Alternatives to ACA (Obamacare) Individual Health Insurance

Finding affordable coverage...

While the advent of the Affordable Care Act (ACA), also known as Obamacare, helped a lot of people who couldn't afford coverage or were once considered uninsurable receive coverage, it also has left many with few options who exist outside of certain income and age ranges. This is especially true in Florida, a state that chose not to expand Medicaid.

Many people ask us if alternatives to ACA plans exist. The answer is yes and no. The most comparable coverage to the major medical plans found within the healthcare.gov marketplace are short-term health plans. These policies do not generally last more than three months, but some can be rolled over up to four times a year to create annual coverage. While these plans are comprehensive, they do not offer all of the protections that ACA plans do. For example, most plans bar access to care for complications resulting from pre-existing conditions. These plans also generally have high deductibles and out-of-pocket limits, but these can be offset with critical illness and accident riders, which can cover up to and over any deductibles and out-of-pockets limits in the event of major incidents like heat attacks, strokes, cancers, fractures and more.

Another option is Ministry Healthshare Plans. These are association based plans, usually through Christian organizations, that take premiums collected from all members and pay out to claims from there. It should be plainly stated here that these plans are not insurance, as they are not backed by any insurance company. However, the structure of these plans operate similarly to other insurance plans. There is a monthly association member fee that you would pay like one would pay an insurance premium, which is based on your age. From there, there is the Member Shared Responsibility Amount (MSRA) that has to be paid before any claims can be covered, which operate like a deductible would in a traditional insurance plan. From there, the plan will pay covered claims and the members pay a co-share responsibility of a fixed perfect (hypothetically 20% of anything above the MSRA). These plans can potentially cost much less than ACA plans, which Ministry Healthshare Plans claim is because they do not cover many pre-existing conditions, therefore lowering their risk. Similarly to Short-Term Medical plans, MSRAs can be high with these plans, which can be potentially offset with critical illness and accident riders or supplemental coverage.

Finally, a new type of insurance plan has become increasingly popular over the last few years, for better or for worse. These plans are called Fixed-Benefit plans or Fixed-Indemnity plans. With these plans, there are no deductibles or co-pays. The insurance company pays a fixed-benefit for covered services according to the insurance plan. For example, a plan might pay for you to see your Primary Care Provider (PCP) three times a year at $100 per visit. This means the plan pays the first $100 of the visit and you pay anything above this amount. The plan might pay the first $2,000 per day of everyday you are hospitalized as an impatient, and $4,000 if you are in an Intensive Care Unit (ICU). While this sounds very good on the surface, these plans have basically reversed the unlimited liability from the insurance company to the insured. For example, if you suffer a heart attach and go into the hospital for a few days, the bill could potentially reach $60,000 or more with treatment and surgeries. While the Fixed-Benefit plan would pay $300-$600 for the ambulance, $500-$10,000 for surgery, $12,000 for three days in the ICU along with a few other covered expenses, in this scenario the insured would still be on the hook for almost half of the bill, or $30,000. On a traditional Short-Term Medical plan, if the deductible was $5,000 with an out-of-pocket limit of $7,000, the insured would pay the first $7,000 and the insurance company would have to pay any liability above this amount. While Fixed-Benefit plans can be an cost-effective alternative to ACA plans, they must be clearly explained to anyone who is thinking about purchasing one. Unfortunately, many times people are talked into these plans not fully understanding the limitations of the plans only to be burned when an emergency occurs.

If you would like to learn more about your options outside of the ACA Marketplace or are interested in purchasing Short-Term Medical, Health Ministry, or Fixed-Benefit plans and would like a quote please fill out of the form below. As an independent insurance brokerage firm, we have the ability to quote rates across dozens of carriers, assuring we can find the most cost-effective and appropriate coverage available for you. You can also always call as at (866)868-9294.