Medical sharing plans

[daveinaz]

We have good health insurance now through our employer. The current state of medical insurance is atrocious. It is already, basically, a health sharing plan. The difference is that under traditional medical insurance, there is no incentive for healthy living. It was just recently that health insurers started providing coverage with no deductible for preventive care. In the past they wouldn't pay for preventive care but would pay for when you were sick --- not paying your costs toward not getting sick in the first place. Then "Obamacare" came along forcing people to buy Cadillac policies with coverage they neither needed nor wanted, pricing many people out of real coverage -- yes, they had insurance, but to meet the new higher requirements, they had to get deductibles that were astronomical, effectively pricing them out of the market.

So, current , traditional health insurance is, in effect, a health sharing system -- where the healthy pay for the cost of the unhealthy -- that was the whole premise, cornerstone of the ACA -- they counted on healthy young adults to buy into the system and subsidize the costs of unhealthy adults. But they didn't, choosing to pay the penalty instead which was still cheaper than buying a health plan they didn't need.

To me, a similar analogy would be when a group of people go to a restaurant. The majority are ordering expensive meals and they suggest that they all split the bill. Of course, those ordering steak and lobster and adult beverages are in favor of the idea. But those content with a hamburger, fries, and soda aren't. But they all vote on it and of course the measure passes. So the burger and fries crowd are forced to subsidize the expensive tastes of the others.

Both traditional health insurance and "health sharing plans" are sharing the costs of everyone's medical treatment among members of the group. The difference is that "health sharing plans" limit membership to those who avow to make healthy lifestyle choices and aren't subsidizing those who choose otherwise.

As others have mentioned, I have also looked at the explanation of benefits forms that come back from the insurance companies. Their "negotiated" amount is under 50% of the billed amount. It's a racket. They intentionally inflate their bill knowing that the amount paid is going to be negotiated down. That's way more and more providers have a separate fee schedule for cash where they can afford to charge less by bypassing all the expense and tedium of the insurance maze.

It's all about choices. Sort of like whether or not to get an extended warranty. I have chosen to refuse extended warranties and instead put that money aside to cover break downs should they occur and so far, I haven't regretted that approach.

We would rather have enough set aside to cover a large deductible and only have health coverage to cover the catastrophic events as opposed to paying thousands a month for coverage we don't need.

I know it's "to each his own," and that this a debated topic. But I think that when people are more directly involved with the costs of their health care, they are more careful about what they choose. In the traditional system, most people don't shop around despite the fact that the cost of procedures can vary by thousands of dollars from one place to another. But they don't care because they aren't paying for it -- well, not directly at least.

I would certainly like to keep the nice coverage we have. I know we've gotten spoiled by it these past 15 years. In fact, losing that coverage was the one thing keeping up from retiring. The only reason we were still working was for health insurance, but we've finally decided that it's not worth it. We would rather get out of the rat race without the current coverage than stay in it and keep putting up with it.

I've also started looking into prescription costs since the sharing plans don't cover them. I've found that I can go to Walmart or Costco and pay cash for the same Tier 1 meds I'm getting now for either less or about the same as my co-pay is now. But the insurance companies are paying the top price for the same meds plus I pay the co-pay.

The cynical side of me smells a rat. Someone's getting rich off this current scheme /set-up and I know it's not me!