Health insurance market closed to most, now what?

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:

Health insurance isn’t a year-round thing anymore

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 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 MinistriesChristian 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-benefitcritical 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.

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7 Responses to Health insurance market closed to most, now what?

  1. Alex Forrest says:

    This is summarized very well. I’d add telemedicine to the list of alternatives – I know you’ve discussed this before. Telemedicine and the supplemental plans you discussed (especially accident insurance) are pretty cheap ways to supplement a short-term plan or participation in a sharing ministry, where you’re usually on your own for routine doctor visits and the first $500 or so of expenses.

    At the risk of sounding self-serving, as an insurance broker I bundled together a little package for our clients that we’re calling the “Nobamacare” plan, which includes some of what you’ve discussed above (with telemedicine).

  2. Thad says:

    Sean, as you know, The Health Co-Op adds a set of premium benefits to Samaritan Ministries, including Telemedicine, and access to Christian counselors among others. We make the switch to self-pay pretty simple.

  3. Jerome Bigge says:

    The more that a person can do for themselves, the less the cost of maintaining your health becomes. If people could “import”medicine from elsewhere in the world for their own use (there are bills in the House of Representatives to support this), the cost of taking care of your own health can drop considerably. Repeal of prescription laws of course will be opposed by the AMA because a sizable portion of doctor’s incomes is in fact based upon their government enforced legal monopoly over access to medical drugs. Which in turn creates incentives to do “profit seeking” through unnecessary tests and services. It has been estimated that as much as a third of US health care costs is generated by medical services for which there is lacking any true justification except as a combination of “defensive medicine” and simple profit seeking at the expense of patients. There are a number of books available through the public library system that will go into this. One is “OVERTREATED” by Shannon Brownlee. Another is “OVERDOSED AMERICA” by Dr. John Abramson. There has been a recent decision too that some of the previously recommended preventive medical services are not actually justified upon the basis of their cost/benefit ratio. I also recommend reading “THE BEST CARE ANYWHERE” by Phillip Longman which shows that the idea that “socialized medicine” (as practiced by Veterans Administration) provides better care at less than two thirds the cost of our supposedly “free enterprise health care system”.

  4. Jim Johnson says:

    I am a bit surprised to learn that enrollment is virtually impossible. It was my understanding (from the book Self-pay Patient) that one could sign up at any time but would not be eligible for subsidy. Now I’m not so sure.

    • says:

      “Virtually impossible” may be a bit strong, but for a lot of people that is the case, at least until the next open enrollment period rolls around.

    • Alex Forrest says:

      The only way to sign up for individual health insurance outside of open enrollment is if you have a “qualifying event.” These would include things like losing employer health coverage, moving to a new state (or coverage area), getting married or divorced, or having a child (via birth or adoption).

      Outside of that…. yeah you have to look at other options like short-term health insurance or the sharing ministries.

  5. Patricia Crocker says:

    Here are two more resources:

    Bidding for procedures:


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