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Old 12-15-2020, 03:05 PM   #41
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Originally Posted by GTFan View Post
Yeah and that second part is what concerns everyone here. The ACA has legal insurance requirements, HC ministries are the wild west.

Plus the ACA can be very cheap if income can be managed so guaranteed coverage doesn't have to be expensive. I realize that not everyone can take advantage of this, but it is a huge cost factor for coverage today.
Many folks are against the management of income for low ACA premiums, as they aren't able to pull it off themselves. Many folks on this forum are able to take advantage of other tax based situations, of which I have no issues with.
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Old 12-17-2020, 10:02 AM   #42
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One other concern is "what if I get some horrific disease that requires lots of expensive treatment?" Of course the cost sharing should help you out, but even if it doesn't, that would only last 6 months, on average, because open enrollment would be upon you again, and you'd make a decision based on the current calculus with the horrific disease.
In the meantime you could be on the hook for multiple $100k's of treatment. Not saying it's likely, just possible.

I had to LOL at the 'moral & ethical' requirements of membership in that pdf. Whose morals & ethics? Smoking a joint, frex, specifically disallows you from cost-sharing. This is one of the problems with these setups IMO, they can basically deny you for anything if they think you're not Mr. Rogers.
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Old 12-17-2020, 12:06 PM   #43
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In the meantime you could be on the hook for multiple $100k's of treatment. Not saying it's likely, just possible.

I had to LOL at the 'moral & ethical' requirements of membership in that pdf. Whose morals & ethics? Smoking a joint, frex, specifically disallows you from cost-sharing. This is one of the problems with these setups IMO, they can basically deny you for anything if they think you're not Mr. Rogers.
Mr Rogers who knows, but basically I think it's an out for covering claims that result from illegal behavior. i.e drunk driving. It up to an individual to decide if they want to accept those conditions.
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Old 12-17-2020, 02:55 PM   #44
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I did some research on this recently. Read all about "Sedera" (pdf, if you care to read about specifics). The idea seemed to be that you sign up with a doctor you go to that's not doing the current/broken insurance model where they can only charge for a sick code combined with a service code (aka, the sicker the better). They help you find "Direct Primary Care", a local practice where they collect a monthly amount from everyone, use it or not, and they just do your medical stuff. That monthly fee, plus the payment to the cost sharing group can be about half of what you'd pay (rack rate) for insurance. So as long as the cost sharing paid for the unexpected/big thing, you'd be fine. I read another, very detailed PDF, and they said if they didn't have enough to pay everybody's claims, everyone would get less.

Frankly, I think that would work. I'd say you'd get MUCH better service (some of these Direct Primary Care practices pick up the phone 24/7, and you can always get an appointment in a reasonable time, not 2 months out). Also, rather than trying to slap a sick-code on everything, they just do what you want to maintain and improve health. I'm even considering joining a Direct Primary Care practice while on ACA. It doesn't count towards deductible, but with HDHI, any historically few services needed, I don't get close to the insurance paying for anything anyway.

The cost sharing company supposedly can help you negotiate for things, either before or after the fact. They have resources to get an insight on pricing of things (they have exactly what Medicare would have paid, and they often have access to the secret prices that are set-up between insurance companies and healthcare providers). It's like the situation with other "real" insurance...you've got someone on your side who does this stuff every day; you're not on your own. So true, you do not have access to the pricing negotiated by the insurance companies, but if it's before the fact, you can probably get a pretty good price up front with the help of the cost sharing company, and if it's after the fact, if they try the "charge master" BS on you, the cost sharing company will slap that down in a hurry.

One other concern is "what if I get some horrific disease that requires lots of expensive treatment?" Of course the cost sharing should help you out, but even if it doesn't, that would only last 6 months, on average, because open enrollment would be upon you again, and you'd make a decision based on the current calculus with the horrific disease.

Most of the people that are on this board buy traditional insurance, and don't want to hear that they've been "doing it wrong" (cognitive dissonance). I get it. Any change is going to be an uphill battle. Some people "need" contractual. Me, less so. I tend to explore ideas like this in a modeling/decision tree kind of format. This is a tough one, but when I assemble all of the decision nodes and chance nodes, the health and cost is leaning toward the abandonment of the broken insurance / medical industrial complex and going to something else. Of course it makes a big difference what value you place on health, and what the likelihood is of having better health outcomes if you have someone who's trying to make you healthy, rather than someone who only gets paid if you're sick. Not a model any two people will build the same way.
Direct primary care + insurance could be the best if you are willing to pay. You get the responsiveness but you are covered for the unusually large expenses. Most people will not have a huge claim and will do fine with the ministries.
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Old 12-17-2020, 03:44 PM   #45
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Direct primary care + insurance could be the best if you are willing to pay. You get the responsiveness but you are covered for the unusually large expenses. Most people will not have a huge claim and will do fine with the ministries.
Thanks for your perspective on it. I'm seriously considering DPC while still on the ACA. This way, I'd have a non-clouded (or I suppose, technically, "alternatively clouded") relationship with a doctor. There's no such thing as a perfect relationship with a medical provider. The gold standard is the relationship you have with the pilot in an aircraft....he's saving his own "hide" while saving yours. I want to get as close to that arrangement with a doctor as I can
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Old 12-17-2020, 03:47 PM   #46
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Many folks are against the management of income for low ACA premiums, as they aren't able to pull it off themselves. Many folks on this forum are able to take advantage of other tax based situations, of which I have no issues with.
Agreed. Furthermore everything is OK until you get REALLY sick. Managing income for a subsidy is really the best choice. While this flies in the face of my personal philosophy, in todays world it is perfectly acceptable. My hypocrisy knows no bounds. Our healthcare system is in shambles and it's every man, woman and family for themselves.

In the interest of full disclosure I would like to add I have retiree medical coverage from my large corporate plan and medicare in a few months. Likewise all my children have topnotch govt and corp plans. However, that does not mean that because I got mine doesn't mean the problem does not exist.
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Old 12-17-2020, 04:41 PM   #47
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Please let us know how it works out. Wishing you all the best.

A couple of interesting twists:

When we first spoke with the physician in October (?) prior to the surgery we asked how much the procedure would be (I fully expected him to say he had no idea since he does one part, the hospital does theirs etc) but he was quick to say $50k all in, I was pleasantly surprised that he had an idea and that he would share that with me but even if it's 2x that amount we will be okay with it.

Three days ago my wife calls the hospital trying to find out how much we owe and asks for the itemized bill they tell her it's $172k+(only the hospital portion and that doesn't include the doctors, labs etc), my wife told them that the estimate they gave us was $59k the lady was quick to say it was only an estimate and that they aren't done with it yet...

I called this morning and spoke to another lady in the billing department today the bill is $48k.

This will be a bumpy ride.
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Old 12-17-2020, 05:33 PM   #48
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Mr Rogers who knows, but basically I think it's an out for covering claims that result from illegal behavior. i.e drunk driving. It up to an individual to decide if they want to accept those conditions.
Doctors have to treat everyone without judgement, they take an oath to that effect. So these moralists get to decide who gets treatment or not? Then, it's not health insurance; it's biblical judgment
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Old 12-17-2020, 05:37 PM   #49
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Doctors have to treat everyone without judgement, they take an oath to that effect. So these moralists get to decide who gets treatment or not? Then, it's not health insurance; it's biblical judgment

They treat everyone without judgment, just like you
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Old 12-17-2020, 05:42 PM   #50
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Ah. but I'm not an MD, I get to judge
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Old 12-17-2020, 05:50 PM   #51
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I had to LOL at the 'moral & ethical' requirements of membership in that pdf. Whose morals & ethics? Smoking a joint, frex, specifically disallows you from cost-sharing. This is one of the problems with these setups IMO, they can basically deny you for anything if they think you're not Mr. Rogers.
I had some friends on this. Middle-aged, married many years. They denied her claim for birth control.
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Old 12-17-2020, 06:06 PM   #52
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I like plans with max out of pocket defined. Once I hit that number I'm done.
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Old 12-17-2020, 06:15 PM   #53
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Doctors have to treat everyone without judgement, they take an oath to that effect. So these moralists get to decide who gets treatment or not? Then, it's not health insurance; it's biblical judgment
Hold on a second, no one is forced to sign up for those exclusions and no one says they can't get treatment...if you don't like the conditions, buy other coverage...no one said these groups were health insurance.

Why don't you calm down a little.
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Old 12-17-2020, 06:16 PM   #54
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I had some friends on this. Middle-aged, married many years. They denied her claim for birth control.
I call BS on that one.
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Old 12-17-2020, 06:16 PM   #55
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Ah. but I'm not an MD, I get to judge
You're good at it too..
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Old 12-17-2020, 06:52 PM   #56
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I like plans with max out of pocket defined. Once I hit that number I'm done.
The problem is out of pocket limits don't cover out of network billing. It's not uncommon for in network hospitals to have doctors working there that are out of network and bill separately. Congress is working on a bill to address 'surprise billing' but it hasn't passed yet and not sure what all the details are.
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Old 12-17-2020, 07:01 PM   #57
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When I retire in a couple of months at age 63 1/2, I am looking into all options for health insurance.

Will stop receiving health insurance from my employer. The company only has 7 employees so do not qualify for COBRA.

Option 1 - Healthcare sharing ministries, does anybody have any good or bad experiences, recomendations.

Option 2 - Pay the very high premiums.

Option 3 - Hold down my income below $51,040 to get tax credit on an ACA plan. I can afford to do that, could use savings if I need to.

What do you all recommend?
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Option 4- pay the ACA premiums w/o the subsidy.
I have no experience/opinion on the healthcare ministry option.
For 18 months, keep it simple and go with either option 2 or the suggested option 4. My guess is that neither will put a dent in your assets for that period of time. No need to gamble with the sharing ministries. I have nothing against them, but I would rather pay more for good, complete health care coverage.
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Old 12-17-2020, 07:22 PM   #58
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I call BS on that one.
I would think birth control would normally not be enough to meet the cost sharing limit...unless you're talking surgery for permanent sterilization.

Which I can see not being covered as elective as opposed to being medically necessary.
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Old 12-17-2020, 07:33 PM   #59
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fwiw, I recently heard a radio advertisement for one of these plans.
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Old 12-18-2020, 06:41 AM   #60
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When I retire in a couple of months at age 63 1/2, I am looking into all options for health insurance.

Will stop receiving health insurance from my employer. The company only has 7 employees so do not qualify for COBRA.

Option 1 - Healthcare sharing ministries, does anybody have any good or bad experiences, recomendations.

Option 2 - Pay the very high premiums.

Option 3 - Hold down my income below $51,040 to get tax credit on an ACA plan. I can afford to do that, could use savings if I need to.

What do you all recommend?
Man, this conversation went off the rails in a hurry. Appears to be allot of health share haters out there.

OP, since you asked for opinions, here's mine based on experience. I have been self-employed for over 32 years so shopping HI has been an annual function of mine. Over the years I have had company HI through "associations", private insurance, high deductible catastrophe insurance, ACA, and now have been on a health share plan for the last 3 years. I look at insurance (including HI) like any other business decision and size up the risks/rewards, do my homework, and then make a decision. For me, what finally did it, was my ACA plan year after year got worse in coverage, dropped all of our regular docs, added more hoops to jump thru to see certain docs, and the cost was getting ridiculous. I did my research, looked at our current health/pre-existing conditions, etc. and pulled the trigger and chose a health share plan. Like you and many of us, I have to solve my HI issue until I hit 65 (currently 56) and will continue to evaluate the options year by year. So far, my 3 year experience has been great. We have had procedures/medical expenses from $1000 - $10,000 and so far everything has been covered as expected. Based on the quoted ACA premiums 3 years ago, I was saving $18K/year in premiums alone. I also have evaluated the worse case scenario should the 25 year old health share company not come thru on a catastrophe (I have assets to self-insure and can jump back on ACA again at some point if need be). You could also look at it as I have banked $18K/year in savings for the last 3 years which goes in my emergency fund. The trade off to me is I am in control of my health care and choose the docs and facilities I want to go to... that is valuable to me. Do these plans require some faith... you bet. But guess what, we all put our faith in something.

Is a health share plan right for you? Consider the following...
- Are you comfortable being part of a Christian plan and it's by laws... they do have some?
- Are you and those covered in decent health with minimal pre-existing conditions? These plans work best for the more healthy.
- Do you have the ability to cover some out of pocket costs for a few months until you are reimbursed?
- Are you comfortable dealing directly with doc offices about procedure costs, asking for 'Cash pay" discounts?
- Do you like saving $10K - $18K/year in premiums/costs?
- Are you comfortable taking some risk since it is not insurance?

Good luck on finding a solution!
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