Although the Affordable Care Act (Obamacare) provides low-cost health insurance to millions of Americans, the ACA is also unaffordable to millions of other Americans. Premiums are high, deductibles can reach $8,150, and your physicians and specialists may not be "in-network." Cost-sharing programs and other medical plans provide numerous additional options for individuals and families needing low-cost coverage.
For non-Seniors that are not yet eligible for Medicare, the under-65 Open Enrollment period begins November 1 and ends December 15th. During this time, guaranteed coverage is available with pre-existing conditions covered, and a financial subsidy offered to applicants that qualify. Platinum, Gold, Silver, Bronze, and Catastrophic-tier Marketplace plans can be purchased. Note: Several states operate their own Exchanges and their Open Enrollment period is extended.
There are many reasons why Exchange plans are not chosen. Missing the Open Enrollment deadline is a very common reason, but many persons also prefer a less expensive alternative that provides major medical benefits from a reputable carrier. Also, maternity, mental illness, and pediatric dental benefits are often not needed or required.
Many of the most popular and suitable Obamacare alternatives are described below. Each option may not be available in every state, prices can vary, and specific benefits may differ. Medical underwriting may be required, and it is possible that an application for coverage will be rejected. Affordable healthcare for self-employed persons is sometimes found in the plan options described below.
Short-Term Health Insurance
Temporary plans provide low-cost medical coverage that can be approved within 24-48 hours. Available in all states except California, Hawaii, Colorado, New Mexico, and Maine, plans are generally issued from 3 months to 36 months. Although pre-existing conditions are not covered, up to $2 million of coverage is generally available, and plans can be approved within 24 hours.
Policies can be purchased at anytime throughout the year, regardless whether an Open enrollment period has started or ended. Enrollment applications are very short and basic, and can be completed in less than 25 minutes. Benefits can begin the next day when a payment is submitted with the application. Persons between jobs or just graduated, and others seeking more affordable options than Marketplace plans are frequent applicants.
Temporary contracts are not Affordable Care Act-compliant, and should be reviewed for all exclusions and limitations. Essential Health benefits are mostly covered (office visits, prescriptions, emergency room visits, hospitalization...), although a deductible, coinsurance, and copayment may apply. Federal subsidies are not available, and benefits will cease when the plan duration has expired.
You may re-apply for additional coverage when a ST plan expires. However, a new application is required, and medical underwriting must be completed. A new deductible period will begin along with maximum out-of-pocket expense limits. The applicant may choose different benefits than the previous policy. It's possible that the prior plan may change, and the new rate and benefits may be different or no longer available.
Current Short-Term Health Insurance Rates (Monthly In Selected Cities):
Phoenix, AZ -- 30-Year-Old Male
$68 -- $5,000 Deductible Independence American Connect STM 50/5000
$89 -- $2,500 Deductible Independence American Connect STM 50/5000
$118 -- $1,000 Deductible Everest Flex $1,000 50/50%
Dallas, TX -- 35-Year-Old Female
$145 -- $5,000 Companion Life Economy 5000
$181 -- $2,500 Deductible Everest Flex $2,500 50/50%
$222 -- $1,000 Deductible Everest Flex $1,000 50/50%
Durham, NC -- 40-Year-Old Male
$95 -- $5,000 Companion Life Economy 5000
$123 -- $2,500 Deductible Everest Flex $2,500 50/50%
$152 -- $1,000 Deductible Everest Flex $1,000 50/50%
Nashville, TN -- 45-Year-Old Male
$96 -- $5,000 National General 5000 80/20
$158 -- $2,500 National General 2500 80/20
$289 -- $1,000 Deductible Everest Flex $1,000 50/50%
Tulsa, OK -- 50-Year-Old Female
$168 -- $5,000 Deductible Independence American Connect STM 50/5000
$225 -- $2,500 Deductible Independence American Connect STM 50/5000
$277 -- $1,000 Deductible Everest Flex $1,000 50/50%
Minneapolis, MN -- 55-Year-Old Male
$194 -- $5,000 Deductible Independence American Copay 50 50/5000
$260 -- $2,500 Deductible Independence American Copay 50 50/2500
$691 -- $1,000 Deductible Independence American Copay 50 50/1000
Cleveland, OH -- 60-Year-Old Female
$164 -- $5,000 Deductible Independence American Copay 50 50/5000
$221 -- $2,500 Deductible Independence American Copay 50 50/2500
$583 -- $1,000 Deductible Independence American Copay 50 50/1000
Christian Health Insurance (Health Sharing) Plans
Christian medical plans have became more popular after the ACA Legislation was passed. Premiums are slightly lower than non-subsidized plans, and like short-term policies, applications are accepted any time throughout the year. As medical costs continue to rise, health care sharing ministries have begun to appeal to many Americans.
More than one million persons in about 30 states are covered through these types of plans. There are more than 100 registered ministries, although only several are currently accepting new members. They are not considered to be insurance, and the companies that issue the policies are not insurance companies.
There are also no medical membership premiums. Instead, members share the cost of other member expenses by paying a per-determined fee, which is sometimes discounted per member for larger families. The fee is not tax-deductible. Prices are also higher for older applicants.
Although standard health insurance plans (Marketplace, Off-Exchange, and Group) utilize provider networks that offer substantial discounts, Christian Sharing plans allow their customers to visit and physician, medical facility, or hospital. The Ministry negotiates the amount of the discount, and also pays the outstanding bill.
The Risk Of Purchasing Christian Health Sharing Plans
Many of the provided benefits may have coverage limits. Conditions that utilize long-term treatment, therapy, and medications may result in substantial out-of-pocket expenses that exceed the policy maximum. These types of contracts are unregulated, so there are no reserve requirements.
Will your medical bills be paid? There is no guarantee that there will be adequate funds to "share," although the larger Ministries are more financially stable. There are also no legal protections to ensure that expenses are paid. For example, if an MRI is not paid because it does meet the policy guidelines, the providers who performed the service will undoubtedly request that you pay the outstanding bill.
Although there is no "ideal candidate" for these types of plans, healthy young persons with no pre-existing conditions will pay low premiums. However, if they are eligible for federal subsidies, a Marketplace policy should be selected. A lifestyle that meets Ministry guidelines will be needed, which means no nicotine usage and little or no alcohol consumption.
A "Belief Statement" typically must be signed with all conditions met. Since it is a non-insurance product, State Insurance Commissions can not enforce or regulate the terms and conditions. The policy can also be terminated by the Ministry with limited prior notification.
Monthly Rates Of Coverage From Five Largest Christian Healthcare Plans
30-year-old with $5,500 deductible -- $173
30-year-old with $3,000 deductible -- $239
45-year-old with $5,500 deductible -- $262
45-year-old with $3,000 deductible -- $355
60-year-old with $5,500 deductible -- $365
60-year-old with $3,000 deductible -- $486
30-year-old married couple with $5,500 deductible -- $276
30-year-old married couple with $3,000 deductible -- $412
45-year-old married couple with $5,500 deductible -- $398
45-year-old married couple with $3,000 deductible -- $598
60-year-old married couple with $5,500 deductible -- $565
60-year-old married couple with $3,000 deductible -- $775
30-year-old married couple and three children with $5,500 deductible -- $448
30-year-old married couple and three children with $3,000 deductible -- $642
45-year-old married couple and three children with $5,500 deductible -- $522
45-year-old married couple and three children with $3,000 deductible -- $744
60-year-old married couple and three children with $5,500 deductible -- $745
60-year-old married couple and three children with $3,000 deductible -- $928
Christian Healthcare Ministries
Gold Program -- $172 per unit per month -- $125,000 per illness. 100% coverage for any medical incident exceeding $500.
Silver Program -- $118 per unit per month -- Shares medical expenses exceeding $2,500.
Bronze Program -- $78 per unit per month -- Shares medical expenses exceeding $5,000.
A "Brother's Keeper" catastrophic bills program can be added to each plan. The approximate cost is $45 per unit per quarter. Gold members would receive unlimited cost support per illness. Silver and bronze members receive an extra $100,000 up to $1 million per illness.
Samaritan Ministries
Samaritan Basic -- Low-cost options with some restrictions on maternity benefits and shareable items. 90% sharing percentage with initial unshareable amount of $1,500. $5,000 maternity limit with $236,500 need limit.
18-29-year-old -- $100
30-44-year-old -- $120
45-59-year-old -- $140
60-64-year-old -- $160
18-29-year-old married couple -- $200
30-44-year-old married couple -- $240
45-59-year-old married couple -- $280
60-64-year-old married couple -- $320
18-29-year-old married couple with children -- $250
30-44-year-old married couple with children -- $300
45-59-year-old married couple with children -- $350
60-64-year-old married couple with children -- $400
Samaritan Classic -- Popular for new and growing families. 100% sharing percentage with initial unshareable amount of $300. $250,000 maternity limit with $250,000 need limit.
18-29-year-old -- $160
30-44-year-old -- $227
45-59-year-old -- $227
60-64-year-old -- $227
18-29-year-old married couple -- $454
30-44-year-old married couple -- $454
45-59-year-old married couple -- $454
60-64-year-old married couple -- $454
18-29-year-old married couple with children -- $530
30-44-year-old married couple with children -- $530
45-59-year-old married couple with children -- $530
60-64-year-old married couple with children -- $530
Liberty HealthShare
Liberty Share -- covers 70% of eligible medical expenses up to $125,000 shareable per incident.
Single under 30 -- $199
Single 30 and over -- $249
Couple under 30 -- $299
Couple 30 and over -- $349
Family -- $429
Family -- $479
Liberty Plus -- $125,000 shareable per incident after yearly unshared amount.
Single under 30 -- $224
Single 30 and over -- $274
Couple under 30 -- $324
Couple 30 and over -- $374
Family -- $454
Family -- $504
Liberty Complete -- $1 million shareable per incident after yearly unshared amount.
Single under 30 -- $249
Single 30 and over -- $299
Couple under 30 -- $349
Couple 30 and over -- $399
Family -- $479
Family -- $529
Sedera Medical Cost Sharing (No Faith Requirements)
$500 IUA
$189 -- Employee only under 30
$448 -- Employee and spouse under 30
$387 -- Employee and children under 30
$646 -- Employee and family under 30
$238 -- Employee only
$511 -- Employee and spouse
$460 -- Employee and children
$726 -- Employee and family
$1,000 IUA
$151 -- Employee only under 30
$351 -- Employee and spouse under 30
$306 -- Employee and children under 30
$508 -- Employee and family under 30
$187 -- Employee only
$396 -- Employee and spouse
$359 -- Employee and children
$564 -- Employee and family
$1,500 IUA
$136 -- Employee only under 30
$311 -- Employee and spouse under 30
$273 -- Employee and children under 30
$451 -- Employee and family under 30
$166 -- Employee only
$349 -- Employee and spouse
$318 -- Employee and children
$498 -- Employee and family
Limited Benefit Indemnity Insurance
A fixed amount of money is paid for specific medical diseases and illnesses. Depending on the severity and duration of the event, there may be insufficient coverage to pay all medical expenses. And although some incidents may be fully covered, others could result in large out-of-pocket expenses.
Generally, there are no deductibles or coinsurance to meet, and policy rates are determined by the level of benefits paid, your age, and state of residency. Unlike Health Ministry plans, limited benefit indemnity policies are considered as insurance and are regulated. However, they are not subject to Obamacare mandates, and thus, all "essential health benefits" are not included.
Often the biggest gaps in coverage are inpatient care and inpatient hospitalization benefits. Plans are mostly purchased outside of the Marketplace Open Enrollment periods, and when Group medical coverage is too expensive for individuals and families.
Popular Limited Benefit Indemnity Health Insurance Plans
UnitedHealthcare (Golden Rule)
Choice Value -- $1,000 per day benefit increasing to $2,000 per day by year 5. ICU or CCU maximum per confinement is $2,000 (31 days). $100 inpatient physician visit per day, $200 ER per day, $500 ambulance per trip (ground), and $5,000 ambulance per trip (air). Outpatient facility fee paid is $500, and four-tier surgical payments range from $500 to $10,000.
Two $100 office visits or Urgent Care visits are paid per year for injury or illness. Up to $250 is paid for a second surgical opinion. $100 is paid for a wellness or preventative care visits after a 6-month waiting period. A discount drug prescription card is included.
Choice Plus -- $2,000 per day benefit increasing to $4,000 per day by year 5. ICU or CCU maximum per confinement is $4,000 (31 days). $100 inpatient physician visit per day, $200 ER per day, $500 ambulance per trip (ground), and $5,000 ambulance per trip (air). Outpatient facility fee paid is $500, and four-tier surgical payments range from $500 to $10,000.
Two $100 office visits or Urgent Care visits are paid per year for injury or illness. Up to $250 is paid for a second surgical opinion. $100 is paid for a wellness or preventative care visits after a 6-month waiting period. Generic and brand drug copays are $20 and $40.
Select Value -- $3,000 per day benefit increasing to $6,000 per day by year 5. ICU or CCU maximum per confinement is $6,000 (31 days). $100 inpatient physician visit per day, $300 ER per day, $500 ambulance per trip (ground), and $5,000 ambulance per trip (air). Outpatient facility fee paid is $1,000, and four-tier surgical payments range from $500 to $10,000.
Five $100 office visits or Urgent Care visits are paid per year for injury or illness. Up to $500 is paid for a second surgical opinion. $200 is paid for a wellness or preventative care visits after a 6-month waiting period. A discount drug prescription card is included.
Primary Preferred -- $4,000 per day benefit increasing to $8,000 per day by year 5. ICU or CCU maximum per confinement is $2,000 (60 days). $100 inpatient physician visit per day, $300 ER per day, $500 ambulance per trip (ground), and $5,000 ambulance per trip (air). Outpatient facility fee paid is $500, and four-tier surgical payments range from $500 to $10,000.
Ten $100 office visits or Urgent Care visits are paid per year for injury or illness. Up to $500 is paid for a second surgical opinion. $250 is paid for a wellness or preventative care visits after a 6-month waiting period. Generic and brand drug copays are $10 and $40.
Select Preferred -- $5,000 per day benefit increasing to $10,000 per day by year 5. ICU or CCU maximum per confinement is $2,000 (60 days). $100 inpatient physician visit per day, $300 ER per day, $500 ambulance per trip (ground), and $5,000 ambulance per trip (air). Outpatient facility fee paid is $500, and four-tier surgical payments range from $500 to $10,000.
Ten $100 office visits or Urgent Care visits are paid per year for injury or illness. Up to $500 is paid for a second surgical opinion. $250 is paid for a wellness or preventative care visits after a 6-month waiting period. Generic and brand drug copays are $10 and $40.
Premier Plus -- $5,000 per day benefit increasing to $10,000 per day by year 5. ICU or CCU maximum per confinement is $10,000 (31 days). $100 inpatient physician visit per day, $500 ER per day, $1,000 ambulance per trip (ground), and $5,000 ambulance per trip (air). Outpatient facility fee paid is $1,000, and four-tier surgical payments range from $500 to $10,000.
Five $100 office visits or Urgent Care visits are paid per year for injury or illness. Up to $500 is paid for a second surgical opinion. $250 is paid for a wellness or preventative care visits after a 6-month waiting period. Generic and brand drug copays are $20 and $40.
Hooray Health
Basic
EE Only -- $99
EE and spouse -- $149
EE and children -- $139
Family -- $229
Basic And MEC
EE Only -- $139
EE and spouse -- $219
EE and children -- $209
Family -- $329
360 Plan With Sedera $500 IUA
EE only under 30 -- $288
EE and spouse under 30 -- $597
EE and children under 30 -- $526
Family under 30 -- $875
360 Plan With Sedera $500 IUA
EE only over 29 -- $337
EE and spouse over 29- $660
EE and children over 29 -- $599
Family over 29 -- $955
360 Plan With Sedera $1,000 IUA
EE only under 30 -- $250
EE and spouse under 30 -- $500
EE and children under 30 -- $445
Family under 30 -- $737
360 Plan With Sedera $1,000 IUA
EE only over 29 -- $286
EE and spouse over 29- $545
EE and children over 29 -- $498
Family over 29 -- $793
360 Plan With Sedera $1,500 IUA
EE only under 30 -- $235
EE and spouse under 30 -- $460
EE and children under 30 -- $412
Family under 30 -- $680
360 Plan With Sedera $1,500 IUA
EE only over 29 -- $265
EE and spouse over 29- $498
EE and children over 29 -- $457
Family over 29 -- $727
Direct Primary Care
Direct Primary Care has been offered for approximately 15 years. The typical customer does not qualify for a federal subsidy on Marketplace plans, and is seeking basic medical care for themselves and their family. The patient and provider agree on which benefits will be provided and the cost of these services. An insurance company is not involved in the process.
A monthly fee is generally charged for coverage, and many customers utilize an HSA (Health Savings Account) with the required High Deductible Health Plan for their major medical benefits. Qualified health, dental, and vision expenses can be paid with pre-tax dollars through the HSA.
Although primary care physician visits are covered by plans, typically, urgent care, emergency room, and specialty visits are not part of the program. However, a discount may be available if the provider is in the HDHP's carrier network.
List Of Direct Primary Care Practices
Arizona -- IORA Primary Care
California -- Elevated Heath, Halcyon Health
Colorado -- Nextera Healthcare, Paladina Health, Cloud Medical Center, San Luis Valley Health
Florida -- Nextera Health Care, Paladina Health, NAB Life Health
Georgia -- IORA Primary Care, Stahl Primary Care
Illinois -- Center For Your Health, Priority Health Family Medicine
Maryland -- Clarii Health, Evolve Medical Clinics
Michigan -- Beyond Primary Care, Health Share Plan LLC, Your Choice Direct Care
New Jersey -- R-Health, Paladina Health, Maitri Wellness, Morningstar Family Health Center
New York -- AMG Medical Group, Grameen Vida Sana
North Carolina -- Paladina Health
Ohio -- Paladina Health, Neighborly Family Medicine, Primary Care One, Whole Family Medicare LLC
Pennsylvania -- Connected Health, R-Health, Lincoln Family Medicine, Revolutionary Health Services
South Carolina -- Paladina Health
Texas -- Diamond Physicians, Direct Med Clinic, Direct Senior Care, Dominion Primary Care, Eagle Medical Center, Shaya Precision Health, South Shore Medical Center
Virginia -- Nextera Healthcare, Capital Family Practice, Modern Mobile Medicine
Washington -- Bliss MD, Direct Primary Care, IORA Primary Care, The Manette Clinic
Wisconsin -- Paladina Health
Medical Services Discount Cards
A Medical Services Discount Card allow the consumer to purchase healthcare services for a reduced cost. The coverage is not considered health insurance and does not meet ACA guidelines and mandates. The discounted fee-for-service benefits can be combined with other policies, but can leave large coverage gaps when chronic conditions are present.
Participating providers can be viewed through online links, although verification by phone is highly recommended. ID cards are typically sent within 7-10 days of the completed enrollment, and a description of benefits is also provided.
Prescription discounts will greatly vary, and your local pharmacy can calculate the savings. Immediate family members are generally included on the policy and can use RX and other discounts.
Also available are prescription (only) discount cards that provide reductions for medications, but not other services. Although several cards have small fees, most cards are free.
Although the actual amount of savings will vary, the average discount percentage for selected categories are listed below:
Alternative Medicine -- 15%-25%. Massage therapy and acupuncture included.
Chiropractic Care -- 18%-35%.
Dental Treatment -- 10%-40%. Orthodontia and emergency treatment reductions will be lower.
Diabetes Care -- 35%-60% for supplies.
Hearing Aids -- 10%-20%. Not all brands eligible for reduction.
Nutrition Supplements -- 20%-40%.
Podiatry Benefits -- 25%-50%. Many foot-related items and services.
Prescription Drugs -- 15%-60%. Specialty drugs may not receive a reduction.
Vision Treatment -- 10%-50%. Glasses, contacts, and routine eye visits are the most common coverage.
Vitamins -- 20%-40%. Many brands available.
The cost of Medical Services Discount Card coverage will vary, depending upon the company providing the service. Estimated monthly rates are below:
$8-$12 -- Basic benefits with drug, dental, and vision coverage.
$15-$18 -- Basic benefits with drug, dental, and vision coverage. Hearing coverage and a 24-hour nurse hotline are often included. Diabetic and chiropractic coverage may also be included.
$20-$25 -- All benefits from the prior two plans with office visits and hospitalization coverage. Strict limits will apply with high out-of-pocket costs likely with serious illnesses and accidents or a chronic illness.