Major Medical Options – For Individuals & Families

Membership at Assurance will take care of most of your medical needs, but most people wonder how to deal with major medical issues – surgeries, hospitalizations, and more.

We’ll help you find something that fits your needs.

There are lots of factors to consider… whether you’re by yourself, with a family, if a spouse has insurance through an employer, how comfortable you are with taking risks, your family finances, etc.

We’ll do our best to simplify things here, but since everybody is a little different it’s best to do some research on what might work best for you and your family.

We also want to help, because this can be an overwhelming process. If you have any questions, please reach out to us and we’ll do our best to find something that fits your needs!

Your options: an overview…

Here’s what you can pair with Assurance membership. More details on each are below.

• Assurance membership only
  • Higher risk of paying more out-of-pocket, but not as risky as you might think.
• Health Sharing Ministry (see list of those available below)
  • Health Sharing Ministries are NOT health insurance, but are a good alternative. Most have affordable monthly costs, but are limited to either Christians or those willing to abide by their ‘guidelines.’
• Health Sharing Organization
  • VERY similar to Health Sharing Ministries, but not limited to Christians. Most have guidelines to abide by. Unfortunately a limited number are available to Washington State residents.
• Employer-sponsored Health Insurance
  • Most Assurance members take advantage of an employer-sponsored health insurance plan. This works well for individuals, but sometimes families can look at a combination of this and health sharing or Assurance membership only.
• Traditional Health Insurance
  • While not the most affordable option, this may be the best option for those with many pre-existing conditions or who are at high risk for major health incidents in the next couple of years.
• Medicare
  • There’s a whole page on our website dedicated to Medicare. If you are eligible for Medicare, then visit this page.

NOTE FOR FAMILIES…

When considering putting together your health benefit package, it sometimes makes sense to have different family members on separate plans. For example, I know a family that…

• A spouse works for an employer, so only that spouse is on the employee health plan
• The children qualify for State healthcare, so the children are on their own (this is not a normal scenario, as the children usually don’t qualify if a parent is offered an affordable health plan via an employer, but… it still happens)
• The non-working spouse is signed up for a health sharing ministry
• The entire family is on an Assurance Membership

So… just because a spouse’s employer offers insurance doesn’t mean the family has to sign up for that insurance. It sometimes makes more sense to look elsewhere for other family members to both save money and get better benefits.

Now, let’s go over the details…

Assurance membership only

Is it possible to only have Assurance membership and not go bankrupt if something major happens?

Yes.

Do we recommend that for everybody? Not necessarily.

Only if you’re willing to take on the risk and responsibility of paying for all of your own health care needs – which is far less scary than you think. Especially if you have a membership with Assurance. We’ll help you every step of the way.

First, everybody should understand that NOBODY should ever go bankrupt because of medical bills. It doesn’t mean nobody should be in medical debt, but that debt should only be to hospitals or other medical providers, NOT to collection agencies.

Let’s play out a couple worst-case scenarios.

First scenario: You have a major accident (not involving a car – car insurance will cover some medical bills), and need emergency surgery.

• Because this was an accident, you likely did not contact Assurance right away – we only deal with non-life-threatening situations. That’s fine – the hospital will still take care of you just like anybody else regardless of whether you have insurance.
• After your hospital visit, surgery, and possible some physical therapy, you start seeing some bills arrive in the mail.
• You’ll first call Assurance and likely talk with Jason, and he’ll tell you to:
  • Call the hospital billing department and ask for:
    • Any prompt-pay discounts available
    • Any cash-pay discounts available
    • What patient-assistant plans are available
    • What else you need to know about getting this bill reduced (most of the time the billing folks will help you)
    • An itemized bill to be sent to you after discounts have been applied
  • Make sure to NOT let any bills go to collection. Stay in touch with the billing department, making sure they do not go past ‘final notice.’
  • If the billing ends up being fair and somehow you do not qualify for patient assistance, you’ll make small payments towards the full bill.
    • We’ve seen people paying $50/month on a $15,000 bill to the hospital.

Second scenario: you discover that you have cancer and are in need of treatment.

• You likely have seen a provider with us here at Assurance, and hopefully because you’re a member, we’ve caught this cancer early due to the ease of access and you coming in to see us as often as possible.
• We will help do the research on where to send you, which oncologist will best suit your needs, and has a cash-friendly payment option.
• You will likely discover that there are several patient assistance programs available for those people that are uninsured, and will most likely be able to utilize those patient assistance programs.
• Depending on the time of year, you may also end up applying for health insurance (during open enrollment – usually between November and the end of December each year). Because insurance companies can no longer discriminate based on pre-existing conditions, you’ll be able to pick the insurance that best suits your needs.
• Just like with the hospital situation above, you make sure to take advantage of any prompt-pay and cash-pay discounts, and can begin making payments towards those balances.

A few IMPORTANT things to know about being a cash-pay patient…

• As long as you’re making payments on any balances to a hospital or health care facility and they are accepting those payments, they CANNOT…
  • send you to collections
  • charge interest on your balance
  • report that balance to a credit bureau
• While you are at risk to pay 100% of any health care bill, there are LOTS of patient assistance programs available, many of which are quite generous.
• You cannot and will not be treated any differently in the hospital if you do not have health insurance. You’ll still receive great care!
• You have MORE negotiating power as a cash-pay patient. If you have insurance, you’re stuck with what the insurance company has already negotiated on your behalf.

Health Sharing Ministries

A general overview:

Health Sharing Ministries are NOT health insurance. They are faith-based organizations (mostly Christian) where individuals, families, and sometimes businesses can join these communities that commit to ‘share in one another’s burdens,’ aka, healthcare expenses. They are typically more affordable and a bit less restrictive than health insurance.

Health Sharing Ministries operate differently than insurance. Here are some general differences…

• They don’t “cover” any health needs, they “share” in them.
• They don’t charge “premiums,” they have a monthly membership amount, or similar.
• They don’t have “deductibles,” they have “unshared” amounts, or “member responsibilities.”
• When a member, you are a cash-pay patient, so you have no ‘insurance’ to present to anyone – no ‘coverage.’
• They CAN factor in pre-existing conditions. Most won’t deny membership, just put a restriction on specific pre-existing conditions (so as to not bankrupt the community).
• There is no open enrollment, but becoming a member can be done anytime – usually depending on their own guidelines.

In our minds, there are different categories of Health Sharing Ministries:

• Those that require someone either sign a statement of faith or prove church attendance in addition to agreeing with their guidelines.
• Those that do not require a statement of faith or church attendance, but that ask that you agree to their general ethics and guidelines.

Here’s a list of Health Sharing Ministries that ask you to either prove church attendance, or sign a Christian statement of faith:

• Samaritan Ministries
  • A trusted and well-vetted community / health sharing ministry.
  • A bit more administrative work on the individual’s behalf:
    • 11 months out of the year, Samaritan tells you where to send your monthly amount (usually via check or PayPal) – to another member of the community.
    • If you have a medical need, you are responsible for tracking whether those needs come to you or not
    • You are responsible for negotiating medical bills (we can help you with this at Assurance)
• Christian Healthcare Ministries
  • A trusted and well-vetted community / health sharing ministry.
    • Less administrative work than Samaritan Ministries.
• MediShare
  • Most popular community with the most options.
  • Has one of the more true ‘catastrophic’ plans available, that pairs well with DPC (likely the most affordable option).
  • They don’t list prices on their website, so you have to reach out (customer service seems great).

Here are Health Sharing Ministries that anyone may join so long as you agree with their ethical statements or guidelines:

• Liberty HealthShare
  • We’re not sure if we can recommend Liberty any more. They grew very, very quickly and didn’t have the staff or software to keep up with growth and have left some members without reimbursement for very long periods of time.
  • We think there are better options in a similar price range.
• Solidarity Healthshare
  • Solidarity is new to us, and we aren’t sure of many details.
  • They are a Catholic community, but non-Catholics are welcome to join.
  • The cost of your monthly DPC membership goes toward your ‘annual unshared amount,’ essentially decreasing your personal responsibility if a medical need occurs.

Visit each ministry’s website if you have questions about whether they could be a fit for you.

Health Sharing Organizations

Unfortunately Office of the Insurance Commissioner in Washington State has disallowed several Health Sharing Organizations from operating in the state of Washington. Sedera and Zion Health were two highly trusted and well-run organizations that we recommended, but are no longer allowed.

Currently, our one recommendation for a health sharing organization is:

Crowd Health

• Crowd Health has been investigated by the Office of the Insurance Commissioner of WA State, and so far has been allowed to operate because of their ‘crowd funding’ structure.
• Instead of paying a flat monthly fee and then sharing that between members of the community, you:
  • pay a ‘subscription’ fee to Crowd Health (currently $55/monthly)
  • share an additional, variable (yet limited to a monthly maximum) amount to that community that is put directly towards medical needs
  • have the option to NOT share in that need if you do not desire – this would impact a ‘generosity’ score that they give you, and is taken into account when you ask others to share in your own medical needs
• We highly recommend Crowd Health, as it is an option that would suit most people.
• Note:
  • Read through their member guide to understand how their program works
  • Use code “Assurance” when signing up to receive your first 3 months at a discounted sharing rate.

Traditional Health Insurance

If your employer offers you insurance and the monthly cost is reasonable, it may make sense to pair that insurance with us.

There may be a case where the above options are simply not a fit for you (if you have a pre-existing condition that will likely cost several thousands of dollars in the next year, if you’re a smoker over the age of 50 who doesn’t want to quit, etc.), so traditional health insurance will be your best option.

Here are some general tips when choosing a health insurance plan to pair with our Direct Primary Care membership…

• If you have a choice between different plans, generally the highest deductible plan will work best (the least amount of money will come out of your pocket, and we’ll keep you from using your deductible as much as possible).
• If you have a choice between different plans – try NOT to choose the HMO (usually Kaiser) option. If you need care outside of our clinic, we will be unable to refer you to outside services. This is mostly a hassle for you, as you’ll have to go to an in-network provider to be referred (or see if you can refer yourself).
• If you want to shop around, try visiting ehealthinsurance.com to compare several different plans.

Medicare

The current reality is that if you’re over 65, Medicare is likely the best option for major medical care.

There are other options, but most either involve some kind of cash-pay option or employer-based insurance. Read our Medicare information here, or contact us if you’d like to know more about options that exist outside of Medicare.