There is a difference between Health CARE and Health INSURANCE. We at Ark Family Health can provide most of your health care needs right in our office. But, there are times and conditions where we need to lean on specialists or specialty services. With everything going on in the Marketplace, we hope to provide you an unbiased overview of things you can do.
Although not inclusive, below is a list of Health Insurance Plans, Government/State programs, and Non-insurance plans our patients have found helpful.
COMPLIANT MAJOR MEDICAL “INSURANCE”
The simple definition of “major medical insurance” is to reduce/remove the catastrophic risks in your life for the smallest premium possible. Insurance is a risk management tool. It’s an agreement where you (the patient) contract with an insurance company, paying a monthly premium and an out of pocket (deductible) expense/obligation for differing levels of health care/coverage. Higher deductibles result in lower premiums. Cancer, Heart Attack, Stroke, and Surgeries are things we try to prevent, but life happens.
ACA Compliant Major Medical “Insurance” Options (All cover pre-existing medical conditions):
Employer group health insurance – Typically, if this is a benefit offered by your employer, your employer pays a portion of the premium plan and you pay a portion. It can be expensive to add other family members. You may want to consider other alternatives for the remaining family members.
Medicaid (“AHCCCS”) in Arizona – If you’re household income is below 138% of Federal Poverty Level, your family is eligible for Medicaid, which covers all medical expenses. Not all providers accept AHCCCS plans and wait times are growing longer and longer across the state. More information can be found here: https://www.healthearizonaplus.gov/Default/Default.aspx
Original Medicare or Medicare Advantage – available for seniors age 65 and over. There are many different plans to choose from and learning which types of Medicare are available. We hope to help you further learn how to manage your new Medicare Enrollment in the near future. We suggest you reach out to a licensed health insurance agent or visit https://www.medicare.gov directly.
Affordable Care Act Plans (ACA aka Obamacare) – for those under age 65 who are NOT eligible for any of the 3 insurance programs discussed above. If you live below 400% Federal Poverty Level for your family size, tax credits and lower deductibles may be available. We recommend that you speak with a licensed health insurance agent or visit https://www.healthcare.gov/
NON-COMPLIANT MAJOR MEDICAL “INSURANCE”
All plans listed below do not cover pre-existing medical conditions and you may or may not be subject to a financial penalty or tax for not owning creditable “insurance” according to the ACA law. Check with a tax advisor/accountant to verify eligibility for an exemption from the penalty or visit https://www.healthcare.gov/health-coverage-exemptions/exemptions-from-the-fee/
Many are not eligible or simply cannot afford any of the programs or tax credits above, due to their age or income, and are subject to paying full price at very high premium levels. Many of our patients fall into this category, in relatively good health, and searching for alternatives to the higher prices.
Short Term Major Medical Plans – Offered by private insurance companies for short periods of time that do NOT cover pre-existing conditions, lacks maternity coverage, medication, and others. Many are EXEMPT from the potential ACA penalty due to qualifying for the “affordability” exemption. Be sure to read the policy exclusions and speak with a qualified agent to determine suitability.
NON-COMPLIANT AND “NON-INSURANCE” HEALTH PLANS
There are still other options out there, Health Sharing Plans and Indemnity Plans, which are another resource if you’re looking for some health coverage and financial risk management.
Health Sharing Plans*
These plans are not insurance, but Christian-Based Alternatives to Health Care. They are nonprofit, voluntary cost-sharing ministry programs to help participating Christians pay each other’s medical bills. They have a structured pay regimen with a pretty detailed screening process, no absolute guarantee of payment for medical costs, but rather help fellow Christians through a detailed voluntary financial contribution. The following are ACA EXEMPT plans:
- Samaritan Ministries http://samaritanministries.org/
- Christian Healthcare Ministries https://www.chministries.org/
- MediShare https://mychristiancare.org/medi-share/
- Liberty Direct Health Sharing http://www.libertydirect.org/
- Altrua HealthShare http://www.altruahealthshare.org/
Indemnity Non-Insurance Plans*
These plans can take on many different characteristics, but are typically structured on a per day or per event basis with a payout cap on each item. Aflac is an example of this type of plan (https://www.aflac.com/individuals/products/default.aspx) For instance, some plans may cover up to $1000 a day in the hospital (you pay the rest). Others pay up to $5000 or more for an “accident” or a “critical illness”. These types of plans are best suited as a supplement to the sometimes high deductible insurance plans above.
We want our patients to be healthy, and we will do everything we can to prevent disease, but we also recognize the importance of having some catastrophic or major medical coverage option for when or if a major health event happens in your life.
I recommend you talk to Linda Samson who is a broker for these types of insurance options.
Linda Samson 480-703-5797
*We highly encourage you to read all of the policy details, and the exclusions listed in these non-insurance plans.
Disclaimer: We are not insurance brokers or providing insurance or financial advice of any kind. We strive to try our best to educate our patients about potential options available to them.