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What happens if we don't buy health insurance?


Moxie
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This would be much harder to control in Moxie's case though because they have to send in payments otherwise they could be penalized. 

 

I adjust mine down as low as I can manage it (this is federal only, there is no way to do this with state).  We usually get about $150 back for federal. 

 

Yes, that would be my hesitation in her case.  I have no idea how or if they break down what you owe as far as it being actual taxes owed or penalty owed. Or if they just lump it all together and call it taxes due, pay up.

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Pardon if this sounds ignorant, but don't most of these plans also have a set out-of-pocket (OOP) maximum? Our old plan had a max OOP just slightly above the deductible which was reassuring. This year the deductible is much higher, the insurance is covering 10% less and the max OOP significantly higher than our deductible. But I still factor on that OOP to be the most I would spend in a year and use that to compare plans and establish HSA contributions. I really hope I am correct. It is my understanding that once I have spent the OOP that insurance will then cover 100%.

My plan from this year is going away. Only two companies are offering exchange plans here next year. Blue Cross's HSA plans have a family deductible of about 14k, with an OOP limit of about 25k in network or 50k out of network! What if an emergency happens Dec 28 and spreads across two calendar years and the hospital uses out of network doctors? Then we could end up paying 100k OOP, despite having a plan that costs $1100 per month!

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Pardon if this sounds ignorant, but don't most of these plans also have a set out-of-pocket (OOP) maximum? Our old plan had a max OOP just slightly above the deductible which was reassuring. This year the deductible is much higher, the insurance is covering 10% less and the max OOP significantly higher than our deductible. But I still factor on that OOP to be the most I would spend in a year and use that to compare plans and establish HSA contributions. I really hope I am correct. It is my understanding that once I have spent the OOP that insurance will then cover 100%.

What Sparkly Unicorn said is right...there are enough loopholes and costs not counted towards OOP maximum that your REAL out of pocket max could be significantly higher. Just like so many costs don't actually count toward your deductible.

 

Also keep in mind that serious illnesses last multiple years. Let's say you meet your deductible and oop max one year, you might still need continuing medical care and treatments again starting in January.

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??? We never had a high deductible plan and HSA till after ACA, so I was under the impression that ACA had created the HSA idea.

 

Before ACA, we only had that kind of plan where you have to guess how much money to put into it and then if you don't use it you lose it at the end of the year. Now we can put in as much as we want because it carries over from year to year.

Nope, the ACA pretty much killed the health savings account style plans, which were paired with high deductible catastrophic plans and low monthly costs along with a tax break for a certain amount of money being put into those savings accounts for health related expenses. They were originally he best of both worlds - saving each month as a budget item to pay for out of pocket health expenses and routine care, while paying into a plan to cover what a family couldn't reasonably weather in terms of a large health expense or emergency/crisis.

 

Nobody touched the accounts year to year, they were in our name and through our bank and the amount rolled over every year. They worked precisely because the cost of the catastrophic plans was extremely reasonable, and so the monthly premium was low and that allowed us and many other families to set aside money into the account to accumulate when we needed it. Once the stupid, flipping ACA came in they started added things to the HSA plans to make them compliant, most of which weren't useful, then raised the out of pocket maximums and deductibles, WHILE increasing the monthly premiums. You cannot really use a health savings account when you're paying hundreds per WEEK to maintain minimal coverage that doesn't even kick in until you've met an astronomical deductible, and then doesn't even cover events in full after that point - there's no money left in the budget to save! While the prior plans remained 'legal' under the ACA it was in name only, because they couldn't actually function as intended with the higher costs rolled in and subsidizing other higher risk individuals - the design of the program was completely incompatible with how catastrophic insurance and individual medical savings accounts were supposed to work. Like, polar opposite territory.

Edited by Arctic Mama
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What Sparkly Unicorn said is right...there are enough loopholes and costs not counted towards OOP maximum that your REAL out of pocket max could be significantly higher. Just like so many costs don't actually count toward your deductible.

 

Also keep in mind that serious illnesses last multiple years. Let's say you meet your deductible and oop max one year, you might still need continuing medical care and treatments again starting in January.

That happened to us several years in a row. Our out of pocket max was almost double our deductible anyway and most of what I needed to treat was excluded. Grrrrr!

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STOP with the bankruptcy scare tactics. The majority of bankruptcy cases are people who do have insurance. Insurance does not save anyone from bankruptcy.

And bankruptcy is not the end of the world either.

 

If you don't pay for insurance, then you will use that money to pay for what medical treatment you can afford. You might or might not face a fine, many don't, which will be deducted from your tax refund (should you have been eligible for it) or added to your taxes owed when you do your taxes. And the fine is likely to be far less than having paid $1500 a month.

 

How much this affects your medical needs depends on your income, location, medical needs, and pure dumb luck. I think you should sit down and write out all your estimated medical expenses for the year and add 50% to them. Look into where to buy meds and how much and how your drs will handle no insurance. You might find $1500 isn't that bad (how scary is that?!) or you might find that $1500 a month will go towards a lot more medical care outside of insurance.

 

We have not had insurance in years now. Can't say what you should do, but if anything major happened to us, insurance or not - we'd still be screwed, so for us this is the best option (only option actually) for now.

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??? We never had a high deductible plan and HSA till after ACA, so I was under the impression that ACA had created the HSA idea.

 

Before ACA, we only had that kind of plan where you have to guess how much money to put into it and then if you don't use it you lose it at the end of the year. Now we can put in as much as we want because it carries over from year to year.

 

No.  This is not correct.  HDCPs and HSAs were available long before ACA.  Initially you did lose what you didn't spend but then the laws changed so that they rolled over (before the ACA).  What is offered depends on your state and what insurance companies offer in your state.  There are still some HSAs offered here in this state but they no longer were a good financial option for our family because the deductible went so high that it was no longer viable.

 

edited because dh distracted me and I hit post too soon.

Edited by Jean in Newcastle
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No.  This is not correct.  HDCPs and HSAs were available long before ACA.  Initially you did lose what you didn't spend but then the laws changed so that they rolled over (before the ACA).  What is offered depends on your state and what insurance companies offer in your state.  There are still some HSAs offered here in this state but they no longer were a good financial option for our family because the deductible went so high that it was no longer viable.

 

edited because dh distracted me and I hit post too soon.

 

Our FSA's pre ACA didn't roll over (and still don't, but we don't use that option anymore) . Our pre ACA HSA did roll over and still does. That's the plus to the HSA. The negative is that you don't get access to all of the money right away. With the FSA, we got access to the whole amount at the beginning of the year but if we didn't use it all (never happened), we'd have lost it.

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Our FSA's pre ACA didn't roll over (and still don't, but we don't use that option anymore) . Our pre ACA HSA did roll over and still does. That's the plus to the HSA. The negative is that you don't get access to all of the money right away. With the FSA, we got access to the whole amount at the beginning of the year but if we didn't use it all (never happened), we'd have lost it.

 

Yes, FSA and HSA are two different animals. Our FSA has never rolled over and sometimes you end up ordering a bunch of items at the end of the year but I am very thankful I have it. This year I used up every dime at the chiro, though.

 

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STOP with the bankruptcy scare tactics. The majority of bankruptcy cases are people who do have insurance. Insurance does not save anyone from bankruptcy.

And bankruptcy is not the end of the world either.

 

If you don't pay for insurance, then you will use that money to pay for what medical treatment you can afford. You might or might not face a fine, many don't, which will be deducted from your tax refund (should you have been eligible for it) or added to your taxes owed when you do your taxes. And the fine is likely to be far less than having paid $1500 a month.

 

How much this affects your medical needs depends on your income, location, medical needs, and pure dumb luck. I think you should sit down and write out all your estimated medical expenses for the year and add 50% to them. Look into where to buy meds and how much and how your drs will handle no insurance. You might find $1500 isn't that bad (how scary is that?!) or you might find that $1500 a month will go towards a lot more medical care outside of insurance.

 

We have not had insurance in years now. Can't say what you should do, but if anything major happened to us, insurance or not - we'd still be screwed, so for us this is the best option (only option actually) for now.

 

Since I am in the same boat and also researching medical shares I would like to hear why not more people opt for the medical share system? I am not trying to sell people on it; rather I would like to hear the cons that you (not just Martha but anyone who wants to chime in) perceive that make you decide against it.

I know no simple solution fits all circumstances but it's helpful to see some pros and cons others have encountered or anticipate with the medical shares system.

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Since I am in the same boat and also researching medical shares I would like to hear why not more people opt for the medical share system? I am not trying to sell people on it; rather I would like to hear the cons that you (not just Martha but anyone who wants to chime in) perceive that make you decide against it.

I know no simple solution fits all circumstances but it's helpful to see some pros and cons others have encountered or anticipate with the medical shares system.

I don't get the concept of the health shares.

 

If I could afford to pay premium AND pay up front for all our medical - then why would I bother paying premiums? Supposedly to get reimbursement? But the majority of our expenses wouldn't be eligible. Like insulin/diabetic care. Dental. Vision. I'm reaching an age where pregnancy won't be much of an issue, but I'm not there yet and most of them don't cover maternity. So nearly everything we need, we'd be paying OOP without it covering anyways.

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Since I am in the same boat and also researching medical shares I would like to hear why not more people opt for the medical share system? I am not trying to sell people on it; rather I would like to hear the cons that you (not just Martha but anyone who wants to chime in) perceive that make you decide against it.

I know no simple solution fits all circumstances but it's helpful to see some pros and cons others have encountered or anticipate with the medical shares system.

 

None of them cover pre-existing conditions which make them pretty useless for me. And, I object to the extreme judging that is involved with the "Christian" plans.

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There is that too. I'm fairly certain I'm not Christian enough for them.

 

FYI there is apparently a Catholic one operating under the umbrella of Samaritan.

 

My family has been lucky enough to have employer-based (or COBRA through a previous employer) coverage but if we needed to, I would consider putting all of us except my SN child (who qualifies for Medicaid because of her disabilities) on a health-share.

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I don't get the concept of the health shares.

 

If I could afford to pay premium AND pay up front for all our medical - then why would I bother paying premiums? Supposedly to get reimbursement? But the majority of our expenses wouldn't be eligible. Like insulin/diabetic care. Dental. Vision. I'm reaching an age where pregnancy won't be much of an issue, but I'm not there yet and most of them don't cover maternity. So nearly everything we need, we'd be paying OOP without it covering anyways.

 

Liberty Health Shares (and to some extent Samaritan's) do take pre-existing conditions. Liberty has your doctor/hospital send them the bills and you do not need to get in the middle - at least this is what I have learned from multiple reviews and their website. Several other share systems want you to negotiate the lowest amount first which I would abhor since I am not a gifted haggler. It is true that neither Dental or Vision are covered. Most plans I reviewed so far do cover maternity. Arctic Mama has one that does if I remember correctly.

Again - not trying to convince you of anything here. I am just writing what I have learned in the last couple of weeks since I started researching.

 

 

None of them cover pre-existing conditions which make them pretty useless for me. And, I object to the extreme judging that is involved with the "Christian" plans.

 

Again, from what I read Liberty Health Shares does cover some pre-exisiting conditions. I wish there were someone here who uses Liberty and could chime in. Samaritan's also covers some things with certain provisions. I have to get deeper into this as well to be fully informed.

 

There is that too. I'm fairly certain I'm not Christian enough for them.

 

I have read a few very strict "sounding" conditions but some don't care what "brand" of Christian you are, they also take Muslims, and other faiths. One of them emphasizes ethical responsibility more so than "living by certain Christian standards." Again, just mentioning this here in case it could help someone.

I won't be signing on with any of the ACA policies as they read right now. It would cost me nearly $1000 monthly by myself.

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FYI there is apparently a Catholic one operating under the umbrella of Samaritan.

 

My family has been lucky enough to have employer-based (or COBRA through a previous employer) coverage but if we needed to, I would consider putting all of us except my SN child (who qualifies for Medicaid because of her disabilities) on a health-share.

Yes, but I am not married to a Catholic or "committed" Christian, whatever that means, and my husband the diabetic is the bulk of our recurring medical expenses.

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I loved our health share group (it DID cover pre-existing conditions, and on more than one occasion acted in our best interest even to their own hurt). We would still be in it if it weren't for a rule with DH's (new) company that he *must* take their employer-sponsored insurance (it would cost them FAR less $ to agree to our health share).

 

The ACA has been painful here, too. :(

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I have Liberty and it depends on what pre-existing condition you have whether they would accept you as a member.  In ,my opinion, I would be surprised if they would cover a diabetic. 

 

 

Thank you for chiming in! Overall are you satisfied? If you would rather discuss some things via PM, please PM me.

 

 

I loved our health share group (it DID cover pre-existing conditions, and on more than one occasion acted in our best interest even to their own hurt). We would still be in it if it weren't for a rule with DH's (new) company that he *must* take their employer-sponsored insurance (it would cost them FAR less $ to agree to our health share).

 

The ACA has been painful here, too. :(

 

May I ask you what health share group you used since you seemed to have been very happy with it? Please PM me if you'd be more comfortable discussing.

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Yes, but I am not married to a Catholic or "committed" Christian, whatever that means,

This is why we left Samaritan last year which we were happy with (and they paid for the birth of my youngest). Now that insurance is getting so outrageous, I am wondering if the kids and I should join a health share and just get insurance for my DH.

 

It's unfortunate that Samaritan (and Medi-share, from what I've seen of their statement of faith) makes no provision for anyone going through doubts about their faith.

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Yes, but I am not married to a Catholic or "committed" Christian, whatever that means, and my husband the diabetic is the bulk of our recurring medical expenses.

 

Same here. Husband is sort of a believer, but not attending Church, and would not agree with the statement of faith most require. 

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Same here. Husband is sort of a believer, but not attending Church, and would not agree with the statement of faith most require. 

 

This is directly from this website: http://acforrest.com/altruas-statement-standards/

Altrua’s Statement of Standards

Altrua is unique among health sharing ministries in that members sign a Statement of Standards rather than a statement of faith.

So while the organization itself is founded on Christian principles, there is no theological statement or doctrinal requirement for membership.  By operating with a Statement of Standards, Altrua expands the potential member base due to the fact it is not tied to one specific faith or doctrine.

 

ETA: I am not a member of this organization, just came across them in my research and don't know everything about them. ;)

Edited by Liz CA
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We would both qualify for Altrua but I can't seem to find much info about them (as in reviews by members). I couldn't understand their membership plan deductible structure either.

 

When we first joined Samaritan, we knew about 3-5 families who had been members for years and had successfully made claims. I'm a little leery of joining one I can't find much info about. Although I am entertaining the idea of joining and also getting a cheap high deductible policy as a backup.

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http://samaritanministriesreview.com/samaritan-ministries-vs-liberty-healthshare/

 

Read the comments on this post. It seems that many Liberty members are unhappy because their claims are being denied. With Samaritan, members were encouraged to ask for cash discounts. With Liberty, it looks like they try to dictate to doctors what they will pay (based on 50-70% more than Medicare charges). If the provider doesn't accept this amount, it is unclear what happens. Perhaps the patient is balance billed?

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This is directly from this website: http://acforrest.com/altruas-statement-standards/

Altrua’s Statement of Standards

Altrua is unique among health sharing ministries in that members sign a Statement of Standards rather than a statement of faith.

So while the organization itself is founded on Christian principles, there is no theological statement or doctrinal requirement for membership.  By operating with a Statement of Standards, Altrua expands the potential member base due to the fact it is not tied to one specific faith or doctrine.

 

ETA: I am not a member of this organization, just came across them in my research and don't know everything about them. ;)

 

Thanks. That one is closer, but it explicitly defines marriage as between a man and a woman, and he couldn't agree to that. (and how on EARTH does that effect insurance costs/healthcare costs???)

SaveSave

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Well, for those who said they just take it out of your refund... I just got a bill in the mail today.  We always do an extended filing because DH's income is seasonal and we never have money in April.  So we filed in October. :(  I am very unhappy.

 

We signed up with Liberty this year though.  It's what we can afford.

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Yes, that would be my hesitation in her case.  I have no idea how or if they break down what you owe as far as it being actual taxes owed or penalty owed. Or if they just lump it all together and call it taxes due, pay up.

 

I got two bills.  We usually file a payment plan for whatever we owe federal. We pay it off shortly though, before the next tax year. I got one statement for tax owed and one statement called "unpaid shared responsibility payment".  I'm not seeing that I can include that with our payment plan, I have to check with our CPA.

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I have read a few very strict "sounding" conditions but some don't care what "brand" of Christian you are, they also take Muslims, and other faiths. One of them emphasizes ethical responsibility more so than "living by certain Christian standards." Again, just mentioning this here in case it could help someone.

I won't be signing on with any of the ACA policies as they read right now. It would cost me nearly $1000 monthly by myself.

 

Can you please explain how/why your ACA plan in CA would cost you, for just you, $1000/mo??

 

I just previewed plans on Covered CA, and it looks to me like, for example, a 40 yo woman living in Encinitas (random guess, but I know it's a pricey area, as my brother lives there, lol) can get coverage in a Bronze ACA plan for 200+/mo, a gold plan for 500+/mo and a PLATINUM plan for about 600-700/mo. The MOST expensive plan was a bit over 700/mo.

 

For the example, I did the calculations based on a single woman, age 40, earning 200k/yr (so no subsidies), in Encinitas, CA.

 

What plan are you looking at? What's your zip code (if you don't mind sharing it)? Do you no longer live in CA? Age?

 

What am I missing here?

 

(I'm TRULY curious. I'm not at all trying to be weird or argumentative. I have used the ACA since its inception, and saw our options for good plans decline each and every year and our family premiums double in 4 years, to 2500+/mo next year for the family of 5 . . . So, I totally get that the ACA isn't perfect, lol. I'd really like to understand what people the ACA is failing so badly, and I can certainly see that most people can't hack 1000/mo, so I'd really like to see that example!!

 

For 2017, our family ended up escaping the individual marketplace ACA to move to the SHOP ACA plans for small employers . . . This dropped our family premium back to 1800+/mo, which was where it was in 2016, and is a much better plan than those available for individuals in our state. Our state (WV) has pretty much SHIT plans for 2017 on the individual exchange, and they're all overpriced, too. It's awful. I just WISH we lived in CA where they have such better plans and options, lol)

 

http://www.coveredca.com

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You are right. If I want to pay $237 (if I qualify for tax credit, otherwise it's $400) a month with a deductible of $4800 and only 50% coverage for some things, it's less than $800. These are the numbers for my zip code - a little more rural area.

I compared what I used to have to what the same coverage would cost me now and it's $870 for the same PPO. Also United Healthcare has dropped out - no longer an option for 2017. I could get added on to dh's insurance which would be slightly less than $800 monthly ( I think he said something around $750) but there are high copays for everything including inpatient care. If I choose a  lower deductible (than $4000-6000), I still have to pay over $600 a month.

 

As I see it the ACA can offer you something for $237 monthly but it is not very good and certainly not comparable to what we used to have. However, I know that it's still better than many other states.

Edited by Liz CA
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Its really false advertising. 237 a month plus a 4800 deductible is 637 a month if you use enough care to meet your dedictible.

 

I am finding the deductible is just high enough that we are essentially self pay if there is no surgery or PET/CT scan. A callback on the mammo, an ultrasound, bloodwork, womens health care such as bone density scan, specialist visits, all add up to the deductible.

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Well, for those who said they just take it out of your refund... I just got a bill in the mail today.  We always do an extended filing because DH's income is seasonal and we never have money in April.  So we filed in October. :(  I am very unhappy.

 

We signed up with Liberty this year though.  It's what we can afford.

 

 

I got two bills.  We usually file a payment plan for whatever we owe federal. We pay it off shortly though, before the next tax year. I got one statement for tax owed and one statement called "unpaid shared responsibility payment".  I'm not seeing that I can include that with our payment plan, I have to check with our CPA.

 

They can bill you. They just don't have any way of legally collecting from you other than via future tax refunds. 

 

This is just one random link. If you poke around, you can find the actual wording in the ACA. I have found it before, but don't have time this morning. 

 

In other words, they can bark at you a whole lot, but they have no teeth to bite you.

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Yes, they fine you, But there is no enforcement mechanism for collection of the fine.

Can you really do this? Won't they just send you a bill? Genuinely curious. We once were fined for not withholding enough. We paid well before tax returns were due and we had withheld some but not enough in their eyes so they fined us an extra $500.

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Since I am in the same boat and also researching medical shares I would like to hear why not more people opt for the medical share system? I am not trying to sell people on it; rather I would like to hear the cons that you (not just Martha but anyone who wants to chime in) perceive that make you decide against it.

I know no simple solution fits all circumstances but it's helpful to see some pros and cons others have encountered or anticipate with the medical shares system.

 

Cons

1) For most, only certain flavors of Christians are welcome. They view an occasional drink as a sin unworthy of belonging, which is not biblical, but a manmade rule. Bible is against drunkeness not drinking. 

2) Mental illnesses, despite actually being medical conditions, are typically not covered. Another sin to pray away, from what I'm told by a few friends that belong to one of the more popular med share groups.

3) Lack of coverage for pre-existing to conditions (although at least one mentioned on here apparently now covers them after a time period).

 

If these existed without the Christian aspect, that'd be great for those of us that are the wrong flavor of Christian, not Christian, etc. But mental illnesses and pre-existing conditions need to be included for it to work for many of us.

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You are right. If I want to pay $237 (if I qualify for tax credit, otherwise it's $400) a month with a deductible of $4800 and only 50% coverage for some things, it's less than $800. These are the numbers for my zip code - a little more rural area.

I compared what I used to have to what the same coverage would cost me now and it's $870 for the same PPO. Also United Healthcare has dropped out - no longer an option for 2017. I could get added on to dh's insurance which would be slightly less than $800 monthly ( I think he said something around $750) but there are high copays for everything including inpatient care. If I choose a lower deductible (than $4000-6000), I still have to pay over $600 a month.

 

As I see it the ACA can offer you something for $237 monthly but it is not very good and certainly not comparable to what we used to have. However, I know that it's still better than many other states.

In my state, OK, premium for Dh and me is $1116 per month. That is with a $6000 deductible which then pays 100% after deductible is met. I don't mind a high deductible....and I like the "cleanness" of 100% of everything after deductible.....but a premium of $1116 is totally unrealistic for our income. And that in me doesn't even cs I get.....so when I lose that cs it would be even more difficult to pay such an amount.

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Cons

1) For most, only certain flavors of Christians are welcome. They view an occasional drink as a sin unworthy of belonging, which is not biblical, but a manmade rule. Bible is against drunkeness not drinking. 

2) Mental illnesses, despite actually being medical conditions, are typically not covered. Another sin to pray away, from what I'm told by a few friends that belong to one of the more popular med share groups.

3) Lack of coverage for pre-existing to conditions (although at least one mentioned on here apparently now covers them after a time period).

 

If these existed without the Christian aspect, that'd be great for those of us that are the wrong flavor of Christian, not Christian, etc. But mental illnesses and pre-existing conditions need to be included for it to work for many of us.

 

I've been devoting some time to research lately and it seems more options are now available than just the well-known Samaritan and CSM. They have probably the highest client base though as they have been around for a while and seem to have fairly good reviews.

 

I have found Altrua which has a statement of principles instead of statement of faith. I quoted it upthread. One of the other medical share organizations had much fewer restrictions on what is an eligible expense.

I remember that Liberty defines pre-existing as something you have dealt with in the previous 12 months, except cancer. They want people to be cancer free for five years.

 

Just throwing this out there in case someone would like to consider it but thinks the faith statement and pre-ex conditions are all treated the same.

I am still mulling it over myself looking for more info.

Edited by Liz CA
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They view an occasional drink as a sin unworthy of belonging, which is not biblical, but a manmade rule. Bible is against drunkeness not drinking. 

 

We were members of Samaritan for about seven years. Their rules said something like "alcohol only in extreme moderation, never to drunkenness," so alcohol was allowed.

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