#139: Two Unconventional Options to Traditional Health Insurance for Freelancers

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To a whole new level. And now, here's your host, Ed Gandia. Hello there. Welcome to the High Income Business Writing Podcast. I am your host, Ed Gandia, and this is the podcast for business writers and copywriters who want to earn more and less time doing work they love for for better client. You can find detailed show notes to this episode@b2b launcher.com Episode 139 and those notes include a summary of our discussion as well as links to resources and downloads mentioned during the show. So today we're talking health insurance for freelancers. And more specifically, we're exploring two unconventional options to to traditional health insurance. And I have to tell you, I can't remember the last time in 139 episodes, almost five years of doing this show, that I heard from so many listeners telling me how much they're looking forward to this particular episode. I put the topic out on Facebook with a couple of basic questions. I basically asked, hey, do you want to hear more about this? And if so, what questions would you have in terms of about getting health insurance? And the feedback that you gave me was extremely helpful. I got tons of comments. Some discussions just kind of took a life on their own in that thread and I got several dozen emails. Even people at conferences have been stopping me, just telling me, hey, I saw that you're doing this show. I can't wait to listen to it. So I'm glad I struck a nerve. Obviously this is a top of mind issue, especially right now. We're with so much up in the air and so many questions unanswered. Now I'm going to do a bit of a longer introduction for the show because there's some things I want to make sure I cover and I want to set the stage for a positive discussion here. The first thing I should mention is I don't want to give you the same information everyone else is giving you on this topic. You know the questions that I got a lot of people asking me where can I get affordable health insurance? And I think that's the wrong question to ask right now. And no offense if you're asking that question, but I think the better question to ask is what are my options? Because where can I get affordable health insurance? Limits your search limits your thinking to one specific approach. And unfortunately, most of the options there for many of us are just either not affordable or just not really a good option. When you ask what are my options? You've just opened up the possibilities, okay? I don't know about you, but I don't want the same garbage from a different source. That, to me, is not a real solution. I'm also not looking to save $50 a month, okay? When I'm up to $1,400 a month in premiums, a $25 to $50 a month savings is not really helping me out. Especially consider the pain of making a transition from a plan that I've had for 11 years that continues to go up by 20, 25% a year. Today, what I'd like to do is I'd like to focus on two options that most people don't even know exist, okay? And this is the result of asking that question, what are my options? You know, what else am I not looking at? Are there options out there that I may not be considering because I don't even know exist? The first option we're going to be talking about is health indemnity plans. And the second one is medical cost sharing. Now, a few points before we get started, and please, again, bear with me. Number one, if you're outside the US there's no need to listen to this episode. Just go ahead and hit pause. Move on to the next one. Listen to some of our archives. There's a lot of great stuff in there, and I apologize, but this is a hot topic for my US audience, so I want to make sure I address it. Number two, these options that I'm going to highlight today are not for everyone, okay? I'm not trying to please everybody. I'm trying to please those of us who are in a situation where we really need to get creative about a solution and we need to take matters into our own hands. Number three, I'm not a financial advisor and I'm not an insurance professional. I don't even play those things on the Internet, okay? So you need to do your own due diligence. You need to investigate these and other options on your own. And in that process, I recommend consulting with your financial professional before making any decision related to your health insurance. Number four, you need to understand that there's no perfect solution out there. I've reached that conclusion finally. This year, our healthcare system in this country is broken. Okay? There's no point in sugarcoating that. And let me just, if you will allow me a minute of editorial. We can do so much better. You know, politicians are so focused on fighting the battle of who will pay for this mess that we're not even addressing some of the other critical issues, such as the cost side of the problem. I really believe that's where a huge part of the problem lies. And there are immense opportunities out there. And I'm extremely disappointed that we're not even having that discussion. As a country, we need the will to solve this complex problem and we need to hold our politicians accountable. If they choose to serve lobbyists, if they choose to pander to special interests, they need to know that we're watching and they're on the hook. And we need to make sure to act and to vote. Number five. It's not just the politicians fault, okay? As much as I like to beat up on them because they, they do need to get beat up on, we all need to take ownership in this area. You know, let's face it, most of us could get healthier by making different lifestyle choices. And we need to start treating and thinking about health insurance as a consumer who's truly vested in the process and not just someone else's problem. In other words, we need to be smarter healthcare consumers. We need to shop around. I mean, when was the last time I've had health insurance? My entire adult life. I've been fortunate enough, I've had coverage and for many, many years I just thought, well, that's the, that's the insurance company's problem, you know, okay, fine, just bill them. I don't know how much it is, you know, in the unfortunate part of that is that it breeds a different type of consumer. It breeds this attitude of, well, it's not my money, you know, it's somebody else's money, it's the insurance company, it's not me. And that's unfortunate because when you think about everything else in life, even big purchases, it's our money and we're better consumers. We get better services and better products when we have skin in the game. So we need to shop around, we need to do a research and we need to make wise choices. And much of that starts happening when we have greater control and what we share into the solution. And I'll give you a quick example of that. So my son needs to have or oral surgery and it's pretty extensive. I won't get into the details, but I'll just say that our dentist said, okay, well I really trust this surgeon across the street. Go to them. You really need to get this done in the next few months. My wife took them there, they quoted us $2,700. Now it sounded high to me, okay, because that is the cash price. I mean the insurance will not cover it, okay, which is another issue it's medically necessary, but the insurance company won't cover it. I went ahead and started doing some research, and in my basic research, I realized that this is on the higher side for the procedures he needs to get done. So how did I know that? Well, I called the surgeon and I talked to the business office, and I asked him to give me the medical codes for what he needs done. With those codes, I was able to do some research online, and I realized that this is on the very high end of the national average. So in our area, I went to Google Maps and found some other oral surgeons within just a few miles of us. I called the one that sounded the most reputable and was also close and I gave them the medical codes. I explained the situation and said, well, we would still need to see them. We need to see your son. However, it would be no more than $1,700. Okay? So just in 10, 15 minutes of research, I was able to essentially save $1,000. You know, when I'm the one who's in the hook, when I have to pay for some of it, when I have to pay for most or all of it, we become better consumers. Now, I want to be sensitive to folks who have preexisting conditions and other situations that are beyond challenging. Okay? I'm not trying to throw out a blanket statement that, you know, this is every. We all need to do this. I'm not talking about that. Those are difficult circumstances that require different approaches, different solutions. I'm just talking about general everyday stuff that when there's no ownership, I think that that's when you start seeing prices escalate. And there are other factors. I understand that. Now. That leads me to my sixth point. Don't send me hate mail because you don't like these options I'm presenting. I've even turned off the comments for this in my other pages. Don't send me emails or private messages asking me questions about these options, about other options. Again, I'm not a financial insurance professional. I'm merely exposing some options for you to consider. Now, in the interest of full transparency, I recently canceled my major medical health insurance policy with United Health Care. And I signed up for an indemnity health plan from New Air Life. And that's the first option that we're going to talk about. And that's how I met my first guest, Mark Dunn. Then what I did, just so you know what I'm doing, I'm not saying this is what you should do. I signed up with a Christian cost sharing ministry as a backup. And that's the second option we're going to be talking about. I won't get into the details, but in doing all my research, I found that this is going to be the best option for me and my family. And even though I have both of those now, my total monthly costs dropped by almost 50%. I just cannot continue to justify premiums that are rising at over 20% per year and have tripled since I first got the policy. Okay, I don't mind paying for health insurance. I want to get health insurance. But there comes a point when, you know, enough is enough. Number eight, I do not profit in any way by telling you about these options. I'm not affiliated with any of these companies or I have no kind of personal or financial interest in any of them. I'm just presenting you with some options that I think most people need to know about because I sure didn't know about them until recently. And then finally I've included a very simple resource guide on the show Notes page that I encourage you to download. Will make your research a little bit easier. You can find that again. B2B Launcher.com Episode 139 all right, so with that, my first guest. His name is Mark Dunn. He's president of America's Benefit llc. It's a health insurance brokerage. And I met Mark recently through my accountant. My CPA suggested that I take a look at this particular option and contact Mark to see if he might be able to help me. I basically approached him saying, look, this is unsustainable. Are there any other options? Do you recommend any other options? And I had a couple other questions and he recommended that I talk to Mike. So that's how we connected. Mark is going to talk about health indemnity plans again. He's going to throw a lot of information your way, couple of resources. He's pointing you to make sure to do your due diligence, do your research. But hopefully this will get you thinking about a different potential option you might be able to take advantage of. Hey Mark, welcome to the show. It's great to have you here.

Well, thanks Ed. I appreciate you having me on board today.

Well, this is a hot, hot topic and it's becoming even more top of mind for, for folks especially self employed professionals who are looking for options. So I'm very excited to be talking with you about that and I wanted to kind of dive right in. But before we do that, I think it's important for you to tell us a little bit about yourself. You know the company that you're with what you guys do and maybe a little bit of history there in terms of, you know, how you guys came about.

Okay, well, I've been in the insurance industry since the late 80s. I'm a certified financial planner, chartered financial consultant. Worked on risk management for most of my clients. I ran into New Era Life a couple years ago when I was searching for things that we could do because my health insurance premiums were going out of whack. They're getting too high even then. And I ran across New Year Life. What is unique about those guys is Dr. Bill Chan. He's the person who bought them out in 1999, took a company, it was almost defunct. Now it's a billion dollar insurance company. It's been steadily upgraded year after year. It's now at B, which is just one little notch between A. He actually, he's one of the world's top statisticians. And he'll be the first one to tell you, if you look at his stats, it's better than most VA companies. But since he's still growing, he's having a harder time getting the A. But he thinks he'll be getting at any time what he focuses on and what his big thing is. He's trying to help change healthcare the way we have it today. He says, it's pretty. It's pretty sad when you take somebody who's 67 years old, they go in for shoulder surgery, he says, and they look down the Medicare list and say, okay, that should have been 6,500 bucks. They take 6,500 bucks, they go on their own way. But two weeks later, you come in age 50, same shoulder surgery, same physician, they do the same surgery, look down the list and say, 6,500. Charge them 25,000. He says, doesn't make any sense. Why should they be getting 6,000 something and you're getting charged 25,000? So that's where he came in to try to help us understand healthcare cost. And once you understand the cost, you can do something about it. So that's the plans he's put together to help us get out of just giving a card down and saying, here, I can do my health insurance without regard to cost. We want people to recognize what things cost in the healthcare arena. And by doing so, we think we control costs in the future.

So just to be clear, you represent New Era Life as an insurance agent, as a financial advisor, and these are the guys who are doing this, right? They're the ones going, yeah, direction, Yes.

I have, I have several other options to go along with it. But that's, that's the base I start out with in most cases because they make a great hospital and surgery program. And then we sort of add things to it and we can sort of build the program to whatever the customer needs, whether he needs everything covered or just. Just wants a hospital and surgical program. Make sure he's protected from the big stuff. We can do it either way for him.

Well, let's. You, you mentioned the cost issue and that was a great example. I actually want to, to talk a little bit about that because I reached out to you because my major medical policy premiums have just gotten out of control. I know I'm not any different from anybody else. They've gone up 23% each year the last two or three years, and they've tripled since I got this particular policy 11 years ago when I went out on my own. So I'm curious what's happening out there? Why are the premiums so out of control? And why is the example you just gave me not an exaggeration that makes zero sense whatsoever.

What's going with the ACA is because premiums are skyrocketing. This next year will be the first year in U.S. history when health insurance premiums are higher than the average mortgage premium. So you're paying more now for your health insurance than you would for your mortgage, which doesn't make any sense at all. People can't afford to pay it. So the healthier people off of health coverage is left and right. They're signing up with programs like ours which help them reduce their cost or they're going without coverage because they just can't afford to keep going up in prices. So what's that leaving on the. The pile of people which are claiming against the ACA now are getting sicker and sicker because the healthier people are dropping out. They can't afford it. But the people with major illnesses have to stay there because that's what they need for coverage. So they're thing in the healthy people are jumping off left and right to plans like art that we offer. Or there's also like, there's, there's some Christian programs. I have, I have pretty much the whole gambit of programs I can offer people. So I sort of try to figure out what their needs are and work from that basis and sort of build the program to what they need. But that's what's happening in the industry. And the premium's going up again. They're going up another 25%. People just can't afford it. So they're going to be dropping off again this year again, which will leave sicker people in the program. And next year you can expect the same thing.

Yeah. So this is a vicious cycle which is going to continue to accelerate based on what you just described. And I understand that there are other fundamental factors such as an aging population and all those things. I don't think personally we're doing enough to really control cost on the side of things where those could be controlled in terms of efficiencies and so forth, but in fraud and waste. But I'm curious, let's go back to that example you mentioned earlier. I paid $6,500. Somebody else, they want to charge them 25,000. I mean, how is that even possible? Because that, at least the way I'm seeing it, that doesn't really address what you just talked about in terms of sicker people versus healthier people. That just seems to me like, I don't know, price gouging or, you know, just doctors and hospitals are just trying to get whatever they can.

It's a big shell game that goes on, if you understand what's really going on out there. I represent, like through some of our programs, you get to utilize some of these PPO programs. Like we utilize PHCs. PHCs. Then I said, well, how does PHCs get PA? So I was talking with the different people at our home office and stuff, and I found out the way they get paid is if they want the bill to be as high as possible, they'll go 6, 8, 10 times Medicare because they get paid off with a discount. So if they get $100,000 bill and they discount it down and they say that, well, the bill should have went in 15, okay, so they reduce it to 15. They get paid off of that, spread the 85,000, they get a percentage of that. So the insurance company then pays 15,000 to the claim and pays the PPO a percentage of the difference. So that's how the PPOs are getting paid. So they want the hospital to put the highest charge as possible on that bill, which doesn't make any sense. It's counterintuitive to try to reduce cost. That's actually what's going on out there. I've been looking at this over and over and it just doesn't make sense. We've got a system that's broken. So that's what we try to do is try to bring that back in. We actually hire an outside advocacy agency to negotiate our hospital bills for our members so they don't get stuck with those real high bills if they're outside of a PPO program.

Yeah, because it sounds like that makes a lot of sense now. I see. I knew there had to be some reasoning to that. So let's talk a little bit about the distinctions between major medical insurance and what New Era Life offers. So could you first describe specifically what New Era Life offers and what this type of insurance is called and then maybe walk us through the biggest differences between that product and what a lot of people call major medical insurance?

Yeah, well, if you understand what major medical is, if you want to be called a major medical, you have to abide by all the Affordable Care act rules. That means you have to cover everything for everybody, no pre existing conditions and you have to have all these mandated coverages in there, which is part of the problem, which is driving the cost up. So what we do at New Era is we pay on an indemnity basis and then we show you that we can pay on. Basically to make it simple, it's not exactly like this, but to make it pretty simple, we offer plans at one times, two times or three times Medicare. So let's say that if you're going in for that shoulder surgery and it's 6,100 bucks, we're going to give you 12,250 for the surgery or two times Medicare if you select a two times Medicare program. If you're going to select a three times program, we're going to give you 18,000.

When it says you, who are you going to give that to? Meaning the.

We're going to give that either pay the provider or give it to you, whichever one you request. But so what's going to happen is now you're going to have 18,000. We have a company that will negotiate the bill generally less than two times Medicare. So if it ends up being 6,000 for Medicare, we have a company that will get you somewhere in the $12,000 range. So if you're buying a two times Medicare program you can pretty much be comfortable with, we're going to get you down to about the $12,000 where you have very little or no money out of your pocket. You may even have money back. Because we work out situations like here in Atlanta, for example, we have a hip nation which they charge about 1.2 to 1.5 Medicare. So if you go in, we just had a guy go in for sixty some hundred dollar surgery with them. A few weeks ago we allowed over $8,000 for it. So not only did he get the sur, since we pay on an indemnity basis, we still had to pay him over 80. Just about 9,000. It was 8,700 bucks, just about 9,000. Even though he only paid 6,700 for the surgery. So we gave him that money, he keeps the difference. So it's a different type of health insurance, but when you understand it, it makes a lot of sense and it also puts control back in the customer's hand, not the insurance company's hand. Our company, which will negotiate rates is called Karis360, not our company. It's somebody we hire. They're an advocacy service. So what they'll do is they' go out and get you five different prices. It can be your surgeon and four other prices. It may be like this. Let's say Medicare was $10,000 and we're giving you 20,000. At two times Medicare you might get prices between 17 and 23,000. If you take the 17,000, we'll pay the 17 and give you 3,000 overage. If you take the 20,000, we'll pay the full 20,000. If you take the 23, well, we're going to pay 20 and you're going to pay 3. But we'll negotiate all those rates for you and give you the information so you can make the best choice for you and your.

So if I understand correctly, basically with indemnity coverage, what you're doing is you're saying, look, there's this menu of services, let's just call it that, and we'll pay for each of those two times what Medicare, Medicare pays for that service. Right. So you know, you can shop it around. We have a partner who will do the shopping for you and give you the prices, but that's what we're going to pay. As opposed to Major Medical, which works a little bit differently. So is that, is that a good representation?

Major Medical almost does the same thing. I talked to a number of what's called the self insurers out there and what they say they cover 80% to 5,000. However, it's 80% of what they deem to be reasonable and customary. And when you talk to them, they deem reasonable in customer to be less than two times Medicare. So when you understand that they're basically paying the same way we just because we don't want to be sucked into the aca, we have to do ours a little differently. So we give you a bucket of money that says you're going to understand that the cost of the surgery might be 20,000, for example. So we're going to allow you 20,000 to get it done. If you get it done for 18, you get to keep the difference. If it's 22, you're going to pay the 2. It's a little different, but it's what we had to do to get outside the Affordable Care act and give the small independent business person and the guy in the middle of the pack that just doesn't get any Medicaid credits like a lot of people do. He's paying his full premium, and he just can't afford it. So this allows us to bring his premium back down and give him some nice options he can select from.

So right now, I mean, there's some great benefits here. It's more transparent. Right. You know, it's two times Medicare, and that information is out there. You have a company you work with that can help you shop things around. And, you know, there's another benefit we haven't talked about, which are premiums. So premiums generally lower or substantially lower than a typical.

Our basic premium that we're seeing is about 50% of what the cost in the Affordable Care Act. Now, we'll add things to our program, like, if somebody's not comfortable with that and says, well, I just want to make sure, in case it's three times Medicare or four times Medicare, I have the money, I can then wrap a bucket of money around another $125,000 bucket of money to give them extra coverage. That'll bring the cost up a little. Also, like, we're really good at hospital and surgery, and we give them a limited outpatient. So we do cover some outpatient, but not everything. I can add on extra outpatient services. Even if I do all that, I'll be 30% less than the Affordable Care act and I'll have no deductible. Where the average premium on the Affordable Care act is over $6,000 now.

Yeah, yeah.

So the person's getting a usable program. You're getting something you can actually use for you and your family, not something you're going to pay for. Then also pay all the bills.

Well, ours dropped in half. So when we signed up with this particular policy, we were close to 1,400amonth, and we're now at about 700. It was significant. I'm curious about one of the questions that has come up is who takes this kind of coverage? Who takes this kind of insurance? Is my doctor on this network? Is there a network?

All the options are in your court. Okay. For One, a lot of my customers will ask their doctor, what's the cash price? However, we also give you PHCs, which is the largest network in the country. So you'll probably find your doctor on PHCs. So in that case, you just give our card and you get the pre negotiated rates. If he's not on PHCs, you just ask him what a cash price is and he can either file it for you, you can file it yourself. It's up to, it's between you and your doctor. Then some of these, what's called direct primary care, that's the whole purpose they're coming in giving you great doctor care services at low premiums. And they're doing that because they don't want to take any insurance. In that case you can still go to those facilities and we're going to reimburse you on that case. But a lot of people don't want to deal with that. Then they use PHCS in there and they just give the card and we take care of it that way. So we get, we give you both options. You can go in a network if you want to or you can go outside. We're going to pay the same either way.

And PHCS is a PPO network you said, right?

Yes. PHCS is the largest. It's just TPO in the country. Many companies like Humana use it in a lot of different areas because they don't have their own doctors in every area. It's used by every hospital in the Atlanta area is owned, except for Kaiser. It's the only hospital in the area is not on it. So you're automatically going to be getting discounted rates in most places you go in most major cities.

So in terms of. Let's talk about aca. You know, the penalties have gone up significantly this year. From what I understand, a 2.5% of your adjusted gross income. It used to be when it first came out, you know, not a big deal. Now you got to make sure that you're compliant or you're possibly looking at a penalty. And I know there's some controversy about whether the government will actually enforce that. But I'm curious, is this policy or are these policies ACA compliant?

We can make them that way. It all depends on what the customer wants. Okay. In order to make a plan ACA compliant, all we have to do is add what's called the minimal essential coverage and we have that available. And what minimal essential coverage is, is no more than your physical. But along with that, the program that I have that adds on the Minimal essential coverage. I can add additional doctor visits, I can add prescription drug service, whatever the customer needs. And even if I put prescription drugs, additional doctor visits, complete outpatient services, I'm still 25, 30% less than the Affordable Care act with no deductible.

Gotcha. So these are bolt on extras, depending on what the customer wants.

Yeah. Some people say, I don't want all that. I don't use it, I don't need it, I don't want it. Okay. So we say, okay, we scale it down, we give them, and they'll end up being half the price of what they're paying with the aca. They want everything that's in the ACA pretty much, except for a couple of the mandated coverages we don't allow anywhere. Like the voluntary sex changes and abortions on demand. We don't put either one of those in our program. But pretty much everything else we have in there, all the other coverages are there, something happens, you get sick, injured heart attacks, cancers. Whatever happens to you, you have full coverage for it.

All right, so I'm going to ask you the big question mark, and this is probably the most common question I got. What about pre existing conditions? That's obviously a big concern. I'm curious what types of pre existing conditions would disqualify someone from getting this kind of coverage?

Where I have answers for everybody, no matter what their condition are. There are some things that my base program can't take, like a heart attack less than 10 years, cancer less than five years ago. But even with that, I have options for those people. For example, I'll take a family who's maybe paying $2,000 a month, which is pretty common right now, and I can separate the person out who's really sick, keep them on the ACA, reduce the family's coverage probably down to $1,000, including his ACA cost, and then we can use maybe that additional money then to fund the illness, the person with the illness so that they bring their deductible down and have lower out of pocket expenses or even have extra cash for the family so they can do other things with it. So, and then I have minimal essential coverage and alternate programs which do pick up those pre existing conditions also. So I do have options. It's not always perfect, but we have, we have a broken system and we have pieces that can, that can fix most things for most people.

Yeah. And obviously, you know, people, when I asked the question, and this question came up about pre existing conditions, nobody was really sharing what they had. But you know, I know pre existing conditions sounds like such a scary term, but it could be anything from high cholesterol to, you know, I get regular ear infections to, you know, I had cancer three years ago. Right.

Well, a standard pre existing is what you've been treated on the last 12 months isn't covered for 12 months forward, but it's covered on the 13th. So what we have is we have available programs like that, minimal essential coverage which I can add, additional doctor visits, things I can add a host of stuff to get you through that 12 month period to where you'll be comfortable with it. I can put emergency room visits, I can cover a lot of stuff for most of these minor illnesses. So you don't really have anything that's not going to be covered. And on the 13th month, the full hospitalization, all that opens back up for any illness. But like cholesterol just means that the cholesterol would have had to cause something. So generally with a person with high cholesterol, the only thing we're not covering is the medication for the first 12 months. So most things are minimal what we're not covering. And years back that used to be different because I've been in health insurance for a lot of years and they used to exclude half your body when something was wrong with it. Nowadays they just look at the specific related illness. So cholesterol, we're just looking at the high cholesterol. As long as you didn't die of high cholesterol two weeks from now, as long as it's controlled, you have no trouble with most of the pre existing conditions.

But that's good to know that there's some options. Right? So what I'm hearing is, look, don't assume that just because you've had something that you don't qualify. The answer is it depends. And there's all kinds of different options and creative ways to get you what you need. Yes, I think a lot of people have given up. That's why I'm saying that.

Yeah, I have. People come to me all the time. That said, it's breaking our back. We're paying $2,000 because so and so has got this illness and we just can't afford to do nothing else with the family. And I show them a way to say put 10,000, $12,000 back in their pocket to help afford the other bills or maybe give them some relaxed time that they haven't had for a couple years. So there are plenty of options for most people.

So you mentioned prescriptions. Let's go there what about prescription drugs? Is there coverage discounts? How is that handled?

I have everything from on our basic program where we just reimburse a little bit towards your medications till I have a full fledged prescription drug card if somebody needs it. So it depends on what they want. Again, if they want to pay for it, I have it. So I can give them a, I can give them a $1 generics and where they paid 10, 20, 30% off of different higher priced medications they get, they get to pay a small percentage of the total but then they'll pay more. So it depends. We put it together for each person. But like I said, even if I put together the prescriptions and everything else, I'll have no deductible and be and still quite a bit less than what the Affordable Care Act's doing right now.

So yeah, that really depends on what you're on, what you've been on in the past and so forth. And you could look to see what would make sense for somebody.

Yep, yep.

I've had a question about natural health practitioners, so. And I think I know what the answer is. But I just want to ask you, let's just say, you know, I got something going on. I don't want to go see a traditional doctor. I want to see a chiropractor or natural health homeopathic type practitioner. What would these policies paid for, if anything.

On chiropractic care? We still give you six visits per year for chiropractic and we pay more than what they allow. Like our two unit programs, which is two times Medicare paid $80 a visit. Most chiropractors here in this area are about 60 bucks a visit. So we're going to pay you $480 or six times 80 and that's how many visits you can get for us to pay for. That's how many visits we'll pay for you for the year. 6. But you're going to actually make money. Each time you go, you'll make about 20 bucks and that might make it seven or eight visits that you get for the year that you didn't have to pay for. So it's not complete coverage, but it is some coverage for you for chiropractic for homeopathics. Now if the person's a certified doctor, we're still going to give you an $80 visit charge. But it all depends on if it's just nutritionist, maybe it doesn't actually, it's not actually a doctor may not be covered, but long as they're a doctor and you Go in for any type of illness or injury. If it's just because you want the nutritionist to adjust your diet, probably not a covered expense, but if you went there because you've got a deficiency which could be considered an illness, then we're going to pay you $80 a visit. So you just can't go there just to have them adjust your diet to make you feel better. Yeah, but if you have, if you actually have an illness of some type, then they'll pay the $80 a visit.

Gotcha. Which is your standard payout for a doctor's visit.

A doctor's visit, yeah.

Okay. In terms of. So we're all self employed. One of the big things that we get as self employed professionals is the ability to deduct the premiums from our taxes. And I know you're a financial advisor, so you can probably, you know, you tell me if you feel comfortable answering that, but are the premiums tax deductible if you own a business?

Yes, they are. Premiums are deductible for all your health insurance premiums. Now, now the other premiums, the things we call minimal essential coverage, they're not actually considered insurance. So you don't actually get the deduction for those. So most of our premiums will be deductible, but there's a couple that aren't. So I go over that with each person also.

Gotcha. Okay.

The biggest part is deductible though.

The deductible for what?

For health. As a health. You can do it. You can do it. A small business owner can deduct it as his health insurance premiums. And also if it's a business owner and he's got employees, he can do it on a pre tax basis also.

Oh, got. Yeah, yeah. Okay. Makes sense. Okay. One of the things that came up is, and I was curious about when you and I started talking is okay, you know, this sounds great. It's, you know, pretty much the option that's best for me and my family. 50% of what we're paying now. But what am I getting into here in terms of increases? What's been the track record of this company in terms of annual increases? Because I've seen 23% the last two years each year. What have you guys been seeing?

Well, if you look back just two or three years ago, we were maybe 20% less than the Affordable Care act, but their rates are skyrocketing because of the claims experience. We have a better group of people. We have more non workers. We have healthier people in General, we don't have to take the guy who just had a heart attack. So our premiums are staying more stable. Our increases have been 1 or 2% plus you go up a little bit for your age each year. I went from 59 to 60. This year. My rate increase was about $25, and that's because most of that was for age. So as you get older, it goes up for that. Then it goes up a little bit for the price increases. Our price increases have been really stable where the ACA is skyrocketing. That's because healthy people are getting off the program. I mean, only people with major illnesses that think they have nowhere else to turn are staying with them.

Yeah, but that's good to know. I mean, I think, you know, anything in that range is totally reasonable. I just think 23, 25, 30% a year, year after year. It's unsustainable, you know, for, for most families. So in terms of, you know, one of the things that I had before this was a high deductible policy with a health savings account component to it. So I was able to set aside pre tax dollars to save up for medical expenses and pay my expenses out of that. Or is there an option for something like that, like a health savings account or flex account where I can put aside before tax dollars to pay for expenses?

Right now there's still limitations on the hsa, so we wouldn't be able to qualify. That's some of the things that I'm hearing about in Congress as well as the President talking about. They're going to make some adjustments in the HSAs to make them more available and hopefully they'll make them available for all type programs. But that's coming up. Hopefully it's coming up in the next year. But right now, currently, we wouldn't be, we wouldn't. You wouldn't be able to take ours in order to fund an hsa because you would need a high deductible program to do that. We don't offer that. Okay. Now, since we're not fully ACA compliant, because that's how we build our program with the, with the indemnity basis. It wouldn't qualify for that currently.

So I have one last question for you, and it's hard for me to kind of come up with an actual example, so I'll just throw kind of a general hypothetical example to you. But let's just say there's a situation where there's an emergency and I wasn't able to shop around and, you know, I Just ended up in the hospital. And, you know, my bill ended up being, I don't know, $50,000. And let's say that the payout, you know, you guys pay even when it's negotiated. Let's just say that I have a 15, $20,000 balance still. Okay. That's scary to me. Right. Because I'm trying to insure against those big dollars. Are there options out there where I can just increase the probability that I can cover something like that? Where there's a gap that when your coverage and what the hospital's billing, that shouldn't really happen.

But I blend together with a Christian program that will give me what's called a bucket of money. So if somebody really wants that for an additional $45 and it pretty much works to make it simple, it would work as an extra bucket of money of 125,000. So let's say you had $100,000. Bill. We only paid 80, for example. It was two times Medicare and they weren't budgeting from their 100. Well, if you put that other $45 on it, that plan would have came back in and paid the entire 20 that was remaining. So we do have options for people with concerns like that too.

Yeah, like the medical cost sharing programs that the Christian ministries have, where you pay a very month, a low month amount. Like, is that where the $45 came from?

Is that, that's where that comes from. I don't mind using them for a backup program. My preference would be use them, use those programs as a backup because there's, there's no additional funding that they don't have to keep a reserve amount like an insurance carrier does. So I've been in health insurance since late 80s, early 90s. I've seen a lot of companies who have good actuaries who couldn't keep up making their claims payment. Neither went under or just closed up their doors. So these Christian ministries, for many years they didn't have that many customers. Now they're getting flooded with customers. So they're also going to get flooded with claims. So they have a bucket of money and bucket of money out. So they pay some premiums in, premiums go out. There's no reserve funding for them. So my concern would be in the next few years when they start getting the major claims that you might see some changes in their, those programs pretty, some pretty hefty increases or some of them going out of business because it just doesn't make sense the way they, they don't really work with a backup. System, you know, they don't have anybody like a Lloyds of London reinsuring them or anything backing up that funding. So I'd be a little concerned. So. But to use it as a backup program. Real comfortable with that.

Yeah. And that's what we ended up doing, right? It's, you know, we got the, this one, we got the backup. I went with CH Ministries. You know, it's 135 for the whole family. But it's strictly. There's a backup. Yeah. Just, you know, if a situation like that ever came up, then, you know, I know I have that as an option. I didn't feel entirely comfortable using that as my main line of defense, although it could be an option for people. We're definitely going to talk about that here in this episode. So, Mark, before we sign off, so tell us where people can learn about more about you. Where can they contact you? Where can they learn more about New Era?

Well, they can. They can come to my website, which is ourplanrocks.com o u r planrocks all one word.com or they can call me directly at 770-628-5914. I'll be glad to get right back with them with answers on their questions or email them whatever they need to find out about their health insurance and do some comparisons for them. And I get them what they what they need. So we can help them out in a lot of different ways. Again, 770-628-5914 or our plan rocks.com and.

In terms of New Era, if somebody wants to check out that particular company, of course through you. But where can they learn more about.

They can also go to new newer life.com perfect new R A Life.

We'll make sure to include all those links and information in the show notes. So Mark, thanks again for coming on today. This has been very, very helpful. I truly appreciate your insight.

Thanks, Ed. I appreciate you having me on today.

All right, so my second and final guest is Dale Bellis, who's the executive director of Liberty Health Share. Dale led the reorganization plan a few years ago that launched Liberty Health Share under the terms of the Affordable Care act for health care sharing ministries. Now that that organization dates to the mid-1980s, but Mr. Belous reorganized Liberty Health Share in 2012 to provide Americans with an alternative to government mandated health care. This is a gentleman who's been around the industry for many, many years and is extremely knowledgeable and I wanted to bring him on to talk about this option of medical cost sharing which is yet another option that many people don't even know existed until very recently. I didn't either. So with that, here's my conversation with Dale Bellis. Dale, it's such a pleasure to be talking with you. Thanks for coming on, Ed.

It's an incredible honor and I appreciate the invitation. Thanks so much.

Excellent. Well, let's dive right in. And I think a good place for this would be just a quick intro, quick description of Liberty Health Share, specifically what you guys do, and maybe a quick history on the company as well.

Sure.

We are a nationwide nonprofit association of men, women and families who, on the basis of our shared values and beliefs, gather around a common cause. And that is paying each other's medical bills. And we do that by the way of an online secure proprietary software. And we match member to member. And utilizing the principles of mutual aid and mutual assistance, we are sharing about 16 to 18 million dollars a month in terms of members medical expenses. So we're paying medical expenses without the aid of an insurance company or the government. Just a regular systematic way to meet health care costs on a whole different methodology and mindset. Because we've abandoned the health insurance model and instead use a mutual aid and assistance model.

That is. That sounds fantastic. And I'm curious, how long has this been around? How did you guys get formed? Because this is kind of a new concept to me as well.

Yeah, it is based upon a tradition that's been alive and well in Christian churches through the generations. And we've simply utilized that model. Our particular sharing group has been in existence since the mid-90s. We reformulated and relaunched under the terms of the Affordable care Act in 2010 through 2012 to make it really available and affordable for all who wish to join in on the basis of our sharing mentality and methodology. But it's really taking the principles of Christian assistance and support that have been practiced literally for generations and turned it into a solution for health care. It's this simple, Ed. If you really believe that you've been placed here on earth to use your time and resources to assist another person, then we've simply turned that principle and value into a solution for healthcare. It's that simple.

I love the concept because we all know somebody who's in need and I think our natural inclination is to see how can we help. You know, and it sounds like you, you've taken that principle and systemized it in a way that it's easier to match the need with the benefactor. Somebody who can actually.

Yeah, we throw in technology, we match and it happens this simply. We asked our members every month to set aside a predetermined share amount and they put it into their online account. We call it a share box. It's a secure account where it's 199 for a single, 299 for a couple, 449 for a family of three or more. We don't count more than three for a family that goes into their online secure account and the share box. Then we match that share amount to another member who literally has expenses that month. And you, on a transparent open basis, you see your dollars flow from your account to the receiving member's account. You can message them with cheer or encouragement or prayer and like a true social community, stand with each other during those times of medical expense crises. And then we send a check directly out of that receiving member's account to the doctors and the hospitals. So every month our dollars are going to another person, not to some company black hole somewhere.

Well, let's take the concept from the other side of the fence. The person who actually has the need. And I got a couple of hypothetical situations just so I can kind of visualize how this might work if you're the one with a medical need. Let's just say that, you know, I have something simple from a regular doctor's visit that might cost me 80, $100 to something more significant. Let's say that I need knee surgery. So how would each of those two scenarios, how might that work?

Sure, the simple doctor visit and the more complex surgery. In both cases, our members out of convenience are presented with an ID card. They present that ID card to the doctor or hospital at the counter and the instructions are given on the card as to where to send the bill. We're all self pay patients. We're responsible for our care and our costs. We just simply choose to share those expenses in community with one another. And so the bill is then sent electronically or by mail. We Liberty Health Share administratively receives it. We process that bill according to our sharing guidelines. Those are rules or the guidelines that our members agree upon as to the kinds of bills we'll share and participate in. Hospital stay, a doctor visit, et cetera are all eligible type expenses that's processed, you see that show up in your individual account online what the doctor or hospital billed. We make adjustments to those bills based upon a national database as to what is a fair and reasonable and generous frankly reimbursement to that doctor or hospital. We ask a sufficient number of members to participate with that. Just basically crowdfund that particular Expense, we send the checks out to the docs and hospitals. That's the cycle. Every time we have a medical bill.

That is pretty remarkable. So something as simple as a hundred dollar doctor's visit to something is more complex, such as a $20,000 surgery. It sounds like it works in a similar fashion from traditional insurance in that I just show my card and then they go ahead and invoice you or send it to you. Is that, am I hearing that we.

Are all self pay patients? And we are, we have an entire department that are, that's every day orienting physicians and hospitals to this sharing mentality and the method by which that provider will get paid. If the provider says, you know what, I'm not going to send my bill directly, I just want to hand it to the patient, that's perfectly fine. We're all self pay patients. Our members would accept that we have a way to electronically just take a picture of it, send it to us, we put it in the queue, process it as we would any other bill. And so whether the doctor presents it to the individual patient on a cash pay basis and awaits the reimbursement, or if the member themselves pay at the counter and get reimbursed personally, either way, it provides the maximum flexibility and convenience to meet those medical bills. And 97%, this is our experience, Ed, 97% of providers will accept our members ID card. The other 3% have questions and we resolve that with them through personal connection and negotiation. But in all cases we're there to advocate on behalf of our individual members to both reduce those bills if there's an excess billing cost or to facilitate that payment on their behalf to the provider.

Now Dale, to be clear, this is not insurance, right? This is not traditional insurance. So there is no such thing as deductible, there's no such thing as premiums. These are, and I'm not familiar with the terminology, but I believe these are contributions as you mentioned. Right. So can you maybe clarify some of these things? Because many of us come from an insurance world where we're used to deductibles and so forth, right?

There are similarities, but we use a different terminology or lexicon to address those kinds of ways in which we share bills together. Because we're not insurance and we don't do it tongue in cheek, but we do it for the very purpose of communicating accurately to a consumer that they understand we're not insurance. We do not operate on the basis of, as insurance does, a contract of indemnity where there are certain promises and guarantees and et cetera, that if I have a particular risk to my health, the insurance company promises to pay that and they pool those dollars and pay out of a premium account. We're totally different. We are premised on a mutual value set where we say we really are motivated on the basis of what is key beliefs on our part. Number one, that our bodies are temples and we're going to really treat it, treat our physical health in a moral and spiritual way, number one. And number two, that we really are motivated to assist another person whenever they have a bill. Those are the primary basis on which we share. We have what we call shared beliefs. They're on our website. And we don't track someone's church attendance or doctrinal beliefs or religious identity. We just simply say here are our values set. If that resonates with you, come join us. And so consequently our members participate with one another voluntarily, cooperatively, but based upon those values that we are living out every day now.

How are membership contributions kept so low? Because I mean, you just shared with me earlier in our conversation the millions of dollars that you are, that you're taking care of every month to people, to members in need. So I'm curious how you're able to keep those contributions so low and how much these contributions typically go up from year to year. Because that's an obvious concern over the past couple of years.

It's a great question. What we call our suggested share amount has not changed over the past three years. It's been adequate to meet all of the medical bills generated by the members sharing person to person, member to member, and it's really a three legged stool. The first and foremost is that we are all self pay patients. These dollars come from our pockets and the pockets of our fellow members. It's not a company account or checkbook somewhere, it is our money. So when I'm standing at the counter, I'm making choices and decisions based upon the cost of my care, looking at the treatment plan, eliminating unnecessary tests and evaluating those kinds of expenses. It's a different mentality. No longer am I entitled to health care, it's my dollars that I'm spending. And so that changes the consumer attitude standing at the counter, number one, Number two is we're health conscious members. As I mentioned earlier, one of our ethical and religious beliefs is that our bodies are temples and we're to take care of our health. So we're proscriptive, we're looking to prevent disease, not just simply go to a doctor because we're sick and so health conscious people typically have fewer bills, lower costs, recover more quickly from the hospital, et cetera. Number two and number three is few people realize the kind of discounts that exist in the marketplace where what a hospital will bill, they will receive far less to settle that particular service. In fact, the billing procedure in the medical care world is different from any other economic sector of our nation. And it can be confusing and awkward, but we stand there with our members assisting them and securing those discounts. And so for all three of those reasons, our cost curve is downward, not upward.

So Dale, what about this is a big concern for my listeners. What about pre existing conditions? What types of pre existing conditions might disqualify someone from becoming a member of Liberty Health Share?

Sure. Health sharing is premised on prospective or future expenses. And so enrolling with Liberty Health Share typically you need to take a look at what are the expenses I currently incur in terms of medical costs the first year. We do not share in pre existing conditions. But that's number one. Number two is we really particularly welcome those with chronic conditions. Those are eligible expenses. Whenever they join us, we assign them a health coach, help them set lifestyle choices and decisions that impact those conditions. And we will share in those costs because they are taking very proactive steps toward addressing the costs associated with those conditions. It would be high blood pressure. All of the ones that I'm going to cite are responsive to lifestyle changes. We, in fact, in the nation today, ed, have an epidemic of chronic conditions and we're excited to help people change their lives because of these kinds of conditions. High blood pressure, heart disease, type 2 diabetes, certainly obesity and smoking, those are conditions that we gladly accept. Folks assign them a health coach. They set those goals and objectives and the health coach simply supports and provides healthy, positive accountability and life change in order to address those conditions. It costs an additional $80 per month. So there's both the motivation to change our health and financially a motivation to once we reach those goals, that $80 drops off. And I'm glad to tell you I'm one of those and we call it Health Track. I'm one of those Health Track members. I'm a type 2 diabetic. I have been a part of Health Track for the last, well since its inception four years ago because I love it. I love the opportunity to consider consult with my health coach, make sure my lifestyle choices and pattern, you know, the way I eat, the way I exercise, reduce stress, sleep. Right. All of the kinds of changes in my life that it that impact my type 2 diabetic condition and I love it. And we see people dropping off the program, hundreds of them a month. We send up digital balloons for them and the $80 drops off and they continue on as a member. But that's the most significant way that we address pre existing conditions now.

And I know that. I completely agree with you. There are many things that we could do lifestyle wise that are hard to do but would make a drastic difference in the quality of our lives and our health. And I guess I was thinking more in terms of situations. Let's say there's so many of them, but I had cancer four years ago and now I'm in remission, for instance. But in a traditional insurance environment, I know that's very, very difficult to get coverage if, you know, if it's not guaranteed. So I'm curious about situations where it's not a lifestyle choice, but maybe something happened a while back or I have to take a certain, you know, medication that's expensive. I think a lot of people are in situations like that as well. Maybe not, not the majority, but certainly, you know, it's a concern for folks. I understand.

Fair enough. And we have a set of guidelines that we follow regarding those preexisting costs. And an individual would just simply need to evaluate if they're presenting a current set of expenses that may not be eligible for sharing in that first year. They just simply need to evaluate whether it's for them. In most cases we, I mean it is a very, very small percentage of individuals who do not enroll regardless of those pre existing conditions. It's a case by case matter. They have an entire team that helps people do that evaluation and consideration. And in your case, you know, a, a cancer condition is, you know, if it's been within a particular number of years and it's our look back is three years. But if there are current medications or treatments ongoing, then it's just a matter of evaluating those costs and moving forward if it is suitable for that individual member.

Gotcha. So everyone needs to look at their situation individually. I know that many different variables out there absolutely makes sense. So I'm curious because you know, this is airing right now during the open enrollment period for ACA and I'm curious how this type of approach fits in with the ACA and open enrollment.

Sure. Under the Affordable Care act, there's an entire section of the law that exempts healthcare sharing ministries, which we are one a recognized healthcare sharing ministry, which just simply means we assist each other and we are exempt from both the requirements to have insurance as well as exempt from the mandates of the Affordable Care Act. That's really crucial to us in both those regards in that because we're not insurance, there is a form that we just fill out with our taxes. I Believe it's form 8365 or some such. But nonetheless it's a simple form that just indicates on our IRS filing that we're a health care sharing ministry member and therefore exempt from the fines for not having insurance, number one. Number two, the mandates that have been so controversial over the passage of the aca, particularly with men and women of conscience and values who do not want to have their money used in ways that violate their closely held beliefs, we as a membership have just simply said we're not going to use our dollars in that fashion. And so we are a safe harbor, particularly from those kinds of mandates that are conscience busting requirements, abortion being the most classic or egregious example of that. And so we've set our own guidelines, follow our own conscience requirements and rights and maintain that as a membership.

So two things. It's I can be exempt from the penalty if I enroll because it's a, it's outside of the ACA requirements. And the other is the open enrollment. I don't have to wait for open enrollment to.

We're not subject to that open enrollment period. We enroll folks 12 months out of the year.

Perfect.

And so while interestingly the nation has kind of been oriented towards making their choices during that period of time as to how they're going to pay for healthcare costs. And so we see typically a large spike of enrollments during that period of the year. It's just simply because it's become the nature of the cycle with making those selections and choices. But we're not subject to the open enrollment period.

Makes sense. Now, one last question for you, and I'm not sure if you can answer this, but because we're self employed individuals, as freelancers, one of the few benefits we get when we do have traditional health insurance is in many cases those premiums can be tax deductible. Do you know if the government considers these contributions to be Liberty Health Share contributions to be tax deductible?

They are not treated as premiums. And so consequently and they are not treated as charitable deductions just under the IRS regulations. If I'm contributing to another person with the prospect of receiving something in return from that membership, then it disqualifies as a true arm's length charitable deduction. Many of our members seek out that kind of tax advice from their advisors and simply follow the pattern that's already been laid out in the tax code regarding costs for their health care arrangement, particularly if they're self employed. But there is pending legislation, interestingly in Congress right now that would clarify that point and treat our health care sharing share amounts in the same way in terms of tax deductibility for self employed individuals. So that there's no further doubt as to whether or not that qualifies. But that's the current status.

That would be fantastic. You know, it's hard enough to be up there on your own, but that would definitely be something that would help us, would help us all. And you know, let's face it, the premiums have gotten gotten so out of control that in many cases, even currently without that deduction, other options suddenly become a lot more palatable. So Dale, well, this has been fantastic. I just want to make sure I point folks to the right place that they want to learn more about Liberty Health Share. Where should I send them?

The best place to go is to our website, liberty healthshare.org liberty health share.org there's a place there to receive a free information packet. We call it our decision guide and it's delivered electronically to your email or by mail if you prefer. There is a toll free number to call to talk to one of our trusted advisors in our contact center for someone just to get all their questions answered. We encourage that there is, I understand, a education curve for healthcare sharing versus insurance and it is a mindset change. It's a paradigm shift and so we just encourage that kind of inquiry and investigation or peruse the pages of the website. But libertyhealthshare.org is the best place to go.

Wonderful. We'll make sure to include that link in the show notes. And Dale, thank you so much for coming on. This has been wonderful talking with you.

Ed, thank you so much for your interest. God bless. The High Income Business Writing Podcast is a production of B2B business launcher.

Learn more at B2B launcher dot com.