So you didn’t sign up for ObamaCare, what now?

So you didn’t sign up for ObamaCare, what now?

Direct Primary Care meets primary care needs – how to pay for other needs outside of insurance…

Did you decide that you could’t afford to continue with your health insurance and are looking for another way to help pay for catastrophic health issues?  Unfortunately, you are not alone. While Direct Primary Care is an excellent way to get your primary care needs met – it doesn’t provide help with paying for catastrophic health problems where you may need to be hospitalized or have surgery.  Many people will opt for a high deductible plan and pair it with DPC – but even those plans prices have risen out of many people’s reach.  Joining a health cost-sharing plan is a solution that can help pay for serious medical issues.

What are Cost Sharing Health Plans?

Cost Sharing Health Plans may be either faith-based or not faith-based.  Some of the faith-based ones (also called Health Sharing Ministries) have been around for many years, and people who had them were exempt from paying the penalty for not having ACA compliant health insurance. Newer plans, like Sedera, were not grandfathered in and do not exempt people from paying the penalty – although this is a moot point now for individuals.  Some plans, like Sedera, can be provided by employers to help care for their employees and can be paired with another insurance product – called a MEC plan (minimal essential coverage plan) as well as direct primary care.

Limitations/ Considerations on Cost Sharing Health Plans

Since these plans are not insurance, they are not required to cover all the same things that ACA plans do.  Pre-existing conditions may not be included – or only partially covered for several years,  people with specific health problems may not be accepted, mental health coverage is unfortunately poor, and some of the plans require participants to sign a statement of faith.  However, for many people the price difference, as well as a different philosophy, make it a desirable alternative.  There are different levels of coverage available.  A membership for a family with $1,000,000 coverage is generally under $500/mo with most of these plans – instead of well over $1600/mo with the plans that are found on the marketplace. There are programs with less coverage, but I would be hesitant to suggest people consider them. 

Another DPC physician I know put together a chart that lists some of the major Cost Sharing plans and wrote a recent blog post.  Click HERE to link to his chart/blog.  PLEASE read the plan specific sites well and ask questions before signing up – they are not right for everyone – but for many people is a great way to get help when you need it.  These plans are based on principle’s of individual responsibility and helping others who are in need.  These are member to member payments – either directly or indirectly – to help each other – instead of paying a large corporation whose motives may or may not be aligned with the patients’.  Also, as I said earlier – this is not insurance – but a great alternative to investigate.

Health Sharing Plans and DPC

Some Health Sharing Plans may partially reimburse or discount monthly sharing amounts for people participating in a direct primary care practice.  Sedera is only available for individuals at this time who are affiliated with a direct primary care practice.  That is why there is an enrollment link on my sign-up page – not that I am endorsing them over any other plan.  They are simply the only group that has reached out to the Direct Primary Care community to make it easier for patients to enroll and and include it in their monthly bill from DPC Practices. You can sign up after you join, and it is definitely not required. 

If you are a patient of mine and are interested in learning more about health sharing plans and whether or not they would possibly meet your needs, please contact me to talk about this further.  

***Note *** This post, like all my other posts, is for general information only and is not to be taken as direct advice.  Please consult your personal physician, insurance agent, or financial advisor for more information.  


Health Sharing Ministries – another option

Health Sharing Ministries – another option

I will be losing my employer sponsored health plan soon as my last day at HealthSource is 2/28/17.  I will be eligible for COBRA of course but I know that 10 years ago when I looked at COBRA it was super expensive and I doubt that it will be any cheaper now since the amount listed on my W-2 as the amount paid for health insurance last year by my employer was over $20,000.  Yup, 20k for  a $3,000 per individual deductible plan with a HSA.  We have been lucky and in the last 5+ years we have had high deductible plans, we only met the deductible one year.   I looked on the website for a replacement plan and didn’t really find any high deductible plans – only really HMO plans to be found – which isn’t something I am interested in.  I find this very strange considering most employer based plans have moved to high deductible plans.  As I was looking into other options, I discovered Health Sharing Ministries.

I have decided to enroll my family in Liberty Complete through Liberty HealthShare.  It is a Health Sharing Ministry run through the Mennonites.  It has much lower administrative costs than your traditional health plans and puts an emphasis on wellness and health care prevention.  The monthly fees go towards helping other members pay their health care costs.  There are several other health sharing ministry programs out there like Medi-Share and Good Samaritan Ministries but those require members to be Christians who have regular church attendance – and I have family members who wouldn’t meet this requirement.  Liberty does have the same lifestyle requirements as the other plans.  There are also some things that aren’t covered, and there are pre-existing exclusions as there were with many plans before the ACA. Actually, it isn’t technically health insurance but it is another way of getting and giving assistance with healthcare. In the past, participating in a Health Share Ministry meant that the person didn’t have to pay the tax for not having insurance.  I am not sure if this tax is going to be in effect in the future, but it is still a good idea to have a way to help pay for catastrophic events.



***Note *** This post, like all my other posts, is for general medical information only and is not to be taken as direct advice.  Please consult your personal physician for more information.

Affordable Care & MLK Day

Affordable Care & MLK Day

Martin Luther King Jr. on Healthcare Injustice

As someone who has worked at a Community Health Center since before the implementation of the ACA, I recognize how many people have benefitted from it.  In Ohio, with the expansion of Medicaid many people were able to obtain help that previously hadn’t been able to.  I have had patients have cancers detected and treated, and hypertension brought down from dangerous levels due to having access to health care. On the other hand,  I have also seen people get health insurance through the marketplace and end up with plans that are essentially worthless – they may be paying $1000/mo or more for a plan that they then can’t afford to use. That doesn’t really help them get health care – it helps them have insurance.  There is a big difference between having health insurance and having health care.  I do believe that access to health care is a basic right and it should be available to all.  Direct Primary Care may be one answer – if someone can pay 50-75/mo for a monthly fee, they may be able to have their primary care needs met and be less likely to have to end up in the ER.  If someone has low enough income where they really CAN’T afford it and would qualify for Medicaid – Medicaid could help fund a HSA for patients – like some employers do currently – and patients could use that money to purchase care through DPC offices or other health care needs.  I hope that whatever this next government decides to do, it will keep the parts about not excluding people with pre-existing conditions and letting young adults stay on their parents health insurance.  It’s still really hard for me to believe that a nation that has as many resources as the United States, hasn’t been able to figure out a way to make sure that people’s basic needs are taken care of.  We need a system where patients have the freedom to choose their care, and physicians aren’t expected to sacrifice their physical/emotional well-being to take care of others.  The system is broken with or without Obamacare.  I don’t know what the answer is,  I just hope that things don’t get worse.  I pray that our elected leaders hold love and compassion for others in their souls, and that their motives are true as they move forward with changing/repealing/replacing the Affordable Care Act.

Learn more about how you can get HealthCARE outside of Health Insurance!!

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