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 $9,100, 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 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 the Open Enrollment period is extended. Additional extensions are often provided for pandemics (COVID for example). Listed below are 2023 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)
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 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
$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
$106 -- $2,500 Deductible Everest Flex $2,500 50/50% with $1 million maximum benefits
$84 -- $15,000 Deductible UnitedHealthcare Short Term Medical Value 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 (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
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 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
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.