ACA-Exempt Altrua Healthshare Plans
A Low-Cost and Legal Way to
Opt Out of Obamacare
Members of Healthshare plans are exempt from the requirements of the Affordable Care Act, including the requirement to purchase a government-approved health insurance plan, as well as the 2.5% tax penalty for not carrying health insurance.
Plans are available with membership responsibility amounts (out of pocket maximums) ranging from $500 to $4000, per person per year. The Lifetime Maximum limit is $1,000,000.
Altrua has been an HCSMs since 1999, and during that time they have never failed to meet the eligible medical needs of their members.
This Not a Health Insurance Policy
Make no mistake - HCSMs like Altrua aren’t big insurance companies. Because of this, they don’t fall under the regulatory guidelines of state insurance regulations. Altrua and groups like it have no backing from the insurance behemoths like Aetna and Blue Cross/Blue Shield. So how do they do it?
Members agree to pay a monthly contribution - which equates to a monthly premium that you’d pay with a traditional plan - and that money goes into escrow. When plan members have qualified medical needs, plan funds are shared to meet those needs.
Levels of Membership
There are three levels of plans - Gold, Silver, and Advantage. The Gold has a maximum out-of-pocket of $3000 per person per year; Silver is $3,500; and Bronze is $4000.
You can choose a Standard plan, which has a lower initial membership responsibility amount, then covers 75% of the next $10,000 before covering 100%. Or you can go with an Advantage plan, in which you are responsible for the full out-of-pocket amount up front before the coverage begins.
More details are available in the Altrua Information Booklet.
How Do My Medical Bills Get Paid?
With HCSMs, things work differently than what you might be used to if, like most of us, you’ve had a “traditional” insurance policy. Here’s a graphic that should help you understand the process that occurs if you have a medical need.
Special Requirements and Conditions
Lifetime Coverage Limit
When the ACA was implemented insurance companies could no longer exclude people from coverage because of pre-existing medical conditions. Because HCSMs are not subject to these rules, you must be in good health to be accepted as a member. This doesn’t necessarily mean that you will be declined if you have a health problem, but your membership may contain what’s called a “member limitation” for a period of time, or even for the duration of your membership. This simply means that your expenses related to that condition won’t be reimbursed by the plan.
Altrua does not accept smokers.
Altrua also has height and weight guidelines.
Another condition of Altrua’s plans is that each member has a lifetime limitation of $1,000,000 in cost sharing. Should your medical expenses exceed this amount, your plan would terminate, however you’d be able to immediately enroll in an ACA plan, since losing your coverage qualifies you for a special enrollment period. Altrua will not cover medical costs associated with cancer treatment during the first year of plan membership, so you also should strongly consider purchasing affordable cancer coverage to ensure that you and your family are adequately protected.
You Must Agree to Altrua’s Standards
When you sign up for membership with Altrua, you state that you agree to their Statement of Standards.
Considerably More Affordable Than ACA Plans!
How do they do it? First of all, the pool of individual members tends to be generally healthier, since each person must qualify for inclusion in the plan based on their health. Second, HCSM plan members are considered “self-pay” patients by providers, and as such they typically get charged at a lower price for services than patients with insurance.
As a member you can visit providers who are part of the PHCS network. Medical costs incurred from providers who are not part of the network are shared at a lower percentage.
Altrua’s monthly sharing amounts have been the same for its members since 2009. Sharing amounts do not vary based on geographic location like traditional insurance policies. The following simple-to-use chart shows you what you might pay as a sharing amount per month, if you apply for membership.
Sign Up Any Time!
Because HCSMs are not insurance, you don’t have to wait until the Annual Enrollment Period (AEP) to sign up - you can get started today saving money on protecting yourself and your family from unexpected healthcare expenses! If you're ready to begin your application process, simply fill out your name and email and click the Sign Up Now! button below.
Want to learn more? Download 30-page Altrua Information Booklet!