Streamline Health Insurance Claims With Automation Alternatives

Traditional health insurance can be expensive, but there are some lower-cost alternatives. These include cost-sharing programs, short-term insurance, association health plans, health savings accounts, and health discount cards. Cost-sharing programs are often faith-based initiatives where members pool their money to pay their medical bills. Short-term insurance covers emergency situations for those who are uninsured or between jobs. Association health plans are a form of group insurance for small businesses and individuals, which is usually less expensive than insurance offered by the federal government. Health savings accounts are tax-deductible and can be used to pay for qualifying health expenses. Lastly, health discount cards offer discounted rates on services from participating healthcare providers for those paying in cash.

Affordable Care Act Plans

The Affordable Care Act (ACA), also known as "Obamacare", was passed in 2010 and created a Health Insurance Marketplace operated by the U.S. federal government. This is an alternative to auto-checking health insurance, as eligibility for ACA plans varies from state to state and is determined by factors such as personal income, marital status, and number of dependents. All of these factors can affect copays, healthcare costs, and out-of-pocket expenses for the ACA plan chosen.

ACA plans offer several benefits, including coverage of 10 "essential" health benefits, such as:

• Ambulatory patient services
• Pregnancy, maternity, and newborn care
• Mental health and substance abuse disorders
• Rehabilitation services
• Preventative wellness and disease management services

However, it's important to note that dental and vision care for adults are not considered essential health benefits under ACA insurance programs.

To explore ACA plan options, individuals can visit healthcare.gov to register and receive estimates of potential plan prices. This website serves as a central resource for individuals seeking health insurance coverage and provides valuable information about eligibility, benefits, and costs associated with ACA plans.

Association Health Plans

AHPs are particularly beneficial for small employers and self-employed individuals as they can avoid the expensive and limited insurance options within the Affordable Care Act market. AHPs can also reduce the cost of health insurance coverage by allowing smaller employers and individuals to band together. This enables the association to negotiate better rates from healthcare providers and insurers.

AHPs are not sold through government exchanges and are therefore not subject to the Marketplace User Fees paid by insurers distributing their health plans on government exchanges. This further reduces costs for those using AHPs.

AHPs are also not constrained by all the benefit mandates of government exchange insurance, meaning they can design benefits around the needs of their employees rather than the one-size-fits-all approach of the Affordable Care Act market. AHPs do, however, have a variety of benefit requirements that exist at both the federal and state level.

AHPs can also consider 'self-funding', where the association manages the health benefits rather than paying a third-party insurance company to perform that function. This has the potential to lower administration costs and eliminate the profit paid to an insurance company.

AHPs are a good option for those who are unemployed, denied private insurance, or employed by a small business that doesn’t offer health insurance.

Medical Cost-Sharing Programs

These programs are run by non-profits, and members pay a monthly fee into a group fund. When a member of the group receives a bill for medical services, the cost-sharing fund pays some or all of the cost.

The monthly charges for these programs are usually lower than health insurance, and they can often get lower prices on treatment as they pay healthcare providers directly. However, they rarely cover pre-existing conditions and do not offer supplemental coverage for preventative health care services.

Some popular medical cost-sharing programs include:

• Liberty Healthshare
• Christian Healthcare Ministries
• Samaritan Ministries
• Medi-Share
• Altrua Healthshare
• AlieraCare
• Sedera

Short-Term Insurance Coverage

Short-term health insurance is a type of health plan that can provide temporary medical coverage in certain situations. It is a good option for people who are between health plans, outside of enrollment periods, or need coverage in case of an emergency. These plans are typically much more affordable than major medical plans, with monthly costs as low as $55 compared to at least $225 for major medical coverage. However, short-term plans have significantly higher deductibles and do not cover pre-existing conditions.

Short-term health insurance is designed for people who are in a transitional period in their lives and need limited health coverage. It is a good option for those who are healthy and do not generally require health services or have regular prescription needs. It can also be useful when major medical plans are unaffordable or unavailable.

Short-term health insurance coverage varies based on the plan chosen. Most plans cover emergency hospital visits, certain prescription medications, and some doctor's appointments that are not related to pre-existing conditions. However, most temporary health insurance plans do not cover treatment for pre-existing conditions, maternity care, and mental health, among other items. Short-term plans do not guarantee the essential health benefits and protections of Affordable Care Act (ACA) plans.

To qualify for short-term health insurance, individuals usually need to fill out a health questionnaire and disclose any pre-existing conditions, which can disqualify them from obtaining coverage. Some insurance companies may also disqualify applicants who are currently insured under another policy, are overweight, have been diagnosed with HIV or AIDS, qualify for Medicaid, or are not US citizens.

Short-term health insurance can be a good option for those who need temporary coverage. However, it is important to carefully consider the limitations of these plans and ensure that they meet your specific needs.

Qualified High Deductible Health Plan with Health Savings Account

A Qualified High Deductible Health Plan with Health Savings Account (HSA) is a health plan product that combines a High Deductible Health Plan (HDHP) with a Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA). This type of plan provides insurance coverage and a tax-advantaged way to save for future medical expenses.

How it works

The HDHP/HSA or HRA gives you greater flexibility and discretion over how you use your healthcare dollars, as the funds can be used to cover qualified medical expenses that are not covered by your health plan.

Who is eligible?

To be eligible for an HSA, you must be enrolled in a High Deductible Health Plan, have no other insurance coverage other than those specifically allowed, and not be claimed as a dependent on someone else's tax return.

How it saves you money

An HSA plan may save you money through lower premiums, tax savings, and money deposited in your account, which can be used to pay your deductible and other out-of-pocket medical expenses in the current year or in the future.

How it is paid out

It depends on the arrangements your health plan has with its providers. Usually, you can access your account in one of three ways: debit card, check, or withdrawal request.

Tax benefits

There are three-fold tax benefits:

• Your additional voluntary contributions are pre-tax or tax-deductible.
• Interest earned is tax-free.
• HSA distributions are tax-free if they are used to pay for qualified medical expenses.

Downsides

If you use your HSA for non-medical withdrawals prior to age 65, the amount will be included in your gross income, and you will pay a 20% penalty.

Frequently asked questions