Buh-bye, Obamacare! Hello, Health Care Sharing

Source: Fearless Parent, by Louise Kuo Habakus

Since leaving our corporate jobs, my husband and I have spent an obscene amount of money on health insurance that never covers… anything. On the rare occasion that I go in-network, the appointment is usually a dud… punctuated by the scripts I won’t fill, the treatments I decline, and the follow-up appointments I won’t make.

So when I took a look at what the Affordable Care Act says my family must now pay, I knew we were done. I had reached the point beyond which I will not be pushed.

When it comes to health insurance, the Habakus family is sending a pink slip to government and industry. I’ve found a solution for my family that’s also a tangible rejection of the current system.

Obamacare doesn’t work for everyone

If you have individual coverage, if you had a plan that was canceled thanks to Obamacare, if you’re young, and if you’re ineligible for subsidies, then you’re probably paying a lot more.

To make matters worse, your doctor might be among the over 214,000 providers exiting the Obamacare exchanges — about 25% of all professionally active physicians.

I’ve kept our insurance this long because, well, you know… someone might need a limb reattached. But I haven’t been applying critical thinking to this decision.

Until now.

The prospect of paying twice as much for less of what I want finally got my attention — along with the knowledge that the pharma-government-insurance complex will deliver more changes that I won’t like.

But there’s a lot more at stake than money

With traditional health insurance, I wonder about entering into a situation I may really regret. Once you choose one of their “can’t-go-out-of-network” doctors and walk through those hospital doors with your child…

YOU’RE ON THEIR TURF

And make no mistake — you are no longer in charge. It’s not always possible to say: “No, thanks.” The institutional response to disagreement about health care treatment has become increasingly draconian.

Imagine, God forbid, your child is very sick and the hospital is insisting on “lifesaving,” standard of care medical interventions that you are unwilling to pursue. The only person standing between you and a total nightmare is your physician. Now let’s assume you chose the doctor because she takes your insurance. Will you be surprised to learn that she’s not on your side?

If the hospital won’t discharge your child, you can’t leave. It happens all the time. It happened to me. Once Child Protective Services is called, you’re in big trouble. Legal medical kidnapping is a growing problem. (Tune into Fearless Parent Radio™ on December 17).

WHY I’M KICKING MY INSURANCE TO THE CURB

I will no longer participate in a system that incentivizes me to use health care I do not want.

I will no longer subsidize health care that conflicts so fundamentally with my values and beliefs.

I will no longer support a hidebound industry with zero innovation, bad customer service, and obscenely high executive compensation.

I no longer feel safe with traditional health insurance coverage. The dynamic has become adversarial. I want more control.

I refuse to pay one more dime into a dysfunctional, overpriced, abusive, unethical, damaging, and totally broken system for insurance coverage that I stand on my head to avoid at all costs.

Big words but now what?

Ways to opt out of Obamacare

If you procrastinated like I did, then you’re probably scrambling to figure out your options. There are different ways to scrap Obamacare. It’s completely legit but you have to do your homework. I learned that:

Huh? What’s a health care sharing ministry?

It is a cost sharing arrangement for medical expenses among people who hold similar religious beliefs. It is not insurance; no one assumes responsibility for your medical bills. It is exempt from Obamacare. There are four “grandfathered” options. Three are open to practicing Christians and one is for people committed to religious liberty. (Read the comments below for an option that has same sex couples and has members of all faiths, including Jews, Muslims, and Mormons.)

THEY SHARE SOME SIMILARITIES

  • Individuals and families pay a monthly share.
  • Payments are made to members with approved medical bills.
  • Members adhere to certain lifestyle guidelines, including abstention from tobacco and illegal drugs, and sign a statement of faith or belief.
  • Certain expenses may be excluded (i.e., those associated with pre-existing conditions, preventive care, vaccinations, dental, vision, birth control, abortions, STDs, and infertility).

THERE ARE ALSO IMPORTANT DIFFERENCES

  • Monthly share amount
  • Extent of financial risk and maximum amount shared per medical need
  • Central payment or direct sharing to members
  • Use of in-network providers
  • Sharing for alternative treatments
  • Incentive discounts for achieving specific health goals

Why we chose Samaritan Ministries

Samaritan Ministries International is an Illinois-based not-for-profit corporation that started sharing medical needs in 1994. As of November 2014, there are 39,000 participating households with 129,500 members (up 62% in the past year).

We chose Samaritan for several reasons:

First, it’s well run. Here’s their 2012 Form 990. We spoke with current members who rave about it. I couldn’t find any online complaints. When I asked our agent for dirt on Samaritan, he mustered a feeble defense for insurance. He admitted that he’s losing customers to it: “It really works.” I love that Samaritan contracts with The Karis Group to negotiate discounts — typically 40-45% — on our behalf.

Second, it works for my family. We agree with Samaritan’s philosophy of health care and its member requirements, including regular church attendance.

Third, Samaritan’s guidelines offer more control over our health care choices. Its rules are the simplest. Members select their own doctors and hospitals, and can travel out of state for procedures. It includes visits to licensed alternative practitioners, including naturopaths. Alternative treatments and “prescriptions” are subject to an additional approval process except for cancer treatment which can be 100% alternative up to the $250,000 maximum. Samaritan is evaluating the equivalency of alternative medicine in more areas.

Finally, instead of paying Blue Cross, I’d rather be part of a community that sends checks to real people to help lift financial burdens during their time of medical need.

Samaritan is definitely not for everyone, however. Read its FAQs and Guidelines, or call 888-268-4377 #2. Here’s what I wanted to know.

HOW MUCH DOES IT COST?

The monthly share is:

  • $405 for 3+ person families
  • $360 for 2 person families
  • $250 for widowed or divorced parents with children
  • $180 for singles.

Young adults aged 25 and under pay less. There is a one-time $200 membership fee.

HOW DOES IT WORK?

Members identify themselves as self-pay patients when they go to the doctor or hospital. Most providers are cash-friendly and many like avoiding insurance hassles. Sometimes cash-pay prices are lower than insurance rates.

Members are eligible to receive up to $250,000 in medical bills per qualifying event, after paying the first $300. Discounts are applied to the $300 first. Members are not terminated for having too many medical events.

When members submit medical bills, they are added to the prayer list so everyone can begin praying. After verification, Samaritan publishes qualifying needs in the monthly newsletter and then they are assigned. Each member is asked to send the full amount of his monthly share amount to a single member with an approved need, along with notes of encouragement.

WHAT ARE THE TAX CONSEQUENCES?

Checks from members are considered gifts but Samaritan ensures that amounts do not exceed the IRS annual gift exclusion (currently $14,000).

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