ACA Insurance questions

[NXR]

Originally Posted by move on

The only way to be sure if your insurance is good out of your home area is to go to the insurance company's website and do a search for providers in the areas you plan to travel to.

Unfortunately that is not a valid method. The Oscar site shows providers everywhere we travel out of state. A call to them, confirmed by our broker, says the only Oscar providers available to use with Oscar ACA are the ones in our home area.

Ray

[oatmeal]

Originally Posted by move on

The only thing I could find that has a truly national network is Medi-share. It uses the PHCS Multiplan network which is the largest in the country. It is technically not insurance but that is what allows it to escape the ACA restrictions.

"Escaping the ACA restrictions" isn't necessarily a good thing. Back when there was a penalty for not having insurance, having a health share ministry plan exempted you from the penalty. But there's not a penalty any more, and the only ACA "restrictions" are benefits to consumers, like covering preventative care, and pre-existing conditions from Day One, neither of which Medi-share does.

Originally Posted by move on

It is a Christian sharing system but you don't have to be Christian.

Where do you get that? Their website has Christian all over it. On the front page, it says this:

Medi-Share is an innovative health care solution for Christians looking to save money without sacrificing on quality.

And in the fine print at the bottom, this:

Medi-Share is a nonprofit health care sharing ministry of Christian Care Ministry, Inc.

These are from the FAQ:

Knowing that a Christian will receive your monthly sharing gift is very gratifying. Medi-Share members know that they are truly making a difference in the life of a brother or sister in Christ.

Christians view Medi-Share as a way to reclaim their biblical mandate to care and provide for their brothers and sisters in Christ.

And one requirement to join, in addition to a Statement of Faith that begins with "Christian Care Ministry is committed to serving the Christian community...," is:

Attend a fellowship of believers and actively support that ministry.

I couldn't find anything that indicates that non-Christians are welcome, or even allowed to join at all. Where did you find it?

[move on]

The point is, these health sharing ministries can solve the problem of the limited provider networks found in ACA plans, and at a much reduced cost. BTW, if Medishare doesn't suit you there are a number of others. I believe there is also a Jewish health share ministry.

[dixonge]

Originally Posted by move on

The point is, these health sharing ministries can solve the problem of the limited provider networks found in ACA plans, and at a much reduced cost. BTW, if Medishare doesn't suit you there are a number of others. I believe there is also a Jewish health share ministry.

I would never give such an organization a dime of my money. Plus they don't cover pre-existing conditions.

[move on]

Why not? It seems to me that the sharing model is far superior to the insurance model. BTW, the members actually vote on how to run the service and what should or should not be covered. If you dont like it you can leave and go to a different one. Note that there is no open enrollment restriction.

[oatmeal]

Originally Posted by move on

The point is, these health sharing ministries can solve the problem of the limited provider networks found in ACA plans, and at a much reduced cost.

No, the point is, you said, "It is a Christian sharing system but you don't have to be Christian." I cited several provisions that refute that.

Do you still claim that you don't have to be a Christian, and if so, what are you basing it on?

[TC Wndsr]

Originally Posted by dixonge

While I'm a fan of having everyone covered by insurance, the current setup gives people with lower income a barebones catastrophic coverage with very little in the way of preventative care. When I was employed I never hesitated to go to the doctor if I thought I needed to. Now you'll pay cash for *everything* until you've spent $6-8,000 *per year*. That's a great way to ensure a lot of people go untreated. But that's what you get when your laws are written by the insurance industry [emoji35]

Our ACA high deductible plan actually does provide for free or low cost preventative care. Yearly physical, bloodwork, some prescriptions, reasonable co pays for physician and specialist office visits. We are reasonably healthy and love our ACA plan.

[Jlo11111]

Originally Posted by oatmeal

No, the point is, you said, "It is a Christian sharing system but you don't have to be Christian." I cited several provisions that refute that.

Do you still claim that you don't have to be a Christian, and if so, what are you basing it on?

Medi-share, Liberty and others ask that you adhere to Christian principles, but they don't send a minister to your house to verify that you're on your knees every Sunday. You just sign a form that you agree to live by their principles. I know this because I used to have medi-share and now have liberty. CHM and Samaritan are more stringent about your adherence to Christianity, but there are now Healthshares that are completely non-religious. Most Healthshares will cover pre-existing conditions on a case by case basis, but you'll pay more for the first three years until your phased in. They usually cover limited preventive things like colonoscopies and mammograms and an annual exam.

[dixonge]

Originally Posted by move on

Why not? It seems to me that the sharing model is far superior to the insurance model. BTW, the members actually vote on how to run the service and what should or should not be covered. If you dont like it you can leave and go to a different one. Note that there is no open enrollment restriction.

The short answer is that such entities are barely regulated, which enables them to pay out a lot less than insurance companies. It turns them into a form of Ponzi scheme. Here's one example of a company that was perfectly legal even though started by an ex-con with a history of financial fraud.

https://www.houstonchronicle.com/bus...h-14065418.php

Please note how they didn't pay (claiming pre-existing conditions) until they were exposed, with multiple clients.

I know you will want to immediately claim that Aliera/Trinity Healthshare is an outlier, but the fact is that *any* healthshare company can *and does* do this. Sure, some are better than others, but when they leave you hanging, who will you turn to? There is *no* existing oversight system in place yet. But it's coming, and when it does, most of these organizations are going to fold, or turn into regular insurance with regular prices.

I'll spare you my lecture on religion and gullibility

[move on]

Originally Posted by dixonge

The short answer is that such entities are barely regulated, which enables them to pay out a lot less than insurance companies. It turns them into a form of Ponzi scheme. Here's one example of a company that was perfectly legal even though started by an ex-con with a history of financial fraud.

https://www.houstonchronicle.com/bus...h-14065418.php

Please note how they didn't pay (claiming pre-existing conditions) until they were exposed, with multiple clients.

I know you will want to immediately claim that Aliera/Trinity Healthshare is an outlier, but the fact is that *any* healthshare company can *and does* do this. Sure, some are better than others, but when they leave you hanging, who will you turn to? There is *no* existing oversight system in place yet. But it's coming, and when it does, most of these organizations are going to fold, or turn into regular insurance with regular prices.

I'll spare you my lecture on religion and gullibility

I have seen that news story. You're right. It's an outlier. Insurance companies keep spreading it around to try to give these ministries a bad name because they are seriously eating into their business. Ever since the ACA the ministry memberships have increased ten-fold. They must be doing something right. Of course, you should always do your due diligence and investigate before you jump in, even if you want to sign up with a regulated insurance company.

One of the things I like about Medi-share as compared to the other ministries is that they have a provider network that bills Medi-share. You don't pay the bill directly. In the unlikely event of a bankruptcy the providers, not you, will be out of luck. The network also negotiates pricing which is a major plus as they have more negotiating power than most individuals. The downside is that you don't get as good a deal if you go out of network, but everywhere I looked I have found all major hospitals nationwide are in the network.

It's not for everyone. If you are getting your premiums paid or subsidized, have pre-existing conditions and don't travel out of your home area you may be OK with an ACA plan.

[dixonge]

Originally Posted by move on

I have seen that news story. You're right. It's an outlier.

No, I did not say it was an outlier. I said that *you* would *claim* it's an outlier. And you just did. But it's not. It's fairly typical of the experience.

Originally Posted by move on

Insurance companies keep spreading it around to try to give these ministries a bad name because they are seriously eating into their business. Ever since the ACA the ministry memberships have increased ten-fold. They must be doing something right.

The link I provided was from an investigative reporter, not an insurance company. And the thing that they are 'doing right' is giving people peace of mind for a price that can't possibly sustain itself. It's a legalized version of a Ponzi scheme, but without oversight. But the oversight is coming.


From what I can see the main draw is people who don't qualify for subsidies but can't afford their premium options. Fix that gap and the incentive for HCSM's goes away.

Originally Posted by move on

One of the things I like about Medi-share as compared to the other ministries is that they have a provider network that bills Medi-share. You don't pay the bill directly. In the unlikely event of a bankruptcy the providers, not you, will be out of luck.

So let's say Medi-share or Aliera goes bankrupt. What would the provider do next? Think about this very carefully...

[oatmeal]

Originally Posted by Jlo11111

Medi-share, Liberty and others ask that you adhere to Christian principles, but they don't send a minister to your house to verify that you're on your knees every Sunday.

Actually, being on your knees every Sunday wouldn't fulfill Medi-Share's requirements--"members must attend a fellowship of believers and actively support that ministry."

And there's nothing to say they won't start verifying people's lifestyles or adherence to the requirements for membership. And you can bet that if they do, it won't be to keep people from joining and paying premiums "making contributions," but instead to keep from paying claims, which is the worst case scenario for any member--paying for membership and then having claims denied.

Of course, you should always do your due diligence and investigate before you jump in, even if you want to sign up with a regulated insurance company.

But at least with regulated insurance companies, there are some standards and oversight. And with ACA plans, there are more standards, like not denying claims because of pre-existing conditions and various things that must be covered.

Plus, you specifically said people don't have to be Christian to join Medi-Share. You can't do that and then hide behind telling people to do due diligence before jumping in. Or, well, you can, obviously. But it's not right.

And to me, there's also a moral angle. One reason health insurance, especially ACA-complaint health insurance, is so expensive is that it covers sick people. I remember a few years ago an agent tried to sell me a plan that was available to me because I'm healthy. It was pretty cheap and had good coverage, but it turned out that if I got sick, I would have to move to a higher level of plan (with a higher premium), and even then, they would keep me enrolled only until the next open enrollment period, at which point they'd kick me off and presumably I'd switch to Obamacare, since it's the only place people with pre-existing conditions can get coverage. So they were insuring only healthy people, and letting someone else (i.e., the government) do the dirty/expensive work of covering people who are sick.

I think this is amoral, and I'm not sure the Christian healthshare ministries are much better. They say they will cover pre-existing conditions after a certain number of years, but there's nothing actually requiring them to do so, since every payment they make is completely voluntary. On the one hand, at least they don't kick you off if you get sick, but is it really that much better to allow someone to keep paying premiums "making contributions" when they're likely to have crushing "requests" for payment that the healthshare ministry would have an incentive to deny?

Furthermore, all Americans support religion, whether they participate or not, through paying more taxes to make up for the taxes that religious organizations and their contributors don't have to pay. It seems to me a bit disingenuous for Christians to not only carve themselves out of the system designed to provide healthcare for Americans, but in doing so to contribute to its destruction by peeling off the healthy people whose lower claims would help support the higher claims of others.

People don't have a choice about bestowing their tax dollars on religious enterprises, and yet the participants in the religious enterprises get to choose to bestow their healthcare dollars only on people whose lifestyles they approve of. That doesn't seem particularly Christ-like.

And I was disturbed by the authorities' allegation that Aliera used just 20 cents out of every dollar "contributed" to pay medical claims. As the Houston Chronicle article noted, that's exactly the opposite of regulated insurance companies, which are required to pay out 80% of premium dollars in claims, and if they don't, they have to write their members a check. That's a good example of the benefits of regulation.

All that said, I wonder if the "Christian" part of these schemes is just a loophole that's being exploited. The good news is that it could mean they wouldn't be all that strict about members adhering to the requirements, especially if they're paying out only 20 cents on the dollar--the more members, the more money.

But that's only as long as things are going well. If it starts to collapse, then it's possible that whoever's in charge of the healthshare ministry would start looking for any reason to deny claims, and whether they were serious about people being Christians before, they could invoke those requirements when claim-paying time comes. Medi-Share allows use, but not abuse, of alcohol. And they have the last word on which it is a member is doing.