94: The Health Insurance Episode: All Your Options + How to Save Thousands

Tired of paying sky-high premiums for health insurance? In this episode, Rachel Coons breaks down all your health coverage options... from traditional insurance and marketplace subsidies to cost-sharing plans that could save you thousands every year.

As a former licensed health insurance agent, Rachel shares insider knowledge about the four main ways to handle health coverage in America. She explains why health insurance became so expensive, what most people don't know about their options, and how her family saves over $15,000 annually using an alternative to traditional insurance.

What You'll Learn:

• Why health insurance costs are so high (and why you might be overpaying)
• The pros and cons of employer coverage, marketplace plans, and going without insurance
• How cost-sharing plans work and whether they're right for your family
• Real-world example: How Rachel's family handled a $17,000 emergency room bill
• Who should (and shouldn't) consider alternatives to traditional insurance

Whether you're a small business owner, self-employed, or just frustrated with your current premiums, this episode will help you make an informed decision that works for your family's health needs and budget.

Christian Health Ministries (cost-sharing plan with 50% off first month available) Click here to learn more about the cost sharing plan Rachel recommneds

xoxo,
Rachel

Where to find me:
Instagram: @heyrachelcoons

Join me for my free training to learn the 5-step RESET Framework: Register HERE

Transcript

Why Health Insurance Feels So Costly

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If you are like most Americans who are paying for their health insurance, you know that it is very expensive. And most people just think it's a part of life. So you suck it up and you pay it. What if I told you that's not 100% true? What if I told you there are other options that could save you thousands of dollars a year and you've just never heard about them? That's what we're gonna talk about today. I'm gonna break down for you all of your health insurance options, traditional insurance, marketplace plans with subsidies, cost sharing plans, and even going without coverage, which I don't recommend, but we are gonna talk about it. By the end of this episode, you're gonna know exactly what's available to you and how to make the best decision for your family. So stay tuned. Welcome to the Money Mom Podcast, the show where we empower moms to take control of their finances, break free from money stress, and build a life of freedom, confidence, and abundance for their families. I'm your host, Rachel Coons, mom, money mentor, and your personal cheerleader on this journey. Whether you're here to save money, pay off debt, or dream bigger for your family's future, you're in the right place. Here, we believe that being a mom is already a full-time job. But your role in shaping your family's financial success is just as important. And the best part, you don't need to sacrifice everything to start winning with money. Let's get started. This is the Money Mom Podcast. Hello, and welcome back to another episode of the Money Mom Podcast. I'm your host, Rachel Koons. And today's episode is not a traditional episode that you would see here on the show, but it's one that I've been wanting to do for a while because whenever I talk about health insurance on social media and the type of health insurance we have and how we have gone about this process, I always get flooded with questions about the topic. And most people don't know this about me, but I actually was a licensed health insurance agent. I worked as an agent and a broker in the state of Utah for a couple years. And so I may not be an expert on this topic. I don't want to like coin myself as an expert. I do have a lot of experience in the field working as an agent with different plans, knowing what plans covered and what plans didn't. And then I've also tried a lot of different things as well for our own family. And so through that knowledge, through that licensure, and as well through our own experiences, I do think it's a topic that I can talk about and share a lot of knowledge with people who just aren't taught about health insurance and what your options are. So outside of college, I had graduated with a degree in health and wellness. And it's always been my first love and passion is the body and physical health, nutrition, all of those things. And so I worked as a personal trainer for a couple of years after college and honestly got kind of burnt out in that industry. It's a very toxic place to be, if especially if you don't have the right mental bandwidth for it. And at the time, in my early 20s, I did not have a good relationship with my body. I did not have a good self-confidence with my body and those kinds of things. And so being in the personal training world was not good for my mental health and for everything that came with it. And so I decided to step away when I was offered an opportunity to work as a health insurance agent right at the time when the Affordable Care Act was being enacted. So it was the end of 2013 where a company approached me. You know, you do a lot of sales in personal training. And so a company approached me and wanted me to come work as an agent for them, um, selling a new health plan in the state of Utah. And obviously things were a mess at the time with the Affordable Care Act and the creation of the marketplace and how insurance was going to change. And so I was kind of trained on all of the new options that families have. And then I would present those options to families and help them get subsidies if they qualified for them and help them sign up for coverage. And in that time, I learned a lot about the good things about health insurance. I heard a lot of really positive stories. And then I also was introduced to some of the nightmares that people experience with insurance. And a lot of people, I will say from that experience, a lot of people, when I talk to them, it's just that health insurance is expensive and it's just going to be part of what I have to take care of as far as with my family. So, first, let's talk about this belief that health insurance is just supposed to be expensive. Here's the truth health insurance became expensive because how the system is set up. Insurance is actually forcing our medical coverage to be so expensive because insurance can pay for it. So insurance is like this umbrella coverage for the people who, if something happened to us, we could not pay the hundreds of thousands of dollars it would cost to stay in a hospital overnight or to have a surgery that would cost so much. So people go out and get insurance to protect them from those crazy expensive experiences that you may or may not have in your lifetime. So what you do is you go out and you get coverage for your family anywhere from 1,500 plus a month for a family plan. And then you have a deductible. Now, if you're going to pay less money for your insurance, your deductible is going to be higher, which means you don't tap into coverage options until you hit that deductible if something happens to you. So, you know, you're paying$1,500 a year for insurance, which means your baseline that you're spending every single year is over$15,000 just for the coverage, right? That's not even paying for anything that happens beyond that. It's not even paying for your deductible. If you have to use your deductible, that means you're paying$25,000 just for coverage with the premiums and the deductibles combined. So for most families, it's pretty simple to bet that you're not going to spend$25,000 worth of healthcare in a year. So why are we paying for it like we are? Because we've been told that we have to. We've been told that this is the only option to stay safe. And we've been told that anything else is irresponsible or risky. And I'm here to tell you that that's just not true, that there are other options. And I'm going to walk through each and every single one of them with you right now. So let's break down some of these options. I would say there are four main ways, like mainstream ways, to handle health coverage. The first one is to have no coverage. And I am not recommending this by any means, but I want to acknowledge that some people are doing that. If you're going to go without coverage, you're not going to spend any money on premiums and you're going to pay all out of pocket for any medical situation that you need. So going to the doctor is going to cost you out of pocket. If you have to go to the emergency room, you are paying out of pocket and you are going to take on 100% of the risk. If you have one emergency or one hospital stay or one major health issue, you could be looking at tens, if not hundreds of thousands of dollars in medical bills. And I personally know people that this has happened to. And I don't want to like doomsday this, but I'm saying if you don't have insurance, you're looking at bankruptcy if something happens to you. So I understand why people feel like this is the only option when they're looking at health insurance and it's so expensive, but it's a huge risk. And personally, I don't think it's worth it. And there are other options that don't cost as much as health insurance. So that's option number one. Don't recommend it. Option number two is employer coverage. Now, most employers, if you are hired on to a company, offer health insurance as part of your compensation package. And this is usually the most affordable options. And I would say most Americans, this is how they get health insurance because your employer is covering part of the premium. Either they're paying for the employee 100% and then they're paying a percentage of your dependents. Or, you know, in a in a perfect world, you would get 100% paid health insurance. So you don't have to worry about the premiums. It's just basically getting taken out of your paycheck. And then you get to use that coverage, whatever it is, whether it's a high deductible plan or a low deductible plan, you get different types of coverage with your insurance. The downside of this is that you are limited to whatever plan the employer offers. Now, a lot of times they'll offer different coverage options. So you could get like a bronze plan, which will have a high deductible, or you could get a gold plan, which is going to cost more money up front for your payments. But then you're going to get a lower deductible and you'll get more coverage up front. But you a lot of times you don't get to choose like what company you're working through for your insurance. And then if you leave that job or you transfer jobs, you could lose that coverage. So it's wholly dependent on your employer. But if you are someone who has access to employer coverage and it's affordable and it's something that you feel good about doing, this is a solid option. A plus, definitely look into your options here if your employer offers it. Now, this episode is mainly for people who do not have an employer that will give them health insurance. And that's why we're talking about all the different options. Option number three is if you are a low-income family specifically, and you're not going to be able to pay thousands of dollars a month on insurance premiums, you may qualify for a subsidy on the marketplace. And you've probably heard of it. It's called healthcare.gov. And it's wholly dependent on your income and your family size. You basically go on to healthcare.gov, you put in your information, and then it'll tell you if you qualify for a subsidy, which will lower your monthly premium. I worked with a lot of families when I was a health insurance agent who qualified for subsidies that then would make their monthly premiums affordable, where they could actually swallow the amount of money that they were paying. But the key here is that you have to go to the marketplace to see what you qualify for. And a lot of people assume that they won't get help, but you may be surprised if you could get help and then you just sign up for that health insurance through the marketplace. I will warn you that I would go and look at a calculator before going on to healthcare.gov because once you submit that application, other insurance agencies are going to have access to your information, which then they will contact you and they will spam you. So be careful about putting in your information unless you really do think you're going to get a subsidy and qualify for that. So then you can go and get that. The downside to this, beyond the spam calls that you may get if you put fill out your information, even with subsidies, the plans can still be expensive. Like you may only qualify for$50 a month of a subsidy and you're paying$1,500 a month for coverage. So even with the$50, it still feels really expensive. And then the deductibles might be really high, but it is worth checking out to see if that's what you qualify for. Okay. And then the fourth option, and this is the option why I actually did this episode is because I've talked to so many people who don't know about cost-sharing plans and are small business owners or don't get employee coverage and are paying outright for health insurance. They're paying, you know, the$1,500, the$2,000 a month for health insurance because they think that's the only option. And when my husband, who is a small business owner himself, when we purchased our dental, he's a dentist. So when we purchased our dental practice, we had to look into insurance options. And when I went on to the marketplace and put our family's information in and our income, we didn't qualify for any subsidies. I am not kidding. When I say our lowest coverage plan, which was the highest deductible, pretty much didn't touch or didn't pay for anything until we hit a$10,000 deductible, was$2,000 a month. That's what we would have paid for the lowest cost Kaiser plan. We live in California. And we don't even, we honestly don't go to the doctor. I will take my kids to the doctor if they have a sickness or they need vaccines or they need a physical, but like we're not people that go to the doctor very often. And if we do, it's usually because of a broken bone or stitches or some like catastrophic event. And so when I was looking at this$2,000 a month coverage, and I was still gonna have to pay for doctor's visits, I was still gonna have to pay for all prescriptions, all of those types of things. I was like, this feels like highway robbery. It feels like the worst option. There's gotta be other options. And so my friend introduced me to a company that is called a cost sharing plan. And I had heard about cost sharing plans when I was working in health insurance, because a lot of people are afraid if you don't have health insurance, the government will fine you, right? It's it's required now by law to have some type of health insurance because of all the things we talked about earlier that can happen when something, you know, catastrophic does happen. And so a lot of people are worried, well, if I don't go the normal route and don't get normal insurance, then I'm gonna be fined. That's not actually true with the Affordable Care Act. There are specific cost-sharing plans that if you sign up for, it's considered traditional insurance. It is considered good enough by the government so that you don't have to pay the fine. But I want to say that these cost-sharing plans, they are not traditional insurances. It's not traditional. Uh, and that's what scares a lot of people from them is that it doesn't work the same way that you're used to, but they do work very similarly. And when I was introduced to a specific cost-sharing plan that we are on now currently, I was blown away by the options and by what type of coverage we did have. So here's how a cost sharing plan works: you pay a monthly share, which is we'll call it a premium, but it's usually way lower than you would for insurance. So for my family, we pay$400 a month for our cost sharing plan instead of the$2,000 that we would pay for health insurance. And then when you do have a medical expense, when you have to go to the doctor, you pay out of pocket for it. So we go to urgent care or the pediatrician, we pay$150 to see the doctor. And then we have to pay out of pocket for any other tests that they do, anything else. X-rays, we're paying out of pocket for. It's usually a couple hundred dollars, which again, we're saving$1,600 a month. So even if we went to the doctor seven times in a month, we still would make out on top of what we would pay for normal insurance. And then if something catastrophic does happen, like last year, my son broke his arm very badly and we had to go to the emergency room. He had to be put under with ketamine and he had to get it set, an orthopedic surgeon, and it was a whole ordeal. You basically are considered by the hospital, you are considered a cash patient. So they treat you like a cash patient. When you show up, you say, I do not have traditional insurance, I am paying cash. So then they send you the bill specifically for whatever procedure you have done. Then you take your bill and you submit it to the cost sharing plan. And there is a deductible usually before coverage will kick in. But for any of these catastrophic events, you pay the deductible and then the cost sharing plan will then go advocate for you with the hospital, with whatever organization you're using for the that's billing you. And they'll make sure the codes are correct. They'll make sure everything looks good. They'll make sure you get any type of, you know, cash discount. And then they will send you a check to pay for everything minus your deductible. Now, your head may be spinning a little bit. So let me walk you through this in real time with what happened with my son and our cost sharing plan. He broke his arm. We went to UC Davis emergency medical room in Sacramento. We were seen that night. We told them originally we are cash patients. They treated us the exact same. We were able to get a room. The doctors came in, they set his arm, we did all the discharge papers, and we were sent on our way. Didn't pay a dime to see the doctor that night. Then, you know, a month later, we received a bill for$17,000 in the mail. Now that can be very alarming to the nervous system when you open up a bill that's$17,000 and you're like, oh crap, this is really expensive. I thought this cost sharing plan was supposed to help us, not have, you know, pay more money. So then I took that bill and I uploaded it into the cost sharing plan's website. I explained what happened, where we went to get coverage, uploaded that bill, and then they do their thing. The cost sharing plan does all their thing where they advocate, they go, you know, make sure everything's correct on the bill. And then they sent me a bill. Our deductible is$6,000 for an event. They sent me a check for$11,000, which then I deposited into the bank account. And then it was my job to pay the hospital that$17,000. So the$6,000 deductible was taken out of the check that they paid off for us. So that's what it looks like. And it honestly, like we've had a couple of these events where a child, it's all been broken arms. My kids always break their arms. And we've had a couple of these events that have cost us, you know, more than$6,000. And so then we submit it to a claim to the cost-sharing plan and they end up paying everything minus the$6,000. So is it actually more affordable than normal insurance? If you are healthy and you don't have more than two of these events a year where you're spending a lot of money to pay for a$6,000 deductible, 100%. Now, what I said earlier is that we are saving$1,600 every single month by using this cost sharing plan without using insurance. So throughout the year, we're saving over, you know,$15,000,$16,000 by doing that. So we have that money that we could use. Hopefully, if something happens, we could use that towards the deductible. And so I cannot speak enough to how wonderful this option has been for us and how much more affordable it has been. I am so happy to go pay for cash at the doctor's office,$150 to see a doctor when I'm saving so much more every single month. So, yes, it is not normal traditional insurance, but if you're healthy, you rarely go to the doctor and you're paying thousands of dollars a month for insurance, you could save a ton of money every single year by using a cost-sharing plan. So, cost sharing plans are a great option if you are a small business owner or you're paying out of pocket for insurance. That like I cannot recommend this enough if that is you. It's also very helpful if you're relatively healthy and you don't have chronic health conditions that don't require medical assistance very often. And if you want to save money on monthly premiums and okay with looking into a different way to go about insurance, this is a great option. This is not a good option for you if you get coverage by an employer and you're not paying much for your premiums right now, or you have chronic health conditions that require frequent care, or maybe you're just really hesitant to not have the security of traditional insurance. I get that. But for us, the risk was worth the benefit for it. And so that's why I wanted to come on and talk about this option because so many people don't even know it's available. In full transparency here, too. I do have an affiliate link in the show notes for the cost sharing plan that I recommend. It's called Christian Health Ministries. Like I said, there's a lot of options out there, but this is the company that we've worked with for five years, and we've had a great experience with them. Whenever I have questions or I need help with the coverage, I call them. They have people 24-7 that can answer your phone call and will help with whatever questions that you have. So it's been, it's been a wonderful experience. In fact, it feels like working with a small business versus like a corporate entity, like a normal insurance coverage. You're dealing with humans. And I really like that. And if you sign up through my link, you can get 50% off your first month with CHM. And then I also just full transparency, I do get a small commission, but it's not any extra cost to you. They'll, the company will just kick back to you. But I really truly am only sharing this because I genuinely believe it's a great option for the right person. And I've had so many conversations with people about this. You know, my friends that I've talked to about this, people online, that I just feel like it's something that more people need to know about. And I'm just amazed at the amount of money some people are paying for insurance. So you can make the decision for yourself. I presented four options here for you today that you can kind of pick and choose which one. Option one, don't do insurance, just take the risk on, don't recommend it. Option two is to go through your employer. Option three is to see if you qualify for a subsidy. And then option four would be working with a cost sharing plan. I highly recommend doing the math. Like look at the numbers and see what you're paying now and what you'd pay with each option. And then factor in how much healthcare you're using, how many times you go to the doctor each year, what kind of coverage your family specifically needs, and make the best option for your family. But the point is through this episode is that you do have options. You don't have to just accept that health insurance is expensive and there's nothing you can do about it. You can take control, you can explore the different options and you can make a decision that actually works for your family and your budget. All right, that's all I have for you today. If you want to check out that link I have below, um I'll put it in the show notes. And if you have questions, DM me. Send me an email or a message on Instagram and we can chat about this and I can help kind of work through the options with you and share my own experience. If this was helpful, share it with a friend or another mom who you feel like has complained to you about health insurance and share with them the options as well. We're here to help each other out. Okay, I'll see you next week.