Catastrophic health insurance?

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CrazyRun
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Joined: Thu Sep 14, 2023 1:53 pm

Catastrophic health insurance?

Post by CrazyRun »

Does anyone know if any insurers offer extreme high deductible health insurance? Something like: Insured covers all medical expenses under $30k-$50k, insurance company covers all medical expenses over $30k-$50k per claim.

I am already very familiar with ACA “High Deductible” plans, but am looking something with much higher deductibles. Thanks
furwut
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Re: Catastrophic health insurance?

Post by furwut »

I think for that you’d have to look for a non-health insurance “health insurance plan”.
All newly purchased individual and small group health insurance policies are required to be ACA-compliant
https://www.healthinsurance.org/glossar ... %2C%202014.
For 2023, your out-of-pocket maximum can be no more than $9,100 for an individual plan and $18,200 for a family plan before marketplace subsidies.
https://obamacarefacts.com/out-of-pocke ... -for-2023/
pizzy
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Re: Catastrophic health insurance?

Post by pizzy »

CrazyRun wrote: Thu Sep 14, 2023 1:57 pm Does anyone know if any insurers offer extreme high deductible health insurance? Something like: Insured covers all medical expenses under $30k-$50k, insurance company covers all medical expenses over $30k-$50k per claim.

I am already very familiar with ACA “High Deductible” plans, but am looking something with much higher deductibles. Thanks
Per claim won’t work the way you want it to.

Per incident makes more sense for something like this.

One incident could be 20+ claims.
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quantAndHold
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Re: Catastrophic health insurance?

Post by quantAndHold »

If you’re under 30, or can get a hardship exemption, you can get a catastrophic plan. No idea what the cost would be, since I don’t qualify.

Otherwise, just get the cheapest Bronze plan you can get.
smooth_rough
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Re: Catastrophic health insurance?

Post by smooth_rough »

Check out US Health Group.

They sell Unitedhealthcare policies with high deductible, up to $20k.

You can't buy yourself through website. You must phone them and jump through some hoops.

It might require screening for pre-existing conditions. They don't accept everybody.

https://www.ushealthgroup.com/
Last edited by smooth_rough on Sun Sep 17, 2023 3:31 pm, edited 2 times in total.
crefwatch
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Re: Catastrophic health insurance?

Post by crefwatch »

You didn't ask for comments on your consumer strategy, so I'll refrain. But the warning about multiple claims for one illness is quite appropriate. You can get five or more bills just for an outpatient surgery at a hospital. The "business" is set up to collect as much insurance as possible. As you know, it's not a "consumer friendly" transaction, even for elective surgery booked well in advance. They tell you things like "We can't control which anesthesiologist is rotated to your treatment that day." So they don't know which practice he/she is employed by.

As you may know, many Emergency Rooms are contracted out, so your plan to protect against catastrophes only may be faulty. Don't assume you can beat the system.
smooth_rough
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Re: Catastrophic health insurance?

Post by smooth_rough »

crefwatch wrote: Sat Sep 16, 2023 10:46 am You didn't ask for comments on your consumer strategy, so I'll refrain. But the warning about multiple claims for one illness is quite appropriate. You can get five or more bills just for an outpatient surgery at a hospital. The "business" is set up to collect as much insurance as possible. As you know, it's not a "consumer friendly" transaction, even for elective surgery booked well in advance. They tell you things like "We can't control which anesthesiologist is rotated to your treatment that day." So they don't know which practice he/she is employed by.

As you may know, many Emergency Rooms are contracted out, so your plan to protect against catastrophes only may be faulty. Don't assume you can beat the system.
Generally speaking all that "catastrophic" coverage means is very high deductible. It is for people who are considered healthy with no known pre-existing conditions. But want coverage in the event of unexpected emergency.

Once that deductible is reached, the insurance company picks up the remainder, even if there are multiple claims from multiple service providers. Then the insurance company picks up the remainder, typically with co-pay such as for example 80/20. But be sure to read the fine print.

In the event you aren't able to pay the deductible or co-pay amounts, then they are supposed "structure" some kind of payment plan over time with interest.
Last edited by smooth_rough on Sun Sep 17, 2023 3:33 pm, edited 1 time in total.
stan1
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Re: Catastrophic health insurance?

Post by stan1 »

Annual max out of pocket is set for ACA marketplace compliant health insurance the max out of pocket will be lower than you might want.
https://www.healthcare.gov/glossary/out ... mum-limit/
For the 2024 plan year: The out-of-pocket limit for a Marketplace plan can’t be more than $9,450 for an individual and $18,900 for a family.
For the 2023 plan year: The out-of-pocket limit for a Marketplace plan can’t be more than $9,100 for an individual and $18,200 for a family.
If you don't want health insurance there are other options such as faith based care. Personally I would not recommend them but people do use them.
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CrazyRun
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Re: Catastrophic health insurance?

Post by CrazyRun »

Thanks to the responses above. Here is an update on my search for catastrophic insurance in the event others find in helpful.

Background: Self-employed. Premiums for ACA-compliant plans for my family start around $2k per month for a high deductible plan with limited networks.

In Jan 2023, frustrated with the ACA plans, we joined Sedera Medical Cost Sharing. It is like insurance in that you pay a monthly fee and sharing starts over a certain amount, but it is not insurance in that there is no contractual right to coverage. Our experience in 2023 was excellent, with Sedera sharing a portion of two preventative procedures and us paying cash for everything else. Despite our good experience with Sedera, I remained uncomfortable becasue it is not insurance. Thus, my search for catastrophic insurance as a back-up.

What I found:
I ended up finding a Short Term Health Insurance plan (which you can get for 12 months and a very high deductible) with United Healthcare that only covers hospital and surgical costs (including doctors in hospitals, chemotherapy, and related).

Benefits:
• Premiums of Sedera + Short Term Health are less than 50% the cost of the cheapest ACA plan.
• Insurance coverage for the costs of an extreme health event (car accident, cancer, heart attack, etc).
• Sedera sharing kicks in at a lower amount than the ACA high deductible plans.
• No networks, so we go to the providers we want to see.

Limitations/Concerns:
• Risk that Sedera does not/cannot pay. In that event we would have to cover all medical out of pocket that is not covered by the Short Term Health Care so need a significant emergency fund.
• Short Term plan does not cover pre-existing conditions and does not cover routine costs.
• No automatic right to renew Short Term plan

Provided one can deal with the limitations, this approach saves a significant amount of money and has more flexibility than ACA insurance.
JoeNJ28
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Re: Catastrophic health insurance?

Post by JoeNJ28 »

Wait it excludes pre existing conditions? Welp that’s useless to people like me who were born sick. Yay me
Patzer
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Re: Catastrophic health insurance?

Post by Patzer »

crefwatch wrote: Sat Sep 16, 2023 10:46 am the warning about multiple claims for one illness is quite appropriate. You can get five or more bills just for an outpatient surgery at a hospital. The "business" is set up to collect as much insurance as possible. As you know, it's not a "consumer friendly" transaction, even for elective surgery booked well in advance. They tell you things like "We can't control which anesthesiologist is rotated to your treatment that day." So they don't know which practice he/she is employed by.

As you may know, many Emergency Rooms are contracted out, so your plan to protect against catastrophes only may be faulty. Don't assume you can beat the system.
Just want to echo this. I just recently had a simple MRI, and it was 5 bills/claims
1. Initial doctor visit that referred me to a specialist
2. Specialist that confirmed I needed an MRI
3. Actual MRI (at the same facility as the specialist)
4. Additional bill for reading the MRI
5. Specialist talking to me about the MRI
Last edited by Patzer on Tue Jan 30, 2024 3:31 pm, edited 2 times in total.
Topic Author
CrazyRun
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Re: Catastrophic health insurance?

Post by CrazyRun »

JoeNJ28 wrote: Tue Jan 30, 2024 2:58 pm Wait it excludes pre existing conditions? Welp that’s useless to people like me who were born sick. Yay me
Sorry to hear that but yes. Specifically the short term plan excludes a condition for which one has sought treatment in the two years prior to seeking coverage.

Sedera excludes some pre-existing conditions for the first few years of coverage, or phases in coverage for specific conditions.
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Liam_I
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Re: Catastrophic health insurance?

Post by Liam_I »

In addition to Sedera, I was able to find 2 other non-faith-specific providers: Zion Healthshare, and MPB Health. (They still exclude habitual drunkenness; but they permit tobacco use, albeit with increased premiums; and they do not seem to exclude other lifestyle-related illnesses like CHM and Samaritan do.)

SEO on this is extremely painful. This thread is one of the few relevant results.
Last edited by Liam_I on Mon May 13, 2024 7:43 am, edited 1 time in total.
madbrain
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Re: Catastrophic health insurance?

Post by madbrain »

Health share plans are not insurance. They are under no legal obligations to pay any benefits/claims. They don't have discounted rates with providers as insurers do. And they collect far less from members which means less is available to "share".

If you want insurance, buy insurance. There are plans off-exchange that are ACA-compliant . You need to go to rhe insurer's web site and look for it. I did this research last month in CA and found that there was a Kaiser plan that was Bronze and designated as catastrophic, which is only available directly from Kaiser, but not through the exchange. The downside of course is that there won't be any subsidy on such a plan since it is off-exchange.

It is worth noting that many people have pre-existing conditions, whether they know it or not. Previously undiagnosed conditions could still be considered pre-existing prior to the ACA. IMO, it would be foolish to go with a non-insurance plan like those health sharing plans.
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Nate79
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Re: Catastrophic health insurance?

Post by Nate79 »

Do they have lifetime max or annual max?
calwatch
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Re: Catastrophic health insurance?

Post by calwatch »

Since this thread was resurrected, in one of the other threads farm bureau health plans were brought up, which exist in about six states (Kansas, Tennessee, Texas, Iowa, South Dakota, Indiana, and soon to be Nebraska after the law was signed by the governor a few weeks ago). They are more in line with pre-ACA individual plans with their individual underwriting, health questionnaire/exam, and pre-existing condition limitations, although the ones I have seen have a 6-12 month waiting period, and a nine month period for maternity. Bills introducing this have been introduced and failed in other states, and while this isn't full ACA insurance, I've searched and haven't seen anything saying that these health plans have denied coverage or short paid doctors like health sharing ministries do. The more common complaint is that this skims the cream off the ACA markets, although ACA networks in rural areas are notoriously poor.
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Liam_I
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Re: Catastrophic health insurance?

Post by Liam_I »

madbrain wrote: Mon May 13, 2024 4:29 pm If you want insurance, buy insurance. There are plans off-exchange that are ACA-compliant .
I want insurance, though, not "insurance" as defined by the ACA to include payments on pre-existing conditions. I'm not in a state that has an individual mandate; I don't want to "participate" in a recurring wealth transfer from the inherently hale to the chronically ill; I only want to hedge against a legitimately unforseeable medical disaster, like a car wreck with a deadbeat, or a surprise cancer diagnosis.
You need to go to the insurer's web site and look for it. I did this research last month in CA and found that there was a Kaiser plan that was Bronze and designated as catastrophic, which is only available directly from Kaiser, but not through the exchange. The downside of course is that there won't be any subsidy on such a plan since it is off-exchange.
Indeed, I'm scouring around for quotes before a QLE this fall. With my income I'm eligible for some pittance subsidy of ~$80 on the cheapest "marketplate" premium options of ~$300, so that's obviously right out; and opting for designated "catastrophic" plans revokes even that tiny subsidy. Yuck.

USAA was not much different than the Marketplace. Kaiser “[doesn't] offer health care coverage in this area”. United quoted me for ~$200 with a pretty high deductible plan that would be serviceable as catastrophic coverage... Hence my looking around for something more frugal. (I had a friend recommend one of the Christian faith-based orgs based on personal experience, but they all seem to have pretty clear and specific requirements that I simply don't meet.)
CrazyRun wrote: Thu Sep 14, 2023 1:57 pm Something like: Insured covers all medical expenses under $30k-$50k, insurance company covers all medical expenses over $30k-$50k per claim
The United rep said he'd quote me up to, IIRC, $10k deductible + $5k maximum of 70/30 coinsurance. Admittedly that's barely half the range you were looking at, but those ranges would have lowered the premium even more than the quote I got, which was only for $7k+$2k@80/20. Not good, but still a far cry better than the Marketplace options.
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whodidntante
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Re: Catastrophic health insurance?

Post by whodidntante »

Patzer wrote: Tue Jan 30, 2024 3:03 pm
crefwatch wrote: Sat Sep 16, 2023 10:46 am the warning about multiple claims for one illness is quite appropriate. You can get five or more bills just for an outpatient surgery at a hospital. The "business" is set up to collect as much insurance as possible. As you know, it's not a "consumer friendly" transaction, even for elective surgery booked well in advance. They tell you things like "We can't control which anesthesiologist is rotated to your treatment that day." So they don't know which practice he/she is employed by.

As you may know, many Emergency Rooms are contracted out, so your plan to protect against catastrophes only may be faulty. Don't assume you can beat the system.
Just want to echo this. I just recently had a simple MRI, and it was 5 bills/claims
1. Initial doctor visit that referred me to a specialist
2. Specialist that confirmed I needed an MRI
3. Actual MRI (at the same facility as the specialist)
4. Additional bill for reading the MRI
5. Specialist talking to me about the MRI
I'm one of those weird people who asks around and doesn't just go along with what a particular health system might want me to do. It's my life and my money, after all.

MRIs done at hospitals are comically expensive. Just call and ask first. I've been quoted and I've seen my insurance billed thousands. I've found much better pricing at radiology labs, and they normally can get me in a few days versus weeks later at the hospital. I get the results on a DVD/USB thumb drive along with a radiologist's report that is readable without special software.
oldfatguy
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Re: Catastrophic health insurance?

Post by oldfatguy »

Liam_I wrote: Mon May 13, 2024 7:08 pm I don't want to "participate" in a recurring wealth transfer from the inherently hale to the chronically ill; ...

With my income I'm eligible for some pittance subsidy of ~$80 on the cheapest "marketplate" premium options of ~$300, so that's obviously right out; and opting for designated "catastrophic" plans revokes even that tiny subsidy. Yuck.
So you view health insurance as a "transfer of wealth," but you are upset that your ACA subsidy is too small? :confused
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mrmass
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Re: Catastrophic health insurance?

Post by mrmass »

LIam_I and CrazyRun same person?
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BrooklynInvest
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Re: Catastrophic health insurance?

Post by BrooklynInvest »

oldfatguy wrote: Tue May 14, 2024 9:11 am
Liam_I wrote: Mon May 13, 2024 7:08 pm I don't want to "participate" in a recurring wealth transfer from the inherently hale to the chronically ill; ...

With my income I'm eligible for some pittance subsidy of ~$80 on the cheapest "marketplate" premium options of ~$300, so that's obviously right out; and opting for designated "catastrophic" plans revokes even that tiny subsidy. Yuck.
So you view health insurance as a "transfer of wealth," but you are upset that your ACA subsidy is too small? :confused
This. But it should be noted that the OP is healthy and has no plans to ever get sick...
beardsicles
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Re: Catastrophic health insurance?

Post by beardsicles »

BrooklynInvest wrote: Tue May 14, 2024 9:29 am
oldfatguy wrote: Tue May 14, 2024 9:11 am
Liam_I wrote: Mon May 13, 2024 7:08 pm I don't want to "participate" in a recurring wealth transfer from the inherently hale to the chronically ill; ...

With my income I'm eligible for some pittance subsidy of ~$80 on the cheapest "marketplate" premium options of ~$300, so that's obviously right out; and opting for designated "catastrophic" plans revokes even that tiny subsidy. Yuck.
So you view health insurance as a "transfer of wealth," but you are upset that your ACA subsidy is too small? :confused
This. But it should be noted that the OP is healthy and has no plans to ever get sick...
And also doesn’t seem to understand what risk pooling is.
madbrain
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Re: Catastrophic health insurance?

Post by madbrain »

Liam_I wrote: Mon May 13, 2024 7:08 pm I want insurance, though, not "insurance" as defined by the ACA to include payments on pre-existing conditions. I'm not in a state that has an individual mandate; I don't want to "participate" in a recurring wealth transfer from the inherently hale to the chronically ill; I only want to hedge against a legitimately unforseeable medical disaster, like a car wreck with a deadbeat, or a surprise cancer diagnosis.
ACA-compliiant plans are most certainly insurance. It's not possible to even formulate a legal definition for the insurance product you desire. It relies on subjective judgment. Even a cancer diagnosis can have pre-existing genetic or environmental causes. Or the cause may simply be unknown. Telling others that their chronic medical conditions are illegitimate is also not something that will earn you support. Doctors will treat any medical condition regardless of cause, and are not supposed to pass judgment. Other than short-term plans, you will not find insurance plans that exclude coverage for pre-existing conditions. And even those plans will likely not fit the very narrow definition of what you want covered and excluded. And those plans likely come with the same pitfalls as many plans did pre-ACA, such as retroactive rescission of coverage, which is the last thing you want.
Indeed, I'm scouring around for quotes before a QLE this fall. With my income I'm eligible for some pittance subsidy of ~$80 on the cheapest "marketplate" premium options of ~$300, so that's obviously right out; and opting for designated "catastrophic" plans revokes even that tiny subsidy. Yuck.
Healthcare spending is 18% of GDP. The above are extremely small numbers. You're likely spending far greater amounts on other essentials, such as food and shelter. Healthcare is also essential, and it doesn't come free either, unless your income is below the poverty level, or you live in a country that pays for healthcare mainly through mandatory taxes and not insurance middlemen.
USAA was not much different than the Marketplace. Kaiser “[doesn't] offer health care coverage in this area”. United quoted me for ~$200 with a pretty high deductible plan that would be serviceable as catastrophic coverage... Hence my looking around for something more frugal. (I had a friend recommend one of the Christian faith-based orgs based on personal experience, but they all seem to have pretty clear and specific requirements that I simply don't meet.)
Again, those are really small numbers. It isn't realistic to expect that you are going to find a health insurance plan that costs much less than $200/month. Even a Bronze plan for an 18 year old is going to cost more than that before subsidies (just did a quote in my zip code : $258.15/mo is the cheapest).
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Liam_I
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Re: Catastrophic health insurance?

Post by Liam_I »

beardsicles wrote: Tue May 14, 2024 9:48 am And also doesn’t seem to understand what risk pooling is.
I understand what risk pooling is; I only wanted to opt out of guarantee-pooling. Overly inflated costs due to lifestyle, things it doesn't make any sense to "risk" pool, etc. — I'm looking to hedge tail-events like car wrecks and cancer, not to subsidize the metabolic syndrome medical complex more than I have to, or pass money thru a middle-man for treatment for the same predictable case of presbyopia which everyone gets.

CrazyRun reported a tentatively positive experience with Sedera; I know someone who had an unambiguously positive experience with one of the Christian ones... but as I noted in my first post in this thread, information about these things is a bit scarce. Even finding the providers in the first place is a bit difficult, hence my post to report what I'd found out so far. — In particular: are there really only two* non-specifically-religious options for this??

*A correction to my first post: after investigating a bit more, it looks like MPB is something like a subsidiary vendor for Zion.
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