Healthshares Pros and Cons

When delving into the world of health insurance alternatives, it can be quite disorienting when learning about options. Today, we’ve broken down healthcare choices that may not be mainstream, along with the pros & cons of each. When traditional insurance leads to sticker shock, people often want to explore alternatives. There are options to conventional insurance and just because it doesn’t have the word insurance in it, doesn’t mean it is not the right fit to manage your health needs.

Primary Care Memberships

Primary care is built on the relationship and continuity of care between the provider and patients. Many times, a 15-minute visit does not meet the needs of the patient and they may feel rushed, not heard, or uncomfortable discussing their health needs within an allotted time slot.

Pros: Offers services for a flat monthly fee; virtual unlimited doctor visits, blood tests, and pediatric care with no copay; almost unlimited access to a primary physician who you’ve chosen yourself instead of needing to rely on a specific insurance network; full transparency into costs.

Cons: These practices tend to cover a narrow range of services and lack consumer protections required by insurance regulators

Who it’s good for: People who want more individual care and are relatively healthy.

Who it’s not good for: People at high risk for health issues, need specialized treatment, or major medical care.

Additional info:

This is what may be included in your membership:Unlimited 24/7 virtual care, extended hours or same-day office visits, free diagnostic tests and office procedures. Not all memberships contract with specialists, so it is a good idea to research ones that may include this type of service for extra discounts to see additional providers.

Medical Services Discount Cards

Medical services discount cards are not insurance, but rather discounts on prescriptions and services. Some may require a small monthly fee. Discount card benefits are available immediately and do not require reimbursement.

Private, Non-Marketplace Plans

Private plans are any insurance plans not offered by the state or federal government. Due to this, they may have more flexibility, but the policies, guidelines, and what’s included with the plan can be confusing.

Pros: May not be governed by the ACA which allows freedom for the healthcare company to create its own parameters for care; may include options that might not be available or offered with a marketplace plan; an option for people seeking options that may include major medical, alternative medicine, or non-traditional ways of practicing medicine.

Cons: Not governed by the ACA; individual and small-group policies must include coverage for the ten essential health benefits with no annual or lifetime coverage maximums; annual wellness, maternity, pediatric care, or mental illness may not be included; may be a very limited or specific plan; may still be healthcare but not have the word “insurance” and will need to be researched carefully to know what is included; research also needed to understand the policy and/or guidelines.

Who it’s good for: People who are seeking a different approach to managing health needs including plans that focus on virtual, concierge, or catastrophic care.

Who it’s not good for: People who want to ensure that it is ACA compliant in all 50 states.

Temporary Health Insurance: Short-Term Health Insurance

Temporary insurance is good if you have a lapse in permanent coverage due to changed jobs, are looking for work, or having to wait for the annual open enrollment period. However, they may not offer coverage for maternity, mental health, or any sort of pre-existing condition. If you suffer from some pre-existing conditions, you could be denied coverage.

Pros: Provides coverage when people need it quickly; affordable; no need to wait for the open enrollment period to sign up.

Cons: Not always renewable; may not offer benefits such as maternity and mental healthcare; may not cover a pre-existing health condition (sometimes coverage may be denied) or serious illness.

The following states still completely prohibit short-term health insurance, according to this report:

  • New York
  • California
  • New Jersey
  • Massachusetts

ACA plans aren’t regulated the same way that ACA policies are, so people must understand some risks they may take by opting for the temporary protection of short-term health insurance. You have to re-apply for short-term health insurance at the end of every term. The problem is that if you or a family member has developed a serious illness, they may not get accepted.

Who it’s good for: Young adults who recently aged off of their parent’s health care plan; families who missed open enrollment for the Affordable Care Act; seniors who will turn 65 and receive Medicare benefits soon; and newly-hired employees waiting for company group benefits to begin.

Who it’s not good for: People with pre-existing healthcare conditions or who would like coverage for services such as maternal or mental healthcare.

Self-Pay/Self-Insuring

Self-funded plans may be more flexible than traditional, fully-insured plans. They’re subject to less regulation and offer businesses the opportunity to customize their health care plan to meet their unique business needs. Because companies are paying only for the health care costs of their own employees, there may be money left over at the end of the year that can go toward other business needs.

Pros: Costs less for both the employer and the employee; doesn’t require premiums based on community rates; more transparency and control in terms of the benefits; self-insurance can be a flexible, cost-effective alternative to fully-insured plans; the opportunity to get money back at the end of the year.

Cons: Could pay less if claims are low or pay more if claims are high; monthly costs reflect only expected claims of employees.

Who it’s good for: Small businesses and startups; self-employed people.

Who it’s not good for: Not suitable for all-sized businesses.

Limited Duration Benefit / Fixed Indemnity Plans

Limited duration or fixed indemnity plans are coverage that cost a fixed-dollar amount, such as $200 per hospital stay or $100 per day in the hospital, regardless of how much the treatment may cost. They have annual and lifetime benefit limits in place.

Pros: Pay a pre-determined (or per-period or per-incident) amount regardless of charges collected.

Cons: Does not provide coverage for all services; may exclude pre-existing health conditions; coverage under this kind of plan does not count as having insurance.

Who it’s good for: People looking to not pay above a certain price point and do not require coverage for a wide range of services or pre-existing health conditions.

Who it’s not good for: People with pre-existing health conditions or serious illness.

Healthshares/Medical Cost-Sharing Programs

Each of these options has its merits, but healthshares offer more of the things people expect from their health care than the alternatives at a reasonable cost by comparison. Healthshares are often sought out by anyone looking for a more proactive way to manage health care needs: they typically include concierge care, fair medical pricing with no surprise bills and same benefits state to state, average savings per family is 20-70%. Compared to traditional insurance.

Pros: Save more money; no set enrollment dates; can join anytime; choose your own care providers; works in all 50 states; only looks back 12-24 months for a pre-existing condition; more proactive approach to managing medical needs; most leverage a concierge team to help guide or navigate care helping you to get the best care at the right cost.

Cons: Not all of the plans meet ACA requirements; some have strict religious requirements; some pre-existing conditions (as well as chronic ones) are often not covered.

Who it’s good for: Healthy, self-employed people.

Who it’s not good for: People with more problematic health conditions.