I met with a representative from US Health Advisors. They’re pretty anti-Affordable Care Act and base their marketing on that. That, however, is beside the point.
The guy I met with said “they got into business because of Obamacare”; that people were being taken for a ride from insurance companies for years and that “USHealth Advisors (USHA hereon out) saw where things were headed and innovated new products to help protect people.”
He ranted about how ACA compliant plans pay for abortions (factually incorrect), can’t deny insurance for preexisting conditions, and that people would still be paying $10,000+ for their medical coverage.
As has already been covered in this thread, USHA offers indemnity benefits rather than true insurance. For the uninitiated, that means they will pay out a set amount per procedure, sickness, or injury. They offer discounts within their network of doctors and providers with less of a discount outside their network, just like a standard PPO.
The trick is that once you get their price sheet and see $10/generic drug and other prices laid out, you start thinking that is what you’ll owe toward those services. It’s actually what they’ll pay out for those services. He had a lot of receipts where people went to the hospital and ended up getting money back after USHA paid their bills and sent them the difference (if the bills come out to less than what the indemnity payout is, you get that difference). These bills, though, were all from 2011. I think we know how much things have changed since then.
He couldn’t tell me how often they adjust for inflation or other cost changes with the state offices, where they file what they’ll pay out to customers.
There are a number of things that aren’t covered:
Birth control — ever
Preexisting conditions for the first 12 months
Wellness/preventative care visits for the first 6 months
Prescriptions aren’t covered, you just get $10 back if you sign up for that option.
There are a ton of other things they won’t cover, but it’s not listed in their online brochure.
In order to get that brochure, you have to sign up and become a member of their “association” (seriously).
There is no out of pocket maximum for a consumer. Consumers will still pay the ACA penalty, but the agent I spoke with suggested lying to the IRS about your insurance status at the end of the year. Yes, he suggested fraud. When I pointed out what he just told me, he said “Of course I would never suggest that!”. Right.
They say that if you sign up for the lowest cost and lowest benefit plan and something happens, within 90 days after that something happening, you can upgrade to a higher level plan and have slightly more coverage. That would raise the maximum of what they’ll pay out for you that year from $100,000 to $250,000.
The amounts they pay out for cancer treatments, accident recovery, and AD&D are considerably less in volume and considerably more restrictive than what Aflac, Colonial, or even Unum provide.
To top it off, when I asked him what their AM Best rating was, he said they didn’t have one. They do: it’s B-. This makes him not just misinformed, but a liar.
Honestly, people would be better off with a bronze level ACA plan, getting a CI rider on their life, and a midrange Aflac cancer and accident policy if they wanted all the bells and whistles of these plans.