Health Insurance Alternatives To Obamacare – Affordable Medical Options

Last Updated on by Edward Harris

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 $9,450, and your physicians and specialists may not be "in-network." Cost-sharing programs, temporary plans, indemnity coverage, and other medical plans provide numerous additional options for individuals and families needing low-cost coverage. Self-employed persons and small business owners also have several budget-friendly options.

For non-Seniors that are not yet eligible for Medicare, the under-65 Open Enrollment period begins November 1 and ends January 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 the Open Enrollment period is extended. Additional extensions are often provided for pandemics (COVID for example). Listed below are 2024 state-operated Exchanges:

California (Covered California)
Colorado (Connect For Health)
Connecticut (Access Health)
District Of Columbia (DC Health Link)
Idaho (Your Health Idaho)
Kentucky (Kynect)
Maine (CoverMe)
Maryland (Maryland Health Connection)
Massachusetts (Massachusetts Health Connector)
Minnesota (MNsure)
Nevada (Nevada Health Link)
New Jersey (Get Covered NJ)
New Mexico (bewellnm)
New York (New York State Of Health)
Pennsylvania (Pennie Exchange)
Rhode Island (Healthsource RI)
Vermont (Vermont Health Connect)
Virginia (Virginia Insurance Marketplace)
Washington (Washington Health Plan Finder)

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. Several states only offer a limited number of carriers in selected counties, and in many other states, specific areas may not offer PPO options (EPO and HMO plans are offered instead). Also, many consumers utilize non-network providers and may not be able to take advantage of traditional network discounts.

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 Medical Insurance

 

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, New York, New Jersey, Massachusetts, Vermont, Rhode Island, Connecticut, 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. Underwriting is simplified and limited questions are asked. Many policies can be renewed for an additional term.

In most states, 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. Healthy persons within 6-12 months of Medicare-eligibility that don't qualify for a federal subsidy also may be candidates for a short-term plan.

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 instant tax credits are not available, and benefits will cease when the plan duration has expired. Maternity and mental illness benefits may be limited or excluded. Preventative coverage, unlike Marketplace plans, may not be covered at 100%. Seniors are generally not eligible for benefits.

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 -- $10,000 Deductible Companion Life Economy 10000 with $1 million maximum benefits

$77 -- $15,000 Deductible UnitedHealthcare Short Term Medical Value with $1 million maximum benefits

$80 -- $5,000 Deductible Companion Life Economy 5000 with $1 million maximum benefits

$91 -- $5,000 Deductible Everest Flex $5,000 50/50% with $1 million maximum benefits

$99 -- $15,000 Deductible UnitedHealthcare Short Term Medical Value with $1 million maximum benefits

$106 -- $2,500 Deductible Everest Flex $2,500 50/50% with $1 million maximum benefits

$128 -- $1,000 Deductible Everest Flex $1,000 50/50% with $1 million maximum benefits

 

Dallas, TX -- 35-Year-Old Female

$84 -- $15,000 Deductible UnitedHealthcare Short Term Medical Value with $1 million maximum benefits

$92 -- $10,000 Deductible Everest Flex $10,000 50/50% with $1 million maximum benefits

$107 -- $5,000 Deductible Everest Flex $5,000 50/50% with $1 million maximum benefits

$116 -- $5,000 Deductible Companion Life Economy 5000 with $1 million maximum benefits

$124 -- $2,500 Deductible Everest Flex $2,500 50/50% with $1 million maximum benefits

$151 -- $1,000 Deductible Everest Flex $1,000 50/50% with $1 million maximum benefits
 

Durham, NC -- 40-Year-Old Male

$64 -- $15,000 Deductible UnitedHealthcare Short Term Medical Value with $1 million maximum benefits

$78 -- $10,000 Deductible Companion Life Economy 10,000 with $1 million maximum benefits

$93 -- $5,000 Deductible Companion Life Economy 5000 with $1 million maximum benefits

$103 -- $5,000 Deductible Everest Flex $5,000 50/50% with $1 million maximum benefits

$123 -- $2,500 Deductible Everest Flex $2,500 50/50% with $1 million maximum benefits

$152 -- $1,000 Deductible Everest Flex $1,000 50/50% with $1 million maximum benefits

 

Nashville, TN -- 45-Year-Old Male

$79 -- $15,000 Deductible UnitedHealthcare Short Term Medical Value with $1 million maximum benefits

$91 -- $10,000 Deductible Companion Life Economy 10,000 with $1 million maximum benefits

$108 -- $5,000 Deductible Companion Life Economy 5000 with $1 million maximum benefits

$135 -- $5,000 Deductible UnitedHealthcare Short Term Medical Value with $1 million maximum benefits

$169 -- $2,500 Deductible UnitedHealthcare Short Term Medical Value with $1 million maximum benefits

$253 -- $1,000 Deductible Everest Flex $1,000 50/50% with $1 million maximum benefits

Note: National General was purchased by Allstate Insurance.

 

Tulsa, OK -- 50-Year-Old Female

$113 -- $15,000 Deductible UnitedHealthcare Short Term Medical Value with $1 million maximum benefits

$155 -- $10,000 Deductible Companion Life Economy 10,000 with $1 million maximum benefits

$189 -- $5,000 Deductible Companion Life Economy 5000 with $1 million maximum benefits

$194 -- $5,000 Deductible UnitedHealthcare Short Term Medical Value with $1 million maximum benefits

$242 -- $2,500 Deductible UnitedHealthcare Short Term Medical Value with $1 million maximum benefits

$302 -- $1,000 Deductible Everest Flex $1,000 50/50% with $1 million maximum benefits

 

Minneapolis, MN -- 55-Year-Old Male

$151 -- $12,500 Deductible UnitedHealthcare Short Term Medical Value with $2 million maximum benefits

$182 -- $10,000 Deductible UnitedHealthcare Short Term Medical Value with $2 million maximum benefits

$249 -- $5,000 Deductible UnitedHealthcare Short Term Medical Value with $2 million maximum benefits

$312 -- $2,500 Deductible UnitedHealthcare Short Term Medical Value with $2 million maximum benefits

 

Cleveland, OH -- 60-Year-Old Female

$135 -- $15,000 Deductible UnitedHealthcare Short Term Medical Value with $2 million maximum benefits

$146 -- $10,000 Deductible Companion Life Economy 10,000 with $1 million maximum benefits

$173 -- $7,500 Deductible UnitedHealthcare Short Term Medical Value with $2 million maximum benefits

$178 -- $5,000 Deductible Companion Life Economy 5,000 with $1 million maximum benefits

$178 -- $5,000 Deductible Companion Life Choice 5,000 with $1 million maximum benefits

$221 -- $5,000 Deductible UnitedHealthcare Short Term Medical Value with $2 million maximum benefits

$248 -- $2,500 Deductible Everest Flex $2,500 50/50% with $1 million maximum benefits

$302 -- $1,000 Deductible Everest Flex $1,000 50/50% with $1 million maximum benefits

 

Christian Health Insurance Plans

 

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. Dependents and children can be covered along with the principal insured. It is possible for different family members to be covered under an unsubsidized Marketplace plan and a Ministry plan.

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 "qualified" insurance, and the companies that issue the policies are not insurance carriers. Thus, there is no regulation by the State Departments of Insurance (in most states).

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 and prices are higher for older applicants. Larger families often receive a discount, although the ACA federal subsidy may be more enticing.

Although standard health insurance plans (Marketplace, Off-Exchange, and Group) utilize provider networks that offer substantial discounts, Christian Sharing plans often allow their customers to visit any physician, medical facility, or hospital. The Ministry negotiates the amount of the discount, and also pays the outstanding bill. Some PPO network options are offered, depending on the carrier.

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. In several states, the sale of Ministry plans have been halted, and new applications are not allowed to be submitted. Prior investigations have resulted in Aliera to cease offering plans in several states.

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. Consistent attendance of church services may also be required.

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.

Average Monthly Rates Of Coverage From The Five Largest Christian Healthcare Plans

 

MediShare

 

30-Year-Old
Medi-Share Complete AHP 12000 -- $109

Medi-Share Complete With Co-Sharing AHP 9000 -- $129

Medi-Share Complete AHP 9000 -- $145

Medi-Share Complete With Co-Sharing AHP 6000 -- $156

Medi-Share Value IMR 1000 -- $162

Medi-Share Complete AHP 6000 -- $177

Medi-Share Value IMR 500 -- $177

Medi-Share Complete With Co-Sharing AHP 3000 -- $200

Medi-Share Complete AHP 3000 -- $229

 

40-Year-Old
Medi-Share Complete AHP 12000 -- $112

Medi-Share Complete With Co-Sharing AHP 9000 -- $132

Medi-Share Complete AHP 9000 -- $150

Medi-Share Complete With Co-Sharing AHP 6000 -- $160

Medi-Share Value IMR 1000 -- $162

Medi-Share Value IMR 500 -- $177

Medi-Share Complete AHP 6000 -- $182

Medi-Share Complete With Co-Sharing AHP 3000 -- $207

Medi-Share Complete AHP 3000 -- $237

 

50-Year-Old
Medi-Share Complete AHP 12000 -- $126

Medi-Share Complete With Co-Sharing AHP 9000 -- $150

Medi-Share Complete AHP 9000 -- $169

Medi-Share Complete With Co-Sharing AHP 6000 -- $182

Medi-Share Value IMR 1000 -- $191

Medi-Share Complete AHP 6000 -- $208

Medi-Share Value IMR 500 -- $210

Medi-Share Complete With Co-Sharing AHP 3000 -- $235

Medi-Share Complete AHP 3000 -- $270

 

60-Year-Old
Medi-Share Complete AHP 12000 -- $168

Medi-Share Complete With Co-Sharing AHP 9000 -- $198

Medi-Share Complete AHP 9000 -- $227

Medi-Share Complete With Co-Sharing AHP 6000 -- $244

Medi-Share Value IMR 1000 -- $273

Medi-Share Complete AHP 6000 -- $280

Medi-Share Complete With Co-Sharing AHP 3000 -- $295

Medi-Share Value IMR 500 -- $300

Medi-Share Complete AHP 3000 -- $339
 

30-Year-Old Married Couple
Medi-Share AHP 12000 -- $203

Medi-Share AHP 9000 -- $287

Co-Sharing AHP 6000 -- $312

Medi-Share AHP 6000 -- $361

Co-Sharing AHP 3000 -- $417

Medi-Share AHP 3000 -- $486

 

40-Year-Old Married Couple
Medi-Share AHP 12000 -- $209

Medi-Share AHP 9000 -- $297

Co-Sharing AHP 6000 -- $324

Medi-Share AHP 6000 -- $375

Co-Sharing AHP 3000 -- $434

Medi-Share AHP 3000 -- $504

 

50-Year-Old Married Couple
Medi-Share AHP 12000 -- $242

Medi-Share AHP 9000 -- $345

Co-Sharing AHP 6000 -- $375

Medi-Share AHP 6000 -- $436

Co-Sharing AHP 3000 -- $499

Medi-Share AHP 3000 -- $580

 

60-Year-Old Married Couple
Medi-Share AHP 12000 -- $343

Medi-Share AHP 9000 -- $480

Co-Sharing AHP 6000 -- $519

Medi-Share AHP 6000 -- $605

Co-Sharing AHP 3000 -- $638

Medi-Share AHP 3000 -- $746

 

Christian Healthcare Ministries

Gold Program -- $205 per unit per month -- $125,000 per illness. 100% coverage for any medical incident exceeding $500. Includes inpatient/outpatient hospital expenses and surgery, medical tests, maternity, physical therapy, and home health care.

Silver Program -- $125 per unit per month -- Shares medical expenses exceeding $2,500. Includes inpatient/outpatient hospital expenses and surgery. Does not include maternity or urgent care.

Bronze Program -- $85 per unit per month -- Shares medical expenses exceeding $5,000. Includes inpatient/outpatient hospital expenses and surgery. Does not include maternity or urgent care.

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. There is a non-refundable $200 application fee. To switch from Basic to Classic, or Classic to Basic requires payment of a non-refundable $100 fee.

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 Essential -- covers 70% of eligible medical expenses up to $125,000 shareable per incident.

Single under 35 -- $159

Single 35-49 -- $179

Single under 50 -- $219

Couple under 35 -- $259

Couple 35-49 -- $359

Couple under 50 -- $379

Family under 35 -- $499

Family 35-49 -- $589

Family under 50 -- $729

 

Liberty Connect --  $125,000 shareable per incident after yearly unshared amount.

Single under 35 -- $209

Single 35-49 -- $239

Single under 50 -- $279

Couple under 35 -- $339

Couple 35-49 -- $389

Couple under 50 -- $489

Family under 35 -- $639

Family 35-49 -- $749

Family under 50 -- $939

 

Liberty Unite --  $1 million shareable per incident after yearly unshared amount.

Single under 35 -- $259

Single 35-49 -- $309

Single under 50 -- $359

Couple under 35 -- $459

Couple 35-49 -- $509

Couple under 50 -- $649

Family under 35 -- $8499

Family 35-49 -- $999

Family under 50 -- $1,239

 

Sedera Medical Cost Sharing (No Faith Requirements)

 

$500 IUA Ages 18-29

$208 -- Applicant only

$396 -- Applicant and spouse

$381 -- Applicant and children

$574 -- Applicant and family

 

$500 IUA Ages 30-39

$244 -- Applicant only

$467 -- Applicant and spouse

$449 -- Applicant and children

$678 -- Applicant and family

 

$500 IUA Ages 40-49

$283 -- Applicant only

$547 -- Applicant and spouse

$525 -- Applicant and children

$793 -- Applicant and family

 

$500 IUA Ages 50-59

$349 -- Applicant only

$677 -- Applicant and spouse

$649 -- Applicant and children

$982 -- Applicant and family

 

$500 IUA Ages 60-64

$601 -- Applicant only

$1,181 -- Applicant and spouse

$1,127 -- Applicant and children

$1,713 -- Applicant and family

 

$1,000 IUA Ages 18-29

$195 -- Applicant only

$370 -- Applicant and spouse

$357 -- Applicant and children

$538 -- Applicant and family

 

$1,000 IUA Ages 30-39

$237 -- Applicant only

$454 -- Applicant and spouse

$437 -- Applicant and children

$659 -- Applicant and family

 

$1,000 IUA Ages 40-49

$248 -- Applicant only

$475 -- Applicant and spouse

$457 -- Applicant and children

$690 -- Applicant and family

 

$1,000 IUA Ages 50-59

$300 -- Applicant only

$580 -- Applicant and spouse

$557 -- Applicant and children

$842 -- Applicant and family

 

$1,000 IUA Ages 60-64

$517 -- Applicant only

$1,013 -- Applicant and spouse

$968 -- Applicant and children

$1,469 -- Applicant and family

 

$2,500 IUA Ages 18-29

$153 -- Applicant only

$286 -- Applicant and spouse

$278 -- Applicant and children

$416 -- Applicant and family

 

$2,500 IUA Ages 30-39

$172 -- Applicant only

$324 -- Applicant and spouse

$313 -- Applicant and children

$471 -- Applicant and family

 

$2,500 IUA Ages 40-49

$193 -- Applicant only

$366 -- Applicant and spouse

$353 -- Applicant and children

$531 -- Applicant and family

 

$2,500 IUA Ages 50-59

$246 -- Applicant only

$471 -- Applicant and spouse

$453 -- Applicant and children

$684 -- Applicant and family

 

$2,500 IUA Ages 60-64

$849 -- Applicant only

$1,013 -- Applicant and spouse

$812 -- Applicant and children

$1,232 -- Applicant and family

 

 

Limited Indemnity Health Plans

 

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. These types of plans are not eligible for Marketplace subsidies, and have many policy restrictions.

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 Plans

 

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, so the billing process is simplified.

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, and contributions are capped to meet federal guidelines. A special "catch up" provides additional deposit options.

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

Idaho -- Initial Point Med, SparkMD

Illinois -- Center For Your Health, Priority Health Family Medicine

Indiana -- Amazing Grace Family Medicine, Dedicated Family Health, Priority Physicians PC

Iowa -- Strada Healthcare

Kansas -- Pro Partners Healthcare

Kentucky -- Bluegrass Family Wellness, Paladina Health, Proactive MD

Maryland -- Clarii Health, Evolve Medical Clinics

Massachusetts -- IORA Primary Care, Gold Direct Care, Direct Primary Care Action Medicine

Michigan -- Beyond Primary Care, Health Share Plan LLC, Your Choice Direct Care

Missouri -- Pro Partners Healthcare

Nebraska -- Strada Healthcare

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.