Healthcare sharing coverage vs traditional ACA insurance
Comparing AlumniCare to Obamacare
The Patient Protection and Affordable Care Act of 2010 (ACA), commonly known as Obamacare, is the primary option for individuals without employer-sponsored or government-funded healthcare coverage. To help you understand the differences between Obamacare and healthcare sharing coverage, we’ve created a comparison chart that compares coverage with a healthcare sharing plan with a Blue Cross PPO Silver ACA plan and visually presents the available options.
If you don’t have significant pre-existing conditions, healthcare sharing coverage is more cost-effective, with potential savings of up to 60% compared with ACA plans and a significantly better plan design. However, if you need immediate coverage for pre-existing conditions that prevent you from qualifying for our health care sharing plans, an ACA plan would be the better choice.
Recommended
Better if no significant PreEx
AlumniCare HCS
Monthly contribution · healthcare sharing
Lower monthly cost, and you choose the Member Responsibility Among (MRA), MRA being healthcare sharing speak for Deductible.
Individual, age 30$356
Couple, ages 35 / 33$528
Family of 4, ages 40 / 35 / 12 / 7$796
Family of 4, ages 52 / 50 / 19 / 15$973
Member Responsibility Amount (MRA) Individual options as low as $500. Member Responsibility Amount functions like a deductible, as it's your maximum out of pocket expense.
Better if PreEx must be covered now
Blue Cross Silver
Monthly premium · ACA benchmark PPO
Single, age 30$476.01 +33.71%
Couple, ages 35 / 30$988.50 +87.21%
Family of 4, younger$1,690.13 +123.27%
Family of 4, older$2,311.68 +375.82%
Maximum out of pocket Individual $9,200 · Couple and family $18,400. Premiums are higher because ACA carriers must accept applicants with and without pre-existing conditions.
AlumniCare Profoundly Superior
AlumniCare Superior
Tie
ACA stronger
Monthly contributions
AlumniCare Superior
AlumniCareLower monthly amount if you do not have significant PreEx. You can trade visit limits and MRA against the monthly payments paid.
Blue Cross SilverHigher premium. No medical underwriting, so healthy members help pay for members with PreEx.
Member responsibility / deductible
AlumniCare Superior
AlumniCareMRA from $3,000 individual, $3,500 couple, $4,500 family.
Blue Cross SilverOut-of-pocket maximum $9,200 individual, $18,400 couple and family.
Customization
AlumniCare Profoundly Superior
AlumniCareMyShare lets you choose how many visits are included. Office visits can be pooled across the family.
Blue Cross SilverVisit limits, services, and pricing are locked. No plan customization.
Hospitalization
AlumniCare Superior
AlumniCareCan share up to 100% of an eligible hospital bill after the MRA.
Blue Cross SilverSilver-level coinsurance in this comparison is about 70% after the deductible.
Primary, urgent, and specialists
AlumniCare Superior
AlumniCareVisit counts are chosen up front and can be pooled. Referrals are not required.
Blue Cross SilverFixed visit and referral rules.
Referrals
AlumniCare Superior
AlumniCareReferrals are not required.
Blue Cross SilverReferrals may be required, depending on the plan.
Emergency department
AlumniCare Superior
AlumniCareEligible emergency care is shared after the MRA, within the membership guidelines.
Blue Cross SilverCovered, subject to deductible, copay, and coinsurance.
CT / PET scan
AlumniCare Superior
AlumniCareEligible imaging shared after the MRA.
Blue Cross SilverSubject to deductible and coinsurance.
Physical therapy
AlumniCare Superior
AlumniCareIncluded under the sharing guidelines you select.
Blue Cross SilverCovered with fixed visit and cost-sharing rules.
Medical fees
AlumniCare Superior
AlumniCareReference-based sharing is designed to keep eligible fees lower.
Blue Cross SilverNetwork contract rates, then deductible and coinsurance.
Provider access
Tie
AlumniCareNo network restriction in this comparison. A non-affiliated provider can raise the MRA cap to $5,000.
Blue Cross SilverPPO network access.
How bills are paid
Tie
AlumniCareEligible needs are shared after the MRA, according to the plan.
Blue Cross SilverCarrier pays its share after deductible and coinsurance.
Telemedicine
Tie
AlumniCareUnlimited telemedicine.
Blue Cross SilverUnlimited telemedicine.
Chiropractic
Tie
AlumniCareIncluded on a comparable basis in this comparison.
Blue Cross SilverIncluded on a comparable basis in this comparison.
Speech and occupational therapy
Tie
AlumniCareTreated as comparable in this comparison.
Blue Cross SilverTreated as comparable in this comparison.
High blood pressure and cholesterol
Tie if treated and medically controlled
AlumniCareTie when the condition is medically treated and is not a pre-existing condition.
Blue Cross SilverACA stronger if the condition is a pre-existing condition that must be covered now.
Pre-existing conditions
ACA stronger
AlumniCareSignificant PreEx is not shared at the start. Some conditions may become eligible after a two or five year waiting period.
Blue Cross SilverCovered. This is the practical choice when a condition must be covered immediately.
Mental health, alcoholism, and drug treatment
ACA stronger
AlumniCareNot the stronger option. Sharing guidelines limit these services.
Blue Cross SilverIncluded as an ACA essential health benefit.
The ACA enabled Healthcare Sharing Ministries (HCSM) to function exactly as health insurance companies without having to be legally considered insurance because they do not themselves purchase stop-loss (umbrella) policies and as such are not under the control of the Department of Insurance. Instead, they operate under the control of states’ Attorneys General and must adhere to all consumer protection laws, especially those requiring fair dealing with consumers (Members). Altrua Healthshare has consistently proven since 1999 that it maintains sufficient cash reserves from operations to pay all covered claims based on Reference Based Pricing (RBP) that requires it to reimburse hospitals at 125% of the Medicare rate, which it of course does. RBP is gaining traction in the health insurance space because traditional insurance usually reimburses hospitals at an average of 247% of Medicare, obviously much more than RBP. This, together with the fact that HCSMs do not have to accept Members with significant preexisting medical conditions (PreEx), represents substantial savings that is passed on to the Members of HCSMs and is why we are 20-60% less than Obamacare. Please see the quote below from the ACA, and feel free to call us if you have any questions. For a greater understanding of why HCSMs are a very necessary element of American healthcare, why American healthcare is such a mess, and what part billionaire businesses, lobbyists, and corruption play in creating this mess, to read our Healthcare Sharing 101, please click here.
