OP here and thanks for all the comments. I should clarify that I would never go without insurance. I’m a big believer in all kinds of insurance! However, right now we don’t seem to be able to escape having a policy with inclusions we don’t need (i.e. pregnancy). These used to be optional on individual plans (remember having to buy a pregnancy rider? I do!) and now owe pay regardless. It’s so frustrating. We have had a HSA for over 10 years, already pay most things out of pocket. I have been digging relentlessly and may have access to some new association plans. That is worth a try I guess. If we switch Primary care providers there is also an EPO plan that is a few hundred dollars a month less.
List prices appear to be set excessively high to be starting points for negotiation with insurance companies. Of course, that makes self-paying medical care more expensive than it should be, so the threshold for being able to self-pay medical care without needing insurance is even higher than it otherwise would be (basically, one needs to have plutocrat-level wealth to do that).
And yes, for any given provider, the negotiated price may vary based on what insurance the patient has, even if the provider is in-network for each insurance.
The point is, what other industry gets away with crap like that?
@threebeans I think it really depends on where you live. I researched some of the plans to death and I could not believe some of the options and costs. If you are healthy and don’t need the whole nine yards, you still have to buy it.
Things sure have changed in the past 10-12 years. There used to be a whole lot more options at all price points along the spectrum. When we were self employed every time I found a plan I liked it was gone the next year.
@yourmomma When my kiddo needed 2 foot MRI’s we scheduled it at the hospital. It was about 5 K. Since I was paying out of pocket I googled inexpensive MRI. Called a local private place. Got an appt 2 days earlier, first one cost about $800 and second was half price $400. I can’t remember the exact costs on all parts, what I do remember is that I saved $3800 with a phone call. And the private place gave us a digital file which the hospital used. It’s crazy. And when I have asked how much things cost they either couldn’t tell me or made me jump through hoops to find out. I guess not that many people price shop health care.
They don’t want you too. Think of what an informed consumer would do to profit margins. It’s absurd. No other business would survive with those kinds of shenanigans.
That’s so interesting @Happytimes2001 . I was traveling through a city a few hours away and there were radio ads for fixed price MRI’s - they said to drive a little and save a lot! Another story to share: DH was feeling depressed after his mother died. His Dr. wouldn’t prescribe anything but did recommend getting his vitamin D levels checked as that can cause depression symptoms. He was deficient, began taking a supplement and continued to get tested for two years. Every test cost us almost $400 out of pocket. He began asking them not to do the test, but they still did iit and we still got charged. Finally he brought it up to his Dr. who was awesome -he wanted to know why a patient was refusing a test. DH explained it’s no longer needed and it’s very expensive. The Dr. was concerned that the out of pocket cost was causing a patient to refuse tests (even though he agreed this test was no longer needed either). He tried getting his hospital group to tell him what they pay for that test - he got stonewalled at every turn. Finally he found the lab that does the test and asked them what they charge - it was less than $10! The hospital got charged $10, our insurance paid about $250 and we paid $400! When he asked why they were charging so much for such an inexpensive test, our Dr. was told “It’s $25 less than the other hospital in town” Translated to mean - because we’re getting away with it!
DH and I are absolutely paranoid about insurance coverage. We chose our wedding date because four days later, I’d lose my coverage under my dad’s plan.
I was diagnosed with leukemia at age 41, no family history, in otherwise good health. Have been on the same medical plan ever since (much to the insurance company’s dismay, I am sure). DH has had had other job opportunities, but he won’t risk losing the protection we have, even though we pay a fair chunk out of pocket (more than our mortgage). We still have control over the doctors I can see, which when one is dealing with “orphan” diseases, is important.
Was also thankful to have purchased an individual life insurance policy on me at age 31 when I was pregnant with S2, as I was completely uninsurable ten years later. That money would have paid for college for both sons.
I read this article expecting to see massive reasons not to consider health sharing companies… and only found the reporters talking about one family who had to appeal to get something covered (done successfully - same as MANY folks have to do with insurance TBH) and then just negative slants put into reasons to be cautious choosing whether to go with insurance or health share.
I think most of us who opt for health share are quite upfront about comparing based upon individual needs. That’s important to do. I know I’ve always said I need to pay for annual mammograms instead of getting them for “free” by paying > $500 more per month every month to have insurance cover them. Ditto that for flu shots or other vaccinations and annual physicals or basic blood tests being sure everything is fine. Then there’s been the occasional antibiotic we’ve paid for too. With Samaritan Ministries (not Medi-Share mentioned the most in the article) we have no deductible or co-pay.
We’ve been with them for 15+ years now through a handful of needs and nary a problem. Saving 5K+ per year on monthly costs (75K+) and not having an OOP of 12K+ (as our insurance would have had) plus deductibles (5K) that would have had us paying totally OOP for some of our needs (like a broken collar bone my son had or blacking out in our horse pasture that sent H to the ER for a checkup), we’ve saved well over 100K compared to what we’d have paid for insurance. I’m pretty sure I can toss in what we need for basic care and still come out ahead. Those needing expensive prescriptions or upkeep won’t want to do health share. For us, it has worked very well - and no networks or preauthorization making most of my doctors quite happy we’ve chosen that route. It also covers us overseas, so no worries there either.
Maybe this is true where you are, but we get self pay discounts essentially everywhere. My regular doctor’s office told me we are smart to pay OOP because some of her clients with insurance pay MORE for their co-pay than they would if they simply did self-pay. I asked her why they didn’t tell them this and was told they weren’t allowed to legally. Some things baffle my mind… She said at least it should go toward their deductible. I have no idea how many max out their deductible to make that worthwhile.
As someone upthread explained, a person making less than 100% of the Federal Poverty Level is not eligible for premium subsidies. In a state that had expanded Medicaid, they would instead be eligible for Medicaid.
If your son is returning to Maine, good news. Maine voted to expand Medicaid, but the current governor refused to implement it. The new governor will.
OP here with an intersting update. Due to the laws, this year we have access to buying group health insurance through an association (with more buying power and a wider risk pool). I met with an agent this morning to get quotes through a local association that we belong to and our SAME POLICY is $380 month LESS just by going through an association.