As the deadline approaches to secure health insurance for 2017, some consumers are still scrambling.
While most Americans who don’t receive health insurance via their employer can buy plans through the Affordable Care Act exchange, some find the plans available too costly, especially if they’re not eligible for a subsidy, or they don’t like the limited medical networks many plans offer.
“Part of the issue is that folks have a hard time figuring out which plans to choose and what they’re eligible for,” says Loreen Brown, vice president of product strategy and commercialization for the Lash Group, which helps connect patients with health care resources. “The existing plans are not bad. … But then can you afford the premiums?”
Finding insurance off the ACA leaves you with few options — and some of those are actually more expensive.
[Read: Which Americans Are Shut Out of the Affordable Care Act?]
“Are there a lot of people out there who don’t like the options that they have?” says Alex Tolbert, founder of Bernard Health, a health care consulting and broker firm in Tennessee. “Yes.”
The deadline is Dec. 15 to sign up for ACA insurance that will start Jan. 1. Open enrollment closes for the year on Jan. 31, 2017.
“There has been a lot of confusion and speculation,” says Sam Gibbs, executive director of AgileHealthInsurance.com, a broker for short-term health insurance and dental plans. “The laws are on the books now. The penalties are in place. … People need to have health insurance. Not having health insurance is very, very risky.”
About 84 percent of Americans who use the health care exchange receive a subsidy toward premiums, according to the U.S. Department of Health and Human Services. But those who don’t qualify for a subsidy may find the “affordable” plans less than affordable.
Insurance companies do offer plans outside the ACA — if you can find them. But they may cost as much or more as ACA plans. Since health insurance is regulated by states, options will vary by location, and costs will differ according to your age and where you live.
If you’re priced out of ACA health insurance, here are six alternatives.
Short-Term Insurance Plans
These plans are designed to cover sabbaticals or periods between jobs. But some healthy people are using them for longer periods, by signing up for one short-term plan after another. Gibbs says the average plan costs $103 per month, though the cost is higher for older users. “They were designed to be coverage for gaps when people left their jobs,” he says. “They’re mostly catastrophic-type plans.”
Most plans last six months to a year, and having one does not exempt you from paying the health care tax penalty, since they are not considered qualified plans — though you may be exempt for other reasons. Gibbs’ 21-year-old daughter, for example, paid $49 a month for one of these plans versus $326 on the ACA exchange when she was between jobs.
These plans are medically underwritten, meaning they may reject people with pre-existing conditions. Or, if you get sick while covered by one of these plans, you may not qualify to renew. And many have caps on how much the plan will pay in total. “If you have a chronic illness, this is not a good choice,” Gibbs says.
“Those are good as long as you don’t get sick,” Brown says. “The older you are, the more risky those are.”
[Read: How Affordable Care Act Marketplace Insurance Plans Will Change in 2017.]
Health Care Sharing Ministries
These plans are not technically insurance but are co-ops that started informally in churches, with everyone making a monthly contribution to pay members’ medical expenses. With one of these plans you won’t have to pay a tax penalty, but they aren’t required to meet the same ACA coverage standards.
Health care ministries can reject people with pre-existing conditions, limit coverage or charge some people more. Most require a statement of faith, and for some you must have a letter from a minister to qualify. The plans with the strictest religious qualifications require members to adhere to traditional evangelical Christian beliefs, including abstaining from sex outside marriage. While there is no requirement that the ministry pay all covered health care expenses, members report that costs for serious illnesses have been covered. Some healthy families who can’t afford ACA policies have found these plans a good alternative.
Children’s Health Insurance Program
This program that covers children up to age 19 is administered by the states, so eligibility varies. Costs are usually on a sliding scale. In some states, families at any income level can use the program, but higher-earning families pay more.
“There are a number of states that have pretty generous offerings,” Brown says.
The same navigators that help people sign up for the ACA can enroll children in this program, or you can sign up through your state’s social service agency or marketplace.
Individual Policies
You may be able to buy an individual policy from an insurance company, but the only way to find those policies may be to contact the company directly because most aren’t advertised online. An insurance broker could assist, but with some health insurance companies no longer paying a commission, brokers may not sell all the policies available.
While some of the health insurance companies that are not participating in the marketplace may sell individual plans, these plans are likely to cost as much or more as those available on the marketplace.
“Carriers don’t show all their plans,” Tolbert says. To find out what insurers are operating in your state, Tolbert suggests checking with the state insurance agency, which has to approve the rates.
Business Policies
Entrepreneurs and self-employed people have traditionally bought business policies rather than individual ones. Exactly how many people it takes to constitute a business and whether they can live in the same household varies by state, as do the types of policies available.
Many small businesses have found that it’s more economical for each employee to use the ACA as an individual, but it’s worth checking with a business insurance broker for options. You might find a policy you like that is not offered on the ACA.
[Read: 10 Things to Do When Choosing an Obamacare Health Plan.]
Association and Organization Policies
Since the ACA, fewer organizations have offered group health insurance to members, but it’s worth checking. In some states, including Tennessee and Iowa, the Farm Bureau offers health insurance plans. “The federal government made an effort to standardize things, but there are still wrinkles in local markets,” Tolbert says. “If they’re pretty healthy, they could do better with Tennessee Rural Health.”
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