An Obamacare Loophole

 

 

This is something we have been talking about for a long time. This article sums it up nicely. Direct Primary Care practices like ours work well with faith based health sharing ministries to make health care affordable for all who qualify. It exempts patients from the ACA tax and saves a lot of money compared to the Obamacare exchange plans.

Save money and opt out of Obamacare…a win/win!!

 

Michael A. Ciampi, M.D.


From The Direct Primary Care Journal:

An Obamacare Loophole — A small group of Christians got together to help each other pay for some medical bills, and the movement was born.

By  On July 15, 2015 

Aaron Monson is the Practice Administrator at Riverton Family Health Center. Riverton Clinic  801-254-0309 Riverton, Utah

A loophole? Yes – well, sort of.You must have a plan for healthcare, but it doesn’t have to be costly health insurance. It’s called health cost sharing, and the concept began decades ago. A small group of Christians got together to help each other pay for some medical bills, and the movement was born. When the Affordable Care Act (ACA) was enacted several years ago, a clause was written into the bill to allow an exemption for this long established practice (see 26 United States Code Section 5000A, (d), (2), (B)). Members of these health care sharing ministries (HCSM) file an IRS form 8965 with their tax return to claim the exemption from the individual insurance coverage mandate required by the ACA.

These cost sharing arrangements are essentially a religious exemption to the individual mandate to carry health insurance. As such, potential members must be willing to agree to a Statement of Shared Beliefs. One such program, Liberty Health Share (LHS), summarizes their beliefs as follows:

  • ”We believe that our personal rights and liberties originate from God and are bestowed on us by God, and are not concessions granted to us by governments or men. We believe every individual has a fundamental religious right to worship the God of the Bible in his or her own way. We believe it is our biblical and ethical obligation to assist our fellow man when they are in need according to our available resources and opportunity. We believe it is our spiritual duty to God and our ethical duty to others to maintain a healthy lifestyle and avoid foods, behaviors or habits that produce sickness or disease. We believe it is our fundamental right of conscience to direct our own healthcare, in consultation with physicians, family or other valued advisors, free from government dictates, restraints and oversight.” (Liberty Health Share: Programs: Do I Qualify?, 2013)

Because these health cost sharing plans are NOT health insurance, they are exempted from the insurance requirement that all must be accepted regardless of pre-existing conditions. They can also discriminate against tobacco users, meaning that smokers will not be accepted.

Some Americans may take issue with the above restrictions or the statement of beliefs. But for the vast majority of Americans that believe in God and practice healthy lifestyles, the reduced costs to participate in a health cost sharing arrangement will be welcome news. Here are a few of the options that LHS provides:

“Liberty Share” option –

Annual “unshared” amounts (similar to a deductible): $500 single, $1000 couple, and $1500 family

70% Cost Sharing up to $125,000 per person, per medical incident

Single    $107 per month (under 30) or $157 per month (30+)

Couple $198 per month (under 30) or $248 per month (30+)

Family   $345 per month (under 30) or $395 per month (30+)

“Liberty Complete” option –

NO annual unshared amount!

100% Cost Sharing up to $1,000,000 per person, per medical incident

Single    $149 per month (under 30) or $199 per month (30+)

Couple $249 per month (under 30) or $299 per month (30+)

Family   $399 per month (under 30) or $449 per month (30+)

(Liberty Health Share: Programs: 3 Program Options, 2013)

For those health cost sharing members who are also members in a Direct Primary Care (DPC) practice, LHS is launching another option called “Liberty Direct” in August 2015 that will reimburse those cost sharing members for the monthly costs of their DPC membership. Many DPC practices charge a very small visit fee (less than a co-pay with insurance), or no visit fee at all to their members, so the combination of a DPC membership with a health cost sharing plan can be a very cost effective way to receive health care and still be in compliance with the law. Zenith Direct Care is a Utah-based DPC group (www.zdirect.care) for those who want to consider the membership pairing idea.

For those who doubt that their cost sharing membership will be accepted as payment for the care they receive, LHS claims a 97% success rate getting care providers to work with them. In general, care providers find it refreshing that the requirements for participation are very simple by contrast to the onerous burden of contract negotiations, credentialing requirements, and claim adjudication required for participation in an insurance network. And claims are paid at generous percentages over Medicare rates – far beyond what most health insurers will pay, with none of the burdens imposed by the typical insurance contract.

LHS (www.libertyhealthshare.org) is not the only health care sharing ministry. Several others are:

www.medi-share.org

www.chministries.org

www.medicalcostsharing.com

These are the four largest HCSM’s, but there are others.  For anyone struggling to cover the costs of Obamacare this is a far less expensive option, particularly if you consider the “shared amounts” comparison to the deductible (an amount that continues to grow) in most health insurance options. Paired with a good DPC provider, members may reduce or even avoid completely the co-pay associated with health insurance. All of this adds up to affordability.

Some will choose health insurance over this model because of the subsidies they receive through the ACA. But with the growing complexity of health insurance and government regulations, some health care providers are moving away from accepting insurance, Medicare, or Medicaid. The irony in a world where all are supposed to be insured is that more may be insured with plans that are ultimately not accepted.

Johnson, H. (2014, October 24). Can’t Afford Obamacare? Consider a Health Care Sharing Ministry Instead. Retrieved from U.S. News & World Report: http://money.usnews.com/money/blogs/my-money/2014/10/24/cant-afford-obamacare-consider-a-health-care-sharing-ministry-instead

Liberty Health Share: Programs: 3 Program Options. (2013). Retrieved from Liberty Health Shares: http://www.libertyhealthshare.org/3-program-options

Liberty Health Share: Programs: Do I Qualify? (2013). Retrieved from Liberty Health Share: https://www.libertyhealthshare.org/do-i-qualify

Worthen, M. (2015, January 31). Onward, Christian Health Care? Retrieved from New York Times: http://www.nytimes.com/2015/02/01/opinion/sunday/onward-christian-health-care.html?_r=0

SOURCE: http://rfhealth.net/2015/07/an-obamacare-loophole/

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