ACA Alternatives

[imjustawarrior]

I checked into this at the nearest 4 year school. Premium cost would be $5200 to cover me and my wife. Tuition cost could be as low as $300, if taking the minimum number of hours. Our doctors and health system are in-network and there is coverage even if going out of network. And coverage is better than what we currently have with our ACA Bronze Plan - by a mile!

While this would be pretty disruptive to my lifestyle, it definitely has my attention. I could save a ton of money and might even enjoy going back to school for a couple of years.

Genius idea!

Look at the lifetime max the policy will pay. For my DS, the lifetime max of the school policy was too low for comfort.

 

[TripleLindy]

Look at the lifetime max the policy will pay. For my DS, the lifetime max of the school policy was too low for comfort.

The plan I’m reviewing show’s unlimited benefits with no lifetime max. It actually has a max OOP limit that’s 50% less than my current plan.

 

[imjustawarrior]

The plan I’m reviewing show’s unlimited benefits with no lifetime max. It actually has a max OOP limit that’s 50% less than my current plan.

Nice. I would make sure I really understand the fine print before trying something like this. Doing things out of the ordinary do not always work out well.

 

[Montecfo]

That's the thing. There isn't really anything other than non-ACA compliant policies. As we all know, the ACA meant things like not getting refused coverage, no pre-existings, no caps, covering preventative care, etc. "non"-aca plans mean that isn't the case. What used to be known as private (non-employer) insurance morphed into ACA plans or died because it wasn't good coverage with the new laws.

no caps, everything covered, no pre-existings, preventative covered, etc.

Thats great but I wonder why it is so darn EXPENSIVE?

I think folks are on the right track with non-compliant plans and sharing services.

Some states may have strate plans that can be considered.

Otherwise I would probably look at the highest deductible ACA plan I could find and look at thinner networks, if healthy.

If not then I would do analysis on various plans and deductibles to see what is the best buy.

I think ultimtely solutions will involve not doing one-size fits all health insurance and quit covering everything for everyone, Training people that medical services are cheap just encourages overuse and poor economic decisions (Like forgoing coverage at all).

 

[TripleLindy]

Nice. I would make sure I really understand the fine print before trying something like this. Doing things out of the ordinary do not always work out well.

No doubt. I’ve reviewed most of the full plan description. It’s a United Healthcare plan and is structured just like most other plans. The primary difference is the coverage, at least based on comparison to my Bronze plan. It’s SO much better - lower costs at every level, out of network is also covered, and of course, the premium is 85% lower. Premiums are priced per semester, with the Spring pricing higher so that it includes Summer. Not sure if that requires attending the Summer semester or not.

 

[SecretlyFI]

I think the college idea is a good one to explore. My friend and I were recently discussing it as an option, since both our kids just graduated, so the college plan program was fresh in our minds. She still has a daughter in college and said when they retire in another year, they will use the college plan for the daughter. And I chimed in…”and maybe for you & DH too, if you want to take some classes!” It really got her thinking about it.

 

[TripleLindy]

I think folks are on the right track with non-compliant plans and sharing services.

Only if you’re a gambler. Non-compliant plans are unregulated and have exclusions for just about everything. Health ministries are not even insurance, as they guaranteed zero coverage. I’ve heard too many “we’re not covering your claim, but we’ll pray for your health” horror stories to even consider one.

I think ultimtely solutions will involve not doing one-size fits all health insurance and quit covering everything for everyone, Training people that medical services are cheap just encourages overuse and poor economic decisions (Like forgoing coverage at all).

Carving out various types of care, providing it only to those who actually need it, is counter to the concept of spreading risk. But I agree for seniors, for things like pregnancy-related coverage. Is that covered by Medicare? As far as over utilization goes, that’s not the primary driver cited for increasing premiums. It’s the rapidly increasing price of healthcare in the U.S., driven by profit motives.

 

[Aerides]

I checked into this at the nearest 4 year school. Premium cost would be $5200 to cover me and my wife. Tuition cost could be as low as $300, if taking the minimum number of hours. Our doctors and health system are in-network and there is coverage even if going out of network. And coverage is better than what we currently have with our ACA Bronze Plan - by a mile!

While this would be pretty disruptive to my lifestyle, it definitely has my attention. I could save a ton of money and might even enjoy going back to school for a couple of years.

Genius idea!

If you only need a couple of years, perhaps try a job with full benefits, and then quit to Cobra for 18 months? Still pricey, but far less time commitment, and the paycheck might help offset that too?

 

[TripleLindy]

If you only need a couple of years, perhaps try a job with full benefits, and then quit to Cobra for 18 months? Still pricey, but far less time commitment, and the paycheck might help offset that too?

I’ve considered it, but really have no desire to do it. And while the $34k premium would leave a mark, we can handle it. Going back to school is intriguing. Time commitment for the minimum number of hours wouldn’t be like working full time. And I might find something that I’d really enjoy, as any area of study wouldn’t need to generate a return.

 

[Flieger]

I'm looking at a Health Sharing to cover the 2 years to Medicare if nothing happens from the "debates" on HC in December. My BIL has multiple family members that are on CHM, and one of them used the plan for a cancer situation. In discussions with them (BIL's family members as they live near me) they have stories of many people being helped when needed. I'm sure there are other stories as well. One that BIL's family talked about was a tragic auto accident where because the member was DUI they would not cover. That is specifically stated in their "plan" though, so not really a we just aren't going to pay issue.

Still investigating.

Flieger

 

[Montecfo]

Only if you’re a gambler. Non-compliant plans are unregulated and have exclusions for just about everything. Health ministries are not even insurance, as they guaranteed zero coverage. I’ve heard too many “we’re not covering your claim, but we’ll pray for your health” horror stories to even consider one.

Carving out various types of care, providing it only to those who actually need it, is counter to the concept of spreading risk. But I agree for seniors, for things like pregnancy-related coverage. Is that covered by Medicare? As far as over utilization goes, that’s not the primary driver cited for increasing premiums. It’s the rapidly increasing price of healthcare in the U.S., driven by profit motives.

Fom your responsees, it seems like other alternatives may not be for you. But I am not sure taking a non-compliant plan is "gambling". It is valuing the benefit, determining the cost, and judgement about whether that makes sense.

And it is true that medical sharing is not insurance, but neither is going without. Millions of people use these services successfuly. I am not touting it. But it is in fact a lower cost alternative.

There are many drivers of higher health care costs. That is a whole separate thread.

As far as spreading risk, that only works when doing so is affordable to the community. When it is not, change needs to happen.

 

[pb4uski]

Here's a possible angle. Given that health insurance costs have escalated so much, I would think there are many instances where the insured could get a hardship exemption based on unaffordability. For 2026 you would qualify if your income is too high to qualify for ACA PTC subsidies (automatic exemption) or if the lowest cost bronze plan available to you exceeds ~8% of your household income (you need to apply for an exemption certificate).

If you qualify and obtain an exemption, you are eligible to buy catastophic coverage policies meant for people 30 and younger. New York and Vermont prohibit age-rating so you would get the same price as catastrophic policies sold to 30 and younger. Masachusetts has a 2:1 maximum and all other states a 3:1 maximum. In other words, if you qualify for a catastrophic policy the most they can charge would be 3x what they charge 30 and younger.

A cat policy from BCBS in VT would cost $421/mo and the benefits and deductibles are similiar to a bronze plan and in NY would cost $400-500/mo. A quick Gemini prompt suggests that a cat policy for a 60 year old in Texas would cost $900-1,000/mo and in CA would cost $1,100-$1,300/mo.

All of the above are for 1 person... for 2 then double it.

We did something like this. When ACA first started I realized that we qualified for a hardship exemption. Since ACA was new and what I was trying to do was unusual, it was a challenge getting a hardship exemption certificate but I was finally able to obtain one in 2014 and the cat poicy was $427/mo compared to $682 for a bronze plan and the coverage so pretty significant savings. I recall checking the insurance filing one year and only 1.4% of the cat policy insureds were over 30.

While we are on Medicare now and no longer VT residents, that VT cat policy is now $421/mo and a similiar bronze policy is $1,532/mo so we would have been saving over $2,000/mo with this approach..

https://info.healthconnect.vermont.gov/sites/vhc/files/documents/2026_CSR_Plan_Designs.pdf

https://info.healthconnect.vermont.gov/sites/vhc/files/documents/2026_PlanDesigns_FinalRates.pdf

 

[SecretlyFI]

Here's a possible angle. Given that health insurance costs have escalated so much, I would think there are many instances where the insured could get a hardship exemption based on unaffordability. For 2026 you would qualify if your income is too high to qualify for ACA PTC subsidies (automatic exemption) or if the lowest cost bronze plan available to you exceeds ~8% of your household income (you need to apply for an exemption certificate).

Income too high to qualify for ACA PTC subsidies qualifies you for a hardship exemption? I believe you, but that sounds so counter-intuitive. What’s the catch? Like if my income was $400,000 a year, that’s hardship territory?

‘The lowest cost bronze plan available to you exceeds 8% of your household income’…sounds like it would apply to everyone who is just a tiny bit over the 400% FPL cliff - based on the premium amounts people have been posting on the recent threads. Or even alot more than a tiny bit over the cliff. A $25,000 premium for a couple with income up to $300,000+? Again, this sounds like a lot of people fall into these hardship definitions. Am I reading all this right?

 

[Highbeam]

I’ve considered it, but really have no desire to do it. And while the $34k premium would leave a mark, we can handle it. Going back to school is intriguing. Time commitment for the minimum number of hours wouldn’t be like working full time. And I might find something that I’d really enjoy, as any area of study wouldn’t need to generate a return.

Do you have to be a good student? We all knew those students that skipped class the whole year, maybe failed, maybe just barely passed. You can take PE classes. I took a cross country skiing class one quarter. 5 credits!

 

[GenXguy]

I'm looking at a Health Sharing to cover the 2 years to Medicare if nothing happens from the "debates" on HC in December.

I've got a lot longer to go on ACA, so I hope it doesn't come to health shares. I'm more concerned about what happens for 2027 and the following years. I can deal with a loss of the enhanced subsidies. It really sucks having this uncertainty year after year - going back years before I retired with things surrounding the ACA. Of course, SS and Medicare have their own uncertainties. It it isn't one thing, it's another - that's life.

 

[RetiredHappy]

I've got a lot longer to go on ACA, so I hope it doesn't come to health shares. I'm more concerned about what happens for 2027 and the following years. I can deal with a loss of the enhanced subsidies. It really sucks having this uncertainty year after year - going back years before I retired with things surrounding the ACA. Of course, SS and Medicare have their own uncertainties. It it isn't one thing, it's another - that's life.

Why 2027?

 

[GenXguy]

Why 2027?

Because, for 2026, the worst was already scheduled to happen - the expiration of the enhanced subsidies. It will cost me a little, but easily absorbed in my case. I'm concerned much more about the damage that could be done with a reconciliation healthcare package, like was attempted back in 2017, failing by the narrowest of margins at that time.

 

[pb4uski]

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[frank05]

Otherwise I would probably look at the highest deductible ACA plan I could find and look at thinner networks, if healthy.

My primary doctor once told me that you are healthy until you are not. Then in many cases you are saddled with a preexisting condition.

 

[anethum]

Fom your responsees, it seems like other alternatives may not be for you. But I am not sure taking a non-compliant plan is "gambling". It is valuing the benefit, determining the cost, and judgement about whether that makes sense.

And it is true that medical sharing is not insurance, but neither is going without. Millions of people use these services successfuly. I am not touting it. But it is in fact a lower cost alternative.

There are many drivers of higher health care costs. That is a whole separate thread.

As far as spreading risk, that only works when doing so is affordable to the community. When it is not, change needs to happen.

Anyone on one of those non-compliant plans is one severe car accident or one life-changing diagnosis away from being bankrupted. I absolutely call that gambling. It would be like buying a homeowner's insurance policy that will cover you for some minor storm damage, but not cover you if your house burns down.

 

[Flieger]

Anyone on one of those non-compliant plans is one severe car accident or one life-changing diagnosis away from being bankrupted. I absolutely call that gambling. It would be like buying a homeowner's insurance policy that will cover you for some minor storm damage, but not cover you if your house burns down.

You are assuming that those non-compliant plans (like a Share plan) will absolutely leave everyone high and dry for any severe car accident or life-changing diagnosis. I'm curious, do you think that religious Share programs are out there just raking in Share plan contributions and paying nothing out? Do you have personal evidence to support this? I'd like to know since I am listening to others that praise them and am considering it for the bridge to Medicare.

Flieger

 

[RetiredHappy]

I have friends on Health Share and they were covered for cancer, and all sorts of illnesses and ortho procedures. I don't dare to try Health Share but their experience have been very good.

 

[zinger1457]

There were changes made for 2026 so anyone over 30 who doesn't qualify for savings on the marketplace can now get a catastrophic plan. Now that it's open to the over 30 crowd you can bet the rates will go up.

 

[Montecfo]

My primary doctor once told me that you are healthy until you are not. Then in many cases you are saddled with a preexisting condition.

Sure. Everything is risk/reward. If we knew in advance no one would buy insurance

Anyone on one of those non-compliant plans is one severe car accident or one life-changing diagnosis away from being bankrupted. I absolutely call that gambling. It would be like buying a homeowner's insurance policy that will cover you for some minor storm damage, but not cover you if your house burns down.

Not trying to talk you into anything. The thread is about alternatives. I offered some.

If you have others to offer maybe present them?

If you wish an alternative to ACA you are going to have to accept some risk. If doing so is "gambling" then not sure why you would be on this thread.

 

[Pluperfect]

Back in 2016 I was looking at alternatives to an ACA plan, including enrolling in college. I'm working from memory, but at least one of the ones I looked at, if you bought a policy in the fall semester, it stayed in effect until just before the next fall semester. Or maybe you had to enroll in the spring semester but could drop out. Anyway, you definitely didn't have to be enrolled in the summer, and maybe not even in the spring.

But this was obviously quite a while back, and after that I looked into it again periodically and they were tightening up their coverage, and a couple of the schools I looked at dropped it entirely.

At the same time I also looked at the "guidelines" for various Christian healthshare ministries, when I could unearth them. With Liberty Healthshare, a hysterectomy was "eligible for sharing," but a second opinion was required "from a physician approved by Liberty HealthShare."

It was the only procedure I saw that required a second opinion, never mind who the second opinion had to be from. I wasn't a candidate for a hysterectomy, but it left a bad taste in my mouth.