If you missed open enrollment–either because you didn’t like your plan choices or because you wanted to take a nap every time you started the application–don’t fret. You still have options. Even if you are enrolled but aren’t happy with your coverage, you may find a solution in one of the less common approaches (read until the end!), which seek to provide an answer for many of the common gripes above.
Getting coverage–particularly for the untraditionally employed among us–can be a real downer. That’s because (a) it can be costly; (b) in-network providers can be inconvenient or ill-suited to your needs; (c) knowing what you qualify for isn’t always black and white.
What are my options?
Going uninsured: The big game changer of 2019 is that the federal mandate (which penalized people without health coverage) no longer applies, meaning you will not be charged for being uninsured in 2019. Young, healthy people who don’t have insurance through work may find this option appealing. Still, going uninsured is a big risk (as in–it could bankrupt you–no matter how little bank you have to rupt). It only takes one unexpected accident or illness to make a seemingly inexpensive choice a very expensive one indeed.
Special ACA enrollment/other state-funded options: If you lose coverage, move, get married, get pregnant, or have a change in income, you may qualify for a special enrollment period for the ACA. Just go to Healthcare.gov and select “See if I can enroll.” If you qualify, you can also apply for Medicaid or the Children’s Health Insurance Program (CHIP) at any point.
Unregulated insurance: Some insurance options are not regulated by the Affordable Care Act, and therefore allow year-round enrollment. You may wish to look into private market insurers or short-term coverage. As always, read the fine print and do your research before deciding these less-common plans are right for you.
Concierge medicine: For a monthly fee, you can essentially have unlimited access to Direct Primary Care (DPC) for all your regular needs. This is not the high-cost concierge medicine of olde. Instead, a monthly fee (sometimes as low as $50) gives you quick access to a doctor on call who, due to a smaller patient base, is highly familiar with your particular situation. Here’s an in-depth Consumer Reports rundown on the pros and cons of this approach. For those already paying insurance for a traditional approach, a DPC means an additional cost. For those foregoing traditional insurance (read on), this option gives access to higher quality care (at least in theory) while also offering cost savings.
Health cost sharing ministries: One of the first things they’ll be sure you know is that this decidedly NOT insurance and should not be thought of as such. However, some people find cost-sharing ministries a good alternative or supplement to traditional insurance. Even with subsidies, some only qualify for plans with high monthly premiums and/or deductibles, which means this option offers cost savings in many such cases. The fact that it allows you to choose your care providers based on factors that are important to you (such as healthcare philosophy, convenient location, specialization in your particular needs, etc.) also makes it highly appealing. The way these ministries operate varies, but the basic premise is that members pool monthly payments to share when someone has a medical need. While qualifying expenses are shared, members are technically self-pay and can therefore go anywhere that is accepting new patients. Here’s a Consumer Reports rundown on this approach.
Other cost-sharing services: While the well known cost-sharing options are considered ministries and therefore require some sort of statement of faith, at least one company is offering health cost sharing without any religious affiliation required. Being in the early stages (first memberships start in Jan., 2019) means information and testimonials are limited, but KNEW Health targets health-minded individuals and considers itself a “safety-net for large, unexpected medical costs.”
Combination of the above: Some find a combination of concierge medicine and some sort of catastrophic or health-sharing plan gives them access to the regular care they want while still maintaining peace of mind that they will not be buried in costs for accidents and unexpected illnesses. Here is some info from two people who use a combination of concierge medicine and health sharing ministries to get the care they want and save money, too. They talk about the costs, benefits in their unique situation, and their experience getting costs reimbursed.
The bottom line
You should always do your own research on big decisions–and healthcare is one of the biggest. What options work for you? Why? Once you’ve knocked this one off your to-do list, you will have earned that nap.
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