Co-pays, deductibles, max out of pocket, escalating premium, HMO, POS, PPO. What does all that mean to my family and me with our health insurance?
Unfortunately, as we head into 2018, our choices for traditional health insurance plans and carriers have again been drastically reduced. For those of us who are not covered by an employer or a spouse’s employer plan, we have two choices: Purchase a Kaiser or Ambetter policy through the health care exchange, or join a health care cost-sharing organization (called a health care sharing ministry).
Kaiser and Ambetter are offering only their HMO plans. An HMO (health maintenance organization) is a closed system in which individuals and families voluntarily enroll to be treated by member physicians, typically including specialists.
If you enroll in an HMO, you will most probably not be able to keep your current doctor. Even if you’ve been seeing your current provider for 20 years, an HMO will require you to use its physicians.
Kaiser physicians are excellent doctors, and some people may not be deterred by changing their current physicians. History shows that patients with chronic conditions (diabetes, respiratory ailments, arthritis, etc.) typically search for a compatible physician for years. They would rather pay higher premiums to stay with their current providers.
In the past, Ambetter has been an administrator for the Georgia Medicaid program, also called the Peach State Health Plan. Ambetter has not experienced an easy ride into the health care marketplace. A simple Google search yields harsh reviews, some of which are downright disturbing and all of which are convincing.
That said, WellStar recently announced that it will accept Ambetter in 2018, which will bode well for some of us. With Ambetter, the premiums are moderately high, the deductibles can be a bit high, and the max out of pocket also can run high. Many families don’t feel they are getting the appropriate value for their substantial premiums.
Many are still under the illusion that if you have the money, you can simply buy private health insurance. This is simply no longer the case, as no matter your income or ability to pay, you still have the same three choices if you’re not covered by an employer (Kaiser, Ambetter or a health care sharing organization).
If you are self-employed or a small-business owner, you have the same three choices. Social status is no longer a factor in determining what type of health insurance you receive.
There is a needle in the haystack, as a business owner can create a group plan, so long as there are at least two employees who are unrelated, one of whom must be a W-2 employee working a minimum of 30 hours a week.
Creating a group plan can be tedious, so make sure you work with a professional agent specializing in group health plans. A group plan will be eligible for coverage by many of the more familiar companies, such as Blue Cross Blue Shield, Humana, and United.
The health care cost-sharing organization, also called a health care sharing ministry, has risen to the top of the viable, affordable options. There are a number of health care sharing ministries with various member requirements. Some exclude pre-existing conditions or prohibit certain prospective members.
Just a few health care sharing ministries have endeavored to cover our families’ health insurance needs while providing an affordable option to traditional insurance. Clients regularly find most, if not all, of their doctors on their new plan. Even better, the health care sharing ministry includes a nationwide PPO network, giving families the flexibility to cover kids living in other cities.
Not all health care sharing ministries are created equal, so make sure you do your homework and work with an experienced health insurance agent.
I often ponder why the Jewish community has not formed a health care sharing ministry of our own. With that, I am wishing all of you the best of health!