There are three primary options for Non-ACA Affordable Healthcare Options these are specified benefit limited medical/indemnity plans, association-sponsored health plans and health care sharing ministry plans. All plans have advantages and disadvantages, read on to find which plan suits your needs.


Benefits of Limited Medical/Indemnity Plans

  • These Plans pay a specified dollar benefit for medical services such as hospitalization, surgery, and physician office visits.
  • Premiums can be very affordable
  • Member receives a cash payment upon a qualifying event such as an accident, specific critical illnesses, or hospital admissions as specified in the Plan
  • Applications can be made any time of the year, with no waiting for Open Enrollment
  • Generally, these Plans have pre-negotiated rates with a healthcare provider network

Problems with Limited Medical/Indemnity Plans

  • Benefits are tied to specific incidences, such as an accident, critical illness, doctor visits, or hospital admission, depending on the policy
  • There may be no benefits for general conditions such as diabetes, arthritis, etc.
  • Medical expenses are often capped at a rate much lower than major medical Plans
  • Certain pre-existing conditions may not be covered or only covered twelve months after the effective date


Benefits of Association Health Plans.

  • These Plans are designed for ages 55 to 64 years
  • May enroll at any time during the year
  • Usually, utilize a Health & Welfare Benefit Trust structure that is wrapped under the Association
  • Usually contain several Plans (Bronze through Gold)
  • Utilize nationwide group PPO networks (i.e., Cigna or Blue Cross/ Blue Shield)
  • The Trust administers the various Plans and uses a Third-Party Administrator (TPA) to verify benefits and pay claims on the part of the Trust
  • These Plans are designed for Self-Employed, Independent Contractors, Sole Proprietors, Managing Members of LLCs, Sub-S Shareholders, other Small Business Owners with fewer than five employees, and W2 employees where the company does not provide group coverage

Problems with Association Health Plans

  • Because the Trust administers the Plans, they act as the self-insured entity paying the actual claims
  • The trustee may ask health and pre-existing condition-related questions (underwriting)
  • The trustee may exclude joining the Trust due to adverse health history or pre-existing conditions

This plan is available to Non-Washington residents.


Benefits of Member Health Share Ministry Plans

  • Plans tend to mimic ACA mandates
  • Monthly rates are usually 30% to 50% less than the cost of ACA (Obamacare) Plans
  • Usually, utilize a nationwide PPO network
  • Enroll year-round; no qualifying event is needed

Problems with Member Health Share Ministry Plans

  • Depending on Plan, maximum lifetime benefits may be limited to $1,000,000
  • Limited drug coverage
  • Any pre-existing conditions at the time of enrollment may be excluded or for up to 24 months after enrollment
  • Pregnancy benefits may be excluded or excluded for the first ten months after enrollment