As a general rule I try not to discuss Obamacare (officially the Patient Protection and Affordable Care Act, or PPACA) here on The Self-Pay Patient blog. I have plenty of other outlets to share my views on that law, and this blog is supposed to be focused on how self-pay patients can find affordable care, whether they’re uninsured, have a high deductible plan, or have more comprehensive coverage but their insurer won’t cover a particular treatment or provider.
But Obamacare is a central feature of today’s health care system, and it’s just not possible to completely avoid the subject here. So today I want to address one of the problems that Obamacare has created for people wanting to buy health insurance, and what some solutions might be.
The problem is pretty basic – the ‘open enrollment’ period for people to buy health insurance is now over (well there’s still some leeway for people who tried to sign up but couldn’t because of technical difficulties, or who at least claim they tried), meaning that it is effectively impossible for many, perhaps most, people to buy health insurance until the next open enrollment period rolls around (November 15, 2014 thru February 15, 2015).
A story in the Washington Post this morning explains the problem pretty well:
WASHINGTON — Here’s more fallout from the health care law: Until now, customers could walk into an insurance office or go online to buy standard health care coverage any time of year. Not anymore.
Many people who didn’t sign up during the government’s open enrollment period that ended Monday will soon find it difficult or impossible to get insured this year, even if they go directly to a private company and money is no object. For some it’s already too late.
With limited exceptions, insurers are refusing to sell to individuals after the enrollment period for HealthCare.gov and the state marketplaces. They will lock out the young and healthy as well as the sick or injured. Those who want to switch plans also are affected. The next wide-open chance to enroll comes in November for coverage in 2015.
It’s a little-noted consequence of President Barack Obama’s health care overhaul, which requires nearly all Americans to be insured or pay a fine and requires insurers to accept people with health problems.
“I have people that can buy insurance, but the companies shut them down. They won’t take the applications,” insurance broker Steve Bobiak of Frackville, Pa., said…
… eligibility for coverage during 2014 is guaranteed only for people who experience certain qualifying life events, such as losing a job that provided insurance, moving to a new state, getting married, having a baby or losing coverage under a parent’s health plan…
What this means is that anybody who decides that they actually should have health insurance (and I’m an advocate for people having health insurance or anything else that provides protection against major medical expenses) but missed the March 31 open enrollment deadline, will have to wait until med-November to roll around.
As the article notes, there are exceptions. People who lose employer-sponsored coverage, get married, age off of their parents plan, or experience another ‘life event’ will still be able to get new coverage before the next open enrollment period.
But if none of those apply, and someone decides they should get some sort of coverage, what options to they have? Fortunately, there are a number of options, which I’ll run through briefly here.
Health care sharing ministries. These are voluntary, charitable membership organizations whose members agree to share medical bills. They provide protection against major medical expenses similar to insurance. There are five sharing ministries that I know of (I have been told there may be a few small, local sharing ministries, but don’t have any info on those).
Four are open only to practicing Christians: Samaritan Ministries, Christian Healthcare Ministries, Altrua Healthshare, and Christian Care Ministry (CCM operates under the name Medi-Share). A fifth, Liberty HealthShare, accepts anyone who shares their belief in religious liberty.
Each of these ministries operate entirely outside of Obamacare, and accept new enrollees year-round. They all operate a little differently, but the basic idea is consistent across all of them, with likeminded people sharing medical expenses similar to insurance. Members of three of the five (Samaritan Ministries, Christian Healthcare Ministries, and Christian Care Ministry/Medi-Share are exempt from Obamacare’s tax on being uninsured, while Liberty Healthshare is seeking confirmation from the Department of Health & Human Services that their members will enjoy a similar exemption. Altrua appears to have been founded too recently (only 9 years before Obamacare was passed, while the law requires 10 years) to qualify for the exemption.
One other major benefits of health care sharing ministries is that they are typically much, much less expensive than conventional health insurance. I cut my own cost of coverage by about 75% when I joined a ministry.
Short-term health insurance policies. If someone is looking for a policy that will cover them for several months, until the next open-enrollment period, a short-term policy may be just what they’re looking for These policies usually last between 1 and 11 months and are not regulated under Obamacare. Because of this, they don’t offer the same level of benefits that drive up costs for conventional insurance, meaning they are typically much less expensive. Deductibles are available that are higher than what is allowed with Obamacare-compliant health insurance, leading to further savings.
Short-term policies can typically be renewed at the end of the policy (technically it isn’t a renewal, it’s simply purchasing a brand new policy, which means it won’t cover any conditions that occurred under the previous short-term policy). This shouldn’t be a problem assuming that someone is simply trying to obtain insurance coverage to fill the period until the next open-enrollment occurs.
Alternative insurance products. While not as comprehensive as conventional health insurance, a sharing ministry, or short-term insurance, there are other insurance products that will provide lump-sum payments if you are diagnosed with a major illness like cancer, or have a heart attack or stroke, or have another medical event. These include fixed-benefit, critical illness, accident insurance, and even some life insurance policies. They cost a fraction of what health insurance costs, and by giving you cash directly you aren’t locked in to any particular provider network.
People might also look at what it would take to qualify for one of the ‘life events’ that allows the purchase of a health insurance policy outside of the open enrollment period. While getting married just to get insurance probably isn’t a very good idea, it may be that you live and work in an area where a short move across state lines will allow you to buy insurance without having to uproot yourself from your job, family, and friends.
And of course, as regular readers of The Self-Pay Patient blog know, not having health insurance or even alternative types of coverage is not a complete barrier to getting affordable care. There are numerous ways to get affordable health care and pay bills if a major medical need arises while uninsured, such as medical tourism, medical bill negotiators, patient assistance programs offered by nearly every pharmaceutical company, and several other options.
It’s unfortunate that Obamacare only allows people to make such an important decision during a limited time frame, but that is how things will work going forward. If for some reason you find yourself in a situation where you missed the open enrollment deadline but still want health insurance or at least some sort of coverage, you do have options that will get you through until the next open enrollment period and perhaps beyond.