With individual health insurance premiums averaging about $393 per month in the U.S., many people may be left wondering if affordable health insurance plans exist.
“The unfortunate reality today is that there’s so much jargon, complexity, and misunderstanding in the health insurance world. It’s become just like shopping for a car. Spend the hours necessary to understand what you’re getting for what you’re paying.” Health care expert, Shelby George says.
One health plan from a well-known insurer promises lower premiums – but warns its clients that they may need to file their claims and even have to negotiate the charges for some procedures. that consumers may need to file their own claims and negotiate over charges from hospitals and doctors.
Another does away with annual deductibles – but requires policyholders to pay extra money if they need certain surgeries and procedures.
Both are among the latest efforts in a seemingly endless quest by employers, consumers and insurers for an elusive goal: less expensive coverage.
Premiums for many of these plans, which are sold outside the exchanges set up under Affordable Care Act, tend to be 15 to 30% lower than conventional offerings, but they put a larger burden on consumers to be savvy shoppers. The offerings tap into a common underlying frustration.
Short-term policies offer limited benefits compared with policies on the Affordable Care Act health insurance marketplaces offered by each state. They don’t include maternity care, substance abuse, and mental health, and can charge more at the outset for people with pre-existing conditions. But, on the whole, they cost less than comprehensive policies without a subsidy. A 35-year-old could purchase a short-term policy with a $5.000 deductible and $500,000 in total available benefits for about $100 a month.
Unfortunately, not everyone is eligible for the ACA health care plans and, in consequence, people are turning to some other ways to pay their medical expenses. Those experiments include short-term policies or alternatives like Christian-sharing ministries – which are not insurance at all, but rather cooperatives through which members pay one another’s bills.
Now some insurers, such as Blue Cross Blue Shield of North Carolina and a Minnesota startup called Bind Benefits, which is partnering with UnitedHealth Group, are coming up with their own with some offers of their own.
Insurers say the two new types of plans meet the ACA’s rules, although they interpret those rules in new ways. For example, the new policies avoid the federal law’s rule limiting consumers’ to an annual in-network limit on certain costs right out of the pocket.
One policy manages that by having no network, with patients being free to find providers on their own. And the other skirts the issue by calling additional charges “premiums.” Under ACA rules, premiums don’t count toward the maximum direct payment costs.