Need Health Care?

Look Beyond Obamacare
December 14, 2018

If you’re a healthyish 20-something with an unconventional employment situation, (i.e. a business of one) then finding your own health insurance plan could prove daunting. Things like “deductibles” and “co-insurance” sound like they come out of a graduate-level economics textbook, yet it’s your job to decipher this strange language by the December 15 insurance enrollment deadline.

Unfortunately, many politicians and talking heads over the past eight years (since the enactment of Obamacare) have made life more difficult for these young health insurance shoppers by arguing that everyone should be required to buy insurance with pricy “essential benefits” mandates (e.g. HIV screening, smoking cessation). Fortunately, due to recent reforms, such as the repeal of the individual mandate and regulatory approval of short-duration plans, it’s possible to build your own, personal “designer” healthcare system.

Step 1: Prepare for the worst

 Bare-boned insurance plans cover little routine care before a deductible (up to $7,350 for an individual plan) but (depending on the state) will only cost a bit north of $100 a month. Even these plans, found on Obamacare exchanges, are unnecessarily expensive due to the aforementioned “essential benefits” mandated benefits that most young people don’t even need.

Thanks to the Trump Administration, though, you can buy a short-term plan without “perks” like smoking cessation starting at roughly $75 per month. While these plans aren’t going to be as comprehensive as Obamacare plans and may have lifetime limits, these are acceptable tradeoffs for young people not looking to break the bank. Plans last a year, but can be renewed up to 3 years in many states.

Depending on religious inclinations, there may be additional options available. Christian Healthcare Ministries, for instance, offers a $45 “sharing plan,” in which each individual is responsible for $5,000 in costs before CHM picks up the tab via other members’ contributions. Other organizations, such as Liberty HealthShare and Medi-Share, offer similar sorts of arrangements. But, with virtually all of these religious sharing arrangements, there’s a catch—the “insured” must foot the bill up front and be reimbursed. This should not be an issue, particularly for Millennials keen on racking up credit card points. For Millenials with little means and/or bad credit, however, short-term plans may be a better option.

Step 2: Find Inexpensive Options for Routine Care

Now that you are prepared for the worst and know that a bad accident won’t bury you in a mountain of debt, it’s important to figure out where to go for medical advice and/or prescriptions that fall short of emergencies. If you walk into the doctor’s office with just a high-deductible plan like the ones just discussed, all bets are off and you could pay hundreds of dollars for a routine visit.

But thanks to a growing model known as “direct primary care,” patients without comprehensive insurance can purchase a primary care subscription service (usually around $50-$100 per month for enrollees under 40; see map of providers). Conditions such as infections, viruses, and skin abnormalities could all be taken care of at these facilities, and direct primary doctors typically have fewer patients in their practices and devote more time to each patient due to a lack of insurance reimbursement-related pressure to get patients in and out quickly.

If you’re not as concerned about “peace of mind” and anticipate only seeing the doctor a couple of times per year, then a la carte services are also available. Doctor on Demand, for instance, offers a telemedicine service that allows doctors to quickly ascertain patients’ conditions and prescribe medications directly to the pharmacy. Each 15-minute “visit” costs only $75, a viable option in the case of more mild maladies such as the flu or a common virus.

Step 3: Shop Around for Medications

Thanks largely to insane Food and Drug Administration requirements and third-party payer incentives, pharmaceutical prices are more expensive than they need to be. Fortunately, many medications can be purchased through a bulk discounter such as Blink Health or through a discount compiler such as GoodRx.

Thirty tablets of cholesterol control medication Lipitor (20 mg), for instance, has a retail price of nearly $50, but buying the prescription at Blink Health (which contracts with multiple chain pharmacies) would set you back less than $10. In many cases, going through a Blink Health or GoodRx can result in lower drug prices than the drug co-pay offered by a comprehensive insurance plan!

Obviously, this how-to guide is not for everyone. Many Millennials, of course, have serious medical issues that require a comprehensive plan. But for a young independent contractor with few health issues, coupling a catastrophic insurance plan with discounted stand-alone services will prove sufficient.

Buying a short-term plan and a subscription to a direct primary care physician will likely set enrollees back $150 per month, around $300 cheaper than most unsubsidized Obamacare plans. With more than $3,500 in annual savings, Millennials can invest in the future, and buy better diets and gym memberships that can ensure greater health over the long-term.

Finally, buying financially cumbersome coverage is no longer necessary.  And, as usual, it’s the free market and creative alternatives that are leading the way instead of the government.