16 and have to wait until 1/1 for a regulated plan. In the meantime, you can send in your large and non-negotiated bills to the share and hope they get covered. Have you seen a $35000 mastectomy bill show up in your share? What about a $4500/month bill for Herceptin treatment? What about adding in Perjeta -- the combined monthly cost is now about $10k?
These plans are only for the young and healthy.
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well under the current system as it sits now you just go to an ACA plan. not saying that wont change but its really the only reason someone wouldnt use this right now is if you have a chronic illness. if you do jump over to the ACA as it sits right now the next open enrollment.
True but there could as long as an 10+ month gap, right? You'd get diagnosed with breast cancer on 2/16 and have to wait until 1/1 for a regulated plan. In the meantime, you can send in your large and non-negotiated bills to the share and hope they get covered. Have you seen a $35000 mastectomy bill show up in your share? What about a $4500/month bill for Herceptin treatment? What about adding in Perjeta -- the combined monthly cost is now about $10k?
These plans are only for the young and healthy.
i dont know that hope they are covered is the right answer. Liberty hasnt ever not paid a bill ... and based on the size and time they've been around someone got cancer.
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its a cost ratio.
just like choosing and HDHP over a PPO etc.
if its 12k per year to insure my family of 4 on typical healthcare plus a crazy 10k deductible on top vs 6k per year to insure on health share. the break even time on something thats 10k per month isnt that long. even if you had to start using it in Jan and then wait to switch... its math. all insurance is a math risk game. but you're talking extreme cases still which i think this type of "insurance" paired with possibly going on a regular plan could work well for a mustachian who is FIREd
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well under the current system as it sits now you just go to an ACA plan. not saying that wont change but its really the only reason someone wouldnt use this right now is if you have a chronic illness. if you do jump over to the ACA as it sits right now the next open enrollment.
True but there could as long as an 10+ month gap, right? You'd get diagnosed with breast cancer on 2/16 and have to wait until 1/1 for a regulated plan. In the meantime, you can send in your large and non-negotiated bills to the share and hope they get covered. Have you seen a $35000 mastectomy bill show up in your share? What about a $4500/month bill for Herceptin treatment? What about adding in Perjeta -- the combined monthly cost is now about $10k?
These plans are only for the young and healthy.
i dont know that hope they are covered is the right answer. Liberty hasnt ever not paid a bill ... and based on the size and time they've been around someone got cancer.
It was a trick question. :) Liberty only covers prescription drugs for 45 days before and after the incident.
Being part of a sharing club and also having a regulated very high-deductible plan might make sense. You'd be covered for minor to mid-range incidents and also covered for extreme illnesses. And if there was a scandal and a director was wasting money on hookers and blow, you'd have a fall back.
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well under the current system as it sits now you just go to an ACA plan. not saying that wont change but its really the only reason someone wouldnt use this right now is if you have a chronic illness. if you do jump over to the ACA as it sits right now the next open enrollment.
True but there could as long as an 10+ month gap, right? You'd get diagnosed with breast cancer on 2/16 and have to wait until 1/1 for a regulated plan. In the meantime, you can send in your large and non-negotiated bills to the share and hope they get covered. Have you seen a $35000 mastectomy bill show up in your share? What about a $4500/month bill for Herceptin treatment? What about adding in Perjeta -- the combined monthly cost is now about $10k?
These plans are only for the young and healthy.
i dont know that hope they are covered is the right answer. Liberty hasnt ever not paid a bill ... and based on the size and time they've been around someone got cancer.
It was a trick question. :) Liberty only covers prescription drugs for 45 days before and after the incident.
Being part of a sharing club and also having a regulated very high-deductible plan might make sense. You'd be covered for minor to mid-range incidents and also covered for extreme illnesses. And if there was a scandal and a director was wasting money on hookers and blow, you'd have a fall back.
It doesn't matter you didn't listen to what I said. Who cares if it's only 45 days before and after. Under the current system I can swap to a real plan during open enrollment. No reason to carry both. The cost of the ACA plans are more than 2x the price. We're talking over 6k savings per year.
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well under the current system as it sits now you just go to an ACA plan. not saying that wont change but its really the only reason someone wouldnt use this right now is if you have a chronic illness. if you do jump over to the ACA as it sits right now the next open enrollment.
True but there could as long as an 10+ month gap, right? You'd get diagnosed with breast cancer on 2/16 and have to wait until 1/1 for a regulated plan. In the meantime, you can send in your large and non-negotiated bills to the share and hope they get covered. Have you seen a $35000 mastectomy bill show up in your share? What about a $4500/month bill for Herceptin treatment? What about adding in Perjeta -- the combined monthly cost is now about $10k?
These plans are only for the young and healthy.
i dont know that hope they are covered is the right answer. Liberty hasnt ever not paid a bill ... and based on the size and time they've been around someone got cancer.
It was a trick question. :) Liberty only covers prescription drugs for 45 days before and after the incident.
Being part of a sharing club and also having a regulated very high-deductible plan might make sense. You'd be covered for minor to mid-range incidents and also covered for extreme illnesses. And if there was a scandal and a director was wasting money on hookers and blow, you'd have a fall back.
It doesn't matter you didn't listen to what I said. Who cares if it's only 45 days before and after. Under the current system I can swap to a real plan during open enrollment. No reason to carry both. The cost of the ACA plans are more than 2x the price. We're talking over 6k savings per year.
His point is you could incur the entire chemo bill before you can do open enrollment and you'd be responsible for anything falling beyond 45 days.
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well under the current system as it sits now you just go to an ACA plan. not saying that wont change but its really the only reason someone wouldnt use this right now is if you have a chronic illness. if you do jump over to the ACA as it sits right now the next open enrollment.
True but there could as long as an 10+ month gap, right? You'd get diagnosed with breast cancer on 2/16 and have to wait until 1/1 for a regulated plan. In the meantime, you can send in your large and non-negotiated bills to the share and hope they get covered. Have you seen a $35000 mastectomy bill show up in your share? What about a $4500/month bill for Herceptin treatment? What about adding in Perjeta -- the combined monthly cost is now about $10k?
These plans are only for the young and healthy.
i dont know that hope they are covered is the right answer. Liberty hasnt ever not paid a bill ... and based on the size and time they've been around someone got cancer.
It was a trick question. :) Liberty only covers prescription drugs for 45 days before and after the incident.
Being part of a sharing club and also having a regulated very high-deductible plan might make sense. You'd be covered for minor to mid-range incidents and also covered for extreme illnesses. And if there was a scandal and a director was wasting money on hookers and blow, you'd have a fall back.
It doesn't matter you didn't listen to what I said. Who cares if it's only 45 days before and after. Under the current system I can swap to a real plan during open enrollment. No reason to carry both. The cost of the ACA plans are more than 2x the price. We're talking over 6k savings per year.
His point is you could incur the entire chemo bill before you can do open enrollment and you'd be responsible for anything falling beyond 45 days.
Maybe I don't get how chemo works but wouldn't the treatments be covered under the health share.
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well under the current system as it sits now you just go to an ACA plan. not saying that wont change but its really the only reason someone wouldnt use this right now is if you have a chronic illness. if you do jump over to the ACA as it sits right now the next open enrollment.
True but there could as long as an 10+ month gap, right? You'd get diagnosed with breast cancer on 2/16 and have to wait until 1/1 for a regulated plan. In the meantime, you can send in your large and non-negotiated bills to the share and hope they get covered. Have you seen a $35000 mastectomy bill show up in your share? What about a $4500/month bill for Herceptin treatment? What about adding in Perjeta -- the combined monthly cost is now about $10k?
These plans are only for the young and healthy.
i dont know that hope they are covered is the right answer. Liberty hasnt ever not paid a bill ... and based on the size and time they've been around someone got cancer.
It was a trick question. :) Liberty only covers prescription drugs for 45 days before and after the incident.
Being part of a sharing club and also having a regulated very high-deductible plan might make sense. You'd be covered for minor to mid-range incidents and also covered for extreme illnesses. And if there was a scandal and a director was wasting money on hookers and blow, you'd have a fall back.
It doesn't matter you didn't listen to what I said. Who cares if it's only 45 days before and after. Under the current system I can swap to a real plan during open enrollment. No reason to carry both. The cost of the ACA plans are more than 2x the price. We're talking over 6k savings per year.
His point is you could incur the entire chemo bill before you can do open enrollment and you'd be responsible for anything falling beyond 45 days.
Maybe I don't get how chemo works but wouldn't the treatments be covered under the health share.
Chemo is drugs. Prescription drugs. Chemo can often take more than 45 (or 90) days, depending on how you count it.
Also, jeez, you just have to have one kid get diagnosed with a serious congenital disease in February and you're in very real danger of reaching that $1,000,000 limit well before ACA open enrollment starts.
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https://mobile.nytimes.com/2015/02/01/opinion/sunday/onward-christian-health-care.html?_r=0&referer=http://www.makingsenseofcents.com/2016/08/liberty-healthshare-review.html
Breast cancer chemo
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I really don't see a down side to these things. The negotiate on your behalf. They basically act like insurance but arent after profit. Obviously the 2 big negatives are
1. The pre existing law changing would effect it
2. Them not paying. Which really hasn't happened much.
Also with the Donald talking of letting everyone contribute to an HSA regardless of plan makes this look even better
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My son's NICU stay was 500k. Would health share cover that? Luckily I had insurance through work and only paid $1250 oop.
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I think it would you can google it. And pay for the 1MM per incident. Also the 500k would be negotiated down just like your insurance does.
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I don't think they're a terrible option, but I think we need the alternative of regulated insurance plans. It's hard to have two systems exist side by side without the full coverage option being subject to an adverse selection death spiral, which is why all insurance must be community rated and accept everyone.
At the end of the day these shares can be cheap because they don't bear risk for the sickest individuals. And people can take that risk because they can always opt into the regulated insurance market.
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We have a medical sharing plan. We were not eligible for an subsidy under ACA. Monthly premium for the plans without a subsidy were over $1,000 a month (with 10k family deductible).
So- I researched medical sharing plans. We went with Christian Healthcare Ministries Silver plan.
Monthly Premium - $255 (that is for a family of 5 including me)
Annual enrollment fee - $40 per year
Brother's Keeper- $75 per quarter (This is the sharing part. Its a fluctuating number based on the claims they have received that quarter. Its our families "share." Its normally about $75 per quarter for all 5 of us.)
Limits: Up to $225,000 per incident
Deductible: $1,000 per incident
Prescription Coverage: None (I do pay Walgreens ~$32 a year for a family discount plan. I can also use HEB (Think Krogers) for a lot of medicines. HEB generics are normally $4 each
Doctor's Visits: No coverage
Ambulance: No coverage
Pre-Existing Issues: Not covered for first 3 years of the plan
(Note that they use incident instead of annually. If we each break a leg this year- I have to pay the first $1,000 for each broken leg. HOWEVER, each dollar I negotiate the bill down will count as a dollar toward that $1,000).
Its not a good fit for everyone. We were ok with accepting some liability in exchange for a massive saving on our monthly premium (Roughly $700 a month compared to ACA). CHM does have lifestyle requirements unlike any insurance company. Smoking and church attendance being the big two. We already dont smoke and go to church- so those were non issues for us.
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yeah i think liberty on the 1MM is what we would end up with we will have both of the children we plan to have before we retire in 7ish years. so we will know if there are any current conditions that would make us need to be on the real insurance. Also who knows what happens with all this in 7 years anyways.
I think liberty is the best place for us based on what exists now. but we can see
I see the concerns but to me these are similar to the market may go down forever concerns so i'll pay off my mortgage. its just a cost/risk analysis at the end of the day.
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To me this just screams mustachian.
1. negotiate the bills down
2. know what the bills are (you never know under existing systems)
3. its affordable
4. they almost all cover pre existing conditions after a certain time frame of waiting.
a. maybe some of you should look into this to supplement you insurance.
5. under the current system if something bad does happen you can figure out if a private insurance plan makes more sense.
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So based on what we know today the subsidies will go away so my family of 4 based on a calculator i just pulled up would pay 12000 a year on obamacare. - with a 12k deductible
or we could pay 449 a month plus a 125 annual membership fee to be on Liberty healthshare. - 5500 a year. with at 1500 deductible . This would give us 1MM in coverage. and includes 1 wellness checkup per person annually that doesnt count towards the deductible.
if we assume a checkup is 300 per person - likely low. thats another 1200 out of pocket on the obamacare plan.
so assuming we're all healthy all year we'll pay 13200 ... vs 5500 a difference annually of - 7700 dollars.
now what happens if someone needs extra care of say 50k. well under obamacare we're gonna spend 25.2k to get there... under liberty we would pay 7k - 18200 difference.
Now what if this care exceeds 1MM dollars. - also i cant find good data on the type of care that would cost more than 1MM a year. but i doubt there are very many or that this is very likely. and at the same time this would have to hit early in the year. but if someone could provide me a list of care that exceeds 1MM dollars i'd be happy to look it over and evaluate whether i think its relevant to be afraid of it happening to me to the tune of almost 8k per year and increasing.
Not to mention the simple compounding effect of that 8k annually i'm saving. if it takes 10 years to get something over 1MM i have an extra 100k in the bank if it takes 30 i have an extra 800k in the bank.
Can anyone provide concrete 1MM+ dollar costs after insurance did their negotiation that occured in 1 year from one person.
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I think it would you can google it. And pay for the 1MM per incident. Also the 500k would be negotiated down just like your insurance does.
They say you are suppose to say you are self-pay and negotiate it yourself. Where do you see they will negotiate it?
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To me this just screams mustachian.
1. negotiate the bills down
2. know what the bills are (you never know under existing systems)
3. its affordable
4. they almost all cover pre existing conditions after a certain time frame of waiting.
a. maybe some of you should look into this to supplement you insurance.
5. under the current system if something bad does happen you can figure out if a private insurance plan makes more sense.
You don't know what the bills are until AFTER you get it. And the current system is being destroyed, why should I assume it is going to be useful and potentially lose ALL coverage to save a few dollars. I see it as being penny wise and pound foolish.
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I hadn't heard of this until the other day when I was listening to a podcast from Scott Allen Turner about it. He and his wife came to the conclusion it was just too risky. YMMV.
https://www.youtube.com/watch?v=EsUJ_9sJPBk
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Awesome!
We need more choices like this. All the accursed regulation/legislation is limiting our choices! grrrr... 'Insurance' was originally just a group of people sharing risk. Fire insurance, crop insurance - they'd all pitch in a small amount, and when something bad happened, the victim was covered.
I hope we can go back to that model. Buy what you need, even if that's nothing at all. My grandparents had true 'catastrophic' insurance (something like $20k deductible) for around $200/yr for the 2 of them through their professional society. It came in handy for them once or twice. Good luck!
I agree, and your grandparents plan is basically like my HDHP. Everyone always asked if i am worried if i can get sick... i am like "no, i just pay 100$ to see the doctor, and 80$ for some meds" and they start preaching to me if i had health care i could only pay 10$ instead of 100, and the meds would be like 5$. Then i have explain to them that i only pay 4$/week for my health care and not 100$/week haha
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I think it would you can google it. And pay for the 1MM per incident. Also the 500k would be negotiated down just like your insurance does.
They say you are suppose to say you are self-pay and negotiate it yourself. Where do you see they will negotiate it?
http://www.medicalcostshare.com/comparison-of-major-healthcare-sharing-ministries.html?utm_term=2196ct
2 of the big 4 do. they ask you to negotiate too. snip
You don't know what the bills are until AFTER you get it. And the current system is being destroyed, why should I assume it is going to be useful and potentially lose ALL coverage to save a few dollars. I see it as being penny wise and pound foolish.
not true in all circumstances. and its not a few dollars its thousands of dollars.
again everyone here is saying but what if xyz. etc. but no one has yet to list out medical needs that total 1MM plus for a given year after negotiating down the price by an insurance provider. and the likelihood of these medical issues occuring.
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also at the end of the day if you're truly that scared you can tack on some of the older non ACA approved insurances for that huge what if the sky falls on me situation. as indicated for about 200/year above.
at the very least that combo makes more sense than any ACA plan.
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also at the end of the day if you're truly that scared you can tack on some of the older non ACA approved insurances for that huge what if the sky falls on me situation. as indicated for about 200/year above.
at the very least that combo makes more sense than any ACA plan.
No, I can't. Literally, I won't be approved. I am one of those people who would be unable to get health insurance because of pre-existing conditions. So, it is not a sky falling kind of situation, it is my normal life.
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also at the end of the day if you're truly that scared you can tack on some of the older non ACA approved insurances for that huge what if the sky falls on me situation. as indicated for about 200/year above.
at the very least that combo makes more sense than any ACA plan.
No, I can't. Literally, I won't be approved. I am one of those people who would be unable to get health insurance because of pre-existing conditions. So, it is not a sky falling kind of situation, it is my normal life.
ok so this isnt for you ... for the 90%+ of the population that this probably applies to it could be beneficial... but it does create a problem for those on the ACA style plans with pre existing conditions if the healthy choose to move away to plans like this.
i assume you're paying much less and have found a plan that benefits you at the expense of the rest on the plan. otherwise you'd pay out of pocket for whatever you need continuous support for.
This is why without having single payer for the country health insurance rates keep rising. its not the same as buying car or home insurance with caps and known rebuild costs. people can get continous support or have pre existing conditions ... and then allowing those people to pay the same as everyone else makes everyone pay astronomical rates for it to make sense.
for the record i fully support a single payer govt/private non profit run plan that covers everyone but until that happens i'll figure out whats optimal for myself. and this appears that way ... assuming my kids are born healthy.
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Just thought I would chime in - we are using MediShare for my family of 5. We have a high income, so Obamacare was very bad for our family (not a political statement, just a fact). Our plan was cancelled, the new plans were WAY more expensive, we got no subsidies. Not exaggerating, we were going to be paying 15k per year for the bronze plan, with 10 k deductible and 50/50 after that until a 20k out of pocket. It was nuts.
So, we did the medishare thing and swallowed all the concerns mentioned here by everyone else. We are now paying 500 per month (6k per year). Total out of pocket max is $2,500.
We had our third child using this plan, it was by far the cheapest child we have had.
We have discovered some loopholes, children get vaccines from doctors. If you have insurance, they will make you pay $1,000+ dollars (per kid and we have 3!) If you say you are uninsured, which is true with medical bill sharing, they give you the exact same thing for free. What a racket.
I will say, negotiating medical bills, especially high ones, is very, very possible. I'm a trial attorney and do it for my injured clients all the time. Even so, if anyone here was to get a huge bill, they could go to a local plaintiff's attorney and pay by the hour for help. For example, if you get a bill for a million bucks, you don't have to write a check within 30 days to pay it. You can fight that sort of stuff.
There are also other strategies that, we all hope, we never have to use. For example, certain states have unlimited homestead exemptions for bankruptcy (Texas, for example). It is legal to take all your assets and purchase a home. Live in the home for a year. Declare bankruptcy to clear all debts - but not be forced to sell your home - and then sell your home and free all your assets. Does anyone here want to do that? No. But, the point is there are asset protection strategies that exist if you get hit with a multimillion dollar medical event. Seek legal advice.
Also, I know certain people don't like the idea of medical care in foreign countries. However, I have lived in Mexico extensively. If I had a major issue that I needed care and could not get it. $100,000 goes A LONG WAY in Mexico City - for example. Mexico City has doctors as good as anywhere else in the world, it is a city of 20 million plus people and the richest man in the world, Carlos Slim gets his medical care here.
Finally, there is insurance for car accidents. Other than chronic illness, this is the most likely way any of us will be involved in a major unforeseen medical emergency.
If you get a chronic condition, under Obamacare you could enroll with your pre-existing condition during the next open enrollment cycle.
Anyway, just some thoughts.
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Just thought I would chime in - we are using MediShare for my family of 5. We have a high income, so Obamacare was very bad for our family (not a political statement, just a fact). Our plan was cancelled, the new plans were WAY more expensive, we got no subsidies. Not exaggerating, we were going to be paying 15k per year for the bronze plan, with 10 k deductible and 50/50 after that until a 20k out of pocket. It was nuts.
So, we did the medishare thing and swallowed all the concerns mentioned here by everyone else. We are now paying 500 per month (6k per year). Total out of pocket max is $2,500.
We had our third child using this plan, it was by far the cheapest child we have had.
We have discovered some loopholes, children get vaccines from doctors. If you have insurance, they will make you pay $1,000+ dollars (per kid and we have 3!) If you say you are uninsured, which is true with medical bill sharing, they give you the exact same thing for free. What a racket.
I will say, negotiating medical bills, especially high ones, is very, very possible. I'm a trial attorney and do it for my injured clients all the time. Even so, if anyone here was to get a huge bill, they could go to a local plaintiff's attorney and pay by the hour for help. For example, if you get a bill for a million bucks, you don't have to write a check within 30 days to pay it. You can fight that sort of stuff.
There are also other strategies that, we all hope, we never have to use. For example, certain states have unlimited homestead exemptions for bankruptcy (Texas, for example). It is legal to take all your assets and purchase a home. Live in the home for a year. Declare bankruptcy to clear all debts - but not be forced to sell your home - and then sell your home and free all your assets. Does anyone here want to do that? No. But, the point is there are asset protection strategies that exist if you get hit with a multimillion dollar medical event. Seek legal advice.
Also, I know certain people don't like the idea of medical care in foreign countries. However, I have lived in Mexico extensively. If I had a major issue that I needed care and could not get it. $100,000 goes A LONG WAY in Mexico City - for example. Mexico City has doctors as good as anywhere else in the world, it is a city of 20 million plus people and the richest man in the world, Carlos Slim gets his medical care here.
Finally, there is insurance for car accidents. Other than chronic illness, this is the most likely way any of us will be involved in a major unforeseen medical emergency.
If you get a chronic condition, under Obamacare you could enroll with your pre-existing condition during the next open enrollment cycle.
Anyway, just some thoughts.
thank you... real world experience is what i wanted to see.
So onto vaccinations. if i tell my doctor i'm not inusred even if i am he will give me them for free?
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Subbed. Good info FIREby35. Thanks for posting that.
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Going to be a "devils advocate" here- but how is an insurance plan that specifically excludes people who are sick a "Christian" health care plan?
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Going to be a "devils advocate" here- but how is an insurance plan that specifically excludes people who are sick a "Christian" health care plan?
It doesnt exclude you... after a certain number of years your pre existing conditions will be covered up to certain levels.
I'd guess all the religious part is just so they dont have to follow all the damn regulations of insurance and the ACA allowing them to provide better more cost effective coverage.
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Going to be a "devils advocate" here- but how is an insurance plan that specifically excludes people who are sick a "Christian" health care plan?
It doesnt exclude you... after a certain number of years your pre existing conditions will be covered up to certain levels.
I'd guess all the religious part is just so they dont have to follow all the damn regulations of insurance and the ACA allowing them to provide better more cost effective coverage.
I would say that not covering pre-existing conditions for a certain number of years is pretty much the same as excluding people who have a pre-existing condition. And the reason that the costs are lower is that people who are sick don't sign up.
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Going to be a "devils advocate" here- but how is an insurance plan that specifically excludes people who are sick a "Christian" health care plan?
It doesnt exclude you... after a certain number of years your pre existing conditions will be covered up to certain levels.
I'd guess all the religious part is just so they dont have to follow all the damn regulations of insurance and the ACA allowing them to provide better more cost effective coverage.
I would say that not covering pre-existing conditions for a certain number of years is pretty much the same as excluding people who have a pre-existing condition. And the reason that the costs are lower is that people who are sick don't sign up.
yes it would be like walking into nationwide after your house had burned down and saying hey can you cover me ... i havent had insurance but i'd like some now that my house is gone. will they insure you nope. Its not in the interest of the private sector to lose money on things. so the govt has to take over and make it the single coverage for basic healthcare it has to be socialized otherwise the burden on the people with out good work sponsored coverage will be insane.
as i said in my OP lets not make this about pre existing conditions. this isnt for people with those. Some one is paying. if you're getting insurance now and its saving you money b/c you have a pre existing condition some one is supplementing you. i as a healthy person have this as an option to not supplement you.
But lets not make this about Pre existing conditions. and i think Fire by 35 has made an excellent post on how this can work for 90%+ of the people here with out those conditions.
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Going to be a "devils advocate" here- but how is an insurance plan that specifically excludes people who are sick a "Christian" health care plan?
It doesnt exclude you... after a certain number of years your pre existing conditions will be covered up to certain levels.
I'd guess all the religious part is just so they dont have to follow all the damn regulations of insurance and the ACA allowing them to provide better more cost effective coverage.
I would say that not covering pre-existing conditions for a certain number of years is pretty much the same as excluding people who have a pre-existing condition. And the reason that the costs are lower is that people who are sick don't sign up.
yes it would be like walking into nationwide after your house had burned down and saying hey can you cover me ... i havent had insurance but i'd like some now that my house is gone. will they insure you nope. Its not in the interest of the private sector to lose money on things. so the govt has to take over and make it the single coverage for basic healthcare it has to be socialized otherwise the burden on the people with out good work sponsored coverage will be insane.
as i said in my OP lets not make this about pre existing conditions. this isnt for people with those. Some one is paying. if you're getting insurance now and its saving you money b/c you have a pre existing condition some one is supplementing you. i as a healthy person have this as an option to not supplement you.
But lets not make this about Pre existing conditions. and i think Fire by 35 has made an excellent post on how this can work for 90%+ of the people here with out those conditions.
That is not actually true. The full price for the ACA plans (in NY and Ca) are the same what I paid for COBRA (on average, a few are more, a few less). My pre-existing condition often does not cost anyone money. I locked my trapezius in college. For years I had no treatment and yet, I could find NO coverage, for any price, for insurance. People lost insurance when they had any sort of medical treatment, which to me, is not insurance.
If you want to talk supplements, going in and saying I have no insurance and getting something for free does not mean it is free, it means the rest of us are paying for it. That is being supplemented. ACA costs are the costs of actually being covered by insurance. Some years it protects you and other years you just pay in. I have paid car insurance. I don't want them to pay me, I pay the money so that in case of emergency I'm covered.
And with health share, I'm not. It is as simple as that. Having a cap on the costs and not being insurance (meaning that when the GOP gets to pulling the pre-existing conditions which is something they have been very clear they want to do), you will have nothing.
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not a debate on pre existing conditions.
I'd really like some of the people opposed to this plan to present a case of a healthcare cost in 1 calendar year for 1 condition exceding 1MM dollars after your insurance negotiated it down.
Everyone keeps saying good luck if you get this or that. well whats the number and what are the odds i get it. and furthermore what are the odds i get it in the first few months of the year.
"But what if" with out data to back it up isnt a good arguement on a finance forum IMO.
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http://www.therichest.com/rich-list/the-biggest/the-10-most-expensive-medical-procedures-in-america/
10 most expensive procedures. only 2 over 1MM which i assume you can get reduced some.
there were 212 people on the 1.2MM dollar procedure waitlist in 2008 so highly unlikely you'd need it.
heart-lung trasplant has 100 performed annually so highly unlikely youd get it regardless of your insurance type.
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http://www.therichest.com/rich-list/the-biggest/the-10-most-expensive-medical-procedures-in-america/
10 most expensive procedures. only 2 over 1MM which i assume you can get reduced some.
there were 212 people on the 1.2MM dollar procedure waitlist in 2008 so highly unlikely you'd need it.
heart-lung trasplant has 100 performed annually so highly unlikely youd get it regardless of your insurance type.
It's not common, but it is devastating. Remember that some procedures are billed per day, like ECMO, which easily runs in the $100k/day dollar range NOT counting all the hospitalization costs associated with such a devastating illness.
You are right that it is quite rare though. According to MEPS, the best data we have on patient-level expenditures, the top 1% of people spend $107k or more on health expenditures per year. This is actual spending/reimbursement, not charges, so reflects the negotiated rate. https://meps.ahrq.gov/data_files/publications/st497/stat497.pdf
It is impossible to talk about this issue without talking about pre-existing conditions though. Your biggest risk in a non-ACA system is you will become uninsurable. It's great for people to have affordable catastrophic options, but over time it takes away our ability to provide insurance for people with high health needs. As someone who has a well over $1M illness (charges incurred over many years, worst single year was $300k negotiated) and is now uninsurable in underwritten products, an "affordable" option like this is simply out of reach.
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I know you say you don't want to make this about pre-existing conditions, but if ACA is repealed without a replacement plan which guarantees coverage of pre-existing conditions, then you can't ignore that in this conversation.
The thing is, I'm a perfectly healthy person, maybe 5 pounds overweight, no ongoing prescriptions outside of birth control, and no health conditions. But before ACA, my parent's (they have been privately insured my entire life) insurance did not cover any medical costs above my shoulders. I had a one-off seizure in 2009 with clean EKG, clean EEG, clean CT, clean MRI, and no further seizures in the 8 years since. When I had migraines in 2010, they wouldn't cover doctor's visit or meds for it or chiropractic visit which really helped relieve the debilitating migraines.
You have to remember that pre-existing conditions are defined by insurance companies. If ACA goes away and it goes back to that, they may deny you coverage for any number of ridiculous supposed pre-existing signs. Despite the fact that I definitely did not have a brain tumor at that time, if I'd developed something like that before/without ACA, the insurance simply would not have covered any of my care.
It sounds like this option might work for your family currently. But I don't think anyone can say with any certainty what our insurance markets will look like in 6 or 12 months. Most of this conversation is YMMV based on your risk tolerance to political and insurance changes as well as the level of insurance you feel comfortable with.
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I know you say you don't want to make this about pre-existing conditions, but if ACA is repealed without a replacement plan which guarantees coverage of pre-existing conditions, then you can't ignore that in this conversation.
The thing is, I'm a perfectly healthy person, maybe 5 pounds overweight, no ongoing prescriptions outside of birth control, and no health conditions. But before ACA, my parent's (they have been privately insured my entire life) insurance did not cover any medical costs above my shoulders. I had a one-off seizure in 2009 with clean EKG, clean EEG, clean CT, clean MRI, and no further seizures in the 8 years since. When I had migraines in 2010, they wouldn't cover doctor's visit or meds for it or chiropractic visit which really helped relieve the debilitating migraines.
You have to remember that pre-existing conditions are defined by insurance companies. If ACA goes away and it goes back to that, they may deny you coverage for any number of ridiculous supposed pre-existing signs. Despite the fact that I definitely did not have a brain tumor at that time, if I'd developed something like that before/without ACA, the insurance simply would not have covered any of my care.
It sounds like this option might work for your family currently. But I don't think anyone can say with any certainty what our insurance markets will look like in 6 or 12 months. Most of this conversation is YMMV based on your risk tolerance to political and insurance changes as well as the level of insurance you feel comfortable with.
the pre existing conditions clause and 26 year old clause cannot be repealed the current congressional setup doesnt have enough people to overturn these. all they can do is change the laws that are effected by budget
so no more subsidies and no more you have to have it or you pay a penalty.
again i have 7 years before i even have to consider this but i wanted to put it out here for others who may be healthy and are retiring soon. as another option bc the costs of those plans are out of control already.
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I know you say you don't want to make this about pre-existing conditions, but if ACA is repealed without a replacement plan which guarantees coverage of pre-existing conditions, then you can't ignore that in this conversation.
The thing is, I'm a perfectly healthy person, maybe 5 pounds overweight, no ongoing prescriptions outside of birth control, and no health conditions. But before ACA, my parent's (they have been privately insured my entire life) insurance did not cover any medical costs above my shoulders. I had a one-off seizure in 2009 with clean EKG, clean EEG, clean CT, clean MRI, and no further seizures in the 8 years since. When I had migraines in 2010, they wouldn't cover doctor's visit or meds for it or chiropractic visit which really helped relieve the debilitating migraines.
You have to remember that pre-existing conditions are defined by insurance companies. If ACA goes away and it goes back to that, they may deny you coverage for any number of ridiculous supposed pre-existing signs. Despite the fact that I definitely did not have a brain tumor at that time, if I'd developed something like that before/without ACA, the insurance simply would not have covered any of my care.
It sounds like this option might work for your family currently. But I don't think anyone can say with any certainty what our insurance markets will look like in 6 or 12 months. Most of this conversation is YMMV based on your risk tolerance to political and insurance changes as well as the level of insurance you feel comfortable with.
the pre existing conditions clause and 26 year old clause cannot be repealed the current congressional setup doesnt have enough people to overturn these. all they can do is change the laws that are effected by budget
so no more subsidies and no more you have to have it or you pay a penalty.
again i have 7 years before i even have to consider this but i wanted to put it out here for others who may be healthy and are retiring soon. as another option bc the costs of those plans are out of control already.
It only takes 51 votes to eliminate the filibuster. And if they end up in a corner where they are facing either death spiral or using the nuclear option, I know where my money is.
For that matter, if they don't pass a replacement and we end up in a death spiral, insurance premiums in the private market could quickly become literally unaffordable, not just expensive. You simply cannot know right now what insurance will look like in a year. If you're comfortable using healthshare until or after the dust settles, go for it.
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I know you say you don't want to make this about pre-existing conditions, but if ACA is repealed without a replacement plan which guarantees coverage of pre-existing conditions, then you can't ignore that in this conversation.
The thing is, I'm a perfectly healthy person, maybe 5 pounds overweight, no ongoing prescriptions outside of birth control, and no health conditions. But before ACA, my parent's (they have been privately insured my entire life) insurance did not cover any medical costs above my shoulders. I had a one-off seizure in 2009 with clean EKG, clean EEG, clean CT, clean MRI, and no further seizures in the 8 years since. When I had migraines in 2010, they wouldn't cover doctor's visit or meds for it or chiropractic visit which really helped relieve the debilitating migraines.
You have to remember that pre-existing conditions are defined by insurance companies. If ACA goes away and it goes back to that, they may deny you coverage for any number of ridiculous supposed pre-existing signs. Despite the fact that I definitely did not have a brain tumor at that time, if I'd developed something like that before/without ACA, the insurance simply would not have covered any of my care.
It sounds like this option might work for your family currently. But I don't think anyone can say with any certainty what our insurance markets will look like in 6 or 12 months. Most of this conversation is YMMV based on your risk tolerance to political and insurance changes as well as the level of insurance you feel comfortable with.
the pre existing conditions clause and 26 year old clause cannot be repealed the current congressional setup doesnt have enough people to overturn these. all they can do is change the laws that are effected by budget
so no more subsidies and no more you have to have it or you pay a penalty.
again i have 7 years before i even have to consider this but i wanted to put it out here for others who may be healthy and are retiring soon. as another option bc the costs of those plans are out of control already.
It only takes 51 votes to eliminate the filibuster. And if they end up in a corner where they are facing either death spiral or using the nuclear option, I know where my money is.
For that matter, if they don't pass a replacement and we end up in a death spiral, insurance premiums in the private market could quickly become literally unaffordable, not just expensive. You simply cannot know right now what insurance will look like in a year. If you're comfortable using healthshare until or after the dust settles, go for it.
the filibuster just kills the funding it doesnt kill the two things i stated above.
as i said i've got 7 years.
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I know you say you don't want to make this about pre-existing conditions, but if ACA is repealed without a replacement plan which guarantees coverage of pre-existing conditions, then you can't ignore that in this conversation.
The thing is, I'm a perfectly healthy person, maybe 5 pounds overweight, no ongoing prescriptions outside of birth control, and no health conditions. But before ACA, my parent's (they have been privately insured my entire life) insurance did not cover any medical costs above my shoulders. I had a one-off seizure in 2009 with clean EKG, clean EEG, clean CT, clean MRI, and no further seizures in the 8 years since. When I had migraines in 2010, they wouldn't cover doctor's visit or meds for it or chiropractic visit which really helped relieve the debilitating migraines.
You have to remember that pre-existing conditions are defined by insurance companies. If ACA goes away and it goes back to that, they may deny you coverage for any number of ridiculous supposed pre-existing signs. Despite the fact that I definitely did not have a brain tumor at that time, if I'd developed something like that before/without ACA, the insurance simply would not have covered any of my care.
It sounds like this option might work for your family currently. But I don't think anyone can say with any certainty what our insurance markets will look like in 6 or 12 months. Most of this conversation is YMMV based on your risk tolerance to political and insurance changes as well as the level of insurance you feel comfortable with.
the pre existing conditions clause and 26 year old clause cannot be repealed the current congressional setup doesnt have enough people to overturn these. all they can do is change the laws that are effected by budget
so no more subsidies and no more you have to have it or you pay a penalty.
again i have 7 years before i even have to consider this but i wanted to put it out here for others who may be healthy and are retiring soon. as another option bc the costs of those plans are out of control already.
It only takes 51 votes to eliminate the filibuster. And if they end up in a corner where they are facing either death spiral or using the nuclear option, I know where my money is.
For that matter, if they don't pass a replacement and we end up in a death spiral, insurance premiums in the private market could quickly become literally unaffordable, not just expensive. You simply cannot know right now what insurance will look like in a year. If you're comfortable using healthshare until or after the dust settles, go for it.
the filibuster just kills the funding it doesnt kill the two things i stated above.
as i said i've got 7 years.
If they eliminate the filibuster (which only takes 51 votes) for legislation, then they can eliminate the other parts of ACA with a simple majority.
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based on all data i've seen i would still sign up for this if i were retired today.
Guess what if they eliminate the pre existing conditions clause the insurance companies will go back to what they were doing before and dropping people so it wont really matter either way will it?
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I know you say you don't want to make this about pre-existing conditions, but if ACA is repealed without a replacement plan which guarantees coverage of pre-existing conditions, then you can't ignore that in this conversation.
The thing is, I'm a perfectly healthy person, maybe 5 pounds overweight, no ongoing prescriptions outside of birth control, and no health conditions. But before ACA, my parent's (they have been privately insured my entire life) insurance did not cover any medical costs above my shoulders. I had a one-off seizure in 2009 with clean EKG, clean EEG, clean CT, clean MRI, and no further seizures in the 8 years since. When I had migraines in 2010, they wouldn't cover doctor's visit or meds for it or chiropractic visit which really helped relieve the debilitating migraines.
You have to remember that pre-existing conditions are defined by insurance companies. If ACA goes away and it goes back to that, they may deny you coverage for any number of ridiculous supposed pre-existing signs. Despite the fact that I definitely did not have a brain tumor at that time, if I'd developed something like that before/without ACA, the insurance simply would not have covered any of my care.
It sounds like this option might work for your family currently. But I don't think anyone can say with any certainty what our insurance markets will look like in 6 or 12 months. Most of this conversation is YMMV based on your risk tolerance to political and insurance changes as well as the level of insurance you feel comfortable with.
the pre existing conditions clause and 26 year old clause cannot be repealed the current congressional setup doesnt have enough people to overturn these. all they can do is change the laws that are effected by budget
so no more subsidies and no more you have to have it or you pay a penalty.
again i have 7 years before i even have to consider this but i wanted to put it out here for others who may be healthy and are retiring soon. as another option bc the costs of those plans are out of control already.
It only takes 51 votes to eliminate the filibuster. And if they end up in a corner where they are facing either death spiral or using the nuclear option, I know where my money is.
For that matter, if they don't pass a replacement and we end up in a death spiral, insurance premiums in the private market could quickly become literally unaffordable, not just expensive. You simply cannot know right now what insurance will look like in a year. If you're comfortable using healthshare until or after the dust settles, go for it.
Doesn't all this non-sense make medical bill sharing (at this particular moment in time) the more stable option? :)
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Logic here says medical bill sharing makes more sense than anything else outside of reasonable employer sponsored plans.
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So based on what we know today the subsidies will go away so my family of 4 based on a calculator i just pulled up would pay 12000 a year on obamacare. - with a 12k deductible
or we could pay 449 a month plus a 125 annual membership fee to be on Liberty healthshare. - 5500 a year. with at 1500 deductible . This would give us 1MM in coverage. and includes 1 wellness checkup per person annually that doesnt count towards the deductible.
if we assume a checkup is 300 per person - likely low. thats another 1200 out of pocket on the obamacare plan.
so assuming we're all healthy all year we'll pay 13200 ... vs 5500 a difference annually of - 7700 dollars.
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The bolded sentence is not correct. All health insurance policies under the ACA cover preventive care (check-ups and vaccines) 100%. Physical exam in doctor's office, routine recommended preventive tests (PAP, colonoscopy), mammogram, flu shot, etc. are all covered at 100% with no deductible.
Modified to add a link to what's covered:
https://www.hhs.gov/healthcare/facts-and-features/fact-sheets/preventive-services-covered-under-aca/
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I think it would you can google it. And pay for the 1MM per incident. Also the 500k would be negotiated down just like your insurance does.
They say you are suppose to say you are self-pay and negotiate it yourself. Where do you see they will negotiate it?
Yes, at least with some of these plans you have to negotiate for yourself and it's not fun. I have a friend whose family's health care is "covered" this way. She was in an accident which required a hospital stay. The hospital would only give a discount if they paid before she left the hospital - but friend didn't have the thousands in cash to do so, or have credit cards to float it. The share plan (I don't recall which one it was) told her to set up a GoFundMe to get the money. Which she did but it was embarrassing for her. I didn't ask her what was going to happen once the share plan paid - would any friends who donated get their money back? (I didn't donate so it wasn't relevant to me).
It just seemed scammy for the share plan to tell her to do this.
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Upthread someone asked about the likelihood of a 1 million plus event.
The ones that I know about personally:
2 people with babies in the NICU for months due to premature birth topped a million.
My grandfather had a massive stroke and the stroke ICU that he was in for a week was 100k a night (so not quite a million, and I'm sure it was negotiated down)
My H (healthy, young) went in for a routine heart procedure and came out with open heart surgery. No complications and total before negotiation was over 500k. No idea how high that can go if you have complications.
Of course it's rare, but if it happens, your entire non-retirement net worth will be wiped out in a single unlucky event.
I haven't heard much said about the pregnancy coverage issue. Individual plans used to not cover pregnant for the most part. It seems like the most high risk thing that normally healthy people participate in all the time. I am a total hippy dippy natural birth person who had a home birth with a midwife and I'd never have a kid without insurance to cover possible birth emergencies.
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I think it would you can google it. And pay for the 1MM per incident. Also the 500k would be negotiated down just like your insurance does.
They say you are suppose to say you are self-pay and negotiate it yourself. Where do you see they will negotiate it?
Yes, at least with some of these plans you have to negotiate for yourself and it's not fun. I have a friend whose family's health care is "covered" this way. She was in an accident which required a hospital stay. The hospital would only give a discount if they paid before she left the hospital - but friend didn't have the thousands in cash to do so, or have credit cards to float it. The share plan (I don't recall which one it was) told her to set up a GoFundMe to get the money. Which she did but it was embarrassing for her. I didn't ask her what was going to happen once the share plan paid - would any friends who donated get their money back? (I didn't donate so it wasn't relevant to me).
It just seemed scammy for the share plan to tell her to do this.
A FIREd mustachian will have the cash/ credit available.
Upthread someone asked about the likelihood of a 1 million plus event.
The ones that I know about personally:
2 people with babies in the NICU for months due to premature birth topped a million.
My grandfather had a massive stroke and the stroke ICU that he was in for a week was 100k a night (so not quite a million, and I'm sure it was negotiated down)
My H (healthy, young) went in for a routine heart procedure and came out with open heart surgery. No complications and total before negotiation was over 500k. No idea how high that can go if you have complications.
Of course it's rare, but if it happens, your entire non-retirement net worth will be wiped out in a single unlucky event.
I haven't heard much said about the pregnancy coverage issue. Individual plans used to not cover pregnant for the most part. It seems like the most high risk thing that normally healthy people participate in all the time. I am a total hippy dippy natural birth person who had a home birth with a midwife and I'd never have a kid without insurance to cover possible birth emergencies.
Upthread someone asked about the likelihood of a 1 million plus event.
The ones that I know about personally:
2 people with babies in the NICU for months due to premature birth topped a million.
My grandfather had a massive stroke and the stroke ICU that he was in for a week was 100k a night (so not quite a million, and I'm sure it was negotiated down)
My H (healthy, young) went in for a routine heart procedure and came out with open heart surgery. No complications and total before negotiation was over 500k. No idea how high that can go if you have complications.
Of course it's rare, but if it happens, your entire non-retirement net worth will be wiped out in a single unlucky event.
I haven't heard much said about the pregnancy coverage issue. Individual plans used to not cover pregnant for the most part. It seems like the most high risk thing that normally healthy people participate in all the time. I am a total hippy dippy natural birth person who had a home birth with a midwife and I'd never have a kid without insurance to cover possible birth emergencies.
so seems like most of these would be covered by health share. plus see Fireby35's post on his experience having 2 children with healthshare. cheaper.
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A FIREd mustachian will have the cash/ credit available.
Yes, the saddest part of my friend's story is that they literally had no resources to tap for this accident. But it illustrates the fact that under the share plans, the member will do all of the negotiating and paying - there's no insurance-negotiated rate that automatically chops 50% off the top. (which is another broken part of our whole system but that's probably a topic for another thread).
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A FIREd mustachian will have the cash/ credit available.
Yes, the saddest part of my friend's story is that they literally had no resources to tap for this accident. But it illustrates the fact that under the share plans, the member will do all of the negotiating and paying - there's no insurance-negotiated rate that automatically chops 50% off the top. (which is another broken part of our whole system but that's probably a topic for another thread).
incorrect thats a blanket statement. under SOME share plans the member will do the negotiating and paying. they arent all the same. liberty pays and negotiates.
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posting so I can find it later. Interested to know more about this.
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welcome bean counter.
The goal of the thread was to get people with actual experience using it. so here's hoping more show up.
Personally if the state of healthcare is similar to what it is today i will be using liberty healthshare when i FIRE in 5-7 years dependent on our bun in the oven and future yet unconceived child being born healthy.
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welcome bean counter.
The goal of the thread was to get people with actual experience using it. so here's hoping more show up.
Personally if the state of healthcare is similar to what it is today i will be using liberty healthshare when i FIRE in 5-7 years dependent on our bun in the oven and future yet unconceived child being born healthy.
Thank You. Obviously I don't have experience using it, but I have been in the health insurance business for >10 years. So I might be able to pick it apart.
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welcome bean counter.
The goal of the thread was to get people with actual experience using it. so here's hoping more show up.
Personally if the state of healthcare is similar to what it is today i will be using liberty healthshare when i FIRE in 5-7 years dependent on our bun in the oven and future yet unconceived child being born healthy.
Thank You. Obviously I don't have experience using it, but I have been in the health insurance business for >10 years. So I might be able to pick it apart.
feel free to try. i have yet to see a case where regular insurance really beats this esp when adding a super catastrophic plan for just charges over 1MM dollars.
It has efficiency and healthy people on its side.
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We have belonged to Samaritan Ministries since 5/15. It is the only one of the 4 Christian health sharing groups that has you pay other people directly. The office sends you (I'm signed up to do everything online) a notice to send this month's share to John Doe in Texas, and you mail him a check for your "premium" amount, $440 currently for me and DH. The last 2 months the needs have been less than the total that would have come in, so we paid less. The also have "special prayer needs" so you can voluntarily send money, usually $20 or $25, to people to cover preexisting conditions or other things like dental that aren't covered - we send this, too. If you don't pay your regular amount you are dropped (I've heard people say this can't work because nobody will pay). Their website has details on what's covered and the requirements for membership.
I was in the ER twice in December so have sent in my first bills. The hospital would not negotiate the price, so a third party negotiator is dealing with that part. I'm responsible for the first $300, if the bills are discounted at least $300 I pay nothing. I'll repost to update how things are working.
I just received my first check yesterday. I managed to negotiate most bills by 30%, 2 by about 50% and one by about 70%. No news on the negotiation on the hospital bills yet...
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We have belonged to Samaritan Ministries since 5/15. It is the only one of the 4 Christian health sharing groups that has you pay other people directly. The office sends you (I'm signed up to do everything online) a notice to send this month's share to John Doe in Texas, and you mail him a check for your "premium" amount, $440 currently for me and DH. The last 2 months the needs have been less than the total that would have come in, so we paid less. The also have "special prayer needs" so you can voluntarily send money, usually $20 or $25, to people to cover preexisting conditions or other things like dental that aren't covered - we send this, too. If you don't pay your regular amount you are dropped (I've heard people say this can't work because nobody will pay). Their website has details on what's covered and the requirements for membership.
I was in the ER twice in December so have sent in my first bills. The hospital would not negotiate the price, so a third party negotiator is dealing with that part. I'm responsible for the first $300, if the bills are discounted at least $300 I pay nothing. I'll repost to update how things are working.
I just received my first check yesterday. I managed to negotiate most bills by 30%, 2 by about 50% and one by about 70%. No news on the negotiation on the hospital bills yet...
this is amazing and valuable information i look forward to hearing more if you care to share the actual numbers when its all final.
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Been on medishare since 2014. Wife and I pay less than $1000/year. Our annual deductable is $10k but we've never really scratched the surface on that. Not sure how it'll go when we start having kids. But I figured a few years of avoiding Obamacare would help us get financially stable, whilr we are young and insurance (should be) cheap.
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its too bad no new health share ministries are allowed. I think they are an amazing opportunity, and it would be cool if a group like followers of MMM could start their own sharing ministy with our own set of healthy lifestyle criteria to participate.
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yeah this truly is how health insurance should be run.
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Been on medishare since 2014. Wife and I pay less than $1000/year. Our annual deductable is $10k but we've never really scratched the surface on that. Not sure how it'll go when we start having kids. But I figured a few years of avoiding Obamacare would help us get financially stable, whilr we are young and insurance (should be) cheap.
does medishare have a cap i cant find that on their site.
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We have belonged to Samaritan Ministries since 5/15. It is the only one of the 4 Christian health sharing groups that has you pay other people directly. The office sends you (I'm signed up to do everything online) a notice to send this month's share to John Doe in Texas, and you mail him a check for your "premium" amount, $440 currently for me and DH. The last 2 months the needs have been less than the total that would have come in, so we paid less. The also have "special prayer needs" so you can voluntarily send money, usually $20 or $25, to people to cover preexisting conditions or other things like dental that aren't covered - we send this, too. If you don't pay your regular amount you are dropped (I've heard people say this can't work because nobody will pay). Their website has details on what's covered and the requirements for membership.
I was in the ER twice in December so have sent in my first bills. The hospital would not negotiate the price, so a third party negotiator is dealing with that part. I'm responsible for the first $300, if the bills are discounted at least $300 I pay nothing. I'll repost to update how things are working.
I just received my first check yesterday. I managed to negotiate most bills by 30%, 2 by about 50% and one by about 70%. No news on the negotiation on the hospital bills yet...
this is amazing and valuable information i look forward to hearing more if you care to share the actual numbers when its all final.
Sure, it's going to be a couple months but I'll post all the totals here when everything is paid.
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Been on medishare since 2014. Wife and I pay less than $1000/year. Our annual deductable is $10k but we've never really scratched the surface on that. Not sure how it'll go when we start having kids. But I figured a few years of avoiding Obamacare would help us get financially stable, whilr we are young and insurance (should be) cheap.
does medishare have a cap i cant find that on their site.
By cap do you mean deductable or maximum amount that they'll help with? Yes to the former, no to the latter.
So I recently had a consultation w a doctor and decided to follow medishare procedure for prenotification even though I'll be nowhere near the deductible this year. So when I checked out that day, she charged me the $35 copay and said the rest would be billed later. I said how much, response was $210. Well...Several weeks later I got a bill for like $70. Medishare negotiated my price down, presumably because of my high deductible they could persuade the doctor's office that I'd be more likely to pay if it was reduced...
Anyway I am very happy with how that process went.
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Following!
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We're with Liberty. We had to use their prescription discount first time for antibiotics. Went down from $60 to $4. We'll be putting in our first big claim for pre-natal and pregnancy in a few weeks. I'll post updates.
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We're with Liberty. We had to use their prescription discount first time for antibiotics. Went down from $60 to $4. We'll be putting in our first big claim for pre-natal and pregnancy in a few weeks. I'll post updates.
We just finished setting up our appointment for the first pre-natal. The office manager was familiar with it and everything will be forwarded to Liberty. We did have to call, to warn them that we would begin maternity visits, but that wasn't a problem. Once we get more into the billing, I'll continue here or in a new post.
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We make too much for subsidies under ACA, but for a healthy couple would have had to pay $2200/month ( 26k /year). That's a second mortgage payment...
For a while we just kept stringing together some HDHP and the cost kept going up and up for basically emergency coverage.
A friend told us about Liberty Health share and it seemed like a good option, $299/month for both of us. We have yet to "use" the service.
Personally I find the religious part disturbing, but am choosing to ignore it. Other than that, as pointed out previously this is the basic model of "insurance" , risk and cost is shared over a large group.
Healthcare in this country will eventually end up single payer from the sheer weight of ever growing Medicare and Medicaid and the ways in which insane amounts of money that could grow the rest of the economy are swallowed up by healthcare costs. It would be smarter to head down that path in a deliberate fashion IMO.
Side note, they sent us an email last week urging us to call our Congress people because Trumpcare or Wealthcare as I called it , would eliminate the health sharing companies. Moot point now I guess......
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Interesting thread. Following as we are looking for options with a lot of unknowns at the moment with healthcare.
Does anyone have an example / suggestion of a non ACA super catostrophic plan that might be a good supplement to healthshare?
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We're with Liberty. We had to use their prescription discount first time for antibiotics. Went down from $60 to $4. We'll be putting in our first big claim for pre-natal and pregnancy in a few weeks. I'll post updates.
We just finished setting up our appointment for the first pre-natal. The office manager was familiar with it and everything will be forwarded to Liberty. We did have to call, to warn them that we would begin maternity visits, but that wasn't a problem. Once we get more into the billing, I'll continue here or in a new post.
We mentioned that we would comment as things went along. Unfortunately, my wife had a miscarriage after three months and she needed a D & C. We called the health share for pre-notification, before the surgery, and the doctor filled out a form.
About a month and half later we got our equivalent to the EOB and it's exactly as it said. We pay our $1000 unshared bit, and the rest is taken care of by the healthshare. Now we haven't seen any bills from the providers yet, so there might be surprises. However, we also got a reimbursement for the prescriptions that were related as well. We didn't want to use the service this early on, especially for a matter like that. However, for those following, so far, Liberty has delivered on what they say.
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We're with Liberty. We had to use their prescription discount first time for antibiotics. Went down from $60 to $4. We'll be putting in our first big claim for pre-natal and pregnancy in a few weeks. I'll post updates.
We just finished setting up our appointment for the first pre-natal. The office manager was familiar with it and everything will be forwarded to Liberty. We did have to call, to warn them that we would begin maternity visits, but that wasn't a problem. Once we get more into the billing, I'll continue here or in a new post.
We mentioned that we would comment as things went along. Unfortunately, my wife had a miscarriage after three months and she needed a D & C. We called the health share for pre-notification, before the surgery, and the doctor filled out a form.
About a month and half later we got our equivalent to the EOB and it's exactly as it said. We pay our $1000 unshared bit, and the rest is taken care of by the healthshare. Now we haven't seen any bills from the providers yet, so there might be surprises. However, we also got a reimbursement for the prescriptions that were related as well. We didn't want to use the service this early on, especially for a matter like that. However, for those following, so far, Liberty has delivered on what they say.
so sorry to hear about that. We actually just went thru the same thing on our work provided HDHP with an HSA earlier this year. our out of pocket costs were around 4k or so. I was shocked to hear how common they were when we lost ours, again sorry to hear about that.
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We have discovered some loopholes, children get vaccines from doctors. If you have insurance, they will make you pay $1,000+ dollars (per kid and we have 3!) If you say you are uninsured, which is true with medical bill sharing, they give you the exact same thing for free. What a racket.
Fuck.... this is not true. Its not. Vaccines are considered preventative and are covered 100% by any "real" insurance plan in the United States...
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We have discovered some loopholes, children get vaccines from doctors. If you have insurance, they will make you pay $1,000+ dollars (per kid and we have 3!) If you say you are uninsured, which is true with medical bill sharing, they give you the exact same thing for free. What a racket.
Fuck.... this is not true. Its not. Vaccines are considered preventative and are covered 100% by any "real" insurance plan in the United States...
If you don't have insurance, which we didn't, they will charge you $1,000+ dollars. I can tell you, from experience, they will in fact charge you that money if you don't have insurance. Or you can go to the health center and get it for free.
The point is that we didn't have health insurance and they tried to make us pay. We didn't have health insurance because we had Medi-share. Medi-share isn't considered "real" insurance and sometimes people can't wrap their head around the fact that you are, in fact, not insured.
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IN!!
Thanks!
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We have discovered some loopholes, children get vaccines from doctors. If you have insurance, they will make you pay $1,000+ dollars (per kid and we have 3!) If you say you are uninsured, which is true with medical bill sharing, they give you the exact same thing for free. What a racket.
Fuck.... this is not true. Its not. Vaccines are considered preventative and are covered 100% by any "real" insurance plan in the United States...
If you don't have insurance, which we didn't, they will charge you $1,000+ dollars. I can tell you, from experience, they will in fact charge you that money if you don't have insurance. Or you can go to the health center and get it for free.
The point is that we didn't have health insurance and they tried to make us pay. We didn't have health insurance because we had Medi-share. Medi-share isn't considered "real" insurance and sometimes people can't wrap their head around the fact that you are, in fact, not insured.
You are contradicting yourself. Which is it? I am confused.
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We have discovered some loopholes, children get vaccines from doctors. If you have insurance, they will make you pay $1,000+ dollars (per kid and we have 3!) If you say you are uninsured, which is true with medical bill sharing, they give you the exact same thing for free. What a racket.
Fuck.... this is not true. Its not. Vaccines are considered preventative and are covered 100% by any "real" insurance plan in the United States...
If you don't have insurance, which we didn't, they will charge you $1,000+ dollars. I can tell you, from experience, they will in fact charge you that money if you don't have insurance. Or you can go to the health center and get it for free.
The point is that we didn't have health insurance and they tried to make us pay. We didn't have health insurance because we had Medi-share. Medi-share isn't considered "real" insurance and sometimes people can't wrap their head around the fact that you are, in fact, not insured.
Also confused. Makes a difference if you say "have insurance" versus "do not have insurance". The two statements are irreconcilable. Makes me think you are making shit up, lying, etc... I could be wrong, but you would have to explain yourself first.
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We have discovered some loopholes, children get vaccines from doctors. If you have insurance, they will make you pay $1,000+ dollars (per kid and we have 3!) If you say you are uninsured, which is true with medical bill sharing, they give you the exact same thing for free. What a racket.
Fuck.... this is not true. Its not. Vaccines are considered preventative and are covered 100% by any "real" insurance plan in the United States...
If you don't have insurance, which we didn't, they will charge you $1,000+ dollars. I can tell you, from experience, they will in fact charge you that money if you don't have insurance. Or you can go to the health center and get it for free.
The point is that we didn't have health insurance and they tried to make us pay. We didn't have health insurance because we had Medi-share. Medi-share isn't considered "real" insurance and sometimes people can't wrap their head around the fact that you are, in fact, not insured.
Also confused. Makes a difference if you say "have insurance" versus "do not have insurance". The two statements are irreconcilable. Makes me think you are making shit up, lying, etc... I could be wrong, but you would have to explain yourself first.
I thought of that too but if you read the rest and the following sentence he wrote exactly what he meant so he is just contradicting himself. If you have insurance, vaccines are free. If you dont have insurance, they are free I believe. So i dont see under what circumstance a vaccine would cost thousands. Besides even if you paif out of pocket, regular vaccines dont cost thousands. The only one i know of in the thousands is the rsv vaccine.
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We have discovered some loopholes, children get vaccines from doctors. If you have insurance, they will make you pay $1,000+ dollars (per kid and we have 3!) If you say you are uninsured, which is true with medical bill sharing, they give you the exact same thing for free. What a racket.
Fuck.... this is not true. Its not. Vaccines are considered preventative and are covered 100% by any "real" insurance plan in the United States...
If you don't have insurance, which we didn't, they will charge you $1,000+ dollars. I can tell you, from experience, they will in fact charge you that money if you don't have insurance. Or you can go to the health center and get it for free.
The point is that we didn't have health insurance and they tried to make us pay. We didn't have health insurance because we had Medi-share. Medi-share isn't considered "real" insurance and sometimes people can't wrap their head around the fact that you are, in fact, not insured.
Also confused. Makes a difference if you say "have insurance" versus "do not have insurance". The two statements are irreconcilable. Makes me think you are making shit up, lying, etc... I could be wrong, but you would have to explain yourself first.
I thought of that too but if you read the rest and the following sentence he wrote exactly what he meant so he is just contradicting himself. If you have insurance, vaccines are free. If you dont have insurance, they are free I believe. So i dont see under what circumstance a vaccine would cost thousands. Besides even if you paif out of pocket, regular vaccines dont cost thousands. The only one i know of in the thousands is the rsv vaccine.
we're getting really nit picky over one comment in this thread here. if you'd like to debate the cost of vaccines feel free to start a different thread.
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What happens is the health care providers don't understand that your Medi-share is not insurance and they treat you like you have insurance when you actually don't. Your confusion is the same confusion the healthcare providers have. So, they bill Medi-Share (who denies it), then you get a bill and you go tell the doctors you are uninsured and they say, "What about medi-share." You are then forced to explain to them, "It's not insurance." But they don't really get it. They try to stick you with a $1,000 bill.
The way to avoid it is to go to the health department for the free vaccines. Never say, "I have something like insurance." Never assume the health care providers understand what health care sharing is. On medi-share you should always say, "I am uninsured."
Sorry for any confusion based on my writing.
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we're getting really nit picky over one comment in this thread here. if you'd like to debate the cost of vaccines feel free to start a different thread.
This isn't a debate about the cost of vaccines. It's a discussion about how vaccines are handled when on a medical sharing plan - I thought questions about the plans and answers from those with experience was the point of this thread:
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The goal of the thread was to get people with actual experience using it. so here's hoping more show up.
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If you don't have insurance, which we didn't, they will charge you $1,000+ dollars. I can tell you, from experience, they will in fact charge you that money if you don't have insurance. Or you can go to the health center and get it for free.
The point is that we didn't have health insurance and they tried to make us pay. We didn't have health insurance because we had Medi-share. Medi-share isn't considered "real" insurance and sometimes people can't wrap their head around the fact that you are, in fact, not insured.
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I think we should be able to re-route this to actual experiences about Medical Bill sharing.
Boarder was really just trying to protect me from a severe reaction to my own inarticulate writing which I hope has now been cleared to everyone's general satisfaction or they have accepted me as the liar they presume I am. There's no way he could have known I've been called much worse in my day.
So, I'm happy to hear any one else's medi-share stories. The stories usually involve some sad medical situation. Those experiencing those conditions have my sympathy.
We can share experience for mutual benefit on the MMM forum, right? :)
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I am starting to look into these health sharing options now for my upcoming FIRE (a few months from now).
How is it going for everyone?
I'm also having a hard time with google search in finding the other health sharing threads on this forum. Maybe we should have a "sticky" for these types of plans in one of the sections of the forums.
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I am looking into this. I just struck a deal with my boss to work 7 more months.
My concerns: If I look at what are supposed to be the three largest health share organizations, they have significantly different share rates (the amount you pay in per month). It makes me suspicious of the lowest cost organization. I would expect them to be somewhat close in monthly cost. But they aren't.
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Following, and agree with a sticky or subforum for health care.
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Well I called Liberty Health Share and am going through the approval process. i hope I get through!
After talking to their representative, I am very excited about Liberty. It seems like a great plan. Some of the highlights important to me:
- I can go to any doctor anywhere, any hospital, there is no network.
- Even international medical bills are considered! As long as the bill is in USD and in English.
- Covers naturopathic doctors.
- If you are a member over 2 years and you die, your family gets about $10,000 for funeral costs.
- It just seems so much simpler than dealing with insurance companies, at least for now.
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Well I called Liberty Health Share and am going through the approval process. i hope I get through!
After talking to their representative, I am very excited about Liberty. It seems like a great plan. Some of the highlights important to me:
- I can go to any doctor anywhere, any hospital, there is no network.
- Even international medical bills are considered! As long as the bill is in USD and in English.
- Covers naturopathic doctors.
- If you are a member over 2 years and you die, your family gets about $10,000 for funeral costs.
- It just seems so much simpler than dealing with insurance companies, at least for now.
I'd agree please keep us updated on your progress.
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I am self-employed. I had the same traditional insurance for fifteen years, major medical, traditional, 10k deductible then 80/20. Started at age 31. Premiums gradually increased until ACA. Now no one new can join this grandfathered plan, so premiums will eventually go up exponentially.
I was paying a little over $8000 per year for premiums. So with deductible, I would have to pay $18,000 per year before I get a dime back. Fortunately, we never had a medical condition that expensive.
Last October, I switched to Medi-share. I kept the $10,000 annual household portion (their name for deductible--they don't use insurance terms because it is not insurance). Difference is it is 10k for the whole family. Old plan was 10k per person which could have become a nightmare. Monthly share portion (their name for premium) is about $351 ($80 of which is for a health partnership fee because one of us does not meet their height/weight standards) which is $4212 annually.
I had one medical issue this year. One family member had to have an outpatient procedure in an ambulatory surgery center. The surgery center was not familiar with medi-share. Once I explained it, they said they are not in the PHCS PPO network that medi-share uses (even though the PHSC website says they are--they said yes but not they don't take this kind of PHCS. Whatever.). No problem, though, because they said that with the PHCS PPO discount even if they take medi-share our cost would have been well over $10,000, not including anesthesia. Instead they were able to offer me a cash price of $7600 including anesthesia.
The surgeon had checked beforehand and told us our cost would be $600, which we paid. Later we got a bill for about $2800 more. (because "deductible" was not met, they said). I argued and told them their cash rate would be way less than this. The office manager settled the account for $1800. With all the other charges (pathology, lab, etc.) the charges were all reduced an appropriate amount by the PPO network.
So, all said and done I'm still slightly under the $10,000 annual sharing portion.
By continuing to save $4000 per year on an ongoing basis, I feel this is an acceptably low risk option for my family.
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So I had indicated earlier in this thread that my wife is on Liberty Healthshare because we gave it a try after we could not have her on my insurance plan due to employer restrictions.
We have been in this situation for about 18 months. She had a scan several months ago and we are still waiting for a ruling for Liberty on if they will cover it and this is about six months ago. My wife has been very unhappy with the service level and how long it takes to get any answer. We will most likely move to using her employer plan for her next year even though the premiums are higher because the unknown of what we have to pay and when we do have to pay a full bill ourselves is too big of a risk. This scan was $2,800 as billed and if we end up on the hook for that (they were looking for ovarian cysts, so certainly nothing that would be out of their acceptable coverage clauses) then Liberty becomes more expensive than her employer medical option. I have heard a lot of good things about medical sharing but so far our experience has been poor.
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So I had indicated earlier in this thread that my wife is on Liberty Healthshare because we gave it a try after we could not have her on my insurance plan due to employer restrictions.
We have been in this situation for about 18 months. She had a scan several months ago and we are still waiting for a ruling for Liberty on if they will cover it and this is about six months ago. My wife has been very unhappy with the service level and how long it takes to get any answer. We will most likely move to using her employer plan for her next year even though the premiums are higher because the unknown of what we have to pay and when we do have to pay a full bill ourselves is too big of a risk. This scan was $2,800 as billed and if we end up on the hook for that (they were looking for ovarian cysts, so certainly nothing that would be out of their acceptable coverage clauses) then Liberty becomes more expensive than her employer medical option. I have heard a lot of good things about medical sharing but so far our experience has been poor.
Thanks for posting this. I sincerely appreciate it.
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So I had indicated earlier in this thread that my wife is on Liberty Healthshare because we gave it a try after we could not have her on my insurance plan due to employer restrictions.
We have been in this situation for about 18 months. She had a scan several months ago and we are still waiting for a ruling for Liberty on if they will cover it and this is about six months ago. My wife has been very unhappy with the service level and how long it takes to get any answer. We will most likely move to using her employer plan for her next year even though the premiums are higher because the unknown of what we have to pay and when we do have to pay a full bill ourselves is too big of a risk. This scan was $2,800 as billed and if we end up on the hook for that (they were looking for ovarian cysts, so certainly nothing that would be out of their acceptable coverage clauses) then Liberty becomes more expensive than her employer medical option. I have heard a lot of good things about medical sharing but so far our experience has been poor.
Thanks for posting this. I sincerely appreciate it.
i would say much more information is needed to determine why they may be witholding payment or reviewing. but one 2800 dollar scan shouldnt be breaking a mustachian bank. and you're looking at this in a vacuum sure it becomes more expensive this year. but you have to look at the whole cost over time. not just this year it cost a bit more.
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I love the concept and should explore this more for our family. It is definitely something I think that would help in the early years of FIRE, and I think I would enjoy giving money to families with health needs directly. The only concern is maintaining our own health -- my weight is creepnig up but I'm not near obese, but my husband's weight is creeping up and he's closer to obese and has high blood pressure and not the greatest diet, so I don't know if he would get coverage without cleaning up his life a bit. But I love the concept. I'm a little afraid to try it. Our health bills are in many ways minimal, but... I had a breast infection earlier this year that required mammogram, ultrasound, specialist, and I also had another concern checked out that required ultrasound. I'm not exactly free, but on the other hand most years we have very little for expenses.
Question -- so if you go the medi-share route, are you paying the government penalty for not having "health insurance"? Or will a medi-share count as coverage in the government's eyes?
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I am not involved with a health share, but would like to share my experiences of the last 13 months.
We were a pretty typical, normal family that paid for health insurance for decades and with a few exceptions here and there (pregnancy), paid way more into the system that we got out. With preventative care being covered by the ACA, our out of pocket expenses were typically about $300/year. This does not include premiums. We never met our deductible. Although I never felt this way, we could argue that we were the healthy people who didn't want to be forced to subsidize sick people.
In July 2016, my then 13 year old was diagnosed with cancer. In an instant, we became a family with a high risk, critically ill child with catastrophic medical expenses. From July 2016-July 2017, he has spent about 150 days in the hospital with literally dozens and dozens of appointments. He has had more than 50 transfusions, at least 10 operations and procedures that use the OR. Our typical bills before the negotiated rate were about $100,000 per month. I'm sure the negotiated rate was probably at least $25K. Chemo and support drugs are insanely expensive - one month the charge was $156,000 before the negotiated rate (so probably at least $40K). One of the prescription drugs he takes at home (so from a pharmacy - see what a health share says about those) is $11,000 per month.
His treatment wasn't going as well as we had hoped, so in June 2017 he got a bone marrow transplant. That is at least $1 Million.
There are cancers and conditions that only really have transplant as an option to cure. Meaning you or your child could be diagnosed with cancer (and we had no warning AT ALL), get chemo for a few months to prepare for transplant and then get a transplant. The time from diagnosis to transplant could be as little as 3-4 months.
Is my situation rare, sure. But with 1 out of every 300 or so kids gets getting diagnosed with cancer before age 20 - it is not that rare. And cancer in adults is not rare at all.
I would be VERY careful about signing up for these plans. I would also be VERY careful about thinking if you are diagnosed with something, you can just hold out until open enrollment for the ACA. You can incur millions of $$ of expenses in a matter of months. Also, keep in mind that if it is the person who is working that gets sick - they most likely will not be able to work either. I had to stop working to care for my son, we on top of everything else, we have lost 1 of our incomes.
If we had been on a health share instead of real insurance, we would be financially ruined.
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I am not involved with a health share, but would like to share my experiences of the last 13 months.
We were a pretty typical, normal family that paid for health insurance for decades and with a few exceptions here and there (pregnancy), paid way more into the system that we got out. With preventative care being covered by the ACA, our out of pocket expenses were typically about $300/year. This does not include premiums. We never met our deductible. Although I never felt this way, we could argue that we were the healthy people who didn't want to be forced to subsidize sick people.
In July 2016, my then 13 year old was diagnosed with cancer. In an instant, we became a family with a high risk, critically ill child with catastrophic medical expenses. From July 2016-July 2017, he has spent about 150 days in the hospital with literally dozens and dozens of appointments. He has had more than 50 transfusions, at least 10 operations and procedures that use the OR. Our typical bills before the negotiated rate were about $100,000 per month. I'm sure the negotiated rate was probably at least $25K. Chemo and support drugs are insanely expensive - one month the charge was $156,000 before the negotiated rate (so probably at least $40K). One of the prescription drugs he takes at home (so from a pharmacy - see what a health share says about those) is $11,000 per month.
His treatment wasn't going as well as we had hoped, so in June 2017 he got a bone marrow transplant. That is at least $1 Million.
There are cancers and conditions that only really have transplant as an option to cure. Meaning you or your child could be diagnosed with cancer (and we had no warning AT ALL), get chemo for a few months to prepare for transplant and then get a transplant. The time from diagnosis to transplant could be as little as 3-4 months.
Is my situation rare, sure. But with 1 out of every 300 or so kids gets getting diagnosed with cancer before age 20 - it is not that rare. And cancer in adults is not rare at all.
I would be VERY careful about signing up for these plans. I would also be VERY careful about thinking if you are diagnosed with something, you can just hold out until open enrollment for the ACA. You can incur millions of $$ of expenses in a matter of months. Also, keep in mind that if it is the person who is working that gets sick - they most likely will not be able to work either. I had to stop working to care for my son, we on top of everything else, we have lost 1 of our incomes.
If we had been on a health share instead of real insurance, we would be financially ruined.
Cindy - I'm really sorry to hear your story and I'm glad to hear it might be looking up.
I just want to point out, you don't know how health share would have handled your situation because you were not on health share.
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I am not involved with a health share, but would like to share my experiences of the last 13 months.
We were a pretty typical, normal family that paid for health insurance for decades and with a few exceptions here and there (pregnancy), paid way more into the system that we got out. With preventative care being covered by the ACA, our out of pocket expenses were typically about $300/year. This does not include premiums. We never met our deductible. Although I never felt this way, we could argue that we were the healthy people who didn't want to be forced to subsidize sick people.
In July 2016, my then 13 year old was diagnosed with cancer. In an instant, we became a family with a high risk, critically ill child with catastrophic medical expenses. From July 2016-July 2017, he has spent about 150 days in the hospital with literally dozens and dozens of appointments. He has had more than 50 transfusions, at least 10 operations and procedures that use the OR. Our typical bills before the negotiated rate were about $100,000 per month. I'm sure the negotiated rate was probably at least $25K. Chemo and support drugs are insanely expensive - one month the charge was $156,000 before the negotiated rate (so probably at least $40K). One of the prescription drugs he takes at home (so from a pharmacy - see what a health share says about those) is $11,000 per month.
His treatment wasn't going as well as we had hoped, so in June 2017 he got a bone marrow transplant. That is at least $1 Million.
There are cancers and conditions that only really have transplant as an option to cure. Meaning you or your child could be diagnosed with cancer (and we had no warning AT ALL), get chemo for a few months to prepare for transplant and then get a transplant. The time from diagnosis to transplant could be as little as 3-4 months.
Is my situation rare, sure. But with 1 out of every 300 or so kids gets getting diagnosed with cancer before age 20 - it is not that rare. And cancer in adults is not rare at all.
I would be VERY careful about signing up for these plans. I would also be VERY careful about thinking if you are diagnosed with something, you can just hold out until open enrollment for the ACA. You can incur millions of $$ of expenses in a matter of months. Also, keep in mind that if it is the person who is working that gets sick - they most likely will not be able to work either. I had to stop working to care for my son, we on top of everything else, we have lost 1 of our incomes.
If we had been on a health share instead of real insurance, we would be financially ruined.
Cindy - I'm really sorry to hear your story and I'm glad to hear it might be looking up.
I just want to point out, you don't know how health share would have handled your situation because you were not on health share.
A previous post stated that Liberty paid out a max of $1 million for the higher plan and $125,000 per incident on the lower plant and prescriptions for 45 days per incident. I'm not sorting through pages of posts to find that. Assuming that is the case, and we had been on that health share in 2016, we would have been financially ruined. My son probably consumed $150,000 of medical care in the first 6 weeks. Even a negotiated rate would for the first 6 weeks was probably about $50,000. My son has been ill for 10 times longer than that.
Suppose we had gotten the higher plan, we may have squeaked by with $1 million until we could enroll in the ACA but that is *only* because he was diagnosed in July - had it been Feb - no way. That prescription plan would have ruined us. One year of just one the lifesaving drug my son takes costs $138,000 (NOT the negotiated rate). That is the most expensive prescription he has, but there are at least a dozen more that total tens of thousands of dollars. 45 days is a joke. My son has taken those for more than 300 days.
All that with no guarantee that they will pay. Nice.
I hope you are lucky enough to not have any idea of how expensive the non-medical portions of having cancer are as well.
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So I had indicated earlier in this thread that my wife is on Liberty Healthshare because we gave it a try after we could not have her on my insurance plan due to employer restrictions.
We have been in this situation for about 18 months. She had a scan several months ago and we are still waiting for a ruling for Liberty on if they will cover it and this is about six months ago. My wife has been very unhappy with the service level and how long it takes to get any answer. We will most likely move to using her employer plan for her next year even though the premiums are higher because the unknown of what we have to pay and when we do have to pay a full bill ourselves is too big of a risk. This scan was $2,800 as billed and if we end up on the hook for that (they were looking for ovarian cysts, so certainly nothing that would be out of their acceptable coverage clauses) then Liberty becomes more expensive than her employer medical option. I have heard a lot of good things about medical sharing but so far our experience has been poor.
Thanks for posting this. I sincerely appreciate it.
i would say much more information is needed to determine why they may be witholding payment or reviewing. but one 2800 dollar scan shouldnt be breaking a mustachian bank. and you're looking at this in a vacuum sure it becomes more expensive this year. but you have to look at the whole cost over time. not just this year it cost a bit more.
I do not disagree, but my wife's frustration with their entire lack of communication is what makes this difficult. I have some more patience and am willing to hound them to get an answer. She (somewhat rightfully) expects them to do their jobs like a "regular" insurance company and give timely responses, not just sit on things with zero communication. We both expect it to take 2-3 months like normal, but she has literally not had them pay anything yet over 18 months. She feels bad for the doctor's offices etc. and also is concerned (again, perhaps rightfully) that this dragging of feet in the process will impact her ability to get services if she really needs them from a doctor who is sitting there waiting for a payment on something for 9-12 months.
While the $2,800 does not break the bank, if they cover nothing, just paying less premiums only goes to far and it very quickly adds up to being more expensive. And that's the problem right now, is that we've not gotten a single dollar back from Liberty. My wife does not go to the doctor very often, most cases just for annual checkups, so not that many opportunities for Liberty to pay granted but it is just a very noticeable difference from what we had read they do (respond just like an insurance company) in a couple months to what we have experienced, which is nothing.
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I am not involved with a health share, but would like to share my experiences of the last 13 months.
We were a pretty typical, normal family that paid for health insurance for decades and with a few exceptions here and there (pregnancy), paid way more into the system that we got out. With preventative care being covered by the ACA, our out of pocket expenses were typically about $300/year. This does not include premiums. We never met our deductible. Although I never felt this way, we could argue that we were the healthy people who didn't want to be forced to subsidize sick people.
In July 2016, my then 13 year old was diagnosed with cancer. In an instant, we became a family with a high risk, critically ill child with catastrophic medical expenses. From July 2016-July 2017, he has spent about 150 days in the hospital with literally dozens and dozens of appointments. He has had more than 50 transfusions, at least 10 operations and procedures that use the OR. Our typical bills before the negotiated rate were about $100,000 per month. I'm sure the negotiated rate was probably at least $25K. Chemo and support drugs are insanely expensive - one month the charge was $156,000 before the negotiated rate (so probably at least $40K). One of the prescription drugs he takes at home (so from a pharmacy - see what a health share says about those) is $11,000 per month.
His treatment wasn't going as well as we had hoped, so in June 2017 he got a bone marrow transplant. That is at least $1 Million.
There are cancers and conditions that only really have transplant as an option to cure. Meaning you or your child could be diagnosed with cancer (and we had no warning AT ALL), get chemo for a few months to prepare for transplant and then get a transplant. The time from diagnosis to transplant could be as little as 3-4 months.
Is my situation rare, sure. But with 1 out of every 300 or so kids gets getting diagnosed with cancer before age 20 - it is not that rare. And cancer in adults is not rare at all.
I would be VERY careful about signing up for these plans. I would also be VERY careful about thinking if you are diagnosed with something, you can just hold out until open enrollment for the ACA. You can incur millions of $$ of expenses in a matter of months. Also, keep in mind that if it is the person who is working that gets sick - they most likely will not be able to work either. I had to stop working to care for my son, we on top of everything else, we have lost 1 of our incomes.
If we had been on a health share instead of real insurance, we would be financially ruined.
Cindy - I'm really sorry to hear your story and I'm glad to hear it might be looking up.
I just want to point out, you don't know how health share would have handled your situation because you were not on health share.
A previous post stated that Liberty paid out a max of $1 million for the higher plan and $125,000 per incident on the lower plant and prescriptions for 45 days per incident. I'm not sorting through pages of posts to find that. Assuming that is the case, and we had been on that health share in 2016, we would have been financially ruined. My son probably consumed $150,000 of medical care in the first 6 weeks. Even a negotiated rate would for the first 6 weeks was probably about $50,000. My son has been ill for 10 times longer than that.
Suppose we had gotten the higher plan, we may have squeaked by with $1 million until we could enroll in the ACA but that is *only* because he was diagnosed in July - had it been Feb - no way. That prescription plan would have ruined us. One year of just one the lifesaving drug my son takes costs $138,000 (NOT the negotiated rate). That is the most expensive prescription he has, but there are at least a dozen more that total tens of thousands of dollars. 45 days is a joke. My son has taken those for more than 300 days.
All that with no guarantee that they will pay. Nice.
I hope you are lucky enough to not have any idea of how expensive the non-medical portions of having cancer are as well.
This is the biggest issue. My wife is convinced they will sit on their hands and simply say they can't pay. I'm trying to be optimistic and point out that it certainly does not violate any of their provisions so that if they do that she could just push back. Her point is she should not have to fight for general coverage. If we were in Cindy's situation and waiting around for months with no response, we'd be emotional wrecks. Also Liberty and others are $1 million per incident as she indicated, and looking at any of their guidelines, the situation she described would certainly be viewed as 1 incident and capped at the $1 million. This is where for all the groaning about the ACA provisions needing to be repealed things like pre-existing and no life time maximums need to be retained or we create a very untenable situation for families like Cindy's.
If our experience with the health share had any positives to it, I'd be more likely to try to defend it, but so far, I have been very sad to be the one who encouraged my wife to strongly look into this option for her insurance and now seeing the strife it has caused her, and she's not dealing with anything like a situation like Cindy. Unless something massive changes, we'll be switching her to her employer plan at the end of 2017.
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simple solution to the above proposition is to have an insurance policy over the top of the healthshare for extreme cases where something like that may happen. i know they are much harder to find now that the ACA has jacked up everything. but you can still have super high deductible plans to supplement a healthshare if you're that worried. also your bone marrow thing face value was 1MM just b/c it was 1MM face value does not mean it would have cost that on healthshare as they negotiate those down.
so while mostly anecdotal i'd have been much more interested to hear about this case on healthshare and how it was handled.
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I had promised an update on medical bills I submitted to SMI (Samaritan Ministries International) from (still) undiagnosed GI issues. I had 2 ER bills in Dec. 2016, a followup with a surgeon, GI specialist, a lab test for ulcers, and a family doctor followup (I didn't even have a family doc at this point). I have had no health issues since early 2017.
Total bills before me negotiating discounts $6567.42 minus $1331.74 in discounts = $5235.86 all of which was paid. I am resposible for paying the first $300 but since I got more than that in discounts I paid nothing.
I negotiated discounts from about 15% to 67%. Not all bills showed the discount so the figures above are not exact, but close. The GI specialist and surgeon are independent practices - not owned by a hospital, and were easy to work with and big cash discount. The hospital billing dept. are assholes and so is the family doc's billing - their practice is owned by the hospital. Rural area, little choice in an emergency, but for non-emergency I have learned what questions to ask and how to deal with billing.
So, in a nutshell, this is doable but you have to be your own advocate and ask questions not just about the money end of it but what is best for your health.
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I was accepted by Liberty Health Share! I am now ready to pull the plug on my job and FIRE and not have to play games with my Roth conversion pipeline and keeping my income in a certain range to qualify for ACA subsidies!
I am also excited by their acceptance of naturopathic practitioners and their coverage for health care while travelling internationally.
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Resurrecting this thread to see if any original posters have more data to share or if many more mustachians are flocking to these for 2018. Please post more info if you can. @caracarn , did Liberty pay that $2800 bill?
I am getting laid off at the end of March and am shopping for health insurance. ACA plans were between $860 and $1400/mo in premiums and have deductibles of at least 8k. I do not qualify for subsidies due to decent income in 2018 (3 months wages + severance). Looking at providers, these plans don't have my doctors in network. From what I understand, many healthcare providers did not remain in network for ACA plans in 2018 due to funding concerns. If federal monies dry up, they won't get paid. So I'm looking at min $7.7k to be insured for 9 months if I have no healthcare costs post layoff. A hopeful case in the event of a high cost health concern would be finding someone in network and spending $15.7k (OOP max). Worst case would be I can find no providers in network and OOP max does not apply, sky is the limit on billing and maybe go bankrupt. Healthshare is looking pretty damn good compared to the broken ACA.
I'm considering Liberty Healthshare at least for a the remaining 9 months of 2018. I can re-evaluate ACA plans vs. Liberty during ACA open enrollment with very low 2019 income and subsidies. I don't think we'd have any problem with being accepted.
Since Obamacare repeal failed, seems like not as high of a risk of becoming un-insurable if some new condition is identified in these 9 months. I can actually do COBRA retroactively within 60 days of layoff if needed.
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You'll get more than 47K in 3 months wages plus severance? Nice! Have you compared. COBRA costs to ACA costs?
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**Full disclosure** I am a licensed insurance agent in the state of OK. However, this product is completely new to me and my company. None of these statements should be taken as fact, or a sales pitch.
I'm going to an informational meeting tomorrow about Sedera. It's a newer health share based out of Austin, TX. From my preliminary research on sedera.com, it sounds like:
-It *isn't* insurance, so just the Medical Cost Sharing (MCS) membership alone doesn't meet ACA guidelines of insurability. You have to have a Minimum Essential Coverage plan (MEC) to comply with ACA, and Sedera provides that as part of the package. The MCS takes care of preventative health needs and can provide a framework for Health Savings Accounts (HSA).
-They don't exclude smokers, the overweight, or non-Christians. The only mention of Christianity was to explain that "this model is built upon the principles used by some of the Christian healthcare sharing groups". I found no mention of compulsory church attendance or required religious affiliation. (And I LOOKED.)
-"No one is denied membership based on prior medical conditions." There's a certain time limit on pre-existing conditions. I believe it's 36 months with no symptoms or medical visits.
-They do the negotiation on lowering bills. You aren't supposed to pay bills up front, because they want a chance to negotiate the final cost. There is some leeway on things like childbirth that you might normally pay up front. "Please note: use of this [negotiation] service by Sedera Health members is completely voluntary."
-They haven't raised their rates since 2015.
The website is very comprehensive, so I urge everyone to check it out for themselves.
I will bring some of these concerns to my meeting and report back here!
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Have you compared. COBRA costs to ACA costs?
Cobra costs for 2017 insurance rate were higher than 2018 ACA and I know my employers health insurance costs increased for this year. I'll have to dig around for their 2018 Cobra price, but I know it is higher.
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1st time poster on sedera so probably a spammer but they appear to be targetted employers not individuals. But there are more and more health shares popping up. A friend just started using altura.
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@caracarn , did Liberty pay that $2800 bill?
Yes they did. We have stayed with it currently for my wife. Nothing new that has been run through there so I cannot elaborate on anything else. Me and kids are covered through my employer.
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@caracarn , did Liberty pay that $2800 bill?
Yes they did. We have stayed with it currently for my wife. Nothing new that has been run through there so I cannot elaborate on anything else. Me and kids are covered through my employer.
Of course they did. This matches their track record.
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A video that explains Liberty's 100% paid bills history:
https://fast.wistia.net/embed/iframe/4253hii376?popover=true
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@caracarn , did Liberty pay that $2800 bill?
Yes they did. We have stayed with it currently for my wife. Nothing new that has been run through there so I cannot elaborate on anything else. Me and kids are covered through my employer.
Of course they did. This matches their track record.
That may be true, but the reason he asked was they were being anything but simple to deal with in handling this.
Also, it is important to note they paid, but were certainly not timely. Took well over six months, and we had to fight with the providers we owed to keep them from resorting to collections. So painting the picture that all is great because they say so on their video is not really accurate. Hence the questions in this thread so not sure the belittling the response is really beneficial to the audience that wants to see the reality behind the promotional video on their web site.
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1st time poster on sedera so probably a spammer but they appear to be targetted employers not individuals. But there are more and more health shares popping up. A friend just started using altura.
Not a spammer, just someone who finally got it together to register for the forums to contribute instead of just reading :)
According to my informational meeting today:
Sedera is targeted for employers, but there's nothing to stop individuals from joining the share. If not, check out sedera.com or makina.com. The latter is definitely for businesses, but it explains how the system works.
You do have to sign a 'healthy living' pledge, that you won't drive while drunk, take illegal drugs, etc. But there is no religious component at all to Sedera. It is based on a system that started (and some that continue) under religious principles by religious groups.
Smokers pay a larger premium, just like with other insurances. But they aren't barred from participating.
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Of course they did. This matches their track record.
That may be true, but the reason he asked was they were being anything but simple to deal with in handling this.
Also, it is important to note they paid, but were certainly not timely. Took well over six months, and we had to fight with the providers we owed to keep them from resorting to collections. So painting the picture that all is great because they say so on their video is not really accurate. Hence the questions in this thread so not sure the belittling the response is really beneficial to the audience that wants to see the reality behind the promotional video on their web site.
Thanks for the reply, @caracarn . I will note I've had similar experiences with employer insurance in the past. Medical billing and payment can be a huge fucking mess. I have no idea how many people are employed sorting this stuff out (and making it more complicated), but it is not a trivial number.
The video says they pay timely, 20-40 days, but I'm sure that is not always the case, as in your example.
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1st time poster on sedera so probably a spammer but they appear to be targetted employers not individuals. But there are more and more health shares popping up. A friend just started using altura.
Not a spammer, just someone who finally got it together to register for the forums to contribute instead of just reading :)
According to my informational meeting today:
Sedera is targeted for employers, but there's nothing to stop individuals from joining the share. If not, check out sedera.com or makina.com. The latter is definitely for businesses, but it explains how the system works.
You do have to sign a 'healthy living' pledge, that you won't drive while drunk, take illegal drugs, etc. But there is no religious component at all to Sedera. It is based on a system that started (and some that continue) under religious principles by religious groups.
Smokers pay a larger premium, just like with other insurances. But they aren't barred from participating.
i see nothing on their site that targets indviduals if you could point me to that i'd love to see a link
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Of course they did. This matches their track record.
That may be true, but the reason he asked was they were being anything but simple to deal with in handling this.
Also, it is important to note they paid, but were certainly not timely. Took well over six months, and we had to fight with the providers we owed to keep them from resorting to collections. So painting the picture that all is great because they say so on their video is not really accurate. Hence the questions in this thread so not sure the belittling the response is really beneficial to the audience that wants to see the reality behind the promotional video on their web site.
Thanks for the reply, @caracarn . I will note I've had similar experiences with employer insurance in the past. Medical billing and payment can be a huge fucking mess. I have no idea how many people are employed sorting this stuff out (and making it more complicated), but it is not a trivial number.
The video says they pay timely, 20-40 days, but I'm sure that is not always the case, as in your example.
I have had employer insurance issues in the past. Nothing like the difficulty we had in resolving the issues with Liberty. I think the big difference is that insurance is regulated and they have to perform to certain levels or they lose licensing. Health shares are beholden to no one (other than the people who pay the monthly fee) and as such are a step above a volunteer organization that passes money from one person to another. All attempts to get any response from Liberty during the process went without a response. To be clear, I'm not saying a response we did not like, I'm saying NO RESPONSE AT ALL. The phone was not answered, the e-mails were never returned. We just got to sit and wait and talk with the bill collectors that we were trying. Never has that problem with employer insurance.
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Caracarn, you are exactly right. What scares me about health shares is that they are not regulated. State regulated insurance companies have to maintain minimum assets to insure that they can pay their members claims. And they have stop loss insurance to protect them from a million dollar claim. With health shares you get none of that. If you have a million dollar claim and your health share doesn't have enough assets to pay it, you're fucked.
You also can appeal to the state on a claim if your insurer isn't paying per the contract. I've had to do this with a nursing home claim and the state stepped in and told the insurer to pay up.
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Hi,
My family has Christian Healthcare Ministries (CHM) so I have some experience with filing claims and thought I'd share. I'm terrible at trying to make stuff short so this is really long haha!
My parents:
They have the gold program which is $150/month (per each adult, and plus $150 for dependents combined) with a $500 deductible but if you get a discount on your bill, it count's towards this deductible so get a $500 discount and you have no deductible.
- My dad had a kidney stone and went to the ER. He said he was not insured (healthcare sharing organizations are not insurance) asked if we paid before leaving if he could get a 40% discount and they said yes so he paid out of pocket and was reimbursed in under 60 days by CHM. Didn't have any cost that wasn't reimbursed. CHM says not to pay immediately unless the total is under $1,000 and you get a 40% discount. If you don't get a 40% discount, CHM will "coach you or even negotiate with your providers on your behalf".
Summary: Had no cost that wasn't reimbursed and no deductible.
- He broke his arm while bike riding. Transported by ambulance, had surgery, 3 nights in the hospital, and multiple follow up visits with the various specialist involved. Had two prescriptions (filled at a pharmacy). Since this cost was so large, no negotiations took place before he was discharged but afterwards he asked for discounts and and told some of the providers that he was not insured and to others he explained what CHM was. They all gave a discounts of at least 20% but some gave up to 40%. The pre-discount total was about $65,000 and the post-discount total was about $45,000. CHM sent a check right at about 60 days for the total cost and the only cost my parents had to pay was the ambulance ($1,200) cause CHM does not cover transportation.
Summary: Had $1,2000 ambulance ride that was not reimbursed. Everything else was reimbursed and had no deductible.
- He went to the ER for an eye problem. The bill was $1,700 but before he left he said we cash paying and asked for a discount if he paid now. They discounted the bill to $1,000. He also got $80 worth of prescriptions. CHM again paid for all of it after about 60 days.
Summary: Had no cost that wasn't reimbursed and no deductible.
My brother and his wife:
Have the Silver plan which is $85 a month (per each adult, and plus $150 for dependents combined) and $1,000 deductible.
- They've had two kids on their Silver plan which has a $1,000 deductible. Both deliveries were with a mid wife at a birthing center (not a hospital). The silver program covers $2,500 for midwife services and when that was explained to the midwife, she reduced the $5,000 bill to $2,500 for both deliveries. This resulted in no deductible because the discount was more than the deductible and no out of pocket cost since the midwife didn't want to charge more than the max coverage. The silver and bronze plan do cover $125,000 "hospital treatment" for pregnancies but I don't think that includes normal delivery charges. The Gold plan does cover all delivery cost up to $125,000 if you get the optional Brother's Keeper program (details on that program below). Not sure how long reimbursement took for them but they were satisfied.
Summary: Had no cost that wasn't reimbursed and no deductible but only cause they used a midwife, not a hospital, and she was extra kind.
- My brother also had a broken arm with an ER visit and an ER visit for a panic attack. The ER visits were completely reimbursed by CHM because discounts were given to cover the deductible amount. But follow up visits were not covered because the Silver and Bronze plans do not cover doctor office visits (but the gold plan does if they're related to an incident).
Summary: ER visits were reimbursed, no deductible, but follow up visits were not reimbursed because of their plan.
My cousin and his wife:
Gold plan.
- My cousin's wife had a terrible delivery and the wife's bill would be discount by 50% if they paid it before she was discharged so he called CHM and they overnight-ed a check to them. The baby was in the hospital longer and they just got billed after discharge and negotiated after receiving the bill. They were also satisfied with when they got the money but couldn't remember the exact time frame.
Summary: Had no cost that wasn't reimbursed and no deductible. CHM even overnight-ed a check to ensure a discount.
Things worth noting:
- CHM doesn't cover transportation to hospital but does cover transportation between hospitals if it's a life threatening matter. Ambulances are expensive but medical helicopters are crazy expensive! The national average for a medical helo flight is 55 miles. That would cost an average of $23,000 with the providers in my state but that can, and does go up to $70,000+ sometimes. But regular insurance doesn't always help either since some helicopter companies aren't in-network. North Dakota has one company that charge an average of $44,000 and insurance companies only paid 33 percent of that, on average.
Those numbers are from this article: http://archive.sltrib.com/article.php?id=4139196&itype=CMSID
- Prescriptions are only covered with gold plan and still, that only covers incident-related prescriptions.
- There is a maximum coverage. It's $125,000 on all the plans but increases if you buy the optional Brother's Keeper program which has a $40 annual fee and a quarterly fee that is based on how much the program paid out. That quarterly fee has usually been around $15 and never more than $25 in the 4 years we've had the program.
With Brother's Keeper the gold plan increases to unlimited coverage, the silver and bronze plan get an additional $100,000 in coverage for every year you're a member.
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They're getting panned a lot lately on yelp. Mostly about delays in getting reimbursement.
https://www.yelp.com/biz/liberty-healthshare-canton-3?sort_by=date_desc
Page 8 of their annual report* is where it gets interesting. There was $167M contributed by members into their member sharing accounts and the management company received $63M for functional expenses. Of that $63M, 26% was used for management and 74% was used for "direct program purposes," whatever that means given that the member sharing accounts are segregated. You can decide if that's too high or not.
The total net assets at the EOY 2017 in the member sharing accounts is $1.6M. There were 87,000 families in the health share in 2017, which is an average of $1920 in the sharing accounts/family/year.
In summary, Liberty depends on healthy people. The low reserves and low average sharing fund might work well in, say, the Netherlands, but appears dangerously low for US health care.
* https://www.libertyhealthshare.org/content/annual_audit_2017.pdf
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Thanks for sharing Mike R. Real world examples are great to hear.
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There was $167M contributed by members into their member sharing accounts and the management company received $63M for functional expenses. Of that $63M, 26% was used for management and 74% was used for "direct program purposes," whatever that means given that the member sharing accounts are segregated.
Well that may explain why Liberty is so expensive compared to Christian Healthcare Ministries for comparable coverage!
I have CHM but they require that you are active in a Christian Church (though I've never heard of them checking) and I'm no longer active cause my former church is homophobic and I'm homo so that didn't work out haha! I've looked at switching to Liberty as it's the only non-religous one but it's just really expensive compared to CHM or subsidized health insurance through the ACA/healthcare.gov.
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Sedera, as mentioned above, is non-religious.
http://sedera.com/membership-guidelines/
A "true" health sharing plan is a substitute for an ACA plan. Sedera is not, as no new ones can be created. It's just a (for-profit) sharing program and the member has to have a MEC, which can be expensive. Lacking a MEC may not mean a penalty anymore, however.
https://www.healthcare.gov/glossary/minimum-essential-coverage/
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There was $167M contributed by members into their member sharing accounts and the management company received $63M for functional expenses. Of that $63M, 26% was used for management and 74% was used for "direct program purposes," whatever that means given that the member sharing accounts are segregated.
Well that may explain why Liberty is so expensive compared to Christian Healthcare Ministries for comparable coverage!
I have CHM but they require that you are active in a Christian Church (though I've never heard of them checking) and I'm no longer active cause my former church is homophobic and I'm homo so that didn't work out haha! I've looked at switching to Liberty as it's the only non-religous one but it's just really expensive compared to CHM or subsidized health insurance through the ACA/healthcare.gov.
Not active member of my church either but happy to be be in CHM. I've mostly been waiting for my church to talk about genuine spirituality rather than abortion, pedophilia and donating money. Every once in a while it peeks through the non-sense, but not as often as it should!
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I was accepted by Liberty Health Share! I am now ready to pull the plug on my job and FIRE and not have to play games with my Roth conversion pipeline and keeping my income in a certain range to qualify for ACA subsidies!
I am also excited by their acceptance of naturopathic practitioners and their coverage for health care while travelling internationally.
Hi Daisy,
Were you able to use the international coverage? I'm planning on using mine soon but when I went to clarify the requirements last Nov 2018 they said the billing should be CPT coded too. Meaning, the international hospital/clinic should be following US medical coding standard too for their billing statements (which is very rare). Btw, that requirement isn't written in their fine print.
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I was accepted by Liberty Health Share! I am now ready to pull the plug on my job and FIRE and not have to play games with my Roth conversion pipeline and keeping my income in a certain range to qualify for ACA subsidies!
I am also excited by their acceptance of naturopathic practitioners and their coverage for health care while travelling internationally.
Hi Daisy,
Were you able to use the international coverage? I'm planning on using mine soon but when I went to clarify the requirements last Nov 2018 they said the billing should be CPT coded too. Meaning, the international hospital/clinic should be following US medical coding standard too for their billing statements (which is very rare). Btw, that requirement isn't written in their fine print.
I have travelled internationally but have not needed to use my Liberty health share plan. No medical issues while abroad yet!
I don't know what CPT is. Let me know how it goes for you.
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So I had indicated earlier in this thread that my wife is on Liberty Healthshare because we gave it a try after we could not have her on my insurance plan due to employer restrictions.
We have been in this situation for about 18 months. She had a scan several months ago and we are still waiting for a ruling for Liberty on if they will cover it and this is about six months ago. My wife has been very unhappy with the service level and how long it takes to get any answer. We will most likely move to using her employer plan for her next year even though the premiums are higher because the unknown of what we have to pay and when we do have to pay a full bill ourselves is too big of a risk. This scan was $2,800 as billed and if we end up on the hook for that (they were looking for ovarian cysts, so certainly nothing that would be out of their acceptable coverage clauses) then Liberty becomes more expensive than her employer medical option. I have heard a lot of good things about medical sharing but so far our experience has been poor.
Thanks for posting this. I sincerely appreciate it.
i would say much more information is needed to determine why they may be witholding payment or reviewing. but one 2800 dollar scan shouldnt be breaking a mustachian bank. and you're looking at this in a vacuum sure it becomes more expensive this year. but you have to look at the whole cost over time. not just this year it cost a bit more.
For someone claiming to be open to hearing everyone's experience with a health-share, you sure do seem to be shaming anyone who doesn't remotely agree with you. You've already made up your mind on which option is better, so why are you even on here?
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So I had indicated earlier in this thread that my wife is on Liberty Healthshare because we gave it a try after we could not have her on my insurance plan due to employer restrictions.
We have been in this situation for about 18 months. She had a scan several months ago and we are still waiting for a ruling for Liberty on if they will cover it and this is about six months ago. My wife has been very unhappy with the service level and how long it takes to get any answer. We will most likely move to using her employer plan for her next year even though the premiums are higher because the unknown of what we have to pay and when we do have to pay a full bill ourselves is too big of a risk. This scan was $2,800 as billed and if we end up on the hook for that (they were looking for ovarian cysts, so certainly nothing that would be out of their acceptable coverage clauses) then Liberty becomes more expensive than her employer medical option. I have heard a lot of good things about medical sharing but so far our experience has been poor.
Thanks for posting this. I sincerely appreciate it.
i would say much more information is needed to determine why they may be witholding payment or reviewing. but one 2800 dollar scan shouldnt be breaking a mustachian bank. and you're looking at this in a vacuum sure it becomes more expensive this year. but you have to look at the whole cost over time. not just this year it cost a bit more.
For someone claiming to be open to hearing everyone's experience with a health-share, you sure do seem to be shaming anyone who doesn't remotely agree with you. You've already made up your mind on which option is better, so why are you even on here?
He's not. LOL. That was just his way.
https://forum.mrmoneymustache.com/off-topic/r-i-p-boarder42/
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I have CHM but they require that you are active in a Christian Church (though I've never heard of them checking) and I'm no longer active cause my former church is homophobic and I'm homo so that didn't work out haha! I've looked at switching to Liberty as it's the only non-religous one but it's just really expensive compared to CHM or subsidized health insurance through the ACA/healthcare.gov.
Thanks mike_R. Are you still with CHM? My family and I are looking at FIRE pretty soon and our biggest hang up is the health insurance. Its hard to swallow that when we don't have any monthly expenses near that high right now. There's 5 of us so ACA costs are quite high compared to what we pay now with my company plan.
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Posting to resurrect this thread. Health shares are an interesting alternative to traditional health insurance, and I'm interested in hearing more from people who went for this option.
I definitely hear the concerns about catastrophic costs exceeding $1 million, time-limited prescription coverage, and dangerously low cash reserves. Also, the high overhead at Liberty rivals that of traditional insurance companies, which is disappointing. The structure should enable them to have much lower overhead, which is kind of the point.
One thing that hasn't been mentioned: Obamacare and other traditional insurance plans also have their risks. No matter how careful you are, you can't be sure of avoiding these several main exposures: out of network costs and balance billing, denials of coverage that can be capricious, and limited prescription coverage. It is fortunate that the very high hospitalization and prescription costs cited by an earlier poster for cancer treatment were covered by insurance, but it's very common (probably more common) for families in these situations to end up with massive medical out of pocket costs that dwarf the advertised out of pocket maximums. Health shares have the advantage here, because the OON issue goes away entirely and they don't pick and choose what prescriptions to cover based on the medication.
BTW this is also why I wouldn't under any circumstances consider a Medicare Advantage plan.
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Posting to resurrect this thread. Health shares are an interesting alternative to traditional health insurance, and I'm interested in hearing more from people who went for this option.
I definitely hear the concerns about catastrophic costs exceeding $1 million, time-limited prescription coverage, and dangerously low cash reserves. Also, the high overhead at Liberty rivals that of traditional insurance companies, which is disappointing. The structure should enable them to have much lower overhead, which is kind of the point.
One thing that hasn't been mentioned: Obamacare and other traditional insurance plans also have their risks. No matter how careful you are, you can't be sure of avoiding these several main exposures: out of network costs and balance billing, denials of coverage that can be capricious, and limited prescription coverage. It is fortunate that the very high hospitalization and prescription costs cited by an earlier poster for cancer treatment were covered by insurance, but it's very common (probably more common) for families in these situations to end up with massive medical out of pocket costs that dwarf the advertised out of pocket maximums. Health shares have the advantage here, because the OON issue goes away entirely and they don't pick and choose what prescriptions to cover based on the medication.
BTW this is also why I wouldn't under any circumstances consider a Medicare Advantage plan.
Health Shares do not have the advantage in the case of extremely high cost treatments. Actually that is where they are at a distinct disadvantage. They don't have the large network negotiating power that the big insurers do. So they will be subject to whatever the provider or pharmacy charges. And if they don't have the cash reserves and go under because of your million dollar claim, you're screwed. I don't even think they are required to carry stop loss.
While traditional insurance is by no means perfect, at least it's regulated by the DOI and you have the opportunity to appeal at the state level to demand coverage. I have done this, and it was on a MA plan and the state came in and demanded the insurer pay.
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I have used Medishare since Obamacare cancelled my catastrophic health insurance plan back in the day. I'm a small business owner with no option for corporate health care. Don't forget, there is a large class of Americans who have never had the luxury of health insurance paid for by the corporation. It's not THAT big a deal :)
Sometimes, it takes thinking outside the box. Let me tell you what I mean...
1. By probability, the most likely traumatic injury situation any of us likely to face is a car/work accident with serious injuries. In that case, you will be immediately taken to the hospital and provided life-saving treatment without request for your insurance. Medical bill sharing should help in that situation. If it does not then the next best protection is significant property and casualty insurance with an umbrella policy. That insures a large part of the risk of unexpected medical bills.
2. Chronic health conditions are often caused by lifestyle choices. The best way to avoid type two diabetes, hypertension and many other common chronic illnesses is to control your diet and physical health. Say what you want, but that is a fact.
3. Cancer or organ failure of some sort is, generally, a slow moving situation that would allow for planning. I have saved tens of thousands of dollars in premiums over 7+ years of insuring a healthy family of five with medical bill sharing. I know I can take $50,000 cash to any major metropolitan city in Latin America (Mexico City, for example) and receive the best health care available to over a billion people who live in those countries. You can dismiss this if you want, but I have lived in Mexico and know for a fact that intelligent, caring doctors with advanced technology do, in fact, exist in their country of 190+ million people.
4. You can negotiate cash service for cancer and other treatments in America as well. $100,000 cash goes a long way. It is absolutely possible to save $100,000 in reduced premiums in five years for families (2k per month for 60 months is over 100k). I'm way past five years of ditching expensive health insurance.
5. Medical bill sharing does cover cancer issues and there is no reason to assume they will not except fear. I don't generally like to give fear that much power. As has been discussed, your health insurance can try to screw you as well.
6. Medical debt incurred in an emergency situation is highly unlikely to be collected at the billed rate. Hiring an attorney to negotiate reductions on a large medical bill could cost a few thousand dollars, block the hospital from collecting for years and eventually lead to 50%+ reductions on any bills. If necessary, you can simply stonewall a hospital's collection efforts - people do it all the time. For the record, the health insurance "discounts" are often pathetic back scratching between the health insurer and the medical provider that do no justice to the consumer. I've seen it personally, repeatedly. Negotiating with a competent attorney is likely to get bigger reductions than the health insurance provider accepts for a fraction of the price.
7. There are ways to protect assets even if a medical provider became very aggressive - which I have not seen in my county courthouse. It involves a bankruptcy attorney, moving to a state with a homestead exemption for one year and planning.
8. When it comes to anyone trying to get to the assets of a financially independent person, remember something my contracts professor told me in my first year of law school: When you have the money, you have the advantage. It is their problem to get money from you and nothing says you have to make it easy. I sue insurance companies all the time. Trust me, they don't make it easy and there is an army of attorneys who are very experienced in asset protection.
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I have used Medishare since Obamacare cancelled my catastrophic health insurance plan back in the day. I'm a small business owner with no option for corporate health care. Don't forget, there is a large class of Americans who have never had the luxury of health insurance paid for by the corporation. It's not THAT big a deal :)
Sometimes, it takes thinking outside the box. Let me tell you what I mean...
1. By probability, the most likely traumatic injury situation any of us likely to face is a car/work accident with serious injuries. In that case, you will be immediately taken to the hospital and provided life-saving treatment without request for your insurance. Medical bill sharing should help in that situation. If it does not then the next best protection is significant property and casualty insurance with an umbrella policy. That insures a large part of the risk of unexpected medical bills.
2. Chronic health conditions are often caused by lifestyle choices. The best way to avoid type two diabetes, hypertension and many other common chronic illnesses is to control your diet and physical health. Say what you want, but that is a fact.
3. Cancer or organ failure of some sort is, generally, a slow moving situation that would allow for planning. I have saved tens of thousands of dollars in premiums over 7+ years of insuring a healthy family of five with medical bill sharing. I know I can take $50,000 cash to any major metropolitan city in Latin America (Mexico City, for example) and receive the best health care available to over a billion people who live in those countries. You can dismiss this if you want, but I have lived in Mexico and know for a fact that intelligent, caring doctors with advanced technology do, in fact, exist in their country of 190+ million people.
4. You can negotiate cash service for cancer and other treatments in America as well. $100,000 cash goes a long way. It is absolutely possible to save $100,000 in reduced premiums in five years for families (2k per month for 60 months is over 100k). I'm way past five years of ditching expensive health insurance.
5. Medical bill sharing does cover cancer issues and there is no reason to assume they will not except fear. I don't generally like to give fear that much power. As has been discussed, your health insurance can try to screw you as well.
6. Medical debt incurred in an emergency situation is highly unlikely to be collected at the billed rate. Hiring an attorney to negotiate reductions on a large medical bill could cost a few thousand dollars, block the hospital from collecting for years and eventually lead to 50%+ reductions on any bills. If necessary, you can simply stonewall a hospital's collection efforts - people do it all the time. For the record, the health insurance "discounts" are often pathetic back scratching between the health insurer and the medical provider that do no justice to the consumer. I've seen it personally, repeatedly. Negotiating with a competent attorney is likely to get bigger reductions than the health insurance provider accepts for a fraction of the price.
7. There are ways to protect assets even if a medical provider became very aggressive - which I have not seen in my county courthouse. It involves a bankruptcy attorney, moving to a state with a homestead exemption for one year and planning.
8. When it comes to anyone trying to get to the assets of a financially independent person, remember something my contracts professor told me in my first year of law school: When you have the money, you have the advantage. It is their problem to get money from you and nothing says you have to make it easy. I sue insurance companies all the time. Trust me, they don't make it easy and there is an army of attorneys who are very experienced in asset protection.
I only wish I could be as naive as you are about the potential for catastrophic health expenses and how they are covered.
Your umbrella insurance will pay nothing for your medical expenses in a car accident. You will be provided services under EMTALA and billed for them. Follow up care will also be billed to you. There's a good chance in a car accident you'll be stabilized, sent home, and asked to return for surgery, at which point they will absolutely verify your insurance or ask for payment.
The risk of chronic conditions is not type 2 diabetes or hypertension, which are relatively cheap until you get a complication, but that you'll be diagnosed with MS at 33 like a friend of mine was. 45 days of prescription drug coverage is not going to cut it in those cases. In this case, you are provisionally insured by being able to go into the regulated ACA market, but if you are diagnosed in January you'll have to figure out a way to pay for infusions every 28 days for a year before your ACA plan kicks in. "Just go to Mexico" is not a real option for "acute chronic" conditions which need serious immediate treatment to prevent progression and disability.
The ACA has lowered the risks of going without insurance because you can always retreat into the ACA market if something happens. That is probably the only reason these health shares are acceptable risks to people. At the most you are on the hook for a year of care minus whatever health share will pay.
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I have used Medishare since Obamacare cancelled my catastrophic health insurance plan back in the day. I'm a small business owner with no option for corporate health care. Don't forget, there is a large class of Americans who have never had the luxury of health insurance paid for by the corporation. It's not THAT big a deal :)
Sometimes, it takes thinking outside the box. Let me tell you what I mean...
1. By probability, the most likely traumatic injury situation any of us likely to face is a car/work accident with serious injuries. In that case, you will be immediately taken to the hospital and provided life-saving treatment without request for your insurance. Medical bill sharing should help in that situation. If it does not then the next best protection is significant property and casualty insurance with an umbrella policy. That insures a large part of the risk of unexpected medical bills.
2. Chronic health conditions are often caused by lifestyle choices. The best way to avoid type two diabetes, hypertension and many other common chronic illnesses is to control your diet and physical health. Say what you want, but that is a fact.
3. Cancer or organ failure of some sort is, generally, a slow moving situation that would allow for planning. I have saved tens of thousands of dollars in premiums over 7+ years of insuring a healthy family of five with medical bill sharing. I know I can take $50,000 cash to any major metropolitan city in Latin America (Mexico City, for example) and receive the best health care available to over a billion people who live in those countries. You can dismiss this if you want, but I have lived in Mexico and know for a fact that intelligent, caring doctors with advanced technology do, in fact, exist in their country of 190+ million people.
4. You can negotiate cash service for cancer and other treatments in America as well. $100,000 cash goes a long way. It is absolutely possible to save $100,000 in reduced premiums in five years for families (2k per month for 60 months is over 100k). I'm way past five years of ditching expensive health insurance.
5. Medical bill sharing does cover cancer issues and there is no reason to assume they will not except fear. I don't generally like to give fear that much power. As has been discussed, your health insurance can try to screw you as well.
6. Medical debt incurred in an emergency situation is highly unlikely to be collected at the billed rate. Hiring an attorney to negotiate reductions on a large medical bill could cost a few thousand dollars, block the hospital from collecting for years and eventually lead to 50%+ reductions on any bills. If necessary, you can simply stonewall a hospital's collection efforts - people do it all the time. For the record, the health insurance "discounts" are often pathetic back scratching between the health insurer and the medical provider that do no justice to the consumer. I've seen it personally, repeatedly. Negotiating with a competent attorney is likely to get bigger reductions than the health insurance provider accepts for a fraction of the price.
7. There are ways to protect assets even if a medical provider became very aggressive - which I have not seen in my county courthouse. It involves a bankruptcy attorney, moving to a state with a homestead exemption for one year and planning.
8. When it comes to anyone trying to get to the assets of a financially independent person, remember something my contracts professor told me in my first year of law school: When you have the money, you have the advantage. It is their problem to get money from you and nothing says you have to make it easy. I sue insurance companies all the time. Trust me, they don't make it easy and there is an army of attorneys who are very experienced in asset protection.
I only wish I could be as naive as you are about the potential for catastrophic health expenses and how they are covered.
Your umbrella insurance will pay nothing for your medical expenses in a car accident. You will be provided services under EMTALA and billed for them. Follow up care will also be billed to you. There's a good chance in a car accident you'll be stabilized, sent home, and asked to return for surgery, at which point they will absolutely verify your insurance or ask for payment.
The risk of chronic conditions is not type 2 diabetes or hypertension, which are relatively cheap until you get a complication, but that you'll be diagnosed with MS at 33 like a friend of mine was. 45 days of prescription drug coverage is not going to cut it in those cases. In this case, you are provisionally insured by being able to go into the regulated ACA market, but if you are diagnosed in January you'll have to figure out a way to pay for infusions every 28 days for a year before your ACA plan kicks in. "Just go to Mexico" is not a real option for "acute chronic" conditions which need serious immediate treatment to prevent progression and disability.
The ACA has lowered the risks of going without insurance because you can always retreat into the ACA market if something happens. That is probably the only reason these health shares are acceptable risks to people. At the most you are on the hook for a year of care minus whatever health share will pay.
I'm fortunate not to know much about chronic health issues. That's true.
The umbrella is for when the other person doesn't have enough insurance for an accident they caused and your own property and casualty insurance has been exhausted. In that case, the umbrella will apply and will cover your medical expenses. Since we were talking financial protection for a catastrophic event, I think of this as insuring against one of the highest probability causes of a catastrophic health event that happens with no notice (i.e. a car accident caused by an underinsured driver).
But your point about the umbrella is well taken in a situation where you cause the accident. A good insurance against this risk would be to drive as little as possible.
When/if I am asked for insurance or payment for follow up surgery (or significant care) as you described, the good news is I will have medical bill sharing and lots of cash (saved premiums over the last few years, at least). I'm not worried about not being able to pay for things that cost under 100k in the final price (approximate amount saved in premiums over the last 7 ish years). That is A LOT of things - even in America.
Everything I said about the collection capabilities of hospitals after a catastrophic event is based on personal experience defending debtors of hospitals from collections. Owing a bill is not a financial catastrophe to a financially independent person. Paying a bill might be, depending on the size of the bill. There are many steps between owing a bill and actually paying the bill. By the time you pay the bill, it should have been greatly reduced in negotiations/law suits. Paying the sticker price for a large hospital bill is a mistake. Take it or leave it, but it's true.
"Just go to Mexico" is a legitimate solution for me. I understand if it is not for you -but did you really think about it or just reject it out of hand? It might be a solution for more people than you think. To me, the situation you described is actually a perfect example of when going to Mexico to receive the treatment would be a very interesting option. You could probably get a luxury apartment in Condessa in Mexico City, a personal doctor/oncologist/whatever to make house calls with the latest technology and plane tickets for yourself and family for the cost of the treatment you described in the United States. Thankfully that is a very unlikely scenario relative to a teenager blowing a red light and crushing us (i.e. a careless driver is a much bigger risk). Also, I said it was outside the box.
You are right that the ACA does limit the potential exposure. To me, that is a justification for getting medical bill sharing - I can get ACA coverage within one year if I absolutely must have it. Can I figure out something for a year with all the money I saved in premiums? Especially if I can take advantage of geography/currency? I do have medical bill sharing and it has worked every time I needed it. Well...I'm taking my chances.
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You definitely have to read the fine print. This is Sedera's prescription coverage (to take an alternative to Liberty which I agree does sound problematic):
Prescriptions for medication related to a qualifying medical condition are shareable for the
customary cost of the first 120 days. (Treatments for cancer and sublingual immunotherapy
—a curative treatment for allergies—are not subject to this limitation
; medications related to
organ transplants are limited to 12 months duration
) All medication, prescribed or not,
administered during inpatient hospital stays will be shareable. Sedera employs various
mechanisms in order to substantially reduce the cost of maintenance medications, including
the use of a mail-order pharmacy program (buy-up option).
Note: Sedera members do not share the cost of prescriptions for maintenance of chronic or
recurring conditions (e.g. diabetes, eczema, blood pressure control) beyond the initial 120-day
period. Subsequent sharing of a prescription for maintenance of the same condition will
occur only when there is a new need. Sedera members do not share expenses for
psychotropic medications for chemical imbalances that cannot be verified by laboratory
tests.
So, no issues for cancer chemotherapy, but a multiple sclerosis patient is out of luck once they're past the 120 day coverage period. Also, it's not clear whether a new clinically-evident lesion would be considered a new shareable "need". They also explicitly exclude long term coverage for diabetes, high blood pressure etc. And the "chemical imbalances" suggest that they won't cover things like Prozac for depression, Ritalin for ADHD etc.
The overall approach with Sedera is not to cover the routine small potatoes stuff, but to focus on the unexpected. I like this approach actually, since it incentivizes patients to put some effort into minimizing ongoing costs that won't break the bank for an individual, but that can in aggregate put a large burden on an insurance plan. With traditional insurance, there is no such incentive.
However, their exceptions sound like there hasn't been a lot of thought put into it. If I were seriously considering Sedera (or other health sharing plan) I'd call and ask some hard questions about expensive long-term conditions like MS.
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You definitely have to read the fine print. This is Sedera's prescription coverage (to take an alternative to Liberty which I agree does sound problematic):
Prescriptions for medication related to a qualifying medical condition are shareable for the
customary cost of the first 120 days. (Treatments for cancer and sublingual immunotherapy
—a curative treatment for allergies—are not subject to this limitation
; medications related to
organ transplants are limited to 12 months duration
) All medication, prescribed or not,
administered during inpatient hospital stays will be shareable. Sedera employs various
mechanisms in order to substantially reduce the cost of maintenance medications, including
the use of a mail-order pharmacy program (buy-up option).
Note: Sedera members do not share the cost of prescriptions for maintenance of chronic or
recurring conditions (e.g. diabetes, eczema, blood pressure control) beyond the initial 120-day
period. Subsequent sharing of a prescription for maintenance of the same condition will
occur only when there is a new need. Sedera members do not share expenses for
psychotropic medications for chemical imbalances that cannot be verified by laboratory
tests.
So, no issues for cancer chemotherapy, but a multiple sclerosis patient is out of luck once they're past the 120 day coverage period. Also, it's not clear whether a new clinically-evident lesion would be considered a new shareable "need". They also explicitly exclude long term coverage for diabetes, high blood pressure etc. And the "chemical imbalances" suggest that they won't cover things like Prozac for depression, Ritalin for ADHD etc.
The overall approach with Sedera is not to cover the routine small potatoes stuff, but to focus on the unexpected. I like this approach actually, since it incentivizes patients to put some effort into minimizing ongoing costs that won't break the bank for an individual, but that can in aggregate put a large burden on an insurance plan. With traditional insurance, there is no such incentive.
However, their exceptions sound like there hasn't been a lot of thought put into it. If I were seriously considering Sedera (or other health sharing plan) I'd call and ask some hard questions about expensive long-term conditions like MS.
This is extremely risky.
Many cancers are now treated with chemotherapy or follow up chemotherapy in pill form. My mother was on one, after her $1M stem cell transplant, for five years. The pill cost $900 per day. Prior to getting a blood cancer she was a fit women who didn't smoke and walked five miles per day with NO family history of cancer.
The idea that one can go on a health share for as long as they are healthy and then move to the ACA when they become sick is exactly why the ACA is struggling. I was a finance director of a plan on the exchange that shut down because we were bleeding money. All our members were sick. And this is also why premiums have gone up so much.
Also, as mentioned previously in this thread Health Shares have extremely high administrative expense. This in conjunction with their very low reserves (if any) really just make them not much better than a pyramid scheme. Or akin to just setting up a GoFundMe once you get sick.
I'm not a fan at all of our current system. I could go on and on for pages on how broken it is. But joining a health share in lieu of commercial insurance is truly putting your assets at risk.
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This can be difficult to imagine until you've been there, but the last thing I'd want to do when terribly ill is travel, if it could be avoided. (That's assuming you're even fit to travel. Sometimes you aren't.) My chronic illness is unpredictable and disruptive enough to my family without us having to uproot our lives to deal with it in another setting for an unknown period of time, with doctors who may not know as much about it as a subspecialist closer to home.
It's not that I don't have faith in the healthcare systems of other countries, but some diseases and procedures are more common in certain parts of the world than others. Even within states or multi-state regions, there will be hospitals that direct specific patients to other hospitals for proper treatment. There are two sides to traveling for treatment, and people often focus on the more optimistic one, which is finding yourself in a situation so benign that you have the option to shop around and travel to maximize savings. The darker side is having to travel because it's your spouse's or child's only hope for survival.
There's so much variability around what a disease can take from you, how quickly (and painfully, and sometimes permanently) it might happen, and where to receive the best care for your situation. When I first got sick, as a toddler, with a common illness that had nothing to do with neglecting my health or making poor life choices, the bill was $200k, adjusted for inflation. That was several times what my parents' house cost back then. Many more hospitalizations followed. They sometimes had trouble locating doctors and surgeons with the right expertise to treat my level of disease severity. Thirty years later, my dad still gets emotional when he remembers the terror he felt when the bills arrived, and the relief when he saw insurance covered nearly everything.
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@FIREby35, I think you are much more apprised of the true risk profile of these plans than most people and are quite capable of making an informed decision. You are right about hospital collections and bankruptcy options, but most people would find that to be quite an adverse outcome.
I can see myself traveling to Mexico for treatment in some scenarios and not others. Certainly a person who is FIRE and retired is much more able to travel for medical care than someone who still relies on their U.S. based income.
My biggest issue is options that make people think they have coverage but have many exclusions that leave them with significant exposure. It's also my beef with short term health plans. I actually was on a short term health plan when I first got very ill almost 20 years ago, and nothing was covered because it fell under a plan exclusion. No healthy person expects to suddenly develop a serious illness, but it happens all the time. And catastrophic is a matter of degrees. When I was 22, $2k a month in health care costs and $1800 a month in income was catastrophic. I literally couldn't pay for medication I needed.
Ultimately, we need to solve health care costs in this country. I'd prefer a solution that works for everyone, young and old, sick and healthy, rather than a workaround that benefits a few at the expense of others.
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PS - No, I don't know why I felt compelled to write such a long post on medical bill sharing. My wife made fun of me.
Life is risky. I hope we all make it out alive, but I doubt it :)
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Sedera's online info made it clear that time limits on prescriptions did not apply to cancer chemotherapy, so the cited example above would not be an issue. Regarding the 12 month time limit on organ transplantation, that gives you enough time to switch to an ACA plan or go on Medicaid. The latter being more likely...if you are an organ transplant case you're highly likely to qualify as disabled. (In NY state the ACA plans are actually Medicaid managed care plans with premiums so this doesn't matter in terms of coverage.)
The problem BeanCounter raises about health shares saving money by skimming off the healthy population is right on target. Private insurance companies have been doing this too, because the majority of medical costs in the US are actually paid by Medicare and Medicaid (about 2/3). Basically, the sick population is already mostly on government insurance. The healthshare vs no insurance vs ACA issue is the same phenomenon, just limited to the remaining 1/3 of health costs. The only way to fix this is to establish a single-payer or single-risk pool scheme. From an individual's standpoint there's nothing you can personally do about it. You have to consider what's optimal for you given the structure we have.
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I was thinking about this a bit more. Does it boil down to two risks? 1) the financial catastrophe part 2) access to medical care?
My message/point on the financial part is that you can do a lot with legal strategies that cost less than the monthly premium and offer the same protection against financial considerations. Non-lawyers don't have to know the details, but if they know not to panic and to seek help if/when the worst happens then they are good (At least, I feel that way and I have coached my wife in case I'm not around). You could go so far as finding a person with experience dealing with hospitals in advance as "insurance."
The access to care part seems like a financially independent person could get access to care with cash. Not everyone can "self-insure" because they don't have savings. But, for me, I have enough cash. I suspect many others here are in that position as well.
Beside financial shock from a big bill and access to care - is there something else important I am missing?
PS I agree about the macro level points that healthy people opting out of the private market isn't good for the entire system. But I also think we all make individual decisions based on the incentives that exist in the current (crazy) system. For me $1,500 to $2,000 per month for a family of five while still paying big deductibles was/is a lot to ask for the benefit of "the system."
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Just wanted to bring this post back from the dead to see if healthshares are still relevant and a good idea for my situation. I left my job a month ago, so I have one more month remaining on my COBRA opt-in, but having quit mid-year my AGI would put me at very little if any healthcare subsidies. I'm thinking I'd do Zion Healthshare with the $5,000 IUA, so it would just be for catastrophic emergencies as I'm relatively young and healthy and don't routinely seek medical care.
The ~$150/mo sure beats the high deductible and expensive premiums I'd be offered from a larger healthcare company -- especially since I'm unlikely to use it the rest of the year anyways! (knock on wood) And then I can re-evaluate beginning of 2022 to see if subsidies would cover me.
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MMM had a recent post about it. Personally we're planning on the ACA with the new expanded credits
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MMM had a recent post about it. Personally we're planning on the ACA with the new expanded credits
Are you referring to this review of Sedera? https://www.mrmoneymustache.com/sedera/ (https://www.mrmoneymustache.com/sedera/)
I'll have to read that whole thing when I get a chance. And also re-evaluate how the ACA expanded credits will affect me.
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MMM had a recent post about it. Personally we're planning on the ACA with the new expanded credits
Are you referring to this review of Sedera? https://www.mrmoneymustache.com/sedera/ (https://www.mrmoneymustache.com/sedera/)
I'll have to read that whole thing when I get a chance. And also re-evaluate how the ACA expanded credits will affect me.
in my state and county a bronze plan is about 20 dollars a month for a family of 4 with 81k in AGI - and at 16k in agi i can get it for about 250 a month but you can easily run your numbers on the healthcare.gov site.