Keith Buchanan’s story is a familiar one. Even though he is a successful IT entrepreneur in Marion, NC, Keith found it hard to pay the rising premiums of the health insurance for himself and his wife Diana. In this week’s episode of “The Cost of Health,” we spoke to Keith about his solution to finding an alternative to traditional health insurance – and the financial benefits – and risks – of deciding to go without insurance.
We first learned about Keith from an article on Bloomberg News by John Tozzi.
“It was extremely expensive for us to continue healthcare,” Keith says, as he sat down to chat with our executive director in the beautiful mountains of Western North Carolina. “As far as our co-pays, out-of-pocket, and insurance premiums go, we were reaching $30,000 per year for my wife and I. We were both working full-time jobs and that was far more than our mortgage payment. In my scenario, I still use healthcare.gov just to look at my options and subscribe to a plan, but there was none. Based on our income, we were not eligible for any subsidies or anything like that.”
There were very few options for Keith and his wife Diana. Blue Cross and Blue Shield of NC is the only insurer that chose to stay on the individual marketplace in his area -- which is true across most of North Carolina. In Keith’s area, Blue Cross recently had some conflict with the largest provider, Mission Hospital. Mission had wanted to raise their rates, which would lead to even higher premiums for people like Keith. The negotiation between the two become heated. The conflict led Keith to decide, for him, it was time for a change.
“[Healthcare] is just one of those things where at some point, you stop and say, ‘Wait a minute. There has got to be a better way.’”
“[Premiums were] directly debited from the bank account for monthly payment, but you know, still, when you're getting hit for over $1,500 a month, it is very frustrating. Because when you work 40-plus hours a week, and then you feel like you're giving it your all, and then so much of your money is having to go to healthcare -- and quite honestly, we weren't using it that much. Even with the issues we have going on, we were not using it enough to justify $30,000 a year… It's just one of those things where, at some point, you stop and say, wait a minute, there has got to be a better way.”
Keith found a way that he believes works for him -- though it is not without its own risks. In 2015, the Kaiser Family Foundation found that about 1 million adults declared bankruptcy due to medical costs. For Keith, leaving behind insurance meant using a mix of direct-pay primary care, a health share ministry, and a commitment of personal responsibility to be healthy.
Going without health insurance is a roll of the dice. But Keith and his wife have calculated the odds and are willing to take their chances.
“Direct pay primary care came to my attention after a little research,” Keith shares. “I found a doctor that we absolutely love. This is direct pay primary care, which basically means that you subscribe like a gym membership to a doctor's office. You don't have co-pays, but you do have a monthly payment to them. They don't bill insurance or deal with insurance at all. In this scenario, we have no co-pays to go to her, and we get unlimited visits. So, if I want to go every single day, I could go for $99 per month. That's one piece of the puzzle as far as how to pay for a doctor -- and obviously, that equates to less than $1,200 per year for that doctor.”
The second piece of the puzzle was using a health share ministry in case of an emergency. Health share ministries are kind of like an unregulated health insurance. The member pays for their care on their own, and then submits their paperwork for reimbursement. Because it is not regulated as insurance, there are risks involved. There is no legal guarantee your costs will be reimbursed in the same way as with traditional insurance. Unregulated care also means that members can be rejected for having pre-existing conditions, and the plan imposes limits on payouts. And many health share plans have morality clauses, considering how medical problems were incurred before deciding whether to pay for the costs. These plans often require participants to sign a pledge to attend worship services. Keith chose to use Liberty HealthShare, a religious-based plan which he pays into monthly. His payments are $299 per month.
The last piece of the puzzle was a dramatic lifestyle change. For Keith, a diet and exercise routine basically was non-existent prior to the plan to switch from traditional healthcare.
“Since then, I've lost a tremendous amount of weight just by diet and exercise and cutting out carbs,” Keith shares. “I'm down 70 pounds … it's been a phenomenal journey. I think knowing this year I was going to have to be a little more responsible for my health – and the way I was treating my body was causing [health] issues … so it’s been a blessing in disguise. I thought if I was eating something that said ‘whole grain,’ I was good to go. Carbs and pastas and that stuff is a huge enemy of mine, so I really cut back on fried foods, French fries, bread. I still enjoy some of those things on occasion, but I do it within reason.”
Keith also bought a Bowflex elliptical trainer -- something he could not have afforded earlier. He hopes that adopting a more healthy lifestyle will help reduce some of the risk of not having health insurance with regards to preventable medical problems. Along with the weight loss, the Buchanans have their eye on building their dream home, something they have put on hold for years, but could not afford to do with their high premiums. Keith notes that other families are in the same boat, paying for health insurance premiums instead of enjoying their earnings.
“It just seems a travesty that people should have to change their quality of life or their standard of living based on insurance premiums that are not justified or did not equate to that particular person’s medical needs.”
The North Carolina Coalition for Fiscal Health wants to make sure that stories like Keith Buchanan’s are heard. To listen to this week’s episode, and learn more about how taking personal responsibility for his health has affected Keith’s way of life, download our podcast here, or listen to the full interview below.
As our state and federal legislators work to fix our broken healthcare system, it is important that they remember that every regulation, every mandate, can result in costs that require dramatic lifestyle changes and piecemeal healthcare plans for North Carolinians.
Past (and future) episodes of our podcast “The Cost of Health” are available for download. Visit here, or listen and subscribe on your favorite podcast app.
Do you use a health share plan, or participate in direct pay primary care? Let us know your experience in the comments, or join the conversation on our Facebook page.