The Benefits Academy
  • Home
  • Products
  • WA State Long Term Care
    • The TBA Alternative
    • More LTC Info
    • LTC Calculator
  • Our Story
    • Fan Page
  • Blog
  • Contact
  • Agent Login

Benefits Bites

The end of the individual mandate opens new doors for individuals

10/31/2018

3 Comments

 
Picture
The individual mandate has been a burden for some. But with its demise, non-traditional coverage, such as Cost Sharing and Direct Primary Care Programs, may be viable options for those looking to reduce costs. Here is a look at these two insurance alternatives. 
​As we enter into the open enrollment season for individual medical coverage, this year will be a little different for one primary reason. As of 1/1/2019, individuals will no longer be penalized for going without health coverage. While premiums are not rising substantially this year (for most carriers), we all know individuals who may take the risk and go without insurance. Some clients may choose to go a non-traditional route through a Cost Share plan or a Direct Primary Care provider. While not full coverage by any means, they may be non-insurance alternatives for clients who are not able to afford traditional insurance.

Cost Share Programs
“Cost Share” plans, sometimes referred to as “Health Ministry” or “Health Share” plans, can be almost half of the premium of an individual policy, but of course, there are reasons for this. The coverage is lower, there’s health screening required for entry, and the plans have lifetime limitations (and in some cases annual limitations). 

​Let’s look at one popular program, Altrua HealthShare. They offer 4 plan levels. For a 45 year old, monthly premiums are $296 Gold / $269 Silver / $202 Bronze / $100 Copper. While they give different names to benefits, the “Bronze” plan basically looks like a $1500 deductible plan, then 25% coverage of the next $10,000, then 50% coverage for the next $10,000. Therefore, the “out of pocket maximum” would be $11,500 for covered services. Plus this Bronze plan has a $250,000 annual maximum benefit limitation. One other hurdle to enrollment is that you will need to “agree” that you will live a clean and healthy lifestyle and share the “ethical or religious beliefs” outlined on their website.    

Things to consider about Cost Share Programs
Cost Share Programs can be a viable option, especially if your client is healthy and clean living. If they have a pre-existing condition, they may not be approved for the program, and if they are, they‘ll want to consider whether the program accommodates that condition and/or assesses additional premiums. Also, keep in mind that coverage in one year does not guarantee coverage in subsequent years. These programs are voluntary on both sides and a program can elect to discontinue coverage. Finally, the survival of a specific program is dependent on its financial strength. Clients should do their research to ensure the program is well managed and solvent.

Direct Primary Care Programs
“Direct Primary Care” refers to an agreement between a physician and a patient where the patient pays a monthly fee to be a part of the physician’s practice. The typical monthly fees range from $60 to $150 per month, depending on the age of the patient – each physician sets their own membership fees.  Typical services provided at no charge include office visits, office-based procedures, medical management, writing of prescriptions, coordination of care, and some urgent care. For an additional cost, patients are also able to obtain vaccines and lab testing, or home/facility visits from the physician. 

In the state of Washington, there are over 40 Direct Primary Care physician practices. They must register with the Office of the Insurance Commissioner, which makes it easy for a consumer to find a DPC physician near them.  Here’s the direct link to the OIC’s list, which provides addresses and links to each provider’s practice. 

​Things to consider about Direct Primary Care Programs

Again, if your client is generally healthy, Direct Primary Care will definitely save them money. But, while Cost Sharing Programs may cover medical needs beyond those provided in a primary doctor’s office, a client utilizing a Direct Primary Care Program should consider also enrolling under a catastrophic health plan to cover, say, a cancer diagnosis or severe injury.

Other Programs
If you have clients who are looking to go without insurance this coming year, whether or not they enroll in a Cost Share Program and/or a Direct Primary Care relationship, they may benefit from some of these other programs:
  • 24/7/365 telephone access to a doctor – one program we recommend is AllyHealth/MDLive, which can be purchased on an individual basis
  • Rx Discounts – have your clients check out GoodRx any time they are going to fill a script, so they can find the least expensive place near them
  • Healthcare Benchmarking – even patients without insurance can negotiate with their providers using Healthcare Bluebook - they have about 250 procedures’ costs available, plus a printable “agreement” that can serve as a document in their negotiations.
  • Individual Aflac policies – Aflac provides their Accident, Cancer, Critical Illness, Dental and Life products on an individual basis – if you need a representative, contact Shawna Scott Hayes at trishawna_scotthayes@us.aflac.com (or 253-988-5900).

Agents understand the need for insurance, after all, we see the astronomical cost of cancer treatment, specialty drugs, and even a one-day hospital stay for an appendectomy. I’ll continue to pay my $500+ premium every month because I know all too well how a single medical event could cost so much more than my $6000 premium and $7,000 out of pocket maximum. But as we all know, some people don’t have the luxury of slapping down $500 a month, and it looks less and less appealing the healthier you feel you are.

​At least having some options in your back pocket to provide some “backup” for these clients can help you feel like you have done all you can to cover them as best as they can afford.  Plus you’ll be able to replace a little bit of lost individual commissions. AllyHealth/MDLive and Aflac both have commissions built in, and some Cost Share programs provide commissions (Altrua HealthShare is one of these).
3 Comments
Bob Holland link
11/1/2018 02:12:03 pm

Hope all is well, always good to read what you have, I have not had time to use your tool,especially now with open enrollment. I might ask a question....are Bronze level HSA plans creditable per Medicare Part D rules. I forgot as I do not want some clients on group coverage and keeping parts A & B not get a PDP if their group coverage will cause them to get penalized.

Thanks for the feedback.

Reply
Sandra Wood link
11/11/2018 01:28:50 pm

Hi Bob - Sorry for the delay - just seeing your question! Not all Bronze HSA plans are non-creditable. You need to find out from each carrier which plans are and are not creditable. I have found in the past that some nonHSA plans are even non-creditable! I will shoot out an email to all the carriers and see what they say!

Reply
David Hagen
11/17/2018 07:13:07 am

they are 100% not HSA compatable, they don't qualify as insurance, to even imply that is fraud

Reply



Leave a Reply.

    This section will not be visible in live published website. Below are your current settings:


    Current Number Of Columns are = 1

    Expand Posts Area =

    Gap/Space Between Posts = 10px

    Blog Post Style = card

    Use of custom card colors instead of default colors =

    Blog Post Card Background Color = current color

    Blog Post Card Shadow Color = current color

    Blog Post Card Border Color = current color

    Publish the website and visit your blog page to see the results

    About Sandy

    I love numbers.  I'm a math geek. I read benefits industry articles and periodicals for relaxation (but, honestly, I'm still a fun gal).  I also like to share what I've learned and you'll find it all here.

    View my profile on LinkedIn

    Archives

    September 2022
    July 2022
    December 2021
    November 2021
    March 2021
    February 2021
    January 2021
    December 2020
    November 2020
    October 2020
    September 2020
    August 2020
    July 2020
    June 2020
    May 2020
    April 2020
    March 2020
    February 2020
    January 2020
    December 2019
    November 2019
    October 2019
    September 2019
    August 2019
    July 2019
    June 2019
    May 2019
    April 2019
    March 2019
    February 2019
    January 2019
    December 2018
    November 2018
    October 2018
    September 2018
    August 2018
    July 2018
    June 2018
    May 2018
    April 2018
    March 2018
    February 2018
    January 2018
    November 2017
    October 2017
    September 2017
    August 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    November 2016
    October 2016
    September 2016
    August 2016
    June 2016
    May 2016

    Categories

    All
    2017
    2018
    2019
    2020
    2021
    2022
    2023
    ACA
    ACA Lawsuits
    ACA Reporting
    ADA
    Aetna
    Age-banded Rates
    AHP
    Ambetter
    Association Health Plans
    Associations
    Asuris
    Balanced Billing
    Benefit Bites
    Benefits Coordination
    Biden Administration
    Bridgespan
    Bridge Span
    Busy Season
    Carrier Corner
    Carrier Exit
    Cascade Care
    CMS
    COBRA
    Community Health Plan
    Community Rated Plans
    Compliance Notices
    Continuation
    Conversion
    Coordinated Care
    Coronavirus
    Cost Sharing Programs
    Cost Sharing Reduction
    Data Match
    Dependents
    Direct Primary Care Programs
    Disability Insurance
    Domestic Partners
    EIDL
    Executive Order
    Facility Fees
    Facility Scope Creep
    FAIR Health
    FFCRA
    FSA
    Group Health
    Group Life
    HDHP
    Health Alliance NW
    Healthnet
    Health Savings Account
    Heart Health
    HRA
    HSA
    ICHRA
    Individual
    Individual Coverage Health Reimbursement Arrangement
    Individualized Medicine
    Individual Mandate
    Individual Penalty
    IRS
    Kaiser
    Kaiser NW
    Kaiser WA
    Life Insurance
    Lifewise
    Long Term Care
    Long Term Care Services And Support Trust Act
    Mandate
    Medicaid
    Medicare
    Medicare For All
    Micro Group
    Moda
    Molina
    Monthly Freebies
    Networks
    Nondiscrimination Testing
    Notice Requirements
    Paid Family & Medical Leave
    Pandemic
    Part D
    Partnership
    PCT Updates
    Penalties
    PFML
    Pharmacogenomics
    Plan Comparison Tool
    Portability
    PPO Networks
    PPP
    Premera
    Prescription Assistance Programs
    Pre-Tax Premiums
    Providence
    PTO
    Public Option
    QSEHRA
    Rates
    Referenced Based Pricing
    Regence
    Regence OR
    Reinsurance
    Renewals
    Repeal
    Risk Adjustment
    Risk Corridor
    Rx Copay Accumulator Programs
    S-Corp
    Section 105(h)
    Section 125
    Section 79
    Self Funded
    Self-funded
    Short Term Medical Plans
    Single Payer
    Small Employer Health Credit
    Small Group
    Social Distancing
    Stimulus
    Subsidies
    Tax Credits
    Trump
    Trust Plans
    Uninsured
    United Hea
    United Healthcare
    Vetted Vendor
    WA Cares
    WA LTC
    WA OIC
    Washington State
    Wellness Program

    RSS Feed

Services

Products
Resources

Company

Our Story
Blog
​Fans

Support

Contact
​Agent Login
© COPYRIGHT 2020. ALL RIGHTS RESERVED.
  • Home
  • Products
  • WA State Long Term Care
    • The TBA Alternative
    • More LTC Info
    • LTC Calculator
  • Our Story
    • Fan Page
  • Blog
  • Contact
  • Agent Login