With ACA uncertainty, consider these health insurance alternatives
Options that could shield you from disruption
The uncertain repeal of the Affordable Care Act makes it hard for consumers to plan ahead for their health insurance needs. But in Tennessee, some consumers can take advantage of nontraditional coverage options. These ACA alternatives include MediShare, underwritten health plans and direct primary care.
These types of plans allow consumers to access healthcare outside of ACA insurance, which could insulate consumers from disruption if the law is repealed.
However, it is important to note that none of these options are considered “qualified coverage” under the ACA. This means that as long as the law is still in place, consumers who only have these types of plans are liable for the tax penalty for lacking qualified coverage.
But in the event that the ACA and the tax penalty is repealed, these options could provide even more value for eligible Tennessee consumers.
Let’s look at each option and what type of consumer might benefit from them.
Medi-Share is a healthcare sharing ministry. It isn’t insurance, but it allows members to “share” medical bills. Medi-Share members are not required to pay the individual mandate tax penalty, so this can be a good option regardless of what happens with the ACA.
Eligible members pay premiums based on age, and there is a deductible-like threshold that must be met before member’s bills are shared. Payments are then used to match other members’ bills.
Because Medi-Share isn’t insurance, services aren’t “covered” in the traditional sense. Certain types of bills are eligible for sharing, but bills for many common types of services, like routine, preventive, and mental healthcare are not.
Medi-Share is a Christian organization, so there are faith and lifestyle requirements, but eligible consumers can substantially avoid federal policy changes through this type of program.
In Tennessee, eligible consumers can sign up for underwritten health insurance through Farm Bureau Health Plans. This is the type of individual coverage that was available before the ACA. Underwriting means insurers can use an enrollee’s health status to determine premiums or deny coverage altogether.
The ACA prohibited this practice, but Farm Bureau is technically considered a rural health organization in Tennessee, and still offers these “traditional” plans.
These plans are much cheaper than ACA insurance, which has attracted healthier consumers. Currently, those with non-ACA-compliant insurance do owe the ACA tax penalty, but if the individual mandate is repealed, this type of coverage will become an even better deal for eligible consumers.
Direct primary care
Direct primary care is not insurance, but rather, a different way to pay for basic healthcare services. Instead of using your health insurance to access primary care, patients contract directly with their doctor.
Through direct primary care, the physician provides all primary care services at a flat monthly rate. All basic care, from check-ups to vaccines, physicals and flu shots, are covered. Think of it like a healthcare subscription.
Of the three insurance alternatives, direct primary care covers the least. This arrangement will not cover bills for services outside of primary care like hospitalizations or surgery, so consumers should think carefully about using this as an alternative to insurance.
It can, however, be a smart add-on to health plans with a lot of cost-sharing. In some cases, paying out-of-pocket for primary care is more efficient than pushing claims through your insurance.
In general, these healthcare and coverage options are not as robust as the type of coverage required under the Affordable Care Act. But for eligible consumers worried about losing their ACA plan at the end of the year, one of these options could be an alternative.
This article was originally published in The Tennessean. If you enjoyed this post, you may like "The American Health Care Act's winners and losers in Tennessee."
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