At HSA for America, our ongoing mission is to simplify the process of comparing, choosing, and enrolling in a health insurance plan. There’s no shame in it: We all struggle with the question of how to pick the best health insurance plan. But if you’ve found your way to this blog, then you’re off to a pretty good start. Check our our health insurance quiz below.
Take the Quiz: Which Health Insurance Plan is Best for Me
1.) Does Your Employer Offer a Healthcare Option?
If you said YES: In most cases, employer-sponsored healthcare is more affordable than buying coverage on your own. However, there’s no requirement that you use your company’s health insurance if you find a plan you like better.
If you said NO: Going without health insurance is a significant financial risk. According to Forbes, that risk is as much as $115,000 per year in out of pocket costs. Fortunately, as of 2021, health insurance subsidies have been expanded for almost every income level, making individually-purchased plans more affordable.
2.) Do You Have Ongoing Prescription Needs?
If you said YES: You need to familiarize yourself with the plan’s formulary before you make a decision. While all marketplace plans are required to cover certain preventive care medications at no-cost, the full list of covered medications will vary by plan.
If you said NO: If you don’t have prescription needs, a high-deductible plan paired with a Health Savings Account could be the better financial move.
3.) Do You Already Have a Doctor, Provider, or Hospital You Want to Keep?
If you said YES, Then health sharing may be right for you. Unlike traditional health insurance HMOs and PPOs, health sharing plans typically don’t have narrow provider networks. Though some do negotiate deeper discounts with some providers, you typically are notn’t limited to staying within your network.
And unlike HMOs, health sharing plans usually don’t require you to get a referral from a primary care doctor before you’re allowed to see a specialist.
If you do choose a traditional health insurance HMO or PPO plan, Make sure that the doctor or provider you want to work with is included in your plan’s network. With HMO plans, there’s no coverage for services you get out-of-network.
PPO plans are more flexible with out-of-network coverage, but it is almost always more affordable to stay in-network anyway.
Healthsharing works best if you don’t have serious pre-existing conditions. That’s because unlike traditional health insurance plans, health sharing organizations can and do impose a waiting period on pre-existing conditions.
If you said NO: Even if you don’t currently have a doctor, researching the plan’s provider network can save you a lot of hassle down the line. Consider things like how far the hospital or doctor is from your house, or whether you spend time in multiple states.
4.) Do You Have the Money to Cover a High Deductible?
If you said YES: If you’re confident that you can pay the plan’s deductible, then choosing a high-deductible plan (HDHP) is a good way to cut down on monthly payments. Read our HSA Strategy: How to Maximize the Value of Your Health Savings Account [2024 Guide] to find out more.
If you said NO: For many people, paying more per-month in exchange for a much lower deductible is well worth it.
5.) Do You Feel Like You’ve Been Left Behind by Obamacare?
If you said YES: You could be a good match for Healthcare Cost Sharing. This is a legal and low-cost workaround to traditional health insurance plans. They’re a particularly good match for people who are paying for expensive health insurance that they barely ever use.
If you said NO: You can enroll in a health insurance plan during 2024 Health Insurance Open Enrollment, which begins every year on November 1st. With expanded subsidies that started in 2021, a lot of people should be seeing lower premiums, as well as reduced copays and deductibles.
6.) Are you inside of an open enrollment period?
If you said YES: Then you may sign up for a traditional health insurance plan, such as an Affordable Care Act plan available in your state’s Marketplace. These are the only individual and family health care plans that qualify for a subsidy under the Affordable Care Act.
Note: The general open enrollment for Affordable Care Act (“Obamacare”) plans starts November 1st, and goes through January 15th. If you want coverage to be effective as of January 1st, you must enroll by December 15th, however.
This is normally the only time during the year when all Americans have the right to enroll in a health insurance plan, regardless of pre-existing conditions or medical history.
If you miss open enrollment, however, you may qualify to enroll outside of open enrollment if you have a qualifying life event that entitles you to a special enrollment period.
Examples of qualifying life events include the cancellation of your current health care plan, moving to a new state, the loss of a spouse, the birth or adoption of a child, etc.
If you qualify for a subsidy, you must enroll in an Affordable Care Act plan in order to use the subsidy. Health sharing plans don’t qualify for a subsidy.
However, if you don’t qualify for an ACA subsidy, then health sharing may be a great choice, since health sharing plans are available at just a fraction of the cost of an ACA marketplace plan without a subsidy.
If you said NO, and you don’t qualify for a special enrollment period described above, then you don’t have the ability toign up for an ACA-qualified plan right now..
But you can still enroll in a health sharing plan. Health sharing plans don’t have open enrollment periods. You can enroll in them at any time throughout the year.
The primary advantage to health sharing is that it costs just a fraction of what an unsubsidized Obamacare plan typically costs.
The primary disadvantage is that health sharing plans don’t qualify for an Obamacare subsidy.
They also may impose a waiting period on pre-existing conditions. But you may still enroll and get some financial protection for everything else that’s not a pre-existing condition.
Which is usually far preferable than going without a health plan altogether until next year!
That’s where health sharing can be a terrific option: It’s an affordable way to get meaningful protection for yourself and your family against many potentially catastrophic health care expenses, even outside of open enrollment for Affordable Care Act plans!
You can sign up now. Then re-assess your situation in November, when the next ACA open enrollment period commences.
7.) Is your income too high to qualify for Obamacare subsidies?
If you said YES, then you should consider a health sharing plan. Especially if you don’t have preexisting conditions.
Health sharing plans typically provide significant protection against unexpected and potentially catastrophic health care costs – all at a fraction of the unsubsidized cost of an Affordable Care Act policy.
So if you don’t qualify for a subsidy, or only get a small one because you earned too much money last year, then a health sharing plan may be the way to go: Health sharing may save thousands of dollars per year for a typical family of four.
Note: If you or a member of your family has pre-existing medical conditions, that may affect your decision. That’s because unlike ACA-qualified traditional health insurance plans, health sharing plans may impose a waiting period on pre-existing conditions.
That is, bills related to the treatment of pre-existing conditions may not be shareable for some months or years after you sign up for the health share plan.
So if there are pre-existing conditions, you may want to stick with a traditional health insurance plan, even though it may cost you more in deductibles and premiums – particularly if you don’t qualify for a large subsidy.
If you said NO, then sticking with a traditional Affordable Care Act policy may be best. Health sharing plans are much cheaper than the unsubsidized cost of health insurance. But for lower- and moderate-income households, the presence of an ACA subsidy can change that equation.
Health sharing plans do not qualify for an Affordable Care Act subsidy. And so may cost more out of pocket than an ACA marketplace plan with a subsidy.
Every family’s situation is different, though. Contact one of our Personal Benefit Managers for a free consultation and analysis.
Compare Pricing on the Best Insurance Plans Available
Frequently Asked Questions
How much money does health sharing save?
Plans and individual circumstances vary. But it’s very typical for the monthly cost of a health sharing plan to come in around 40% lower than the premium for an ACA-qualified Marketplace plan without a subsidy.
For example, the average cost for an ACA-qualified plan for a family of four without a subsidy as of 2021 is $1,437, according to research from the Kaiser Family Foundation.
A family health sharing plan covering a family of four can be had for about $800 or less in most cases – leaving money for additional plans such as a direct primary care plan.
Health sharing patients enjoy other benefits, too. For example, they frequently get discounted pricing as cash payers (though you will probably have to ask for this, specifically, or have your health sharing plan negotiate pricing for you).
When is open enrollment for health insurance or health sharing?
Health sharing plans don’t have an open enrollment period. You can join a health sharing plan at any time during the year.
However, health insurance plans do have an open enrollment period. Under the Affordable Care Act (ACA), open enrollment runs every year from November 1st through January 15th.
However, if you want your health insurance to be effective as of the first of the year, you must complete your enrollment by December 7th.
The ACA open enrollment period is the only time during the year when everyone has a guaranteed right to join a health care plan at the best possible rating, regardless of medical history or condition.
During open enrollment, health insurance companies are prohibited by law from turning down applicants or charging higher premiums because of preexisting medical conditions.
If you have a qualifying life event, you may also qualify for a special enrollment period.
This entitles you to enroll outside of the ACA open enrollment period, again without regard to any preexisting conditions.
What qualifying life events make me eligible for a special enrollment period?
Here are some common examples of qualifying life events:
Loss of qualifying coverage
- Decrease in income that makes you newly eligible for savings under a marketplace plan
- Turning 26 and losing coverage under your parents’ plan
- Loss of job or spouse’s loss of job resulting in loss of access to a workplace plan
Change in household size
- Marriage or divorce
- Birth or adoption of a child
- You are a victim of domestic abuse or spousal abandonment and want to enroll yourself and any dependents in a health plan separate from your abuser or abandoner
Relocating
- Moving to a new county or ZIP code
- Moving to the U.S. from a foreign country or U.S. territory
- Moving to or from the place you attended school
- Moving to or from a place of seasonal employment
- Moving to or from a shelter or other transitional housing
Change in eligibility for a subsidy
- You or anyone else in your household becomes newly eligible for a subsidy, or experiences a change in income that changes the amount of subsidy qualified for.
- Becoming newly eligible for help paying for an ACA plan because of naturalization or newly lawfully present in the U.S.
- Release from incarceration.
- You or anyone in your household are eligible for premium tax credits AND have an estimated household income at or below 150% of the Federal Poverty Level
Incapacity
You can show you had an exceptional circumstance that kept you from enrolling in coverage, like being incapacitated, a victim of a natural disaster, or impacted by another type of national or local emergency or disaster during an Open Enrollment Period or another Special Enrollment Period qualifying event.
Access to an HRA
You may be entitled to a special enrollment period if you can show that you have newly gained access to an individual coverage Health Reimbursement Account (HRA), or are newly provided a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA).
This list is not exhaustive. And other restrictions may apply.
What if I’m not sure if I qualify for a special enrollment period?
If you’re in doubt about whether your circumstances qualify you for a special enrollment period, the best thing to do is make an appointment with a Personal Benefits Counselor. We can review your circumstances. If you do qualify, we’ll help you enroll in the best possible health care plan for you.
If you don’t qualify for a special enrollment period, we can help you find an affordable health sharing plan to tide you over until the next open enrollment period. At that point, you can reassess your circumstances. In some cases, you’ll be better off staying in a health sharing plan.
In other cases, such as if you qualify for significant help paying for an ACA plan due to your income, or if you have pre-existing conditions and you want or need them covered as soon as possible, we’ll help you enroll in an ACA plan as soon as you qualify!
Do health sharing plans cover pre-existing conditions?
Unlike Affordable Care Act health insurance plans, health sharing plans may discriminate on the basis of pre-existing conditions.
Each health sharing plan is different. But it’s common for plans to impose a waiting period before bills related to pre-existing conditions become shareable. For example, you may have to be a plan member and consistently contributing for at least 12 or 24 months before your own bills related to your pre-existing condition qualify for sharing.
But if you’re accepted into the plan, you’ll enjoy protection against catastrophic health care costs for unrelated accidents and illnesses.
Some plans impose a waiting period before bills for surgery or cancer treatments become shareable.
Some plans are more welcoming to members with pre-existing conditions than others. And some plans are more willing to take people on with specific pre-existing conditions than others.
If you’re interested in joining a health sharing plan but concerned about pre-existing conditions, the best thing to do is make an appointment with a Personal Benefits Counselor.
We’ll go over your medical history, timeline, medications, and whether your conditions are under control, and help you choose the healthsharing organization that best suits your specific circumstances.
If healthsharing isn’t suitable, we’ll help you choose a health insurance plan that fits your needs and budget. Our PBMs are appointed with all the major insurance companies, including Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthCare, Humana, and many others.
So you can be confident we can help you into the best plan for you and your family, whether it’s a traditional ACA marketplace policy, another individual or family plan not in the ACA marketplace, or an affordable non-insurance alternative such as health sharing.
Do I have to be a Christian to join a health sharing plan?
No.
While most health sharing ministry organizations are faith based, you can join a health sharing plan even if you aren’t a professed Christian, or you don’t attend regular religious services at all.
In most cases, all you need to do is affirm that you agree with the health sharing organization’s statement of belief. Most healthshares have Christian belief statements, but several health sharing ministry organizations have a non-denominational or even secular approach to membership.
There are a few health sharing ministry organizations that do require you to attend services in a mainstream Christian denomination.
There’s also at least one health sharing organization, United Refuah Healthshare, focused on the Jewish community.
How do I sign up for a health sharing plan?
It’s very easy to enroll in a health sharing plan! You can check out plans and prices on our website, and enroll online. If you’d like some assistance, just click here, select your state, and pick an appointment time that works for you!
If you don’t see a suitable time, or you’d just rather pick up the phone, that works, too! Call us at 800-913-0172, let us know what state you’re in, and you’ll be connected directly with one of our Personal Benefits Managers.
Our PBMs are appointed with all the best major health sharing plans in the country, and with all major health insurance carriers (and some excellent smaller regional ones, in many states!) So whether you choose a traditional health insurance plan or a health sharing alternative, we have a solution that fits your needs and budget!
Compare Health Insurance Now with Your Personal Benefits Manager
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