Health share plan?

[DawnM]

Anyone use a healthcare plan and do you recommend them? I am looking into one as a temp solution, probably a year or so, and would like some information. Zion seems to have good reviews, any others?

This is for my son, 27, no health issues, but we need something for emergency medicine, and I may pair it with a local direct care plan ($65/mo at the local doc's office for his age group.)

Any and all information is helpful.

Thanks

 

[WDW_fan_in_TX]

Following. I often hear CHM on the DR Show. I've researched into it just a bit. It doesn't seem like a good deal. I think you have to pay the bills then you get reimbursed if I understood it right? Not 100% sure, though. Our insurance through work just went up. I'm paying almost $300/month, and I have to pay out of pocket up to $5k. Makes no sense why we have to pay for insurance if we're having to pay out of pocket anyways.

 

[Tiggr88]

What exactly does "Once your paid medical expenses rise above the threshold of your IUA, the eligible medical costs become shareable with the community." mean? Are you sure you the expenses will actually be covered by other members beyond your threshold amount? If not, I suspect you will be on the hook for them. And it doesn't look like they get discounted rates from the providers either, but that is hard to tell. Most insurers are also rated for their financial health and regulated. Not sure exactly what recourse you have here if there are any issues.

Have you looked into any Affordable Care Act coverage that might be available or other state subsidized plans if available? Will they be traveling at all and need emergency coverage out f state and is that all included as well? Lots of considerations.

 

[barkley]

but we need something for emergency medicine,

if it's strictly for local to where he lives emergency medicine then you might call patient services at whatever local e/r he would use to find out what plans they accept.

 

[DawnM]

if it's strictly for local to where he lives emergency medicine then you might call patient services at whatever local e/r he would use to find out what plans they accept.

He lives 4 hours from home away at college and travels back and forth, I am most concerned about a car accident which may require the nearest hospital, so that won't work. He lives here most of the summer and holidays and at school the rest of the year.

 

[DawnM]

What exactly does "Once your paid medical expenses rise above the threshold of your IUA, the eligible medical costs become shareable with the community." mean? Are you sure you the expenses will actually be covered by other members beyond your threshold amount? If not, I suspect you will be on the hook for them. And it doesn't look like they get discounted rates from the providers either, but that is hard to tell. Most insurers are also rated for their financial health and regulated. Not sure exactly what recourse you have here if there are any issues.

Have you looked into any Affordable Care Act coverage that might be available or other state subsidized plans if available? Will they be traveling at all and need emergency coverage out f state and is that all included as well? Lots of considerations.

The cheapest plan is $425 for each of them. No subsidies. they don't qualify and are there any anymore? According to the application we filled out and the response we got, the cheapest is $425, which is why I am looking into alternatives.

You are looking at a website I presume, and don't have first hand knowledge? I have read through several of them, I am asking for any personal experiences or recommendations based on firsthand knowledge.

 

[DawnM]

Following. I often hear CHM on the DR Show. I've researched into it just a bit. It doesn't seem like a good deal. I think you have to pay the bills then you get reimbursed if I understood it right? Not 100% sure, though. Our insurance through work just went up. I'm paying almost $300/month, and I have to pay out of pocket up to $5k. Makes no sense why we have to pay for insurance if we're having to pay out of pocket anyways.

they all operate a little differently. The alternative is marketplace and the cheapest is $425 per person and the coverage stinks.

 

[firefly_ris]

Not totally useful, but I know that my boss uses CHM and has never had an issue with them. You do get reimbursed and there was a little more leg work calling the hospital ahead of time when his wife was pregnant to get price listing and all that, but they sent him the money to cover it very promptly. I don't have any personal experience or knowledge at all, that's just what I've heard from him.

 

[Tiggr88]

The cheapest plan is $425 for each of them. No subsidies. they don't qualify and are there any anymore? According to the application we filled out and the response we got, the cheapest is $425, which is why I am looking into alternatives.

You are looking at a website I presume, and don't have first hand knowledge? I have read through several of them, I am asking for any personal experiences or recommendations based on firsthand knowledge.

I quoted from Zion since that is what you mentioned. I guess my general point is, how do you know your bills will be covered? I have no experience with a health share plan. It doesn't appear there is any contractual obligation for them to cover amounts above your one time payment max amount? I'm not familiar with them so wasn't sure how that would work.

 

[DawnM]

I

I quoted from Zion since that is what you mentioned. I guess my general point is, how do you know your bills will be covered? I have no experience with a health share plan. It doesn't appear there is any contractual obligation for them to cover amounts above your one time payment max amount? I'm not familiar with them so wasn't sure how that would work.

I am going off of reviews and web searches and YouTube and TikTok and Reddit with live giving their experiences, but I am looking them up one by one and wondered if anyone had general recommendations based on their own experience.

For example, I am reading that there are a few (can't remember off hand because I stopped looking after I read this) that take a very long time to reimburse. Zion reportedly does not.

This should be a temp solution (maybe 1 year) and I pray nothing major happens, but if it does, I don't want them stuck with NO insurance.

You may also be asking about general medical care. They are clear on their website of what they cover and don't cover. This is really more of a catastrophic plan with one physical yearly. I have not read of anyone with major issues (like a car accident or heart attack) where it they did not cover the bill.

Thankfully, neither of them have any health issues, other than one son with ADHD but his meds are cheap and he has to visit the doctor once every 6 months, which he will cover.

Some people pair this with a program ($65 locally/mo) for a personal physician, where they can go at any time.

 

[barkley]

He lives 4 hours from home away at college and travels back and forth, I am most concerned about a car accident which may require the nearest hospital, so that won't work. He lives here most of the summer and holidays and at school the rest of the year.

have you checked with his college? the one my oldest attended had (still has-i just checked their website) a requirement that a student's private health insurance had to meet a certain criteria or students HAD to opt in to the student healthcare plan ($465 per term). this plan does NOT cover emergency services BUT the insurance company the college uses DOES offer optional additional coverage. both are also available for continuing students to purchase for over the summer break (even if they are not attending BUT will return to the college for the follow term)-and there's no break in coverage during term breaks (like the 1 month they are off now).

 

[Mackenzie Click-Mickelson]

I won't really have the best information because when I had to get insurance on my own it was pre-ACA. It was back when you graduated college and were removed from your parent's healthcare plan. I rejected COBRA but went with Blue Cross Blue Shield which gave a comparable coverage. Back then that was a referral plan pricing but it was something like $110 per month compared to COBRA at $330. I opted to keep Aetna for Dental (which is what my mom's company had) and then back then EyeMed for eye care paying those separately. The EyeMed coverage was pretty inexpensive, the Aetna not that much overall.

I used that plan for about a year before I was employed with a company that I could get their healthcare plan.

I do think your question might be hard to answer because you're asking about healthshare not healthcare plans. It might be hard to find personal experience with something like that. Healthshares aren't insurance plans and just a brief look are probably a more niche thing. Can your son ask around in his local college area or ask around on Nextdoor, FB, etc for more information.

 

[spit11fire]

Following. I often hear CHM on the DR Show. I've researched into it just a bit. It doesn't seem like a good deal. I think you have to pay the bills then you get reimbursed if I understood it right? Not 100% sure, though. Our insurance through work just went up. I'm paying almost $300/month, and I have to pay out of pocket up to $5k. Makes no sense why we have to pay for insurance if we're having to pay out of pocket anyways.

There are multiple reasons for that. 1. Different employers pay different amount towards insurance, the portion they don't cover will be the employee share of the premium. Some also will offer different premium for full time, and part time. Some will offer lower out of pocket/deductible for higher premium. My employer's offered 3 plans, with different numbers. The higher premium had the lowest out of pocket, but the low premium had the "high deductible" that was only $1k higher deductible then the 2nd tier copay plan, and the out of pocket was actually the same as the 2nd tier but higher then the highest premium plan. When comparing the plans between premium I would pay, the out of pocket, and deductible, the total possible cost if hit out of pocket was within $500 - $1k. I can't remember if that was before or after the HSA donation they would make for the HDHP.
2. The premium is just like the other insurances you can get. There are alot of people that don't use much of their insurance but pay the premium for coverage, if they only had to pay the out of pocket if they went in, then there is no reserve built up for those that do use the insurance. Then there are alot of people that have healthcare expenses that far exceed their out of pocket max. Since they already reached their out of pocket max, the insurance has to have money from somewhere to pay the hospital/clinic. Pretty much all insurances work off from a group that uses less of the benefit subsidizing those that use large amounts of the benefits. Prior to ACA insurance companies were willing to offer cheap plans that had more limited coverage or by having the ability to remove those that were considered high usage or high risk of usage, or they would charge them more. Similar to how car insurance can raise tons for those who get into multiple wrecks or have multiple traffic infractions, that or they drop them. Should people be dropped or ineligible for insurance because they had genetic or uncontrollable condition? No. But it is also crazy to expect that rates would not go up excessively having to cover them without raising premiums of only those people, or by with adding more and more required services etc.
They provide the free preventative services to try to help eliminate surprises from people who would not get checkups or screenings that would help to prevent or treat conditions early if detected, in attempts to avoid high cost treatments.

Medicare/Medicaid keep raising their allowable payment amounts for services. Insurance companies try to negotiate their payment rates for servics as close to this as possible, but often are atleast 20% higher offered to them then the goverment. Some research indicated that this is due to both medicare having larger patient base that gives them bigger bulk discount, and that there are plenty of services that health systems determine are under the actual cost and make up for in the higher rates that they charge insurance.

 

[spit11fire]

I

I am going off of reviews and web searches and YouTube and TikTok and Reddit with live giving their experiences, but I am looking them up one by one and wondered if anyone had general recommendations based on their own experience.

For example, I am reading that there are a few (can't remember off hand because I stopped looking after I read this) that take a very long time to reimburse. Zion reportedly does not.

This should be a temp solution (maybe 1 year) and I pray nothing major happens, but if it does, I don't want them stuck with NO insurance.

You may also be asking about general medical care. They are clear on their website of what they cover and don't cover. This is really more of a catastrophic plan with one physical yearly. I have not read of anyone with major issues (like a car accident or heart attack) where it they did not cover the bill.

Thankfully, neither of them have any health issues, other than one son with ADHD but his meds are cheap and he has to visit the doctor once every 6 months, which he will cover.

Some people pair this with a program ($65 locally/mo) for a personal physician, where they can go at any time.

When i looked years ago after having dw cousins using it with good results, there was one plan that indicating that they did the patient pays then reimburses as terms indicated that you would negotiate for cash pay pricing which can be seriously discounted or lower than what many insurance companies pay as their contracted rates.

I don't use a healthshare as I have an autoimmune condition that would typically not be covered by a healthshare since i originally looked it up. But i also choose HDHP now and keep my HSA higher than my out of pocket max. I will actually pay for any of my deductible with credit card first then have my HSA reimburse me so I get points as well. I also try my best to time my biologic med to be as close to the new year as possible so that it is the first expense as my RX does not have a seperate deductible apart from my medical, so I will hit my deductible and a large part of my out of pocket max right away. And the company of my prescription offers copay assistance, so the $3500 deductible becomes $5 cost. My prior biologic was not a self-administer injection but was a IV infusion so that would cost more because I would have to pay a portion of the IV services as they weren't covered by the copay card only the medication, but the HDHP goes to 20% once deductible and before out of pocket so the medication copay assistance still paid the large portion. Ussually by the 2nd month of meds i hit my out of pocket max.

DW just went through IVF (in Florida) at a clinic that prioritizes making fertility services much more affordable. Their cash/direct pay rate is quite a bit lower than the rate they charge insurnace if you choose to bill insurance instead (if it is covered), indicating that the time and effort and addtiional manpower to deal with the insurance companies was their reason for insurance being higher than direct pay. They rather just get paid instead of doing all the paperwork and other process involved to bill insurance.