Affordable Care Act (ACA) plans are designed to make health insurance affordable and accessible for people who are not eligible to receive health coverage through other means. However, if you're seeking to purchase a plan outside of the ACA marketplace to help cover out-of-pocket costs associated with receiving health care services, your options are plentiful. You can choose from short-term coverage, health shares, and hospital indemnity. You could also consider critical illness or accident plans to help supplement your needs. Whether you need something while you await open enrollment, have retired early and aren't yet eligible for Medicare, don't qualify for subsidies, are self-employed, or are simply seeking an alternative to the traditional options, you can find benefits through these other avenues.
With more than 30 years experience helping customers find and compare insurance policies, you can rest assured we're here for the long haul. Our dedicated team of expert Advisors is standing by, ready to help you get the protection you need throughout the many chapters of life.
Let's narrow down your options
Is it open enrollment, or do you have a circumstance for a special enrollment?
Are you open to faith-based health shares that offer broad health care benefits?
Do you need long-term coverage?
This is the most comprehensive health insurance you can buy.
In Health Share membership organizations, members share each others' health care costs. They typically reimburse for a broader range of health care than other alternative options.
These plans typically have broad PPO networks offering access to many providers. They can be purchased for a specified period of time.
These plans available year-round and are generally permanent. They provide reimbursement specified healthcare costs.
Short-term health insurance
If you find yourself without insurance but do not qualify for a special enrollment period and need coverage only for a limited time, a short-term health insurance plan may be right for you. Keep in mind that short-term health insurance plans do not satisfy the requirements for minimum essential coverage (MEC) set forth by the Affordable Care Act.
How does short-term health insurance work?
You can generally purchase a short-term health insurance plan to bridge a gap in your coverage for up to four months within a twelve-month period. They offer coverage options that are similar to other traditional health plans, each with its own exclusions and benefits, which can vary from state-to-state. Pre-existing conditions are typically excluded from the plan, making it best for individuals who don't require health maintenance.
Where can I use a short-term health insurance plan?
Like traditional coverage, your short-term health insurance plan is typically subject to a network. To receive coverage for your services, you must choose providers who participate in the network and can accept payment. One advantage of short-term plans is that they typically have larger networks than ACA plans do, since many of them offer Preferred Provider Organization (PPO) networks, while many ACA plans offer a narrower network such as a Health Maintenance Organization (HMO) or Point of Service (POS) network.
What are the costs of a short-term health insurance plan?
You will be required to pay a monthly premium for your plan, though you may receive a discount if you choose to pay for the entire premium cost upfront. Additionally, your coverage will be subject to copayments, coinsurance, and a deductible based on your chosen plan. Short-term plans are typically much more affordable than un-subsidized ACA plans, mainly due to the fact that they are underwritten and only accept individuals that are healthy at the time of application.
How can I enroll in a short-term health insurance plan?
You can apply for a short-term plan any time of year, as there is no open enrollment period. Many will take effect within a day or so of your purchase and you can begin utilizing the benefits immediately. Your InsureMe Advisor can assist you in choosing the best short-term plan for your needs.
Health sharing organizations (health shares)
Health shares are an affordable alternative to traditional health insurance plans.Health shares are not insurance and the companies (typically non-profit organizations) that provide them are not insurance companies. Health shares do not provide MEC, but for those that are recognized by the Centers for Medicare & Medicaid Services ("CMS"), they (and their members) are generally exempt from any applicable tax penalty.
How do health sharing organizations work?
Unlike insurance companies, which collect a monthly payment and keep money in reserve to cover your health care expenses, health shares are membership organizations where each member's dues are typically pooled to share in each other's eligible health care expenses. The idea is that in sharing health care costs, there is enough to reimburse the costs for those who require medical services. This typically occurs through a process of exchanging monthly shares. The monthly membership dues are pre-determined at an amount deemed sufficient to cover all member's expected eligible health care costs, based on previous experience of the health share membership.
Health shares customize their plans and benefits. With some plans, you'll receive additional benefits such as telehealth, behavioral telehealth, dental benefits, vision benefits, assistance with adoption fees, and benefits for burial expenses. Some even include provisions for pre-existing conditions.
Something to keep in mind is that health shares originally began as faith-based programs. This means your plan may be subject to coverage exclusions you wouldn't encounter in a traditional health insurance plan. Birth control, treatment for sexually transmitted diseases acquired during extramarital relations, abortion services, and injuries related to certain dangerous behaviors may not be eligible for sharing. Additionally, depending on the health share, applicants may be denied benefits if they are tobacco or alcohol users.
Where can I use a health share plan?
Most health shares allow you to use the doctor of your choice anywhere in the United States, so you are typically not bound by networks. However, you will be responsible for requesting to be billed the "cash" value of your services. This cost is often lower than what would be billed to health insurance companies but may be slightly higher than the Medicare cost. Your health share will then coordinate payment for your service, either directly to the provider, or to reimburse you depending on the health share. The reimbursement benefits of health shares are not quite as extensive as coverage under ACA insurance plans, but can be more considerable than other alternatives.
What are the costs of a health share?
The monthly cost for a Health Care Sharing Ministry plan is often significantly lower than a health insurance plan. For instance, a family of 5 can enroll for as little as $365 monthly. You will be subject to a non-shared or household portion, which will vary depending on your plan choice.
You can also expect to pay an application fee that is typically under $100 and will be responsible for any health care costs not shared under your plan.
How can I enroll in a health share?
One benefit of using a health share is that you won't have to wait for an open enrollment period to get started. With the help of your InsureMe Advisor, you can enroll at any time throughout the year.
Health Care Sharing Ministries began as a faith-based alternative to traditional health insurance. This means they typically will require you to sign a statement of faith and submit a membership application. Your InsureMe Advisor can assist you in this process, and with any other questions you may have.
Hospital indemnity insurance
Hospital indemnity insurance plans are designed to supplement other health coverage. Some of them are pretty benefit rich, and do offer large coverage amounts for your health care needs. They offer coverage for hospital stays, surgeries, doctor visits, prescriptions, and other items, on a fixed benefit basis, scheduled based on the type and severity of the care. Hospital indemnity plans do not meet the Minimum Essential Coverage (MEC) requirements under the Affordable Care Act. They generally should not be used to replace your primary health coverage.
How does hospital indemnity insurance work?
Your Hospital Indemnity Insurance plan will provide coverage for hospitalizations, surgeries, emergency room visits, ambulance services, doctor visits, and other items on a scheduled benefit basis. When utilized, the plan will provide cash payments directly to you or to the provider, depending on the plan. You're also free to use the payments to cover costs such as childcare, transportation, utilities, and cost of living expenses experienced during your stay. Because of this, these plans are often used to supplement primary health coverage.
Where can I use a hospital indemnity insurance plan?
Your Hospital Indemnity Insurance plan can pay you directly. It is not generally subject to network rules, and you may utilize the plan with any provider or hospital. However, some plans provide discounts for receiving services from within the plan's network (if one is offered).
What are the costs of a hospital indemnity plan?
You will pay a monthly premium for your Hospital Indemnity plan. The premium will vary based on your chosen plan, and personal factors such as age, location, and tobacco use. Your InsureMe Advisor can assist you in determining how much a plan will cost.
How can I enroll in a hospital indemnity plan?
You do not need to wait for open enrollment to purchase a Hospital Indemnity plan. Contact your InsureMe Advisor to compare and shop for plans.
Critical illness insurance
Critical Illness Insurance plans are designed to supplement other health coverage. They are not intended to replace your primary health coverage. They offer benefits in the form of cash payments after you experience a covered critical illness such as a heart attack, cancer, stroke, kidney failure, organ transplant, or other life-changing illnesses. Nearly two thirds of bankruptcies occur due to medical reasons.1 This isn't all that surprising if you've had friends or family with serious medical issues; however, what is surprising is that about 80% of those individuals did in fact have health insurance.2 Critical Illness insurance is designed to solve this problem by paying you a large lump sum, ranging from $2,500 to $100,000 or more, when you are diagnosed with a covered critical illness.
Critical Illness insurance does not satisfy the MEC requirements set forth by the ACA and should only be used as supplemental coverage to a primary health insurance plan.
How does critical illness insurance work?
Critical Illness works similarly to life insurance (in fact sometimes it is embedded as part of certain life insurance plans) except instead of paying out the benefit upon a death, it pays it on the diagnosis of a covered critical illness. This lump sum payout is not meant to cover your health care needs directly, it's instead intended to cover all of your other expenses such as your deductible, co-insurance, procedures or benefits not covered by health insurance, lost wages, living expenses, child care, or other needed expenses. This can help by allowing you to focus on your medical care while dealing with a serious life threatening condition, instead of other financial obligations.
Where can I use critical illness insurance?
Critical illness Insurance coverage is not network specific. The benefit payments will come directly to you. You can utilize the facility and physician of your choice, keeping your medical insurance plan and its network restrictions in mind.
What are the costs of a critical illness insurance plan?
When you purchase a Critical Illness Insurance plan, you'll pay a monthly premium based on your chosen plan and details such as your age, location, and tobacco use.
How can I enroll in a critical illness insurance plan?
You do not need to wait for open enrollment to purchase your Critical Illness Insurance plan. When you're ready, contact your InsureMe Advisor to compare options and choose the best plan for your needs.
Accident insurance
Accident coverage is designed to provide additional assistance after an accident in the form of cash payments to cover expenses that your medical insurance plan doesn't. It is not intended to replace your primary health coverage. Accident Insurance does not satisfy MEC requirements. Speak to your InsureMe Advisor to ensure you stay compliant with the ACA.
Accident insurance does not satisfy the MEC requirements set forth by the ACA and should only be used as supplemental coverage to a primary health insurance plan.
How does accident insurance work?
Your Accident Insurance plan will provide cash payments to you after you experience an accident. In some instances, it can overlap with other supplemental coverage, such as Hospital Indemnity and Critical Illness plans, providing payments during hospital stays and critical illnesses related to your accident. You are free to use the cash payments for non-covered medical expenses, personal expenses, household expenses, and lost wages. Many clients will match the accident plan benefits to their health insurance plan's deductible or out-of-pocket maximum, which can allow them to have no out-of-pocket medical costs in the case of an unexpected accident.
Where can I use accident insurance?
Accident Insurance payments will be made directly to you, meaning there are no network-specific qualifications to meet. You'll want to keep your medical insurance plan's network rules in mind when choosing your doctor and hospital.
What are the costs of an accident insurance plan?
You'll pay a monthly premium for your Accident Insurance plan, which is determined by your chosen plan options.
How can I enroll in an accident insurance plan?
You do not need to wait for open enrollment to purchase an Accident Insurance plan. You can enroll at any time. Your plan will take effect shortly after your enrollment. Your InsureMe Advisor can help you choose the right accident benefit for your needs, and enroll into coverage.
Choosing the right alternative plan
Choosing the right insurance plan or combination of plans starts by determining your needs. Your benefit requirements, the length of time you'll need plan, and whether you already have an existing plan all play a role in choosing the best plan.
If you are seeking a plan that will cover your health care needs similarly to your traditional plan, but only for a short time, a Short-Term Health Insurance plan is probably best. However, if you need an alternative to a traditional plan that is long-lasting and exempt from the requirements of the ACA, a Health Share membership may be the best option.
If you already have traditional coverage but want to ensure you'll have enough assistance during a catastrophic event, a supplemental plan such as Critical Illness or Accident coverage may be most appropriate.
Whenever weighing your decision, seek the advice of your InsureMe Advisor to ensure that you're meeting the ACA requirements for Minimum Essential Coverage and choosing the right plan for your needs.