I get it.
Money is important.
Health insurance is important.
Health insurance is expensive.
Why Health Insurance is Expensive
The biggest reason that health insurance is expensive is that healthcare is expensive. It’s not the cost of a few stitches or a flu shot that make the premiums so expensive. It’s the cancer treatments, the transplants, the dialysis. The reasons why healthcare is so expensive include administrative costs and defensive medicine (ordering lots of tests to avoid getting sued), among other factors.
It is easy to look at a monthly premium and make the assertion that “I am never sick – I should not have to pay that much!” You take care of your body; regular exercise and eating well should be rewarded with lower premiums. Again, I get it. However, the problem with that thinking is that cancer, for example, does not care whether you take care of your body. It does not discriminate. Neither do car accidents, for that matter, which is where having good health insurance comes into play.
Health Care Sharing Ministries
I have heard a few folks toying with the idea of going to a health care sharing ministry-type of plan (HCSM). On the outside, the premiums are attractive and they boast of providing health care needs. But there is a vast difference between attractive premiums and actual health care benefits.
It’s also important to note that since it is not insurance it is not regulated by the Department of Insurance and therefore has no consumer protections. You could pay thousands to an organization only to not have the benefits you thought you did, and without the DOI to turn to for recompense. Here’s a great article on HCSMs.
I’ve read many of these policies whose brochures tout “this is not insurance…” and “we will pay UP to…” There are also pre-existing conditions and many services such as emergency care, surgery, maternity, etc. that are not covered. There are also plays on words – such as showing that benefits are “Excepted as part of the ACA” instead of “Accepted.” There is also fine print of “covered services”. Whereas traditional insurance will have a $250 copay for emergency room services, these plans will show $250* for emergency room services. Reading the asterisk shows that it will allow UP to $250, which basically amounts to sitting in the waiting room and not being seen by a provider. Plus you could be responsible for untold thousands in medical bills.
Plans that are part of the Affordable Care Act (ACA) will outline the coverages, have a maximum out-of-pocket you will pay, and have benefits built in that will cover you in case of cancer or a car accident. If you are unsure of whether you have a true ACA plan, you can either reach out to the Department of Insurance or one of the insurance professionals at A and H Insurance to see if they are a true insurance company.
I recently spoke to a client who owned a roofing company and was thinking of going to one of these types of plans. I asked him what he would think if I found a company that could re-roof my whole house for $1,500. His reply was, “You get what you pay for.”
I couldn’t have said it better myself.
You get what you pay for.
Grace Daidone is a Health and Benefits Consultant for A and H Insurance. She specializes in small group, individual and Medicare health benefits insurance.