Health insurance options for the self employed

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Brad W

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To those of you who are self-employed without group health insurance, what do you do for medical coverage?

I'm 58 and have group coverage for my family through my work
but I'm itchin' to "retire".
My wife is just a few years younger, and runs her own small business...no group insurance there
She wants to keep working a few more years...enjoys it, it's rewarding, and pays well.
Truthfully I'd probably end up piddling with her visit as an office facilities manager and general part time handyman. She's got several locations and I'd imagine it would be very helpful for me to drop by each location every few weeks for a few odd jobs

Anyway
We have three kids ranging from middle school to college sophomore. My middle schooler has 4-1/2 more years, then presumably college...so I reckon I'll need to cover her for about 9 more years or so....

We're both old enough to have some issues, but nothing too major. Some imaging now and then and she needs a few prescriptions.
Mostly it's just routine wellness visits and we've had a couple falls over the years which prompted ER visits (daughter broken arm, etc...)

My dental covers some but I don't see that as a huge issue to self-pay. Mostly dental insurance covers the cleaning and exam... no big deal

I've not run the numbers, but honestly except for a few outlier years I'd imagine it wouldn't be too much of a burden to cash pay.... I'll bet that often cash rates are less anyway than the silly insurance game.

So I was thinking it's primarily energy catastrophic coverage that I really need...although I'd like a little better than that for peace of mind

I suppose I could quit and do cobra for a while, but as I recall that's expensive
I've been wondering about these things such as medishare?
otherwise, what is there...Obamacare?
 
This depends on your state. Some clinics in liberal states will find insurance coverage for you, or put you on a sliding payment scale, very reasonable prices and coverages provided you are on top of everything, and referrals to providers for specialist items. Sometimes coverage is based upon your income so if you are retired then you might literally pay zero or just a few bucks for each visit. Medications are also discounted at practically insurance rates or better. I would look for that and see if that works for you. Get full blood work ups and all the good testings (colonscope) and vaccines. If you are healthy then you can probably get by on that for another 10 years or longer. It’s a risk though that you have to evaluate for your situation.
 
We're in the same boat. I've bought my own health insurance for over 25 years. catastrophic coverage was perfect for us and relatively inexpensive. Obamacare came along and I was grandfathered. Then after a couple years I got a letter informing they were no longer offering my policy. When that happened, the best comparable policy I could find was 500% increase in premium and for less coverage.

After going through a series of different types of coverage, we now have an expensive policy that we don't use. I say that because we have a high deductible and health providers offer discounts for cash, so we just pay cash. Health insurance in America is really a sad state of affairs.

When looking for coverage, make sure you're covered outside your home State. Perhaps consider a health sharing ministry.
 
Brad W said:
To those of you who are self-employed without group health insurance, what do you do for medical coverage?

I'm 58 and have group coverage for my family through my work
but I'm itchin' to "retire".
My wife is just a few years younger, and runs her own small business...no group insurance there
She wants to keep working a few more years...enjoys it, it's rewarding, and pays well.
Truthfully I'd probably end up piddling with her visit as an office facilities manager and general part time handyman. She's got several locations and I'd imagine it would be very helpful for me to drop by each location every few weeks for a few odd jobs

Anyway
We have three kids ranging from middle school to college sophomore. My middle schooler has 4-1/2 more years, then presumably college...so I reckon I'll need to cover her for about 9 more years or so....

We're both old enough to have some issues, but nothing too major. Some imaging now and then and she needs a few prescriptions.
Mostly it's just routine wellness visits and we've had a couple falls over the years which prompted ER visits (daughter broken arm, etc...)

My dental covers some but I don't see that as a huge issue to self-pay. Mostly dental insurance covers the cleaning and exam... no big deal

I've not run the numbers, but honestly except for a few outlier years I'd imagine it wouldn't be too much of a burden to cash pay.... I'll bet that often cash rates are less anyway than the silly insurance game.

So I was thinking it's primarily energy catastrophic coverage that I really need...although I'd like a little better than that for peace of mind

I suppose I could quit and do cobra for a while, but as I recall that's expensive
I've been wondering about these things such as medishare?
otherwise, what is there...Obamacare?
Click to expand...
We've been members of Samaritan Ministries for ...7 years, maybe 8. We've been very pleased with our experience. It's kind of a pain when you actually have an expense because you get a bunch of $300 checks and you have to make sure everyone on the list sent their share. They do require that you are Christian and attend church regularly. I was a bit annoyed to find out that they don't count Mormons as Christian when a LDS friend of mine applied. They also have some requirements like not drinking to excess or smoking. We don't have any chronic issues, so it's been great. Not a fit for everyone though.

We have a "concierge" primary care doctor who takes care of a lot of small procedures in office. A service like that works very well in concert with a healthshare that covers only the big stuff.

We did Obamacare for the first couple years after it came out, but it was closing in on $2K/month even with a modest subsidy. Samaritans winds up being around $400 for all seven of us. We have the "basic" plan and "save to share" which covers amounts above the limits of basic.
 
In which state do you live? I am self- employed, and until this year when I became eligible for Medicare I got coverage for my wife and myself here in Maryland from Kaiser-Permanente via our state ACA exchange. Worked out great for us.
 
Brad W said:
what is there...Obamacare?
Click to expand...
As mentioned, some states have other options but when I retired 10 years ago the ACA was my only real option. HOWEVER, whether you can qualify for any of the subsidies depends on your household income. If you can mix income streams between taxable and cash, you can get a decent rate. The sign-up period for ACA is going on now until Dec 15th. Perhaps go to the Marketplace website an see what your ACA options. You don't need to sign up but you can play with various incomes to see where you stand. Regardless, without the subsidies or work-insurance the premiums can be brutal for some especially if all their income is taxable.
 
Yeah… I retired a little early this year. Was surprised that I was still able to get coverage through healthcare.gov at about half the cost of COBRA. Good thing o did that, too… I quit working 7/1 and my darling bride decided a little over a month later was a good time to have a stroke. Hit her deductible and the out of pocket limit before 3 in the afternoon.
 
Doesn’t cost you anything to go to the healthcare.gov website and see what’s out there and what it costs, including any tax reimbursement depending on income. I am a year younger and retired in June. Cobra was $36k/yr. Obamacare ranged from $12-18k. We did one of the middle programs and got about half knocked off for lower income this year.
 
Jim K said:
We've been members of Samaritan Ministries for ...7 years, maybe 8. We've been very pleased with our experience. It's kind of a pain when you actually have an expense because you get a bunch of $300 checks and you have to make sure everyone on the list sent their share. They do require that you are Christian and attend church regularly. I was a bit annoyed to find out that they don't count Mormons as Christian when a LDS friend of mine applied. They also have some requirements like not drinking to excess or smoking. We don't have any chronic issues, so it's been great. Not a fit for everyone though.

We have a "concierge" primary care doctor who takes care of a lot of small procedures in office. A service like that works very well in concert with a healthshare that covers only the big stuff.

We did Obamacare for the first couple years after it came out, but it was closing in on $2K/month even with a modest subsidy. Samaritans winds up being around $400 for all seven of us. We have the "basic" plan and "save to share" which covers amounts above the limits of basic.
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We’ve been with Samaritan about that same amount of time. My employer’s health insurance started changing the rules and making stuff up (we actually had to have a doctor provide proof that he wasn’t in network,) so we switched to Samaritan. The only real injury we’ve had was when my wife broke her finger when the dog bolted after something while on the leash. (Just now getting her wedding ring repaired/resized.) besides the multitude of small checks coming in, we did have to carry a balance on the credit card for a couple of months, since technically getting the surgery to fix her finger properly was “elective.”

It’s also probably worth noting that they won’t cover preexisting conditions.
 
DaleB said:
Yeah… I retired a little early this year. Was surprised that I was still able to get coverage through healthcare.gov at about half the cost of COBRA. Good thing o did that, too… I quit working 7/1 and my darling bride decided a little over a month later was a good time to have a stroke. Hit her deductible and the out of pocket limit before 3 in the afternoon.
Click to expand...

The values driving Cobra premiums is your the age of the workforce, the claim history and the quality of the insurance. At age 64 when wife retired her Cobra plan was a no brainer. It was less expensive and much lower cost than the exchange.

Also keep in mind the rates on the exchange are subsided by uncle sugar on you are around age 60.
 
For my wife and I, I pay between $1,300 and $1,500 a month for Bronze coverage with a good sized deductible. This has been a pretty consistent payment for us for the last 10 years or so. The only thing that changes is we keep going for the higher cost deductible to keep the payment in that range. A lot of people are writing about Cobra payments, those are part of group coverage and generally cheaper than individual premiums.
 
Jim K said:
We've been members of Samaritan Ministries for ...7 years, maybe 8. We've been very pleased with our experience. It's kind of a pain when you actually have an expense because you get a bunch of $300 checks and you have to make sure everyone on the list sent their share. They do require that you are Christian and attend church regularly. I was a bit annoyed to find out that they don't count Mormons as Christian when a LDS friend of mine applied. They also have some requirements like not drinking to excess or smoking. We don't have any chronic issues, so it's been great. Not a fit for everyone though.

We have a "concierge" primary care doctor who takes care of a lot of small procedures in office. A service like that works very well in concert with a healthshare that covers only the big stuff.

We did Obamacare for the first couple years after it came out, but it was closing in on $2K/month even with a modest subsidy. Samaritans winds up being around $400 for all seven of us. We have the "basic" plan and "save to share" which covers amounts above the limits of basic.
Click to expand...

I am interested in that but I'm also nervous about it being a (to me) unknown organization and if they'll be reliable if/when some catastrophic six figure medical event happens.

Right now the cheapest ACA market plan we can get makes airplane ownership look cheap. I really just want catastrophic coverage to avert the risk of some six or seven figure medical event wiping us out. As it is I don't think we'd spend as much out of pocket in a year as we do on a month's premiums now.
 
Clip4 said:
The values driving Cobra premiums is your the age of the workforce, the claim history and the quality of the insurance. At age 64 when wife retired her Cobra plan was a no brainer. It was less expensive and much lower cost than the exchange.

Also keep in mind the rates on the exchange are subsided by uncle sugar on you are around age 60.
Click to expand...
To be clear… the full prices of the exchange plans are close to the cost of COBRA, though for much crappier coverage. It’s about half that for us after the tax credits are applied.

If you retire before you can go on Medicare, one of the options is to manage your income to ease the insurance premium burden with tax credits.

How to manage income, premiums, coverage, and so on very much depends on your particular situation.
 
cowman said:
I am interested in that but I'm also nervous about it being a (to me) unknown organization and if they'll be reliable if/when some catastrophic six figure medical event happens.

Right now the cheapest ACA market plan we can get makes airplane ownership look cheap. I really just want catastrophic coverage to avert the risk of some six or seven figure medical event wiping us out. As it is I don't think we'd spend as much out of pocket in a year as we do on a month's premiums now.
Click to expand...
I think we've had this conversation in the past, but I'll say that Samaritan's has been around for 30 years. A couple new ones sprung up when obamacare was passed, and I know at least one has folded. The "ministry" doesn't touch the money; they facilitate peer to peer sharing. The risk is that you have a big expense and there's not enough people in the program to share it, but I think you'd be able to see that coming insofar as you'd see the membership dropping off long before it got to that point. It seems as though the program is pretty vibrant as of now. As of last month they have a little over 79,000 members and shared $33MM of claims.

One thing that has been interesting to me is how much of a discount healthcare providers give when you don't have insurance. 50-70% off the inital bill is routine. Samaritan's also has a service that finds lower cost providers. Teresa had her gallbladder out last year. The local provider/hospital quote was $20,000. They found a surgeon in Effingham who did it for $8k, mainly because she used a surgery center instead of the big hospital (which is across the street, coincidently). The third party actually coordinated everything, paid the bill, and Samaritan's directed the shares to them, so I didn't have to deal with it. It really worked out great.

BTW, if anybody wants to join, LMK so I can get the $100 credit... ;)
 
I'm trying to figure all this out now, too, as I plan to retire sometime next year. I'm 65 so I'm eligible for Medicare but my wife is 1½ years younger. I can get COBRA for her from my current employer for $1400/month (a plan which pretty much covers everything), or it looks like $800-1000 for an obamacare plan. Most of our retirement income will be taxable and I'll probably do some consulting so we probably won't get too much savings from an income based plan.
 
Long rant warning:
I will be the outlier here and say a radical thing (and I was actually a licensed health insurance agent for about six months about twenty years ago, quit it because of how discussed I was with the buisness ethics of the system). I’m only speaking hypothetically and am offering no advise, only personal opinion that may very well be wrong in many circumstances. That said last time I looked into private coverage expenses for not very good coverage it was something like $20,000 per year. Aside from a few broken bones I have not been to a doctor since 1995 (sport pilot). No check up, no physical, nada. But I eat very well on only simple foods, eat what I have cravings for, and only eat when I’m hungry and only till I’m satisfied, not full, and feel health. I have watched year after year the people I know whom are my age go in for a check up and year after year they have something new “wrong” with them and another pill, or diet restriction and their health dimish year after year to the point that I cannot believe they are my piers in age. I honestly believe treating the symptoms with medication while not addressing the root cause of the bodies imbalance (again in my opinion nutritional) atrophies the bodies abilities to properly regulate it’s function and creates a self feed back loop. That said:
Establish a trust for all your main financial assets to go to your heirs to separate your own financial assets to protect them and keep yourself as executor, take what you would be paying on monthly premiums and deposit them as short term COD’s, and keep rolling them over to cover anything short of catastrophic illness, and rationalize that most catastrophic expense medical expenses are just buying a bit of time at the expense of standard of living for that time and really often not the best option if you are at peace with your life.

My mother worked in hospice for over twenty years, she had a lump, then double mastectomy when it tested positive for cancer, a very brief round of chemo, then remission for ten year, she started to feel unwell again went in got tested and lit up like Christmas tree when they did a full body mri, entire lymphatic system was cancer, the doctors pressed her so bad about treatment that she brought all my siblings and myself to the doctors office with her to have a “discussion” with the doctor, when he showed the images of the scans and tried to talk us into filing an incompetence suit against her to force her to take treatment she let off on him, she had seen it every day for twenty years, she knew it was terminal, and she knew the side effects and standard of life of the “treatment” and told him to go to *#^%, she would not morgage/sell all she owned to buy another year the whole time being sick and feeling like crap, she left the office, called her sister who was retired, and went on a 9 month road trip seeing everything she ever wanted to see, spent the last few months spending time with family (in good health) then one day felt bad, went to the hospital and passed the following morning. It was years latter my oldest sister found a note hidden a book my mother had given her and told her to read during that last weeks that she said how grateful she was that we allowed her to go out “her way”.
 
I was very fortunate that my wife was able to early retire from the federal government and we got access to the federal health plans in her "retirement" and my self employment. It cost us money, but we had access.
 
DaleB said:
To be clear… the full prices of the exchange plans are close to the cost of COBRA, though for much crappier coverage. It’s about half that for us after the tax credits are applied.

If you retire before you can go on Medicare, one of the options is to manage your income to ease the insurance premium burden with tax credits.

How to manage income, premiums, coverage, and so on very much depends on your particular situation.
Click to expand...
Employer plans must at least meet the requirements of a bronze plan on the exchange. Some employers plans may be better, today many aren’t.

Each employer premium can vary significantly. The premiums n employer plans are rated by claims, age and health of that employers work force. If you worked for a company with 500 employees and 2 employees who died of cancer, the premiums can be off the hook for cobra.

In 2021 my wife retired and went on cobra. For a far superior plan the premium was 25% less.

Another savings one needs to determine is when their employer coverage ends. In some companies, your insurance will continue until the last day of the month of the separation.
 
I retired at 60 so I’ve been playing the Obamacare game for a while. Pre-retirement I had been looking into individual insurance plans but those were made illegal. So other than finding a collective of some sort the exchange was my other option. We had enough after tax savings we could draw on that and we were able to keep our taxable income down low enough to get a higher subsidy. We ended up with, what I felt was, a reasonable premium but it was for a plan with a very high deductible. Each year the deductible and max out of pocket goes up. This year (for 2025) the premium nearly tripled. I don’t know why, except maybe we hit a magic age. We’ll be transitioning into Medicare starting next year. My experience with these plans is I’ve not really gotten any benefits other than the negotiated discount on covered services. The remainder has never been close to our deductible.
 
Gosh what a scam, the better question is, how many airplanes can you maintain with your medical insurance costs. Sounds like 2-3 airplanes per year is pretty normal, and that’s pretty disgusting.
 
Flatiowa said:
Establish a trust for all your main financial assets to go to your heirs to separate your own financial assets to protect them and keep yourself as executor, take what you would be paying on monthly premiums and deposit them as short term COD’s, and keep rolling them over to cover anything short of catastrophic illness, and rationalize that most catastrophic expense medical expenses are just buying a bit of time at the expense of standard of living for that time and really often not the best option if you are at peace with your life.
Click to expand...
My wife had a pretty severe stroke at (barely) 63, a month after I retired. It was one that would have left her an invalid for the rest of her life. I was pretty happy that we had good enough insurance that her neurosurgeon was able to get her back to normal without costing us somewhere north of $80K. The bills from my MI a dozen or so years back would have exceeded a quarter mil. That's an awful lot of CDs. My daughter developed breast cancer before she hit 40; I'm pretty sure she wouldn't have had enough saved from medical insurance premiums to pay for that out of pocket, and I'm pretty sure nobody wanted her to just die from it either.

If you hit the genetic lottery jackpot and were wise enough to maintain what we now think is a healthy lifestyle from your teens or 20s on, or if you're lucky, or if you're old enough that you figure you can die happy at any time, great - that's a viable approach. Just hope that whatever you can't afford to pay to have fixed kills you fairly quickly, and doesn't land you in nursing care for a couple decades. I'm not afraid of a heart attack or disease that kills me, I'm afraid of the one that doesn't.

Clip4 said:
Employer plans must at least meet the requirements of a bronze plan on the exchange. Some employers plans may be better, today many aren’t.

Each employer premium can vary significantly. The premiums n employer plans are rated by claims, age and health of that employers work force. If you worked for a company with 500 employees and 2 employees who died of cancer, the premiums can be off the hook for cobra.

In 2021 my wife retired and went on cobra. For a far superior plan the premium was 25% less.

Another savings one needs to determine is when their employer coverage ends. In some companies, your insurance will continue until the last day of the month of the separation.
Click to expand...
My last employer was a company with maybe 100 or so people in the US scattered across several states. The premium I was quoted for COBRA when I left was very close to what I was quoted when I left Wells Fargo, a company with around 300K employees at that time. In both cases we had silver plans. The exchange price for a bronze plan was close to that before tax credits -- just with a much, much higher deductible and no meaningful dental or vision coverage.

Matthew said:
I retired at 60 so I’ve been playing the Obamacare game for a while. Pre-retirement I had been looking into individual insurance plans but those were made illegal. So other than finding a collective of some sort the exchange was my other option. We had enough after tax savings we could draw on that and we were able to keep our taxable income down low enough to get a higher subsidy. We ended up with, what I felt was, a reasonable premium but it was for a plan with a very high deductible. Each year the deductible and max out of pocket goes up. This year (for 2025) the premium nearly tripled. I don’t know why, except maybe we hit a magic age. We’ll be transitioning into Medicare starting next year. My experience with these plans is I’ve not really gotten any benefits other than the negotiated discount on covered services. The remainder has never been close to our deductible.
Click to expand...
I had considered going without for the fairly brief period between my retirement (me at 63, her at 62) and Medicare. Given the fact that she'd had an aneurysm fixed a year ago, I figured that would have been a really bad idea. Turns out I was right.

I thought about how nice it would be if I could just buy a plan that would pay for only major disasters, and I'd cover all of our routine and minor stuff. Catastrophic coverage. Well, that's essentially what you get from the exchange, it's just pretty pricey. Without tax credits COBRA would have been a better choice for us -- a slightly higher premium, but for much better coverage. We had enough savings and I'd managed our HSA so that I was able to keep our MAGI low enough to get the cost of the exchange plan down to less than half. And yes, I know you can't use your HSA to pay insurance premiums... but I'd been maxing out HSA contributions for years, paying everything out of pocket, and keeping the receipts so we can now start pulling money out with no taxes, and it doesn't go towards our AGI/MAGI.
 
cowman said:
I am interested in that but I'm also nervous about it being a (to me) unknown organization and if they'll be reliable if/when some catastrophic six figure medical event happens.

Right now the cheapest ACA market plan we can get makes airplane ownership look cheap. I really just want catastrophic coverage to avert the risk of some six or seven figure medical event wiping us out. As it is I don't think we'd spend as much out of pocket in a year as we do on a month's premiums now.
Click to expand...
That's kind of where I am. The concern is mostly a car accident or some treatable major disease. We have enough saved so that most of our past stuff could have been covered but there have been a few ER visits that would have hurt a bit...and you never know when something else might hit.
Flatiowa said:
Long rant warning:
I will be the outlier here and say a radical thing (and I was actually a licensed health insurance agent for about six months about twenty years ago, quit it because of how discussed I was with the buisness ethics of the system). I’m only speaking hypothetically and am offering no advise, only personal opinion that may very well be wrong in many circumstances. That said last time I looked into private coverage expenses for not very good coverage it was something like $20,000 per year. Aside from a few broken bones I have not been to a doctor since 1995 (sport pilot). No check up, no physical, nada. But I eat very well on only simple foods, eat what I have cravings for, and only eat when I’m hungry and only till I’m satisfied, not full, and feel health. I have watched year after year the people I know whom are my age go in for a check up and year after year they have something new “wrong” with them and another pill, or diet restriction and their health dimish year after year to the point that I cannot believe they are my piers in age. I honestly believe treating the symptoms with medication while not addressing the root cause of the bodies imbalance (again in my opinion nutritional) atrophies the bodies abilities to properly regulate it’s function and creates a self feed back loop. That said:
Establish a trust for all your main financial assets to go to your heirs to separate your own financial assets to protect them and keep yourself as executor, take what you would be paying on monthly premiums and deposit them as short term COD’s, and keep rolling them over to cover anything short of catastrophic illness, and rationalize that most catastrophic expense medical expenses are just buying a bit of time at the expense of standard of living for that time and really often not the best option if you are at peace with your life.

My mother worked in hospice for over twenty years, she had a lump, then double mastectomy when it tested positive for cancer, a very brief round of chemo, then remission for ten year, she started to feel unwell again went in got tested and lit up like Christmas tree when they did a full body mri, entire lymphatic system was cancer, the doctors pressed her so bad about treatment that she brought all my siblings and myself to the doctors office with her to have a “discussion” with the doctor, when he showed the images of the scans and tried to talk us into filing an incompetence suit against her to force her to take treatment she let off on him, she had seen it every day for twenty years, she knew it was terminal, and she knew the side effects and standard of life of the “treatment” and told him to go to *#^%, she would not morgage/sell all she owned to buy another year the whole time being sick and feeling like crap, she left the office, called her sister who was retired, and went on a 9 month road trip seeing everything she ever wanted to see, spent the last few months spending time with family (in good health) then one day felt bad, went to the hospital and passed the following morning. It was years latter my oldest sister found a note hidden a book my mother had given her and told her to read during that last weeks that she said how grateful she was that we allowed her to go out “her way”.
Click to expand...
I agree with most of that sentiment. A couple years ago I went on a research binge into metabolic health. It was driven mostly by horrible GERD. I changed my diet significantly, lost a ton of weight, got off almost all of my scripts. At the same time I went ahead with GERD surgery so I can't say for sure how much my diet and lifestyle changes would have fixed that problem. I assume it would have mostly but probably not totally. Anyway, I do still have one script that I'm still taking but it's cheap. Still I need to go in now an then to see the Doc to get the script renewed.... but regular visits don't cost all that much.

My minor concern is that the GERD surgery as I recall came with a caveat that it won't last forever. It was a TIF procedure. So the assumption is that at some point I may need to go back in to maintain it....and that'll be significant money I suppose. I really wish that I knew how much it all would have cost as a cash pay when I went through it two years ago!

Same for the kids really, as I mentioned in my OP, for them it's just been routine wellness visits, an occasional cheap script for an antibiotic etc... and the rare injury. Once a daughter broke an arm requiring an ER visit and surgery, and once another kid fell and hurt his neck so I took him for an ER visit and MRI imaging to rule out problems. Turned out to be a no-problem, go home and take a tylenol kind of thing.... those would have been big bucks probably if I'd been paying cash!

My wife has a little more going on but I really don't think the cash pay for it all would break the bank. A few scripts, one of which I think are rather pricey and every few years she needs an MRI for a check
 
Jim K said:
BTW, if anybody wants to join, LMK so I can get the $100 credit... ;)
Click to expand...
so...Samaritan's Purse
I have heard of one called Medishare... and when I looked at that one a couple of years ago there was one or two more similar things that I spotted. I wonder if one of them was semaritan's...

So what I gather from your posts in this thread, that if you basically just cash pay what you can and leave samarin's purse out of it. If you have an issue with a more significant price tag, then you submit it to Semaritan's Purse, and they notify some collective of folks who personally send you a small check. Is that how it's working?

How is it decided how many people will split the check? and who determines which members will pay for any given bill?

and going in the other direction, how does it work. Do you get something in the mail every now and then to send $50 to a person, or send $200 to some other person? Is the amount you're asked to send controlled in some way?

Do Medishare or the other sharing ministries work the same way?
 
Brad W said:
:rolleyes:So what I gather from your posts in this thread, that if you basically just cash pay what you can and leave samarin's purse out of it. If you have an issue with a more significant price tag, then you submit it to Semaritan's Purse, and they notify some collective of folks who personally send you a small check. Is that how it's working?
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Basically. There's a "deductible" for lack of a better word. I think it's $1500? I think I've only submitted 2 or 3 things over the years. The gallbladder thing, our 5th kid, and maybe when my oldest broke her hand. You submit your bills and they assign it to other members who send you the money. It used to be only paper checks, but most people take it through PayPal now. If someone doesn't pay, Samaritans deals with them and they either pay or get kicked out and the share is assigned to someone else. I can't say I've ever seen that happen.

It does take a couple months from submittal to getting money. Generally, medical offices will give you six months before they start getting ****ty with you, so you can float them until you get the money, but the best discounts obviously are when you pay immediately, so I usually do that and carry the balance. Invariably a couple people are late. It's sometimes me :rolleyes: ... but everyone has eventually come through.

Another cool thing they do is subtract any discounts you negotiate from your "deductible", so for all my "needs" I've been zero out of pocket... eventually.

I think some of the other med-shares actually handle the money for you too. I participated in a pilot program with Samaritans to do that, but they eventually decided not to move forward with it.

One of your 12 monthly shares goes to the office to pay their staff, who are wonderful when you need to talk to them, btw. The main office is in Peoria. They run sort of like a coop in that they have a board which is nominated and voted in by the members. When the board recommends a share increase, the members vote on it. If the share amount falls short of the need amount, they prorate all the needs. Before the last increase I think one month they got as low as 94%

Once a year, you fill out a continuation form, which involves getting your pastor to sign off that he actually sees you regularly.

Your share is not tax deductible, but the ones you receive are also not taxable. As far as .gov is concerned, you're uninsured. I get letters from the irs every year telling me I'm eligible to participate in obamacare :rolleyes:

Brad W said:
How is it decided how many people will split the check? and who determines which members will pay for any given bill?
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That's decided at the office. I assume it's a computer assigning it. I've never been told to split a share; the whole monthly amount has always gone to one person.

There's a "save to share" program that's on top of the basic program. Usually I send my whole basic share and a smaller amount of the STS money; I assume that's how they make it come out even. Other months the STS amount doesn't get touched and you're supposed to set it aside. Eventually the account grows and you'll get a bigger amount to send. I think the most ive ever gotten assigned at one time was $700ish.

Every month they send out a letter with your assigned share and a little magazine with some reflections and news. There's also a website which is where you submit needs and can view your sharing assignment there, which is what i generally use.

I don't have experience with any of the other groups. One thing I will caution you on is to read the member guides carefully before signing up. One of the ones I was looking at specifically excluded motorcycle and snowmobile accidents. I think another completely banned alcohol and tobacco use. There's also a maximum amount.

It's not for everybody, but it's been great for us. I think generally as long as you don't have any chronic conditions and don't run to the doctor for every sniffle, it works great.
 
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DaleB said:
I thought about how nice it would be if I could just buy a plan that would pay for only major disasters, and I'd cover all of our routine and minor stuff. Catastrophic coverage. Well, that's essentially what you get from the exchange, it's just pretty pricey.
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It really depends on which state your in as to what plans are offered through the ACA. The ACA silver plan (BCBS) I had for 6 years was basically the same coverage as my old day-job BCBS plan. I elected to degrade to a different BCBS silver plan that was increased my co-pays and gave me a better premium. Unfortunately some insurance companies have bailed on a number of states which limited their options.

As to true catastrophic plans it was by design to limit them to 30 years of age under ACA which I think was BS. I retired the same year ACA went live which caused me to alter my original plan: catastrophic plan for $275/mo and “self-insure” for the first $20k of need. If you can manage your income as mentioned above and live in a state with plan options, you can get some decent insurance at a good price.
 
TCABM said:
I’m glad I don’t have to worry about this. Reading that you have to manage income to get a federal grant to help pay for health insurance is lunacy.
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I'm not going to dispute that statement. The fed portion (in the form of. tax credit, so it really just reduces your tax bill) is dependent on your income. A couple years ago a friend went on ACA - from what he told me at the time, he had to keep their annual income down to a little under $75K to get ANY subsidy. Now it's changed significantly. It does impact your choices and strategy a bit, though. For example, if you decide to use a Roth conversion to roll a bunch of money a Roth account from a regular IRA, it could blow your subsidy since it's taxed as income and bumps your AGI up. Just an example.

If we didn't get a subsidy and had to cover the whole thing out of pocket, it wouldn't be the end of the world. They offer it, though, and I'm not going to turn down something like $18K in reduced taxes just because I think the existing system is stupid.
 
Meanwhile the UnitedHealthcare CEO was just shot dead in the middle of Manhattan. They always ask you to stay on for a 10 second survey, I guess someone spoke.
 
TCABM said:
Reading that you have to manage income to get a federal grant to help pay for health insurance is lunacy.
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You have to remember why the system was developed and how it got passed... it was the foundation to a single-payer national healthcare system. And for a single-payer system to work they had to plug the income hole between Medicaid and the 1st tier employee programs. If you dig deep in the weeds on ACA, you'll find its beyond lunacy or stupidity.
 
You can play the taxable income game to maximize the subsidy, just don’t get too good at it. If you don’t have enough taxable income you don’t qualify for O’Care and have to use Medicaid.

There used to be the “ACA cliff”, as mentioned above, at somewhere between $72k and $75k of taxable income. In my case, at our ages at the time, as long as we stayed under that number (lower was better) that made the difference between a $250/month premium and a $2000/month premium for the two of us. One extra dollar would catch you hard. My neighbor used to work some part time jobs after he retired and one of his coworkers ran into that wall. She would have to turn down overtime or she’d make too much and go over that cliff. Her extra pay could never make up for the extra premiums. That cliff has since been smoothed out.

Every fall, during open enrollment, I get reminded of how much I hate this.

When I retired, I did it in Sep. My employer provided plan covered me to the end of Sep and I used COBRA to get to the end of the year. Then I could start fresh with an O’Care plan and a lowered taxable income. I can’t remember how many months you can carry COBRA. But plan ahead so you don’t get into the position where your COBRA ends and you have to start into an ACA plan but your YTD taxable income puts you into a full price premium for the remainder of the year.
 
hmmm.... with my wife continuing to work, I reckon that our income will be too high to look for any sort of income-based discounts

So it seems that the only choices now are a) gamble, b)O'care or c) a ministry share program....at least among the folks who've participated in this thread. Not a very good situation it seems
 
Brad W said:
hmmm.... with my wife continuing to work, I reckon that our income will be too high to look for any sort of income-based discounts
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Don’t be so sure. I’m too young to take IRA and 401k, so am using taxable investment accounts and have decent capital gains and income from it which I thought would disqualify me. Get on the website, enter your numbers, and see what shows up. 4 months before retirement I started looking at the ACA website. It helped me with the math I needed with budgeting.

It’s renewal and enrollment time, but if you have a life change like retirement, you can enroll within a period of time of that change.

Log on and it’ll help answer a lot of your questions.

By the way, I reached out to our dental and eye care providers and asked for billing rates and fees for cash payments and decided to go without insurance for those things.

It ain’t that bad. I’m glad it’s there. And no, I didn’t vote for it, lol.
 
Matthew said:
That cliff has since been smoothed out.
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But only temporarily. The income cliff was voided and replaced with a max percentage of income allowing more people to sign up during covid. Its been renewed twice and is set to expire in 2025 at which time the cliff will return of not renewed again. It basically allowed an additional 4M people to sign up for ACA.
 
Bell206 said:
But only temporarily. The income cliff was voided and replaced with a max percentage of income allowing more people to sign up during covid. Its been renewed twice and is set to expire in 2025 at which time the cliff will return of not renewed again. It basically allowed an additional 4M people to sign up for ACA.
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Of course…

Well, I’ll be under that number one more year, then I’m Medicare eligible.

Oh, yeah:

Vision coverage - never had it, don’t miss it. I just pay out of pocket for any exam or glasses I need.

Dental coverage - since it isn’t regulated by O’Care you can find pretty good coverage for reasonable cost. I ended up with the same company I had with my employer’s plan. The individual plan had nearly identical coverage and the premium was only a few dollars higher (maybe $10?) than what I had been paying while working.
 
Don't forget even with Medicare there's a BIG bump in premium if you earn, or take taxable distributions over a certain amount. They take look at your gross every two years.
Found that out the hard way.
 
Brad W said:
hmmm.... with my wife continuing to work, I reckon that our income will be too high to look for any sort of income-based discounts

So it seems that the only choices now are a) gamble, b)O'care or c) a ministry share program....at least among the folks who've participated in this thread. Not a very good situation it seems
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Is an option for your wife's company (even as a 1-2 employee affair) could get group coverage? I've not looked in detail, but it's something I've considered as it would let me pick an employer plan. I also think that some professional an industry associations MAY have plans you can buy into. I would have her look for her industry to see if there is something there that you could evaluate as an option.
 
Matthew said:
Vision coverage - never had it, don’t miss it. I just pay out of pocket for any exam or glasses I need.
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Not so fast, I’ve seen were medical was denied coverage was denied to a person whom was filling up a low car tire they had driven on to the gas station very low. The side wall bubbled and blew up in his face, imbedding rubber and fiberglass belting debris into his eyes. His girlfriend drove him to the ER, who said the damage to his skin was minor and of no concern but he may be blinded by the damage to his eyes and transferred him to specialty eye surgeon to remove the debris… yep not longer medical, it was specialized optometry, health insurance doesn’t cover that, thank god he had vision. Read the fine print on your policy, all the policy, which anymore is like pulling teeth to even get. You may be unpleasantly surprised about what is not covered. Now it’s just bronze, silver, gold plans, demand an actual copy of the policy and read it. Most people are not even close to being as well insured as they think they are and they don’t realize it until they need it and “sorry, as you can see in line 4 of paragraph three on page 26, we don’t cover that”.
 
Flatiowa said:
Not so fast, I’ve seen were medical was denied coverage was denied to a person whom was filling up a low car tire they had driven on to the gas station very low. The side wall bubbled and blew up in his face, imbedding rubber and fiberglass belting debris into his eyes. His girlfriend drove him to the ER, who said the damage to his skin was minor and of no concern but he may be blinded by the damage to his eyes and transferred him to specialty eye surgeon to remove the debris… yep not longer medical, it was specialized optometry, health insurance doesn’t cover that, thank god he had vision. Read the fine print on your policy, all the policy, which anymore is like pulling teeth to even get. You may be unpleasantly surprised about what is not covered. Now it’s just bronze, silver, gold plans, demand an actual copy of the policy and read it. Most people are not even close to being as well insured as they think they are and they don’t realize it until they need it and “sorry, as you can see in line 4 of paragraph three on page 26, we don’t cover that”.
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That sounds like an episode we had with a daughter many years ago. She needed an oral surgeon- medical wouldn’t pay because they said it was dental, and dental wouldn’t pay because it was medical. It took a long time to sort that out.

Thanks for the warning. I’ll check into that.
 
Flatiowa said:
Most people are not even close to being as well insured as they think they are and they don’t realize it until they need it and “sorry, as you can see in line 4 of paragraph three on page 26, we don’t cover that”.
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I feel that way with my group coverage for work. It's ok but I don't think it's as good as my wife thinks it is. Not covered out of state, except for emergencies for example.
So a few years back when my kid broke her arm. If that had been out of state, I presume that the ER visit would have been covered, but the emergency surgery they did would not have been...now would the anesthesiologist, etc....
and considering the things such as oral surgery, eye surgery mentioned here that may not be covered. Also things like my GERD surgery...some was covered but a lot was not.
 
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