The CARE+ Plan
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If you are not a business owner or self-employed, the CARE+ plan may be a great match for you.
This is a budget-friendly healthsharing solution designed for individuals who are statutory employees, rather than business owners or independent contractors.
The CARE+ plan is closely based on our popular HSA Secure plan. It provides all the same protections against medical emergencies and catastrophic medical expenses as that plan but at a slightly lower monthly cost.
However, unlike the HSA Secure plan, the CARE+ plan does not include preventative care. At this time, the CARE+ plan is also not compatible with health savings accounts (HSAs).
The CARE+ Plan At a Glance
Designed for W2 employees or people not working
One of the lowest cost healthsharing plans available
Great protection for major medical expenses
Does not include wellness visits or preventative care
Mental health/counseling benefits available
Free, unlimited telehealth visits
Note for Self-employed, Business Owners, and Independent Contractors
HSA offers multiple tax benefits. If you’re self-employed, a small business owner, or an independent contractor, we suggest you consider the HSA Secure plan, which qualifies you to make pretax contributions to an HSA, and includes a range of preventative benefits.
The CARE+ Plan vs. Health Insurance
While the CARE+ plan and health insurance both help protect individuals and families against unexpected high healthcare costs, there are important differences between them.
The CARE+ plan is not health insurance. Instead, it’s a health sharing plan , a non-profit association of like-minded individuals who voluntarily agree to share one another’s medical bills.
Since it’s not health insurance, the CARE+ plan administrators have much more freedom to design the plan to be more affordable.
Traditional health insurance plans must by law provide a good deal of coverage that many people don’t want or need. Health insurance companies must also accept very poor health risks and cover preexisting conditions right away, while the CARE+ plan limits pre-existing condition costs (see below).
Health insurance companies must also deal with much more regulation and oversight, which increases cost.
As a result, individuals or families can enroll in the CARE+ plan at a fraction of the cost of an unsubsidized ACA-qualified traditional health insurance policy.
Note: Unlike the HSA Secure plan, the CARE+ Plan does NOT include preventative care or wellness visits. Members should consider joining a Direct Primary Care membership to cover these and other routine medical expenses.
To learn more about combining a healthsharing plan similar to the CARE+ with a Direct Primary Care (DPC) membership, read the link above, or click here to speak with an expert Personal Benefits Manager.
Traditional Health Insurance vs. Healthsharing At a Glance
|Sold by for-profit insurance corporations
|Non–profit 501(c)(3) organizations
|Regulated by Affordable Care Act, state insurance commissioners
|Exempted from Affordable Care Act, Not regulated by insurance commissioners
|Lower-income individuals may qualify for subsidies under the ACA
|No ACA subsidies
|Average unsubsidized cost is $1200+ for a “Silver” plan for a family of four
|Typically 40% to 50% less expensive per month than traditional unsubsidized health insurance. Around $600/month +/- for a family of four
|Premiums are tax deductible
|Contributions are not tax deductible for individuals. May be deductible for businesses offering healthsharing memberships as a compensation expense
|Many healthsharing organizations are faith-based
|Must cover pre-existing conditions right away
|May impose a waiting period before costs related to treatment of pre-existing conditions are shareable
|Must sign up during open enrollment period (Nov. 1 - Jan. 15th in most states) or special enrollment periods due to life events
|No open enrollment, members can enroll at any time of the year
Who Should Consider the CARE+ Healthsharing Plan?
The CARE+ healthsharing plan may be a good fit if:
- You are a W-2 statutory employee rather than a small business owner or self-employed independent contractor;
- You are an early retiree, a stay-at-home parent, or otherwise are not currently working
- You want or need a plan to help you pay for major medical events, such as hospitalizations, ER visits, or critical illnesses
- Your employer does not provide you with a group medical plan of their own
- You want a plan that costs much less out of pocket each month than a traditional health insurance plan
- You can afford to pay for routine or preventive care
- You don’t have significant pre-existing conditions you need covered in the first 1-3 years of plan membership.
Advantages of the CARE+ Plan
Low monthly costs
The CARE+ plan has significantly lower costs per month than an unsubsidized comparable traditional health insurance policy.
As such, it’s a great match for the millions of Americans who don’t qualify for an Obamacare premium tax subsidy, or who only get a limited subsidy.
It’s very common for unsubsidized plan members to save 30 to 50 percent each month compared to the cost of an ACA-qualified insurance policy.
No height-weight restrictions or “rate-ups”
CARE+ accepts members regardless of their height and weight or body mass index.
You will not be charged extra because you are overweight or obese. However, if you have certain comorbidities highly correlated with being overweight, these could be pre-existing conditions and cost sharing may be limited or subject to a waiting period.
No cap on potential sharing benefits
There is no maximum sharing amount for most members.
Potential sharing of catastrophic medical bills is unlimited.
(Exception: sharing for costs related to pre-existing conditions may be subject to a waiting period. Tobacco users over age 50 have a $50,000 cap on cost sharing for certain conditions. See the section on smokers below).
When you enroll in the CARE+ plan, you’ll have an experienced healthcare concierge available to you. This concierge can help you navigate the medical system, suggest or recommend quality care providers, and help you find the best pricing possible.
When you enroll, you should schedule a welcome call with your concierge. This will help you get acquainted with how your plan works and how to get the most possible out of your CARE+ benefits.
Disadvantages of the CARE+ Plan
- Not HSA-compatible
- Does not cover wellness visits or preventative care
- Does not cover mammograms or colonoscopies
CARE+ Plan Tiers
The CARE+ plan has three membership tiers, which are based on the initial unshared amount (IUA) you select.
This is the amount you agree to be responsible for out of pocket each year or for each medical need before the plan will begin sharing your medical costs.
The IUA is also commonly called the member responsibility.
With the CARE+ plan, you can choose from among three member responsibility amounts:
The higher your member responsibility amount, the lower your regular monthly required contribution will be.
Note: You must pay your IUA to the care provider within six months of the date of service or bills may become ineligible for sharing.
Note that HSA Secure defines their IUAs as per medical need, not per year. You could potentially pay more than one IUA for multiple different medical conditions within the same year.
But once you meet an IUA for a given medical need or condition, you won’t have to pay your IUA again until you’ve been symptom free for at least 12 months.
But you won’t have to pay more than three IUAs in any rolling 12 month period. After you’ve paid three IUAs within any 12-month period, any additional medical needs over $500 will be 100% shareable by the plan, with no further member responsibility payments necessary from you.
Using Your CARE+ Benefits
The CARE+ plan is not insurance. When you are getting care as a CARE+ plan member, you should tell your doctor or other provider that you are a cash-pay patient.
Ask for the provider’s “best cash price,” which is usually anywhere from 10% to 80% off the usual insurance-billed price.
This helps stretch your IUA dollars, and helps HSA Secure keep CARE+ member contributions affordable.
Pay only your IUA amount up front. This should only be $1,000, $2,500, or $5,000 per incident, with a max of three incidents per year per household.
When you present yourself for care, you should set up a payment plan, if needed, with your provider as a cash pay patient. You should also obtain itemized receipts and bills that you can use to request reimbursement or payments from your plan.
When you or your doctor’s office sends invoices to the CARE+ plan for payment, the plan will subtract your IUA from the bill, and if the bill is eligible for sharing, they will generally pay the providers directly.
Emergency care is shareable, subject to your IUA amount. In the event of a true medical emergency, you should go to the nearest ER. Tell the finance rep at the ER department that you’re a cash payer, and ask for their best cash price.
Pay the IUA due, or arrange a payment plan as necessary. Then submit the entire bill to the CARE+ plan for sharing.
How to Submit a Sharing Request
If you have a medical need, you can submit the request via HSA Secure’s online portal. If you have questions, you can contact the HSA Secure concierge for assistance.
You should submit your sharing requests as soon as possible.
Most non-emergency medical needs require pre-authorization.
A Great Choice for Maternity Benefits
TheCare+ offers some of the best maternity benefits of all healthsharing organizations in the industry.
For pregnancies that begin at least 60 days after your effective membership date, all pregnancy and postpartum care for both mother and child are fully shareable, subject to a $1,000 IUA for the mother, and a $1,000 IUA for the baby.
Fast, Free Telehealth Access
For minor medical needs and where an in-person office visit isn’t necessary, all CARE+ plan members enjoy free unlimited telephone or video visits with board-certified primary care physicians, pediatricians, and women’s healthcare physicians via CirrusMD, a leading telemedicine provider.
There is zero co-pay or additional cost for this service.
Plan members can use their telehealth benefit any time, 24 hours per day, 365 days a year.
On average, it takes just 60 seconds to connect with a doctor via CirrusMD.
A Good Choice for Smokers
The Care+ is one of the few healthsharing plans that accepts current tobacco users.
Tobacco-using members have to contribute an additional $50 per month, over and above their regular monthly sharing amount.
If you’re a tobacco user and over age 50, some sharing provisions under the CARE+ plan will be restricted. Cost sharing for cancer, stroke, heart conditions, and pulmonary diseases will be limited to $50,000 for smokers and other tobacco users over age 50.
CARE+ shares most costs related to ER visits.
The first ER visit for a medical condition is treated as a normal need request. However, each additional visit related to the same condition requires the member to take on a personal responsibility of $500 in addition to the member’s IUA.
If you have non-emergency needs, you should use the Telehealth benefit, a doctor’s office visit, or a nearby urgent care facility, rather than use a hospital ER. You can contact the 24 hour nurse’s line if you aren’t sure which level of care will be most appropriate.
However, do not delay or avoid going to the ER if there is a reasonable fear of death or permanent disability if care is delayed.
A prescription drug discount plan is also available.
Members can sign up for this benefit for an additional $19.95 per month. This may be cost effective for members who take multiple medications. For those households just taking one or two prescription medications, it’s usually more efficient to pay out of pocket directly, and use a discount plan like one of these prescription discount cards.
The Care+ Health Concierge can help you find the very best pricing available out of all options (including international mail order pharmacies).
A Secular Healthsharing Plan
Unlike many other health sharing plans, the CARE+ plan does not have a religious component. Anyone can join an HSA Secure plan, regardless of religious belief.
Lots of Providers to Choose From
Many HMOs and PPOs have very narrow, limited care networks. They will only pay full benefits for non-emergency care if you use one of the doctors, clinics, or hospitals in their networks.
The CARE+ plan uses the PHCS Network, which includes hundreds of thousands of medical providers nationwide.
But this is just for your convenience. They also allow you to see ANY doctor of your choice, with no additional fees or charges.
No Open Enrollment Periods
Unlike ACA-qualified health insurance plans, healthsharing plans like the CARE+ plan don’t have limited open enrollment periods. You can sign up for the CARE+ plan at any time.
Note: You must enroll by the 20th of the month to get an effective date as of the 1st of the following month.
Costs related to treating pre-existing conditions are not typically shareable right away. If your medical record shows you were treated for, symptomatic for, or taking medications for a pre-existing condition within 24 months before signing up with the CARE+ plan, a waiting period will apply before the plan will share costs for those conditions..
- For the first year after your membership effective date, costs related to pre-existing conditions are not shareable at all.
- For year two, cost sharing for preexisting conditions per need request is limited to $25,000.
- For year three, sharing is limited to $50,000 per need request.
- For year four and beyond, cost sharing for pre-existing conditions is limited to $125,000 per need request.
If you have received treatment or experienced symptoms of any medical condition within the 24 months previous to your enrollment, the treatment costs for these conditions will be limited for the first four years of membership.
Exceptions: High blood pressure, high cholesterol, and diabetes (types 1 and 2) will not be considered pre-membership medical conditions as long as the member has not been hospitalized for the condition in the twelve months prior to enrollment and is able to control it through medication or diet.
Mental Health Benefits
The CARE+ plan includes free mental health counseling via MSEAP.com.
Benefits include live 24/7 support for all household members. Meetings can be via telephone or on-screen, or via an online chat service.
Members can use this benefit for counseling, life coaching, stress management, assessments, elder care and elder law consultation, and relationship counseling.
The plan includes up to 12 sessions annually per individual in the household (six visits in California, limited to three visits every six months).
How To Enroll in the CARE+ Plan
It’s very easy to enroll in the CARE+ plan. The process takes just minutes.
Option 1: You can call one of HSA for America’s experienced Personal Benefits Advisors. We’ll give you individualized, personal attention, answer all your questions, and walk you through the entire process over the phone. Just click here to schedule an appointment, or call 800-913-0172.
Option 2: You can enroll yourself and your family online. Click here, and follow the instructions:
- On the first page, enter your name and date of birth.
- Next, Below your name and DOB fields, you’ll see an option to add dependents. Click the “add spouse” or “add children” buttons on the screen and add their names and dates of birth as appropriate.
- Scroll down to the bottom of the page and click “UPDATE.”
- Select your desired IUA from the drop-down menu. The higher your IUA, the lower your monthly pricing. You’ll be able to see the different monthly costs just by clicking each of the three options. Select the one you want, and click “continue.”
- On the next page, fill in your address, contact, and Social Security number information. To complete the form for all your dependents, click the “pencil” icon next to each name. After you’re done, click “Save dependent” and repeat the process until you have entered all your dependents on the plan.
- Scroll down and review the CARE+ plan’s Statement of Principles. Click “Yes” or “No” on each one as appropriate.
- Review the Health History section. Make sure you understand the CARE+ plan limitations on sharing for pre-existing conditions, pregnancies, and other exclusions. Click “Yes” or “No” on each paragraph as appropriate.
- Select your payment method. You can pay by bank ACH draft or by major credit or debit card.
- Check the “I’m not a robot.” box.
- Click and drag your mouse or touchpad to digitally sign the document.
- Type out your name in the box below.
- Click “Submit.”
- Check for error messages. If you skipped an entry, you’ll be prompted to go back and fix the error.
- Confirm your application went through.
Tip: If you enroll by the 20th of the month, your membership will be effective as of the 1st of the following month. If you apply after the 20th, your membership will be effective the first day of the month after that.
Once you’re enrolled, you should schedule a 30-minute orientation phone call with the Care+ Health concierge. Make sure to take advantage of this orientation opportunity, as it can help prevent a lot of confusion and help keep the process as smooth and seamless as possible.
You’ll also be hearing from us. HSA for America is here to be your resource and advocate for as long as you are a member of the Care+ plan.
Frequently Asked Questions
Once enrolled, can I change my Initial Unshareable Amount?
Yes. Members can change their IUAs once per year. However, if you lower your IUA, the change will be subject to a 60-day waiting period for illnesses. Your IUA for accidents will be lowered right away.
Does CARE+ cover hearing benefits?
Audiological treatment to correct hearing loss is shareable.
How soon do I need to submit supporting documentation if I have a sharing request?
You should submit physician and hospital invoices and other supporting documents to the CARE+ plan as soon as possible. Medical needs will not be shareable if you do not submit the required documentation within six months.
Are cataracts a pre-existing condition?
Yes, cataracts are considered a pre-existing condition. Cataract surgery costs are shareable, but subject to a waiting period of one year.
Each eye surgery will be considered a separate medical need request and subject to a separate IUA.
Are Chiropractic visits covered?
There are two kinds of circumstances that may apply to chiropractic care.
If the chiropractic services are related to the treatment of a specific diagnosed disease or musculoskeletal injury, then CARE+ will share the cost of up to 25 office visits per need request.
All other chiropractic treatments not related to treating a diagnosed injury or disease will be treated as alternative medical therapies, and subject to the extra limitations described above.
Does the CARE+ plan share costs for alternative medical treatments?
Yes, subject to some caveats.
Under the CARE+ plan, most costs for alternative medicine treatments are shareable, provided they are preauthorized, and meet the additional sharing criteria described below.
For an alternative treatment or therapy to be shareable, it must be considered safe and effective by CARE+ administrators. When requesting CARE+ to share the cost of alternative medical treatments, you should be prepared to demonstrate the proposed value of the treatment.
You’ll also need to provide an explanation of why the alternative treatment was selected, and your physician’s notes on your current condition. The plan may be able to help you obtain these notes.
You will also need to provide the estimated cost of the proposed alternative therapy.
You should always ask your provider for their best cash price before submitting the request.
CARE+ considers alternative medical treatment plans on an individual, case-by-case basis. The plan may impose caps on the number of visits or total shareable cost, depending on the service.
Once an alternative therapy is approved, the plan may limit further sharing if you decide to return to traditional care methods.
If you decide to pursue an alternative therapy or course of treatment, CARE+ is there to help. The Plan has a contract with Tivity Health to provide members with a network of alternative health doctors that provides discounts of 10% to 40%.
Tivity Health also provides discounts on dental, hearing, weight loss, pain management, yoga, tai chi, and other exercise therapies, acupuncture, chiropractors, and massage.
Contact your concierge for more information and to preauthorize alternative medical treatment costs.
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Disclaimer: All information on this website is relayed to the best of the Company's ability, but does not guarantee accuracy. Information may be out of date. The content provided on this site is intended for informational purposes only and does not guarantee price or coverage. This site is not intended as, and does not constitute, accounting, legal, tax, and/or other professional advice. Determination of actual price is subject to Carriers.