Health Insurance Alternative

NedRN · Jul 9, 2014

Interesting, but be highly skeptical. Obviously, if you are paying only a quarter or less of free market plans, there are going to be downsides. For example, I don't see anything about contracted prices (in-network if you will). With my traditional private insurance (costing around $200 a month with a 5K deductible), I get billed $1,000 for routine labs. The contracted price is around $60 which is what I actually pay. If these "sharing" plans have a $1,000 deductible and no contracted prices, one routine lab (perhaps titers for your next assignment) will have you paying $1,000 out of pocket. Who the heck knows what the "sharing" percentage is after the deductible.

While the details are even harder to discern than traditional insurance, there will be strings attached without a doubt. Just the blurb on catastrophe coverage with help on bills over 135K makes me wonder how much you pay before that.

If saving money (at the risk of major healthcare issues) is your thing, you can save even more by not being insured at all. The penalty for not having health insurance is trivial.

trackhead, APRN · Jul 9, 2014

Not to mention that PPACA Sect 9007 has changed the tax laws to include IRC®(4) and IRC®(5) that state a hospital can not bill more than "amounts generally billed" to third party payers, and can not charge "gross charges" or "chargemaster" rates. In addition, Sect 9007 also requires non-profit hospitals to adopt a financial assistance policy which almost always excludes the insured, but is typically written for the uninsured. The uninsured are who IRC®(4) and IRC®(5) is basically written for.

So go ahead and get health insurance and pay massive premiums, massive copays, massive coinsurance, and "gross charges" for an ER visit. Or..........skip the health insurance, pay cash for routine visits, and learn the tax laws and argue/negotiate in the event you end up in an ER.

HikingNinja, BSN, MSN, DNP, RN, APRN, NP · Jul 9, 2014

Interesting, but be highly skeptical. Obviously, if you are paying only a quarter or less of free market plans, there are going to be downsides. For example, I don't see anything about contracted prices (in-network if you will). With my traditional private insurance (costing around $200 a month with a 5K deductible), I get billed $1,000 for routine labs. The contracted price is around $60 which is what I actually pay. If these "sharing" plans have a $1,000 deductible and no contracted prices, one routine lab (perhaps titers for your next assignment) will have you paying $1,000 out of pocket. Who the heck knows what the "sharing" percentage is after the deductible.
While the details are even harder to discern than traditional insurance, there will be strings attached without a doubt. Just the blurb on catastrophe coverage with help on bills over 135K makes me wonder how much you pay before that.
If saving money (at the risk of major healthcare issues) is your thing, you can save even more by not being insured at all. The penalty for not having health insurance is trivial.

I understand your concerns. The health coop we picked has no in network or out of network. You are basically a self pay pt. As you may know, healthcare costs can be negotiated. So, let's say I need to go to the ER for a broken leg. After the xray, cast, nursing care etc the hospital wants to bill be $9000. I tell them I am a self pay pt but that I am a member of a healthcare coop and I want to negotiate my bill. At that point I can either negotiate it myself or have my health care coop negotiate the bill for me. The hospital knocks off $2000 from my bill making my total $7000. Because the cost has been negotiated down $2000 I am not required to pay my $1000 deductible. If the hospital refuses to negotiate (this never happens) then I am only responsible for my $1000. I pay the bill, or ask for payment arrangements with the hospital. And send the bill into my coop. It can take up to 90 days for reimbursement. In cases of surgery or large medical bills requiring some portion of funds upfront, the coop will cover the % upfront minus the deductible.

Now for routine things of course you may end up just paying out of pocket. The coop will also help you negotiate these prices if you want. Each illness has a $125,000 cap or you can get additional coverage up to 1 million. So if I have let's say a broken foot, gallbladder removed, then a heart attack (EEEKKK!!!) all in the same year, each incident is treated as a separate illness, each needing to pay the $1000 deductible, each with a $125,000 cap. Of course the deductible I would owe could change if I was able to negotiate the price of treatment lower.

The coop that we signed up with was very easy to understand and transparent in what they considered covered, not covered, etc. Not quite sure which one you might have looked at.

I would recommend anyone interested in this to do their research. I'm just trying to spread the word. I had trusted accountant steer me towards this option and I am so happy they did.

For those who are uncomfortable with nontraditional health coverage, I also found out that 22 states have health insurance coops. These are nonprofit health insurance groups that have rates significantly lower than private or ACA website for profit health insurance companies. They are not located in all states though. You would have to google "health insurance coop and wisconsin" for example to see if your state has one.

If I can explain anything else about this let me know.

D

SummitRN, BSN, RN · Jul 9, 2014

125k limit is a good way to have to file for bankruptcy. That's idiocy. A big surgery, bad car wreck, long icu stay, or cancer treatment will exceed that and wipe you out financially.

trackhead, APRN · Jul 10, 2014

Except when you are "uninsured" and have a low taxable gross income as a travel nurse, you will qualify for almost any facilities financial assistance plan.

NedRN · Jul 10, 2014

Passing for indigent is a huge risk, especially if you have any hopes of being credit worthy. Generally hospitals will put you up for collection before negotiating. Most travel nurses will still have 1040s with 40K of taxable income, and just being a nurse means you have better future income than most hospital financial assistance cases so it seems an uphill road to me.

Let's just take a look at the real risks here of going insurance free or going for bad insurance (effectively what the OP is suggesting). A needle stick and contracting Hepatitis C is a real, not remote, possibility for a nurse. Your liver fails and you need a transplant, guess who is not getting it! Sure, if your agency has workers comp and you can prove transmission at work, you may be able to do it.

Same deal with HIV (although transmission there is much less likely). Where is that 10K a year for drugs going to come from?

Do you smoke? Who is going to pay for that lung resection and chemo?

lub dub · Jul 10, 2014

...skip the health insurance, pay cash for routine visits, and learn the tax laws and argue/negotiate in the event you end up in an ER.

Being involved in a serious car accident, having an MI or other other catastrophic illness, and you will be wiped out financially.

trackhead, APRN · Jul 11, 2014

Life's a gamble, and I'm playing the suckah game like everyone else, paying for health insurance. Just a little annoyed at the moment with the words "Affordable Care Act", as it is anything but affordable.

NedRN · Jul 11, 2014

Affordable is certainly in the eye of the beholder. Republican legislators certainly don't believe it is affordable, no matter how much it is actually saving in our Federal deficit. But the truth is that from a value perspective, it has made a huge difference for the vast majority of people purchasing health insurance privately (not through an employer). No lifetime limits, no denial or change of premium for pre-existing conditions (previously completely unaffordable for those people), basic annual visits free (including colonoscopies appropriately), gyn health, and the list goes on. Care for dependent children to age 27. Insurance company payout mandated at I think 85 percent. Basically there was no insurance at any price meeting those criteria before the ACA.

Yes, for people in our income bracket pay a healthy price for ACA policies, but they are indeed much better than the crap private policies we used to get. Part of the perception issue is the unsubsidized prices that only a few people pay (like us but honestly, we are in the upper 10 percent of all wage earners), and the fact that these new policies are so much better than the old ones - and a better value.

Perhaps an analogy would be buying a cheap car brand that you have to up the cost by 50% with options to get something sort of decent, versus a better brand of say imported car that comes in higher trim levels and needs no added options at a lower final cost. Which is the better value, the stripper that needs lots of maintenance and gives you a headache from the increased road noise, or the better brand that keeps you healthy on your trip?

trackhead, APRN · Jul 12, 2014

Senator Grassley ® from Iowa was a big player in the preamble to the PPACA as it relates to actual charitable care "non-profit" hospitals were actually providing.