Health Insurance options and feedback on my choice

[zinger1457]

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.

I'm no expert on CHM but know there are different price options and and-ons. As mentioned above Brothers Keeper would increase the $125K/illness limit to unlimited with their gold plan for an extra $40/mo, would seem to be a no brainer add-on if one was to go with that type of plan. Another forum member has talked about his experience using Liberty Healthshare, I believe he stated their limit is $1M/incident.

 

[ER Eddie]

This is correct.

Great, thanks. I was afraid of being put in a position where I'd have to choose between a subsidy and continuing to work (which I value). If I can sequester my income from Mr. AGI by squirreling it away in a 403b, then I can get out of that trap.

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.

Gotcha. Thanks for the input. You're right about pricing being different from area to area.

I'll make a call to the ACA insurer in my area. There is only one. Their website did not fill me with confidence. I searched for Primary Care Physicians in my area, and the first one it listed was an elementary school...

 

[jkrm]

My daughter is 31. Two years ago she was the picture of health - never got sick, ran marathons, saw a doctor once a year for annual exam. Then her hands started hurting after a fall. Many months later she got the diagnosis - rheumatoid arthritis. Chronic disease. Biweekly injections of a biologic drug that costs over $1,000 per injection, as well as regular visits to a rheumatologist, frequent blood tests, and regular physical therapy.

So I would go with 1 or 2. You just don't know what might happen. I guess you might get away with a short term plan and switch to an ACA plan at the next open enrollment, so long as the provision still exists that pre-existing conditions can't cause you to be rejected. But I am not sure I would risk that.

 

[MichaelB]

I'll make a call to the ACA insurer in my area. There is only one. Their website did not fill me with confidence. I searched for Primary Care Physicians in my area, and the first one it listed was an elementary school...

Oh boy, That is not a good sign.

 

[ER Eddie]

I just found out COBRA is cheaper than I thought it would be. I expected it would be $1000/mo., but it's actually $600/mo.. That's reasonable. It's good insurance. So, that might be a good option. It's a few thousand a year more than the short-term plans plan or subsidized ACA plans, but it may be worth that to avoid the hassles and downsides of those other options. At least for a while.

 

[MichaelB]

I just found out COBRA is cheaper than I thought it would be. I expected it would be $1000/mo., but it's actually $600/mo.. That's reasonable. It's good insurance. So, that might be a good option. It's a few thousand a year more than the short-term plans plan or subsidized ACA plans, but it may be worth that to avoid the hassles and downsides of those other options. At least for a while.

It's a good option, lasts 18 months, and if you choose an ACA plan, you have guaranteed enrollment outside of the normal November enrollment period.

 

[utrecht]

I'm no expert on CHM but know there are different price options and and-ons. As mentioned above Brothers Keeper would increase the $125K/illness limit to unlimited with their gold plan for an extra $40/mo, would seem to be a no brainer add-on if one was to go with that type of plan. Another forum member has talked about his experience using Liberty Healthshare, I believe he stated their limit is $1M/incident.

Actually the "Brothers Keeper" add on which gives you unlimited lifetime coverage doesnt cost $40/month extra. It costs $25/ quarter extra.

 

[BeachOrCity]

For your long term HC / ACA sanity get your ducks in a row on the rules around catastrophic plans even if you go Cobra. Bottom line is it is alot of paper work, but worth it if you are somewhat healthy and bronze premiums are over 8% of your projected income.
For me the cost was 1/2 that of a bronze plan for what is not that different coverage.

In most states getting the actual catastrophic premium without getting the exemption first is cumbersome and difficult. they do not make it easy which is why few do it....and is also why it is so much cheaper.

Even if going cobra you can apply for the exemption just to understand the process and premiums.

 

[ER Eddie]

For your long term HC / ACA sanity get your ducks in a row on the rules around catastrophic plans even if you go Cobra. Bottom line is it is alot of paper work, but worth it if you are somewhat healthy and bronze premiums are over 8% of your projected income.
For me the cost was 1/2 that of a bronze plan for what is not that different coverage.

In most states getting the actual catastrophic premium without getting the exemption first is cumbersome and difficult. they do not make it easy which is why few do it....and is also why it is so much cheaper.

Even if going cobra you can apply for the exemption just to understand the process and premiums.

Will do. Thanks for mentioning the option. I wasn't aware of it.

 

[utrecht]

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 makes no sense at all. Yes, CHM takes about 4 months to pay. That is clearly stated. Its not a secret. How does that have anything to do with not being covered during your last 4 months under CHM? If I quit CHM and join an ACA plan tomorrow, I was still covered by CHM the past 4 months.



"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."


Again, pre-existing condition rules are clearly stated. This person most likely either didn't disclose the condition when signing up and/or the surgery was performed fairly soon after signing up so it wasnt fully covered.


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


This is 100% total nonsense. CHM members pay cash up front. EVERY doctor loves this. You know how long it takes them to get paid by insurance companies? If its an expensive procedure you can go on a payment plan and pay the doctor in full when CHM pays you. I pick any doctor I want, unlike the ACA plan I was on where most of the doctors in the plan got their degree in places like Granada.


"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."


Cant answer this one but my guess is there's more to the story than this person is letting on. Maybe CHM had a problem with a person going to the emergency room and racking up $15000 in medical costs, for a "first time infection"?
Not too mention that anything over $1000 CHM has their own dept to contact the doctor/hospital to negotiate the price lower for cash patients.


"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."


This entire rant is just more complaints from someone who didnt know what they signed up for.


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

I dont trust Yelp reviews at all. Ive read so many reviews saying a restaurant or hotel was terrible but I saw none of the things they talked about. Ive seen people complain about tiny rooms that I thought were pretty big...ect.

 

[utrecht]

Here's an open and honest description of how CHM works including all the pros and cons.
https://www.clarkscondensed.com/thrifty-living/christian-healthcare-ministries-review/

 

[ncbill]

Different health ministries also handle billing differently.

Some require you to negotiate the bill yourself, others do it for you.

The latter is what I'd pick if I went with one of them.

 

[ER Eddie]

OP here. So this is my re-analysis, based on what I learned (thanks again, everyone, for your feedback).

ACA Plans: Cheapest in my area is 11K/yr, with a 6500 deductible. Only one provider and five plans. Their website does not impress. I'm not clear how good of a choice I'd have with primary care doctors.

I may be able to qualify for a subsidy, if I do a few things (not draw pension, put income in 403b/TSA, and stop fiddling with my index funds).

ACA Catastrophic Plans and the Affordability Exemption: I qualify for this. I need to call the ACA provider and see if they offer any catastrophic plans in my area and get a quote.

Short-Term Plans: I like the idea of catastrophic coverage, and these plans seem to fit the bill. I could carry it for 3 years. After that, I'm not sure what you do. Switch to a different plan, I guess.

The downside of catastrophic coverage is the high deductible and potential out of pocket expenses. With a 12.5K deductible and 10K max for expenses beyond that, the total out of pocket expense for a relatively "minor" event could run 22.5K. I could handle that, but it would sting.

The other potential downside is the exclusions. People raised concerns about that, but when I looked at a detailed overview, I was okay with it. They covered the big stuff, and most of the exclusions weren't things I needed covered. I need to look at any actual policy document, though, because I was only looking at an overview.

Another downside of the ST plans is that they don't cover pre-existing conditions. I have mild HTN. They could reject me because of that, although I think that's doubtful (I spoke with a rep about this, and he indicated if the HTN is under control, I'd be fine). But still, there is some uncertainty in this area.

COBRA: This turned out cheaper than expected ($7K/yr rather than 12K/yr), so that was a happy surprise. COBRA has a number of advantages, the main one being that it's good insurance. During a medical crisis 6 years ago (a "minor" surgery that went awry), I relied on it to the tune of over 300K. This may sound odd, but I feel sort of emotionally indebted to the insurance, and that's part of why I'm okay with paying for it now. Another advantage will be avoiding the hassles and uncertainties of applying for new insurance. It also allows 18 months for me to get more informed about the alternatives, and it will give 18 months for the government and insurance companies to do whatever they are going to do.

So, I think COBRA is my best choice, at least for 18 months.

Another option was a Christian healthshare plan, which appeals to me from a cost and spiritual perspective. However, I keep hesitating because of the "we're under no legal obligation to pay you" part. I know most of them have good track records, but I don't like that element of uncertainty. I also have concerns about some of the companies' coverage limits in the first couple years, if you have pre-existing conditions. I saw stuff like 50K limits in the first year, but I'm looking for 300-500K coverage, from the start, not with some type of waiting period. I also didn't see a high-deductible plan. I'm looking for catastrophic type plans, and I didn't get the sense that these plans offer that.

Someone also mentioned the option of High deductible + health savings account. I did not get around to investigating that one. I'm assuming that's an option under the ACA plans.

Anyhow, I think I've arrived at a decision. Thanks again for all the input. Good group here, very informative and helpful.

 

[pb4uski]

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.

Our savings was about 40% initially as I recall, but is more like 50% now, because the annual premium increases for the bronze plan have been higher than the catastrophic plan. Our premium is a lot less because we happen to live in one of the few states that prohibit age rating but my understanding is that in many other states that the premium difference is much more modest.

 

[isisdave]

You could also expat yourself to Mexico, Costa Rica, Panama, Ecuador, Uruguay, or a similar country with decent healthcare and either free or cheap public insurance, or reasonable private plans. If an expensive illness strikes, you can cover initial treatment there while waiting for an ACA plan to kick in.

 

[Scuba]

OP here. So this is my re-analysis, based on what I learned (thanks again, everyone, for your feedback).

ACA Plans: Cheapest in my area is 11K/yr, with a 6500 deductible. Only one provider and five plans. Their website does not impress. I'm not clear how good of a choice I'd have with primary care doctors.

I may be able to qualify for a subsidy, if I do a few things (not draw pension, put income in 403b/TSA, and stop fiddling with my index funds).

ACA Catastrophic Plans and the Affordability Exemption: I qualify for this. I need to call the ACA provider and see if they offer any catastrophic plans in my area and get a quote.

Short-Term Plans: I like the idea of catastrophic coverage, and these plans seem to fit the bill. I could carry it for 3 years. After that, I'm not sure what you do. Switch to a different plan, I guess.

The downside of catastrophic coverage is the high deductible and potential out of pocket expenses. With a 12.5K deductible and 10K max for expenses beyond that, the total out of pocket expense for a relatively "minor" event could run 22.5K. I could handle that, but it would sting.

The other potential downside is the exclusions. People raised concerns about that, but when I looked at a detailed overview, I was okay with it. They covered the big stuff, and most of the exclusions weren't things I needed covered. I need to look at any actual policy document, though, because I was only looking at an overview.

Another downside of the ST plans is that they don't cover pre-existing conditions. I have mild HTN. They could reject me because of that, although I think that's doubtful (I spoke with a rep about this, and he indicated if the HTN is under control, I'd be fine). But still, there is some uncertainty in this area.

COBRA: This turned out cheaper than expected ($7K/yr rather than 12K/yr), so that was a happy surprise. COBRA has a number of advantages, the main one being that it's good insurance. During a medical crisis 6 years ago (a "minor" surgery that went awry), I relied on it to the tune of over 300K. This may sound odd, but I feel sort of emotionally indebted to the insurance, and that's part of why I'm okay with paying for it now. Another advantage will be avoiding the hassles and uncertainties of applying for new insurance. It also allows 18 months for me to get more informed about the alternatives, and it will give 18 months for the government and insurance companies to do whatever they are going to do.

So, I think COBRA is my best choice, at least for 18 months.

Another option was a Christian healthshare plan, which appeals to me from a cost and spiritual perspective. However, I keep hesitating because of the "we're under no legal obligation to pay you" part. I know most of them have good track records, but I don't like that element of uncertainty. I also have concerns about some of the companies' coverage limits in the first couple years, if you have pre-existing conditions. I saw stuff like 50K limits in the first year, but I'm looking for 300-500K coverage, from the start, not with some type of waiting period. I also didn't see a high-deductible plan. I'm looking for catastrophic type plans, and I didn't get the sense that these plans offer that.

Someone also mentioned the option of High deductible + health savings account. I did not get around to investigating that one. I'm assuming that's an option under the ACA plans.

Anyhow, I think I've arrived at a decision. Thanks again for all the input. Good group here, very informative and helpful.

Thanks for the update, Eddie. Sounds like you’ve really thought this through. IMO, you’re making a great decision.

 

[meleana]

I would do the short term insurance plan if it were me. In fact, in another year it probably will be me, depending on what Hubby's employer offers when he retires.

 

[meridiver]

Let me offer you a cautionary tale regarding short-term health insurance policies.

My brother was diagnosed just over a year ago with stage 4 colon cancer. He had dropped his coverage under the Affordable Care Act in favor of a short term policy just a few months before he was diagnosed. At the time he received his diagnosis, he was told that he needed a couple of months of chemo to try to shrink the tumor, then hopefully surgery to remove as much of it as possible. However, he only had one month left on his short term policy. He went to his insurance agent for reassurance that he would be able to renew his policy and continue his coverage while he was treated. I think you can guess what happened next. His agent informed him that when the renewal came up, he would no longer be eligible for coverage due to a (now) pre-existing condition, leaving him on the hook not only for the remainder of his expensive chemo, but also for any eventual operation.

He chose to forgo standard medical treatment, and instead pursued various (cheaper) diet and supplement options. Recently, he was able to get back on an Affordable Care policy during open enrollment and is now getting chemo. We are optimistic about his progress so far.

Do yourself a favor and maintain standard insurance coverage, regardless of what it costs. It sounds like you have some good options between COBRA or coverage under a catastrophic plan. Short term insurance policies are the equivalent of playing Russian roulette with your health and potentially your life.

 

[meleana]

Let me offer you a cautionary tale regarding short-term health insurance policies.

My brother was diagnosed just over a year ago with stage 4 colon cancer. He had dropped his coverage under the Affordable Care Act in favor of a short term policy just a few months before he was diagnosed. At the time he received his diagnosis, he was told that he needed a couple of months of chemo to try to shrink the tumor, then hopefully surgery to remove as much of it as possible. However, he only had one month left on his short term policy. He went to his insurance agent for reassurance that he would be able to renew his policy and continue his coverage while he was treated. I think you can guess what happened next. His agent informed him that when the renewal came up, he would no longer be eligible for coverage due to a (now) pre-existing condition, leaving him on the hook not only for the remainder of his expensive chemo, but also for any eventual operation.

He chose to forgo standard medical treatment, and instead pursued various (cheaper) diet and supplement options. Recently, he was able to get back on an Affordable Care policy during open enrollment and is now getting chemo. We are optimistic about his progress so far.

Do yourself a favor and maintain standard insurance coverage, regardless of what it costs. It sounds like you have some good options between COBRA or coverage under a catastrophic plan. Short term insurance policies are the equivalent of playing Russian roulette with your health and potentially your life.

Wow! I never thought of that! Very good information. No short term policy for me then!


Glad your brother is doing better.

 

[ER Eddie]

Well, yeah, short-term policies will reject you for serious pre-existing conditions like cancer. That's not a surprise to me. Anyone who's signing up for a short-term policy needs to know that.

You also need to be in a state that allows companies to extend them for a year. That's only become possible, and only in some states, recently. Before that, it was a 3-month limit. See the figure below.

Don't sign up for a short-term plan if you're in a state that doesn't allow insurance companies to extend ST policies for a year. If you do, you could be stuck in a situation like the one meridiver described.

I'm in a state that lets companies offer them for a year's duration. If I were to get a short-term policy, I'd get it starting in November or December. If I got diagnosed with a serious illness during the policy period, I'd switch to an ACA plan next Nov/Dec, during the open enrollment period.

 

[PoorOldCountryBoy]

I have been paying bigtime as an ER but I look at the ACA plans as wealth insurance - if I or DS get a terminal condition without a good noncancellable plan, there goes the nest egg. So it's expensive until you consider the alternatives.

 

[explanade]

I have been paying bigtime as an ER but I look at the ACA plans as wealth insurance - if I or DS get a terminal condition without a good noncancellable plan, there goes the nest egg. So it's expensive until you consider the alternatives.

Yup, that was more or less the thinking here in ER before I Fire'd in 2014 so I approached it the same way.

It is costly but nothing compared to being caught without insurance and having to pay fully.

 

[Calico]

I have been paying bigtime as an ER but I look at the ACA plans as wealth insurance - if I or DS get a terminal condition without a good noncancellable plan, there goes the nest egg. So it's expensive until you consider the alternatives.

Yup, that was more or less the thinking here in ER before I Fire'd in 2014 so I approached it the same way.

It is costly but nothing compared to being caught without insurance and having to pay fully.

Exactly! It is expensive and costly until the minute you really need it - then it instantly becomes priceless.

 

[arch57]

I used Cobra as well

OP: So, I think COBRA is my best choice, at least for 18 months.

I purposely chose 6/30/15 as my retirement date from Mega-Corp so I could get the 18-month COBRA (at $700/month for me and DW) to carry me thru end of 2016 and it worked out well. Since then we're at mercy of ACA and 2017-2019 premiums were $1000, $1270, $1430 for Bronze HSA plan w/$6500 deductible. However we max out ($7900 this year) our HSA and if you stay healthy all year it adds up plus lowers your AGI, which is a plus. Good luck.

 

[PoorOldCountryBoy]

OP: So, I think COBRA is my best choice, at least for 18 months.

I purposely chose 6/30/15 as my retirement date from Mega-Corp so I could get the 18-month COBRA (at $700/month for me and DW) to carry me thru end of 2016 and it worked out well. Since then we're at mercy of ACA and 2017-2019 premiums were $1000, $1270, $1430 for Bronze HSA plan w/$6500 deductible. However we max out ($7900 this year) our HSA and if you stay healthy all year it adds up plus lowers your AGI, which is a plus. Good luck.

We approached things the same way with similar numbers. Thank goodness for the HSA policy!