Affordable health insurance alternatives for individuals and families are easily purchased and are surprisingly cheap. Benefits can be customized to match single or multi-person needs. Our website’s quoting process helps you find these types of plans so you can quickly compare policies and apply for coverage. We understand that your current group, private, Exchange, or COBRA plan may be very expensive. There are many less-expensive options, although it’s important to understand all differences in coverage. Budget-friendly and quickly-approved policies are available.
Firstly, why would someone want an alternative to conventional medical coverage? There are many legitimate reasons. Cost is perhaps the most popular reason. Health insurance policy prices from the major carriers have dramatically increased over the last 5-10 years. And although the passage of The Affordable Care Act has provided large federal subsidies to millions of Americans, many others have watched their rates continue to climb. Other consumers simply do not want Obamacare coverage or other packaged medical coverage plans, and instead, prefer discount cards, indemnity plans, or primary care memberships.
Often deductibles are a high $9,100 for Marketplace plans, out-of-pocket expenses are prohibitive, and the number of local network providers is limited. HMO and EPO plans have replaced many of the previously-available PPO plans, and specialist visit copays have substantially increased. Co-op plans were expected to offer lower pricing, but most of these companies no longer offer coverage, and it is rare that a new co-op is introduced. Several of these failed plans include Healthy CT, Colorado Health OP, Land Of Lincoln, CoOportunity Health, Kentucky Health Cooperative, Louisiana Health Cooperative, Maine Community Health Options, Evergreen Health Cooperative, Health Republic Insurance Of New York, and InHealth Mutual.
Also, you may want to specifically cover emergencies for family situations instead of buying benefits you feel you would not utilize. Seven years ago, 10 “essential health benefits” became mandatory on all Marketplace (Exchange) plans. So although maternity, pediatric dental, mental illness, and other benefits are a “must have” benefit for many persons, others realize they may be needlessly paying thousands of extra dollars, since they only want low-cost major medical coverage.
Cheaper alternative options are always available, but it’s critical to fully comprehend differences in benefits. “Non-insurance” plans, such as limited-benefit contracts, should not be considered because of the lack of major medical coverage, and exceedingly-high out-of-pocket costs. Network-negotiated discounts are also generally not offered on nonconventional plans.
You Won’t Be Denied Marketplace Coverage For Pre-Existing Conditions
Denial of coverage is no longer a reason to seek alternative healthcare. Unless you miss Open Enrollment, regardless of your medications, impending surgeries, or past and existing conditions, you won’t be turned down. If you miss the cutoff date (December 15), you may still qualify for an SEP (Special Enrollment Period), which allows you to apply for subsidized benefits any time throughout the year. All offered plans in your area are available, and there is no medical underwriting.
Note: Several states operate their own Exchanges and the Open Enrollment period is longer than the traditional federal OEP period (November 1- January 15). For example, previously, the Pennsylvania OE Period extended to January 31 because of the COVID epidemic.
Federal subsidies are offered to all applicants (single and family), with the household income determining the amount and eligibility. If your income is too high for tax credits, the full retail cost of the plan will be charged, and the premium may be quite expensive. Applicants over age 55 pay the highest premium, and there is a small surcharge for tobacco usage. Gold and Platinum-tier plans are the most expensive available plans but often feature the lowest out-of-pocket expenses. Many $0 deductible plans are offered with copays on office visits, most prescriptions, and Urgent Care visits.
In previous years, you may have applied for medical coverage through Blue Cross, Aetna, Kaiser, UnitedHealthcare, or another reputable company. If you were denied coverage, there were not many low-cost options remaining. COBRA was (and still is) expensive, and if you qualified for your state’s “Risk Pool” or “Open Enrollment,” premiums could have been out of your price range. But fortunately, that situation now rarely exists. A lapse in coverage can limit your options, but Open Enrollment occurs each year. If your policy lapses outside of the Open Enrollment period, a non-ACA option may be available.
The simplified “State Risk Pool” application was always popular on those types of policies. Often, the number of medical questions was limited, and completing the process usually took less than 10 minutes. You did not have to take a physical, and rarely were asked to provide medical information. Coverage was quickly approved, often without a waiting period. Monthly rates were generally less than $300 per month, and many network physicians were available. Large carriers were utilized, including Keystone in Pennsylvania, and Medical Mutual in Ohio.
Typically, applicants could qualify for coverage within a few days instead of a few weeks. If you were in good health and just wanted a cheap medical plan, it was available. With the passage of the Affordable Care Act legislation, these risk pools were eliminated. NOTE: Prior to Obamacare, Risk Pool policies were how persons with severe medical issues got covered. Pennsylvania featured one of the best options. In the Keystone State, the monthly rate was about $250 per month regardless of age or health. Independence Blue Cross underwrote the policies.
Short-term temporary plans are offered by licensed and regulated health insurance companies. The cost of coverage is very inexpensive, and policies can be approved and issued within 24 hours. Prior medical issues are not covered, and typically preventive services are not offered without a deductible or coinsurance. Online visits (Teledoc) with physicians are typically covered with a copay while ER and hospital visits must meet a deductible. Several insurers offer free online visits for their Marketplace coverage.
“Limited Benefit Plans” Not Always A Good Choice.
Now that we know why they are fairly attractive, what type of “alternative” policy is the best to purchase? And how much can we expect to pay?
Although the most appropriate choice is often not the same for individuals or families, perhaps one of the most common options is a “Limited Benefit Health Insurance” plan. And yes, just as it sounds, benefits are limited! But it’s important to understand which benefits are limited, if those coverages are needed. And it should also be noted that these types of options are typically offered as supplements, although they are often utilized as primary coverage.
A much lower list of covered illnesses and diseases is fairly typical. And for the benefits that are included in the policy, you can expect to pay higher out of pocket expenses. For example, a two-day stay in the hospital may cost $10,000 instead of $5,000. A much larger claim could cost $25,000 instead of $10,000. Of course these are arbitrary examples.
“Limited” policies do have a specific niche that may help. If the options you currently have are either too expensive or are simply not available until a later date, they may be a temporary fix. With the money you are saving on premiums (from the high rates you are being offered elsewhere), that may offset the higher risk you take in the event of a claim. But these types of plans are not designed to be a long-term solution, and especially are not appropriate for persons with chronic health or mental conditions.
The non-refundable enrollment fee must also be considered. Typically, they are approximately $100-$200 and must be paid up-front in addition to the initial monthly premium. Also, if 12 months of short-term coverage is offered in your state, often, this type of temporary plan provides more options, including up to $2 million of maximum benefits. The application (enrollment) fee is generally between $20 and $40, instead of $100-$200. And coverage may be able to be locked in for as long as 24-36 months.
It is also important to understand that private “Limited” plans that are the easiest to qualify for, are often the ones with the highest potential for paying for specific items that otherwise are covered. Often, it’s an unusual lab test that was requested, or a procedure that is not often utilized. If there are no medical questions, there’s probably a good reason. Without medical underwriting, the rate will be high, benefits will be limited, or both. Exceptions include short-term plans that are medically-underwritten and very inexpensive. Coverage can also be effective the day after an application is submitted.
If you see “guaranteed acceptance” used when describing coverage, medical underwriting will be limited and important benefits may be limited or missing. NOTE: This does NOT apply to Federal or State Exchange plans, which provide very comprehensive benefits and our guaranteed (almost) to be accepted. However, when the term accompanies a contract that consists of only a series of discounts, run away, but fast. Treatment for ongoing chronic conditions are likely to result in high out-of-pocket costs, with many upper tier and specialty drugs not covered.
Lately, many “Christian” plans, commonly referred to as “Health Care Sharing Ministries,” are becoming available in various parts of the country. More than 100 options are available, and they are often discussed and offered through local churches. The concept is fairly simple. Customers donate a fixed amount of premium every month (usually between $200 and $600) and that money is pooled together with other persons that have contributed. If the number of contributors reduces, higher amounts may have to be collected.
The funds are deposited and subsequently paid when covered medical claims are submitted. Of course, the more persons participating, the greater the chance of the concept working. This creative alternative has been available for about 20 years and about one million members utilize their services each year. Various plan options are offered, and all family members are eligible for benefits. Medicare-eligible family members, however, can not apply for coverage.
A Jewish sharing option is also offered from United Refuah HealthShare. The monthly rate is $199 for a single applicant, $349 for a couple, and $499 for a family. The single, couple, and family co-share maximum amounts are $1,000, $2,000, and $4,000. This company is based in Cleveland Heights (Ohio) and accepts monthly shared amounts that are not tax-deductible. If prospective sharing members have conditions that can be improved by a change in lifestyle or behavior, the acceptance may be modified or revised.
Typically, members can keep coverage until age 65, and can not be canceled because they developed a serious illness and a large amount of money was paid to cover the claim. The premium does not increase because of excess claims, although the entire Group rate can be impacted. However, federal subsidies in the form of instant tax-credits are not available since these plans are not ACA-approved. And although no major organizations that offer Christian coverage have gone bankrupt, if they do, you could suddenly owe thousands (or hundreds of thousands) of dollars for medical services just performed.
Also, these types of private medical coverage are not regulated by state insurance departments or The Affordable Care Act, so if potential financial or insolvency problems arise, you may be fighting your battle alone. Some of the biggest organizations that offer Christian coverage are Christian Healthcare Ministries, Samaritan Ministries, Liberty Healthshare, and Medi-Share. They are not regulated by the Department Of Health And Human Services.
Medical Tourism Healthcare
No, we’re not referring to traveling abroad on vacations. This concept involves US citizens receiving medical treatment in other countries. Although quality of care is not always equal to the best hospitals here, the savings is often significant. Even if you take into consideration travel and accommodation expenses, the actual cost of surgery and major procedures is often 25%-70% less than the conventional method.ae,
Vaccines, of course, must be current, and it’s recommended that the treated parties are familiar with the culture and the language of the country they are visiting. Common surgeries and procedures tissue and organ transplants, cancer treatment, dental and vision care, fertility, and unapproved surgeries. Note: Usage of counterfeit medicines and low-quality medical devices is also a concern. Also, maintaining medical records (including lab tests and x-rays) is critical if overseas surgery is needed.
Accredited overseas hospitals (by “The Joint Commission”) often utilize doctors and specialists that were originally trained in the United States. By researching and verifying credentials, you can eliminate the “quality” variable out of the equation. The affordability aspect of medical tourism is helped since international healthcare pricing is typically low, wages of physicians, other employees, and facility costs are cheaper, and malpractice insurance rates are less expensive.
We are not formally endorsing the concept of replacing your personal medical coverage with this highly unusual option. However, in selected situations (and there are many factors to consider), it may be a viable alternative. But it’s critical to do your research and understand the risks.
You can easily find them. YouTube. Your local newspaper. Facebook. Perhaps someone at work is selling them. They’re cheap and they are available everywhere. But are they worth the money you pay? Usually, not, since the combination of the application fee and ongoing monthly charge is not offset by the services you receive, especially if all of your medications are generic. Occasionally, there is an enrollment fee to pay. It’s non-refundable, of course. An exception, however is GoodRx (read more below).
And what are those services? Discounts. Some are big and some are small. And many of them don’t work as advertised. Rates for many items are negotiated, although you may be able to obtain the same savings without purchasing a “discount card.” Although these programs can be used as a primary or supplement form of coverage, they will not match the benefits offered by an on or off-Marketplace policy. Also, specialty drugs may not even be partially covered.
Many drug manufacturers offer special copay coupons for some of their expensive non-generic prescriptions. These coupons are very legitimate and easily save thousands of dollars in out-of-pocket expenses. Often, a drug that costs hundreds of dollars each month may become available for a fraction of the cost. Contacting the drug manufacturer directly is the best method to determine if you are eligible for these discounts. Digital coupons may be provided that can be utilized by your local pharmacy.
GoodRx is a legitimate option and often the savings is as much as 80%. Coupons can typically be used the same day and there are no fees or costs. Enrollment in an insurance plan is also not required. More than 70,000 pharmacies accept GoodRx. Popular medications that are discounted include Zoloft, Lexapro, Atorvastatin, Duloxetine, and Sildenafil.
Direct Primary Care
Direct Primary Care is a medical coverage that allows consumers to have access to physician services for a fixed monthly or annual payment. There are no copays, coinsurance, deductibles to meet, or third-party billing paperwork. Rates (the subscription) can vary, but typically are between $50 and $125 per month. Payments are made directly to the attending physician’s office, and other billing arrangements exist between providers and patients.
There is no limit on the number of allowed visits, and often wait-time is much less than regular patients. Same-day or next-day visits are often possible. More than 1,000 practices are available in the US, with most located in the Midwest, Southeast, and East. Popularity is growing and more options are offered in 2023. Transparent upfront pricing is one of the features that consumers embrace, since out-of-pocket costs are not a mystery. Same-day and next-day office visits are also often available.
Health Savings Accounts (HSAs) are not considered an “alternative” since they provide all required “essential health benefits.” Plans are available in all states from multiple carriers, and deductibles can not exceed $7,500 ($15,000 per family). An HDHP (high deductible health plan) is required for all HSA plans. Unlike an FSA, deposited money that is not used, will roll over to the following year. HSA plans remain very popular for persons that use direct primary care. However, the monthly direct care membership fee does not count towards the HDHP deductible.
We provide and find the most affordable health care options for you and your family. Viewing our free quotes is the first step and then, if you choose, you can apply for coverage. We’ll customize policies so they closely match your existing needs. “Alternative” is not always a negative word when searching for your best medical plan options. But it is important to consider all policies that you may be eligible for.