After 20 years in the corporate world as AVP of Sales with UnitedHealthcare and Chief Sales Officer with Health Insurance Innovations (HIIQ), I finally got the courage to start my own business in 2015. Consequently, for the first time in my life I had to purchase my own health insurance plan.
The first year I chose an ACA Silver Plan. It consisted of a $5,000 deductible, 80/20 coinsurance, and a $12,500 maximum out of pocket for my family. We also needed to switch a few of our favorite doctors to fit the ACA plan’s narrow network. The monthly premium for that plan was $1,398 per month.
I have a family of six, I’m in my 40’s, and we are all blessed with good health. After a year of paying close to $20,000 in annual premiums and no claims other than some small routine doctor visits, I decided there must be a better solution. I started researching affordable alternatives. While ACA plans were not a good fit for my family situation we do find that they serve clients with lower-income and/or those with significant pre-existing conditions well.
First I researched all the Short Term Medical Plan options which were much more affordable but also included a sizable ACA penalty tax for not meeting the ACA minimum coverage requirement. By the time I added premium plus penalty, the math just didn’t make financial sense for me.
In addition, there is a new regulation that limits Short Term Medical Plans to 90 days. Therefore, if you find out you have cancer and your 90-day plan runs out, you have the potential of no coverage and no options until open enrollment period, which could be 6 months away. For those reasons, the cost/benefit analysis didn’t add up for me to choose this option.
I then started to research Healthcare Sharing Plans. There are 5 of these which hold exempt status from the federal government because they have been in existence since 1999 and meet all the government requirements. Those 5 include; Medi-Share, Christian Healthcare Ministries, Samaritan Ministries, Liberty HealthShare and Altrua HealthShare. This means that members of these programs are not subject to the ACA penalty tax.
Many of the qualified Healthcare Sharing Plans seem to have too many holes for my risk tolerance. For example, some require you to be a self-pay at the time of your doctor visit, and then you submit the bill for reimbursement. You then wait for other members to send you checks in the mail. This payment model was beyond my comfort zone.
However, one option among these tax penalty free Healthcare Sharing Plans is Medi-Share. The monthly cost for my family was only $358 for a $5,000 AHP (Annual Household Portion). A $5,000 AHP is like a $5,000 annual family deductible, then 100% for eligible sharing expenses.
Medi-Share also includes a large national PPO network; Multiplan/PHCS which included all our doctors and hospitals.
From my point of view as a consumer, the program works much like insurance even though it is not. I go to the doctor, show my member card which prominently displays a widely-accepted Multiplan/PHCS PPO network logo, and I pay a $35 provider service fee much like a doctor office copay. The bills are filed directly to Medi-Share and the PPO network discounts the bill by 30-50% on average.
If I haven’t satisfied my Annual Household Portion, I receive an explanation of benefits and pay the balance due after PPO network repricing. If I have met my Annual Household Portion, the bill will be paid through the proprietary member bill sharing system which is all handled by Medi-Share and their credit union partner ACCU.
The main qualification to becoming a member of Medi-Share is that you must sign a statement of faith which is a standard non-denominational Christian faith statement like the Apostle’s Creed. You must also agree to a healthy lifestyle that includes things like; no use of tobacco and no use of illegal drugs.
After investing 20 years specializing in the individual health insurance market, I am confident I know this space well. I researched the options extensively and for my family, Medi-Share is the best solution.
We align with the core values, we have little to no pre-existing conditions and as a result, I will save over $12,000 this year on my health insurance costs. I will also substantially reduce my out of pocket exposure and not have to give up my favorite doctors.
I believe in the program so much that we have built a software business to help brokers serve individuals, small businesses, and churches to solve this problem. The problem of finding affordable and quality health coverage solutions for small business.
We offer proposal software, enrollment systems, and payroll deduct systems for Healthcare Sharing Plans, along with ACA plans to save clients up to 30-50% on their annual health plan costs. See how much you can save by switching with Remodel Health with our online calculator tool here.
This one-of-a-kind approach is currently empowering hundreds of brokers to serve their small business and church clients with a creative solution that works.