Health Insurance options and feedback on my choice

[zinger1457]

For those people in a health sharing ministry who get a major illness or have a health event how many at the next open enrollment would stay with the ministry vs paying the ACA premiums? Not many I would guess. And the healthshare ministry will be happy to see you go
.

If someone is signed up with a ministry and comes down with an illness why would they leave if their medical bills are getting paid? If you have knowledge of someone not getting their medical bills paid or coverage dropped when someone comes down with an illness while a ministry member please share.

 

[ER Eddie]

OP here. Thanks for the input, folks. To respond briefly to some of the points raised:

1. I don't understand how to manage my capital gains in order to reduce MAGI. I will need to look into this.

2. Don't worry, I won't self-insure. Too risky.

3. I'm not going to increase my hours to qualify for benefits. That's the wrong direction for me.

4. I will double-check the exclusions for short-term policies, thanks for the warning. I want to cover large, catastrophic expenses, such as cancer, heart attack, and stroke. As far as I could tell, those things would be covered under the short-term plans I was looking at (unless they were pre-existing conditions). But I'll take a closer look and ask some questions before signing up for anything.

5. The Christian plans are a nice option, too. They would be my second choice. Some of them have "statements of belief" that I could not in good conscience sign, but others are very broad (e.g., Liberty, Altrua). And I agree that they can probably be trusted to pay out, in most cases (as much as insurance companies, anyhow).

 

[MichaelB]

4. I will double-check the exclusions for short-term policies, thanks for the warning. I want to cover large, catastrophic expenses, such as cancer, heart attack, and stroke. As far as I could tell, those things would be covered under the short-term plans I was looking at (unless they were pre-existing conditions). But I'll take a closer look and ask some questions before signing up for anything.

Drugs are typically not covered with short term policies, this would limit coverage for cancer or any chronic disease.

 

[pb4uski]

.... You have another option. Get an “affordability exemption” based on the premium for bronze being over 8% of projected income. Then you can buy a catastrophic plan. The premiums for this are usually much cheaper (look at your states options for someone 25 years old to get an idea of the percent of premiums you will save)

We have done this since the first year of ACA and it has worked out wonderfully. We are lucky that we live in a state that prohibits age rating so catastrophic coverage is slightly less than half of a bronze policy. Managing our income to qualify has never been a problem... in fact, I don't think they have ever checked it. OTOH, my understanding is that the cost of catastrophic coverage in some states is not that much lower than a bronze plan.

 

[geeky_grrl]

OP here. Thanks for the input, folks. To respond briefly to some of the points raised:

1. I don't understand how to manage my capital gains in order to reduce MAGI. I will need to look into this.

If you are invested directly in stocks then your capital gains aren't in your MAGA until you sell them, so you can control how much you realize each year to stay under the ACA cliff.

If you are in mutual funds you can't directly control if they realize capital gains, but some funds are much more tax efficient than others. In general index funds churn stocks less and don't throw off much capital gains and actively traded funds generate more gains while you are holding them. You'd have to take the tax hit to move your money to different funds if wanted to move to more tax efficient ones, but it might be worth the one time hit.

It's a lot easier to stay under the ACA cliff if you tend to follow a bogleheads strategy (buy and hold index funds) then if you actively trade or invest in funds that actively trade.

 

[utrecht]

That sounds like an excellent option, but 2 questions:
1. How does CHM verify you're a Christian?


2. The "didn't pay" reviews, did any include long term cancer treatments or major heart procedures? Based on a friend of mine who chose chemo to treat his cancer, one treatment was close to $25K. He estimated (although HI paid for large portion) the entire treatment over many months was in the neighborhood of $450K (chemo alone).

When filing for reimbursement, you have to list your church and its phone number. That's the closest they get to "verifying" that you are a Christian.


What "didnt pay" reviews? There are none that Ive been able to locate in relation to CHM. Ive heard plenty of horror stories from traditional insurance companies that refused to pay for treatments recommended by their doctor, or they were billed a ton of extra money due to things like an anesthesiologist being out of network....even though your doctor and the hospital were in network.


CHM doesn't use networks. You go to literally any doctor you want to go to. Any Hospital, any doctor, any specialist in any state. If the doctor says you need a procedure, there is no approval needed or no second guessing from CHM. They are a non profit which is another reason things are cheaper on top of a couple reasons someone listed.


They do have some pre-existing conditions limitations, but they aren't that bad unless you have a very serious and expensive pre-existing condition.


Here another interesting thing I found out. CHM will reimburse for Stem Cell treatments. Good luck getting any insurance company to pay for them.

 

[utrecht]

The health sharing ministry is basically an exemption that allows fairly healthy people without preexisting conditions to cleave themselves out into their own risk pool.

As long as one is reasonably healthy these Healthsharing ministry plans work well. The real risk is that you will have a major event long before open enrollment (Think cancer or bad accident in March for example).
The insurance companies by law have to spend 80% on actual payouts for medical care. Their rates with providers are definitely lower than you can negotiate yourself. So people need to ask themselves where the rest of the 2-3X difference in premiums comes from? Basically it is two things 1). Having healthier enrollees and 2). Not having to pay large claims for the enrollees they do have.

For those people in a health sharing ministry who get a major illness or have a health event how many at the next open enrollment would stay with the ministry vs paying the ACA premiums? Not many I would guess. And the healthshare ministry will be happy to see you go

Alas, everyone has to look out for their own economic need to some extent and balance that with risk. For some who are healthy, the ministries offer a huge economic savings with some risk, but not huge risks.

Why do you think that? Ive had 2 incidents that caused me to see doctors so far and the entire process has been a million times better than it was with traditional insurance/doctor relationship.

 

[onabreak]

I would read fine print on life time caps for CHM. I think they have a 125k limit per condition. They have some other option called Brothers keepers for larger expenses, but might be worthy of some research. I have no experience with these plans but that was a concern for me when I researched them. I am staying on cobra until it runs out and then will likely go ACA plan from state marketplace

 

[COcheesehead]

Interesting overview of the Christian based options. There are enough holes to make me think twice like no coverage for preventive care. What about a colonoscopy, a regular check up? Can’t have a glass of wine? No legal recourse. Hmmmm.
https://www.healthmarkets.com/resources/supplemental-health-insurance/christian-healthcare/

 

[ER Eddie]

OP here. I need to look into the "affordability exemption" idea and also the option of the high deductible + HSA. I hadn't considered those options. Thank you to those who mentioned them.

Re. MAGI and capital gains...

If you are invested directly in stocks then your capital gains aren't in your MAGA until you sell them, so you can control how much you realize each year to stay under the ACA cliff.

If you are in mutual funds you can't directly control if they realize capital gains, but some funds are much more tax efficient than others. In general index funds churn stocks less and don't throw off much capital gains and actively traded funds generate more gains while you are holding them. You'd have to take the tax hit to move your money to different funds if wanted to move to more tax efficient ones, but it might be worth the one time hit.

It's a lot easier to stay under the ACA cliff if you tend to follow a bogleheads strategy (buy and hold index funds) then if you actively trade or invest in funds that actively trade.

I'm all in index funds. I have been moving them around a lot in the past several years, though, and maybe (I don't know) that increased my cap gains. I did a lot of buying and selling and trading -- moving money around from one fund to another, then to another, then to another. I am new to the game, so there was a learning curve. I fiddled a lot with my asset allocation, too. I also moved a bunch of money from a managed fund into Vanguard. About a third of the money was under management for most of the time, and I think my FA did plenty of buying and selling.

So, when I calculate my average cap gains over the past 5 years, it includes all of that buying, selling, and trading.

Question for anyone, then: Does all that buying and selling incur capital gains that I wouldn't have incurred otherwise? That is, do you get more capital gains if you do all the buying, selling, and trading I alluded to above, rather than just letting money sit in an index fund? I don't know enough about how cap gains are calculated to say. If that's the case, then I can hope that cap gains may decrease in the future, once I stop all my fiddling.

It also occurred to me that I could reduce MAGI by not drawing my pension. I could delay that. MAGI would still be a bit high, because my pension isn't all that large. And I plan to keep working -- not a lot, maybe enough to generate around 15K/yr -- and with the 43K average cap gains + dividends, that would still nudge me over the 48K/yr limit for subsidies.

I suppose I could stop working entirely, just to qualify for a subsidy. That feels wrong to me. I enjoy my work and would like to continue in some capacity. I wouldn't want to feel forced out by the fact that I wanted to qualify for a subsidy.


Thanks for the input, folks. I see I have a lot of thinking and research to do.

 

[utrecht]

Interesting overview of the Christian based options. There are enough holes to make me think twice like no coverage for preventive care. What about a colonoscopy, a regular check up? Can’t have a glass of wine? No legal recourse. Hmmmm.
https://www.healthmarkets.com/resources/supplemental-health-insurance/christian-healthcare/

Anything under $500, you pay. Anything over $500 (per incident not per visit) they pay.



A colonoscopy costs more than $500 doesn't it? So what if I have to pay for a regular checkup? We are saving around $800-$900 every month. How many checkups will that pay for?


Ive had around $3200 in medical bills so far. Zero of which would've been covered under any ACA plan. CHM covered it all. You do have to pay cash at the doctors office and then get reimbursed later though.
My premiums just last year alone were about $9000 cheaper than the only plan offered in my area on the ACA exchange. Why would I be concerned with no preventative care coverage?



Who says you cant have a glass of wine? CHM wont pay for medical expenses caused by ABUSE of alcohol because abuse of alcohol is considered a sin. If you get drunk and slam into a concrete pillar, you wont be covered. If your liver fails from 20 years of abusing alcohol, you wont be covered. You can have a glass of wine.

There are certainly some negatives with this kind of plan. You may have philosophical reasons to be against them. You may have pre existing conditions with ongoing treatments than would make it a bad idea..ect.

But for the most part it is so much better than traditional insurance its hard to believe. I bet everyone here could tell a horror story about how they or someone they know was treated by health insurance companies. Try to find one testimonial online by someone who CHM screwed over.

 

[COcheesehead]

Anything under $500, you pay. Anything over $500 (per incident not per visit) they pay.



A colonoscopy costs more than $500 doesn't it? So what if I have to pay for a regular checkup? We are saving around $800-$900 every month. How many checkups will that pay for?


Ive had around $3200 in medical bills so far. Zero of which would've been covered under any ACA plan. CHM covered it all. You do have to pay cash at the doctors office and then get reimbursed later though.
My premiums just last year alone were about $9000 cheaper than the only plan offered in my area on the ACA exchange. Why would I be concerned with no preventative care coverage?



Who says you cant have a glass of wine? CHM wont pay for medical expenses caused by ABUSE of alcohol because abuse of alcohol is considered a sin. If you get drunk and slam into a concrete pillar, you wont be covered. If your liver fails from 20 years of abusing alcohol, you wont be covered. You can have a glass of wine.

There are certainly some negatives with this kind of plan. You may have philosophical reasons to be against them. You may have pre existing conditions with ongoing treatments than would make it a bad idea..ect.

But for the most part it is so much better than traditional insurance its hard to believe. I bet everyone here could tell a horror story about how they or someone they know was treated by health insurance companies. Try to find one testimonial online by someone who CHM screwed over.

The link I posted said no preventive care, no alcohol, etc.

 

[ER Eddie]

The link I posted said no preventive care, no alcohol, etc.

Preventive benefits are built into some Christian healthshare plans but not into others; it depends. With re. to alcohol, the link says moderate alcohol, not "no alcohol":

"To join most health sharing ministries, you must be a Christian who doesn’t use tobacco or illegal drugs, uses alcohol and prescription drugs in moderation, and pursues a healthy lifestyle."

I don't drink at all, so I guess I'll have to start drinking in order to qualify...


I like the idea of the Christian healthcare plans myself. I'm impressed with their track record of paying out. I also like their spirit, as opposed to the entirely profit-driven aspect of insurance companies. Their rates are certainly much cheaper than ACA.

They are still an option for me. My only issue is that I do have some pre-existing conditions (hypertension and high cholesterol), so they could deny me. Hope not. I went carnivore 6 months ago, lost 40 pounds, and both of those conditions have improved substantially. Maybe if I continue to get healthier, I can get those two diagnoses removed, and they can be off my record long enough that I no longer have "pre-existing conditions."

p.s. Here's a half-decent comparison of the major healthshare plans out there. Beware that it is written by someone working for one of the healthshare plans (Aliera), and they're clearly trying to sell you on their plan. So it's a biased overview.

https://www.calhealth.net/health-care-sharing-ministry-comparison-review.htm#statement-beliefs

 

[utrecht]

It says moderate alcohol:

"To join most health sharing ministries, you must be a Christian who doesn’t use tobacco or illegal drugs, uses alcohol and prescription drugs in moderation, and pursues a healthy lifestyle."

I don't drink at all, so I guess I'll have to start drinking in order to qualify...

I like the idea of the Christian healthcare plans myself. I'm impressed with their track record of paying out. I also like their spirit, as opposed to the entirely profit-driven aspect of insurance companies. Their rates are certainly much cheaper than ACA.

They are still an option for me. My only issue is that I do have some pre-existing conditions (hypertension and high cholesterol), so they could deny me. Hope not. I went carnivore 6 months ago, lost 40 pounds, and both of those conditions have improved substantially. Maybe if I continue to get healthier, I can get those two diagnoses removed, and they can be off my record long enough that I no longer have "pre-existing conditions."

They wont deny you. They just have limitations for pre-existing conditions. There are differences in the different companies but CHM gives you $15000 limit of coverage the 1st year, $25000 the 2nd year, $50000 the 3rd year and unlimited after 3 years.

They will only reimburse prescription costs for 90 days so if you have some medicine you have to take long term, you would have to pay for it yourself.

I have a pre-existing condition that flared back up this year. Ive been reimbursed for those charges, but they wont be going over the limits (knock on wood).

 

[COcheesehead]

I will make my final point and then shut up. I buy insurance for insurance. I prefer not to take risks with it and the Christian model seems to have more risk than I am willing to take with something I prefer mininmal risk with, insurance.
Everyone I have talked to and explored the Christian model with usually sums it up as, it’s cheap, but....

 

[cathy63]

Try to find one testimonial online by someone who CHM screwed over.

That's not hard at all! A single Google search turns up plenty. These are just a few of the negative ones from Yelp.

"If you ever heaven forbid change to another health coverage (insurance another cost sharing) then you won't be covered for anything that occurred during the last 4 months you were with CHM because they take 4 months to process your bills and won't pay anything if you cancel during that time. "

"This so called Ministry is a joke. My wife had surgery in 2018 and was denied all coverage and sharing because she had a Pre-existing condition from over 30 yrs ago."

"If you get sick and need a surgery, no good hospital or surgeon will accept you because "you don't have health insurance"."

"Paid as gold member for $150 plus $50 for the so called "brothers keeper" but after getting a first time infection they declined to pay the bills even after I already negotiated very very hard to reduce my bill in half from the hospital. Talked to CHM at 1-800-791-6225 to reconsider, as $15,000 of ER bills is no way I can pay, but they just keep saying Sorry it was denied. CHM personnel/agent did not even offer anything, like helping me further to negotiate with the hospital to see if they can further reduce the bills, or even offer me a what they call "PRAYER". In my opinion I was scammed by CHM. The so called brothers KEEPER is really meant they are keeping your money as a brother."

"Here's what really happens: You have a health issue requiring surgery that's necessary for you to live. You're listed as self-insured by all providers (surgeons, hospital, labs, anesthesiologist, office visits), all of which have their own bills, and often the hospital doesn't send an itemized bill unless you request it directly and then it may take a month. Now you're a month in, and get the claims up to CHM as soon as you can. You request a discount from all providers, which they may or may not offer. Then you wait. And wait. And wait. You're making small payments to each provider to keep collections at bay, but they now call and say you're late and they'll send you to collections if you don't pay more or all of the balance due. You send more or all that's due, because you're now six months and maybe 9 months post-surgery. Then someone at CHM - and you have no idea who, because CHM works behind a curtain - moseys over to the phone and (supposedly) arranges for a deep discount with the provider who's been yelling at you to pay up. In my case, I'm a year out from two major surgeries and waiting on thousands in reimbursement - and I'm the highest level member of CHM. But the checks that actually finally trickle in, although they declare my claims "eligible", remit only a fraction of what I've paid out bc they say the provider offered a substantial discount. I'm sure they did - they've already been paid at this point, so it means nothing to them to tell CHM, Yeah, sure write down the bill so you can tell your member it was really only 20% of what they've paid for, and then CHM can retain 80% of what they've declared is eligible. Want the rest? It's up to you to try to get a refund back from the provider based on what CHM claims they wrote down, except no one provides you with any paperwork substantiating this."

https://www.yelp.com/biz/christian-healthcare-ministries-barbertonhttps://www.yelp.com/not_recommended_reviews/christian-healthcare-ministries-barberton?not_recommended_start=0

 

[Rianne]

CHM doesn't use networks. You go to literally any doctor you want to go to. Any Hospital, any doctor, any specialist in any state. If the doctor says you need a procedure, there is no approval needed or no second guessing from CHM. They are a non profit which is another reason things are cheaper on top of a couple reasons someone listed.

I have no criticism of CHM. I considered joining but was on the fence with my Catholicism, I could not be honest describing myself as a Christian.

Our HC system is also a nonprofit. The doctors, hospitals, procedures, meds are profit. For example, I go to Mayo Clinic, see a specialist. The same specialty is available at my local hospital, but I want the best. I want the tests, procedures and anything that can accurately diagnose my condition with full confidence. The difference in cost of these 2 options is quite extensive. The way you describe the benefits are quite amazing.

 

[ER Eddie]

OP here. I reviewed the inclusions and exclusions of the short-term policy I was looking at, and I don't have any problems with it. The big stuff is covered. None of the exclusions raised any concerns for me. The vast majority of exclusions aren't things I'm interested in having protection against. I don't mind paying OOP for the others. I'm just looking for protection from financial catastrophe.

I also was pleased to discover the definition of a pre-existing condition avoids the horror story mentioned earlier in the thread (someone was diagnosed with cancer shortly after the policy began, and the company denied coverage because the cancer was presumed to have been a "pre-existing condition"). I also live in a state where that language has been tightened up even more.


I woke up early today with some agita about all the unanswered questions, so I'm spending the day researching insurance. Whee...

 

[GTFan]

Question for anyone, then: Does all that buying and selling incur capital gains that I wouldn't have incurred otherwise? That is, do you get more capital gains if you do all the buying, selling, and trading I alluded to above, rather than just letting money sit in an index fund? I don't know enough about how cap gains are calculated to say. If that's the case, then I can hope that cap gains may decrease in the future, once I stop all my fiddling.

Uh, yeah.

Thanks for the input, folks. I see I have a lot of thinking and research to do.

Without a doubt.

 

[ER Eddie]

No need to be condescending. I'm just asking questions.


It looks like I qualify for the affordability exemption for catastrophic coverage mentioned earlier. Bronze will be nearly 20% of my income in 2020. (This is part of why I'm having trouble with the ACA rates. Another part is that an ACA plan would represent nearly a third of my total expenses, which, for a frugal guy like me, is a hard pill to swallow.)

So, the affordability exemption opens up another option, and that's good. I'm not clear how much of a cost difference it will make, though, given that those policies cover the same areas as normal ACA plans do, and the deductible is similar. They quote $7900 as the deductible for catastrophic (although I can't actually view any specific catastrophic plans in my area), and the bronze plan had a $6500 deductible. Anyone have any specific data from their own experience, re. cost savings with catastrophic vs. bronze?

Another MAGI question, if anyone's still following along: If I put income into a 403b, that is not counted in MAGI, correct? So I could reduce MAGI by putting whatever income I get into my 403b?

Thanks, folks. Appreciate the input. It has made me aware of some alternatives I didn't know existed and prompted me to double-check for pitfalls, which has made me feel more knowledgeable and secure.

 

[MichaelB]

Another general tax/MAGI question, if anyone's still following along: If I put income into a 403b, that is not counted in MAGI, correct? So I could reduce MAGI by putting whatever income I get into my 403b?

This is correct.

 

[Bir48die]

Uh, yeah.


Without a doubt.

This reflects my main issue with this forum

 

[MichaelB]

So, that opens up another option, which is good. I'm not clear how much of a cost difference it will make, though, given that those policies cover the same areas as normal ACA plans do, and the deductible is similar. They quote $7900 as the deductible for catastrophic (although I can't actually view any specific catastrophic plans in my area), and the bronze plan had a $6500 deductible. Anyone have any specific data from their own experience, re. cost savings with catastrophic vs. bronze?

A I recall. pb4uski has the most experience here. Looking over some of his posts from the early ACA days might help understand the comparison between Bronze anbd Catastrophoc coverage. As for savings, though, you really need to look at pricing in your area. You may have to call the major insurers to see if they have catastrophic policies available. Also try an insurance agent.

 

[ExFlyBoy5]

I use Christian Healthcare Ministries and will never go back to traditional insurance. At least not until Im eligible for Medicare.

Not wanting to derail this, but since others may see this thread and think that CHM might be a good deal, I came across this...

You can receive assistance up to $125,000 per illness

That, my friend, is not much money in the health care world. When my DW had spinal surgery a few years ago, the bill far exceeded that limit in the period of about 7 hours. That doesn't count for all the additional expenses after surgery and the every 6 month MRI scans that are over $15,000 a pop.

 

[REWahoo]

That's not hard at all! A single Google search turns up plenty.

Interesting distribution on the Yelp! ratings which average three stars (out of five). It appears people either love CHM or hate them.