libertyag said:

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I think that is the best way to go, and always has been, to have coverage that kicks in only in the event of huge medical bills (cancer, heart disease, accident). For too long people have been spoiled with the insurance covering most, or all, of those sniffle and sneeze doctor visits. Escrow funds to meet the deductible and copay.

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libertyag said:

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I think that is the best way to go, and always has been, to have coverage that kicks in only in the event of huge medical bills (cancer, heart disease, accident). For too long people have been spoiled with the insurance covering most, or all, of those sniffle and sneeze doctor visits. Escrow funds to meet the deductible and copay.

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george92 said:

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Im a sole practitioner as well in the exact same boat. I've survived year to year using Costco services health insurance plans. You can check it out on their website for individual and business plans. It's gotten a little worse every year with 2016 me choosing an epo. I'm still paying significantly less than when I was a partner in a large regional firm. I currently have no employees so I set up a benefits corporation to make everything tax deductible under a merp. Also, joining a peo thru administaff or adp will get you access to some group plans not on the exchange. Same with the aicpa and tscpa.

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Talon 07 said:

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I don't have much advice other than to say I know exactly what you're dealing with.

I did get diagnosed with cancer and was kicked off of BlueCross's PPO when they shut it down. Thankfully, I had already had my surgery and radiation before the end of 2015 when the plan ended.

Like LA wrote, MD Anderson does not take the HMO plans offered by Obamacare. By the grace of God, Humana offered a Bronze PPO only on their website with a 6k deductible. It wasn't pretty but it kept me at MD Anderson this year while I do checkups every quarter (my type has a high chance of coming back). I'm worried about next year because I see the articles about such and such insurer is no longer offering a PPO plan next year in various states. I won't be surprised if Humana goes this route also but I pray they don't. If it is an option, you should consider it because it's the only PPO plan I could find.

Thanks for some the suggestions yall gave, I'll have to check it out for next year.

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Quote:

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I am afraid with our next President things will only get worse.

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2wealfth Man said:

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Talon 07 said:

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I don't have much advice other than to say I know exactly what you're dealing with.

I did get diagnosed with cancer and was kicked off of BlueCross's PPO when they shut it down. Thankfully, I had already had my surgery and radiation before the end of 2015 when the plan ended.

Like LA wrote, MD Anderson does not take the HMO plans offered by Obamacare. By the grace of God, Humana offered a Bronze PPO only on their website with a 6k deductible. It wasn't pretty but it kept me at MD Anderson this year while I do checkups every quarter (my type has a high chance of coming back). I'm worried about next year because I see the articles about such and such insurer is no longer offering a PPO plan next year in various states. I won't be surprised if Humana goes this route also but I pray they don't. If it is an option, you should consider it because it's the only PPO plan I could find.

Thanks for some the suggestions yall gave, I'll have to check it out for next year.

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Talon - I am on the Humana PPO and got the letter from them last week saying the PPO was going to be discontinued as of Dec 31.

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ZoneClub said:

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So glad our company has a great plan. I keep hearing horror stories.

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ZoneClub said:

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So glad our company has a great plan. I keep hearing horror stories.

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free_mhayden said:

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That was the other thing I really miss about my old health care -- I could do hard drugs, commit random acts of arson and sleep with unsavory women and I knew I'd still be covered.

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libertyag said:

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free_mhayden said:

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That was the other thing I really miss about my old health care -- I could do hard drugs, commit random acts of arson and sleep with unsavory women and I knew I'd still be covered.

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Just don't carry any insurance. No point in giving up the good life!

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Ark03 said:

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HomeFinderCody said:

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I could have used better language. When people ask, I usually just say "don't do stupid or immoral stuff and you're okay". I'm good with it. If I decide to make a bad decision and I get hurt as a result, that should be on me.

The Medi-Share monthly cost is just over $400 for my family. It's a high deductible plan. I also priced BCBS and some other options....all of them were well over $1000 per month for high deductible plans.

It's certainly not for everyone. But for my family it was a pretty clear best option.

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I helped one of my pastors look into Medi-Share. I administer a fairly large self-insured program at my employer, so I have some perspective I can bring.

Medi-Share is essentially an unregulated self-insured medical program. They do not meet the definition of affordable care provided in ACA, but ACA provides an exemption for members of healthcare sharing ministries, which gives an exemption to the excise tax for failing to have coverage. Along that same line, subsidies that are available to help purchase coverage under ACA are not available to be used for premiums in Medi-Share.

As Medi-Share is completely unregulated and exempt from ACA, they have absolutely no obligation to pay claims - just their own procedures that can change from time to time. They can make arbitrary decisions subject to their own policies, and the only appeal that can be made is a single appeal to other members of the program. If your case isn't compelling enough, or if you just get a bad draw on the "jury," you are SOL. For perspective, the appeals process is one of the more protected components in traditional insurance. In an insured medical program, you can first appeal to the carrier, then to the state's Independent Review Organization. In a self-insured program from an employer, then you may have an additional layer where you can appeal to the administrator at your employer.

How does Medi-Share offer benefits for a lower cost? They exclude coverage for many expensive pre-existing conditions. They can make arbitrary decisions on paying expensive claims, or paying for expensive drugs that may help someone have a successful transplant, or may be the most effective cancer treatment. They avoid the costs associated with running a regulated program, including annual reporting and independent audits. They claim to be members of the huge PHPS network, but many have reported that some providers that take PHPS won't take Medi-Share.

As more people seek them out in the wake of Obamacare, they have the risk of adverse selection in their member pool and negative claims experience, which means the less healthy people flock to them and costs for everyone go up. In a worst case scenario, they run out of money and have nothing more than their promise to pay claims. No department of insurance is there to oversea them and make sure they do pay claims, and they don't have the backing of a company with profits or stop-loss coverage to pay claims.

The legislation excluding them from ACA only applies to companies that had been in existence since 1999 - so that means they pretty much have a monopoly on the market, with no competition to do things better.

Lastly, while Medi-Share looks like a high deductible health plan, it does not make members eligible to participate in a health savings account. There was a movement with H.R. 1752 that tried to change that last year, but it never got out of committee.

Personally, I do hope that programs like this put pressure on the insurance industry to fix itself. But, as long as I have an alternative available through my employer, I'm not taking the gamble on medical coverage with my family. I have coverage so a catastrophic event doesn't bankrupt me. As long as Medi-Share is unregulated with no competition and no recourse for not doing what's right, I don't see that Medi-Share fully mitigates that risk.

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LOYAL AG said:

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Good information, I appreciate your perspective. some quetions/thoughts:

Bolded 1 - With the losses all carriers are incurring I seriously doubt we see any new entrants into this space anytime soon. Worse still with the government mandates of plan structures there is effectively no competition anyway. A few inconsequential differences aside bronze is bronze.

Bolded 2 - I'm not sure the health insurance industry has the ability to fix itself at this point. Far too much government control. They're forced to take expensive pre-existing conditions and their profits are capped in the off chance they did have a good year. ACA has done what it was intended to do which is destroy health insurance.

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