Our 2016 insurance options

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Well, Nov 1 arrived so I was finally able to do a little research on what an insurance plan for my family would cost. I do this so I can keep tabs on how much Samaritan saves us each year. Blue Cross is the company I follow, because it’s who we had before Samaritan, they have better customer service than the other options in my state and I want to maintain consistency. The other companies are running about $50-$100 cheaper than the plans I will mention here so it’s not a giant savings and I’ve heard they are an even bigger headache.

The bronze plan which is the cheapest non HSA available is now $1102.27/mo. That’s for a BRONZE plan. $4500 deductible, $9000 per family and max OOP of $6850 per person (so a total of $13700/family/year) with a 50/50 copay. $13700 max OOP on top of $13227.24/yr in premiums equals…

[drumroll please…]

$26,927.24/year OOP + premium
for BRONZE plan

 

That cost is our total medical outlay assuming we had two medium size events in a year (kidney stones?) on top of our premiums. I’m sorry folks, but that number would bankrupt most families even if you had a decent income.

What if we chose the GOLD plan that we used to have? The gold plan is the one most similar to what we had before Obamacare started.

The one and only Gold plan they offer is now $1683.95/mo. Digest that. Wow. That’s for a GOLD plan. $1500 deductible, $3000 per family and max OOP of $4350 per person (so a total of $8700/family/year) with an 80/20 copay. $8700 max OOP on top of $20207.40/yr in premiums equals…

[drumroll please…]

$28,907.40/year OOP + premium
for GOLD plan

 

I find it interesting that they are only about $2000 apart if you actually need to use your insurance. If you don’t use it, the numbers are $7000 apart. I find it stunning/shocking/mind blowing that the numbers are so incredibly high to begin with. How does anyone on this planet think this is reasonable and acceptable? Are businesses paying this or even a healthy portion of it for their employees? Some of those premiums are equivalent to another salary!

I enjoy this little exercise every year, but I have to admit it’s starting to make me really nauseated. This cannot continue and I fear what will happen in the years to come. Thank goodness for Samaritan and the other health care sharing ministries to give people a way out of this mess. I cannot thank God enough for showing us the clear path to Samaritan and giving such peace in my heart about it.

Updated Math for late 2016:

Insurance Premium: $1102.27/month for bronze plan
Samaritan share: $495/month
SAMARITAN SAVES US: $607.27/MONTH or $7297.24/YEAR
Insurance OOP max: $6850 per person (2 person max)
Our Responsibility with Samaritan: $300 per incident
SAMARITAN SAVINGS: FROM $12,800 to $13,700 (assumes we had 3 incidents per year and would have met our full deductible/OOP, and got full discounts)
Insurance Co-pay: 50/50 (so they leave me with 50% up to $13,700 per year for the family)
Samaritan co-pay: NONE

 

As you can see, the spread between Samaritan’s cost and our Bronze insurance plan choice is getting wider. So the “premium” savings each year is getting bigger by staying with Samaritan. That will probably continue to happen for a while. It’s because insurance premiums are climbing faster and higher than Samaritan’s share’s increase. There’s a big difference between increasing yearly (insurance) and increasing every 1 1/2 – 2 1/2 yrs (Samaritan) and insurance rate hikes are bigger each time. The OOP max is still the same if we have 2 kidney stones, but the annual savings if we don’t have many or any needs is getting wider.

Also note: The gold plan for 2016 that most closely matches the plan we used to have before Obamacare began is now $1683.95/mo for our family. Wow.

Comments (17)

I do have a question about how you calculated your numbers and specifically the “Our Responsibility with Samaritan” portion or maybe the lack of a “Co-Pay” for Samaritan.

If I am understanding Samaritan correctly, any bills, visits, etc that are less than $300 are totally the responsibility of the individual. You are not factoring this in to your calculation, are you? I know this will vary quite a bit from one family to the next, depending on need, but I would think you might want to at least give an idea. For example, if a family of 5 each makes 3 visits for $250/per visit, that is a total of $3,750 that is completely out of pocket. Let me know if I am missing something.

Hi Zach. I thought about it, but these comparisons are for my family, and we typically don’t have a lot of doctor visits so I didn’t feel it necessary to factor it (the dentist is a different story) 🙂 . By the same token I’m also not factoring insurance copays for the office visits. From family to family there will be significant variations in number of visits and copay amounts. (I do include checkup costs in this post: http://samaritanministriesreview.com/why-are-we-falling-for-the-free-checkups/) I’ve been hearing of office visit insurance copays of $40 up to $150, and some cash customers are able to get their visits reduced down to numbers matching or less than what typical copays are. Some drug copays are higher than the discounted rate I can get with goodrx. Since it’s just too variable I left that out knowing both insurance and ministry members would likely have to pay something when they go to the doctor and that price gap isn’t always very much. And as you said, some people just don’t need to visit the doctor that much, others go more often. The question is whether a family will have enough of those visits to erase the cost savings (probably not since those visits also typically have a charge). If cash patients are paying relatively close to what insurance copays are in their area then it’s a wash. If the cash amount is higher then it must be factored on an individual basis to compare likely numbers of visits with a copay vs a cash amount.
The other thing to remember is that not all incidents are handled with one visit. If the need requires multiple visits/bills related to the same need their TOTAL has to be under $300 to not be shareable. So if your visit, lab, and meds run over $300 combined, it’s shareable even though the bills were individually less than $300 (ie: $150, $200, and $45). With rising medical costs more and more medical needs will cross $300 and be shareable. Hopefully medical costs as a whole will start to reduce or at least level off.

I am looking for health coverage. Found your site. Very helpful. I have prayed on the matter and will be calling to join. This is just so different from the “norm”. I admit I am anxious. Just praying it through! I look forward to more of your guidance . Thank you ,your information was helpful.

Hi Karen! I’m glad the site was helpful as you made your decision. I understand how different it feels and that you are a little anxious. Have you watched any videos that members have done? Go to http://www.mysamaritanstory.org and watch a few of those. You will probably feel a lot less nervous. 🙂 It’s interviews of people who have had needs met; big needs, ongoing needs, even special prayer needs. I also have a couple of other favorite videos on my favorite videos page (menu link on right). I like to watch the videos periodically and am always looking for new ones. This is a great ministry. It is outside the norm, but in my opinion THIS is what SHOULD BE the norm. And it used to be the norm a long time ago. God bless and Merry Christmas! 🙂

Hi,
I am researching all the health care ministries, and I came across Medical Cost Sharing Incorporated. Have you ever heard of them? I have seen no objective reviews of their ministry and some of the things that they mention as benefits seem a bit to good to be true.
Would appreciate any insight that you might have. Thanks for all the work you have done, I have really appreciated reading all the information you have given about the various health care ministries.

Hi Reushann. I had not heard about MCS. I did some research last night and here’s my impression of what I learned. They are a small, new ministry. All of them had to start small, but with them being so new (started July 2013) it means they can’t qualify as an ACA exempt ministry for members to avoid the tax penalty. They state they will reimburse members their tax penalties, but those penalties are going up and MCS has stated they will cap what they reimburse, which could leave members with a large remaining penalty on their own depending on income and tax structure. I agree that some of it seems too good to be true. In fact, some of what they offer doesn’t seem mathematically possible long term. It doesn’t make sense how they could give back 10 years worth of unused “premiums”, and cap “premiums” for life without running into major financial issues down the line. The idea intrigues me, but I’d want to see the math behind it. They do compare themselves to the other ministries, but they don’t give full credit to the other ministries for what they offer so the comparison is erroneous. I couldn’t find their complete guidelines for sharing on the site, but maybe I missed it. Their brief list of what’s not covered is rather vague and leaves a lot open to interpretation. I prefer to have more solid details. I do like how they have their plans listed and while their offering isn’t as good a cost savings as what the other ministries currently offer, it’s mostly because they are new and young and don’t have the resources to offer more at this time. As they grow that may improve. They encourage communication through their facebook page, but that page has only 36 members, and a curious person asking a question about when they started wasn’t given an answer other than to call in. Their website felt like a highly commercialized sales pitch instead of a like a Christian ministry. Since I can’t see their guidelines I don’t have enough data to determine how comprehensive their medical sharing is. Definitely anyone interested should call them, get the full data in writing, and then make comparisons. I caution against the things that seem too good to be true, but maybe it will work out fine. Thank you for giving me something new to research, 🙂 I hope to keep tabs on them over time to see how they grow. Their ideas are interesting, and may be successful, but what little I see now is concerning.

I am just now researching and comparing Christian Health Ministries vs. Samaritan Ministries. We are a family of 4 with very little health expenses. Just learned that Dave Ramsey is partnering with CHM. Do you know if he also endorses SM?

And you still think SM is the best?

Hi Julie! I love Dave Ramsey’s message, we paid off our debts with the snowball method long before we even heard about him. It definitely works. 🙂 I don’t know if he endorses all ministries or just one. SMI is still definitely the best for our family, but each family will need to look through the methods and what is “covered” to determine what fits for them. I prefer the direct sharing of Samaritan’s method, SMI is running 1-2 months faster on the payment timeline than other ministries, and they share some things that CHM doesn’t which I wanted to have available (such as certain ambulance needs and alternative treatment options). SMI is also cheaper for families wanting everyone on a gold level plan (we definitely want that and SMI’s is closest to the gold plan), and shares up to $250,000 instead of CHM’s $125,000 for the base plan. CHM also has some wonderful features, they are pretty similar to SMI in many ways, but those details I mentioned were the keys for us and I’m still more than thrilled with Samaritan after 2+ years. I’m so glad you’re considering health sharing ministries, they are a wonderful alternative to expensive insurance and they provide even better “coverage” in my opinion! God bless and happy holidays! 🙂

Do you (or anyone else) know if its legal for an employer to help pay the monthly premium for SM instead of paying the premium of the traditional health insurance plan? If so, how does the employer do this?

I would think it’s legal, but I don’t know what the tax ramifications are for the employer. It may depend on the size of business since at a certain level of employees the rules change for businesses being required to provide insurance for everyone or face a penalty. I would guess that they would have to pay you for the share amount and it would likely be considered taxable income on your check, I don’t think there’s a way to do it in a tax free manner. Now, if the employer is going with Samaritan for every employee then the method is different, and Samaritan does work with groups in that manner. If that’s the case then the employer needs to contact Samaritan, but I’m guessing you are thinking of a single employee situation. In that case the easiest method is to simply boost your check accordingly and it would be taxable to you (90% sure).

Thank you so much for your help! When we join I will be sure and say I was referred by you!

You’re quite welcome. I appreciate it. 🙂

Thank you for all the information you have set forth on Samaritan Ministries International. It is helpful. Do you know if there are bios of the current board members available on the SMI site anywhere? Thanks.

Hi Tiffany. I checked with Samaritan to be sure I had the correct info.
Here are links to Member Spotlights they have done on five elected board members and two appointed board members:
Daniel Ryken: http://samaritanministries.org/member-spotlight-daniel-and-sheri-ryken/
Chris King: http://samaritanministries.org/member-spotlight-chris-and-mercy-king-directed-by-providence/
Kevin Holst: http://samaritanministries.org/member-spotlight-holst/
Daniel Coughlin: http://samaritanministries.org/member-spotlight-daniel-and-tamra-coughlin/
Rick Driggers: http://samaritanministries.org/?p=13433
Bill Kurth: http://samaritanministries.org/?p=13426
Keith Bradshaw: http://samaritanministries.org/tennessee-board-member-depends-god-little-things/

The first five are elected by the members (there isn’t one yet on the sixth elected member). Bill was an original board member, elected several times, but is now an appointed board member. Other appointed board member is Keith Bradshaw. Founder and president Ted Pittenger is the ninth member of the board. His bio is:
Ted A. Pittenger, 60, founded Samaritan Ministries in 1994 and has been its president since December 1996. The Mount Morris, Illinois, native is married to Shari. They have six children. Ted’s job is to oversee the entire ministry and report regularly to the Samaritan Board of Directors. Before working at Samaritan, Ted worked for Campus Crusade for Christ (1978-1981) and was a painting and wallpaper contractor with Pittenger Paint & Paper (1982-1996). He holds a Bachelor of Arts degree in classical civilizations from the University of Illinois.
Thanks for asking and I’m glad you are considering Samaritan! I highly recommend it. 🙂

Thank you for the links on the current board members. It’s helpful to know more about the leadership of SMI. It would be a great addition to their website.

We are looking at options for my husband which has no insurance. When you go to the doctor, do you pay then get reimbursed?

Hi Debbie. It really depends on the size of the charge. If it’s a small office visit with no other expenses, that’s likely a need under $300 and not shareable anyway so you’d just pay their cash rate and be done. If it’s an office visit that is part of a series of other charges that all add up to at least $300, then you can either pay them on the spot and get reimbursed, or pay a tiny amount and wait until shares come in and then pay off the remainder. For bigger charges (surgeries, ER visits, etc) I would recommend paying small amounts and then paying it off later. If you pay it all up front you’d want a healthy cash/upfront discount tied to it (probably at least 30%, more would be better). If we pay it all early then Samaritan can’t get further discounts for us. So in those bigger cases I would pay the minimum, cashflow a couple months of small payments while we wait for member shares, then pay it off when shares arrive a couple months later. Most hospitals have self pay policies offering various no interest terms, or “no interest for 90 days”, etc. We would take advantage of those while shares come in. It’s actually a pretty simple process. This page on how the need process works may help explain that a little better. Also this page on paying a portion up front. So glad you’re considering a health care sharing ministry!

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