Last fall, Rose Swan and her husband saw rising health care premiums on the horizon and decided it was time for a change.<\/p>\n
The Union couple paid hundreds of dollars in monthly premiums and spent hundreds more out of pocket each time they or their daughter went to the doctor. <\/p>\n
\u201cWe were paying $600 a month for nothing,\u201d Swan said. <\/p>\n
Their premiums could have reached $2,000 a month when enhanced Affordable Care Act subsidies expired, so she and her husband sought other options and joined a crowdfunding company called CrowdHealth, one of many\u00a0alternatives to health insurance that have proliferated in recent years.<\/p>\n
Swan\u2019s family joins a growing number of people who, unable to afford conventional coverage, are turning to alternatives that bypass the insurance system altogether. These include health sharing plans \u2013 often linked to religious groups \u2013 that pool resources to cover members\u2019 health expenses, direct primary care subscriptions and health plans for farmers that don\u2019t follow traditional insurance rules. <\/p>\n
\u201cIt really reflects people feeling so squeezed by traditional insurance products that they are willing to take more of a chance,\u201d\u00a0said James Myall, senior economic policy analyst at the Maine Center for Economic Policy. <\/p>\n
Such organizations don\u2019t offer the same consumer protections and aren\u2019t regulated the way insurance plans are, experts warn. <\/p>\n
\u201cIt\u2019s completely rolling the dice,\u201d said JoAnn Volk, a Georgetown University professor who has extensively researched<\/a>\u00a0health sharing organizations.<\/p>\n It\u2019s difficult to say how many people belong to health sharing groups and similar organizations, Volk said. <\/p>\n A report from the Government Accountability Office<\/a>\u00a0from 2023 estimated that at least 1.2 million people were enrolled in nine religiously affiliated health care sharing ministries it studied. But it did not specify how many took part in other programs.<\/p>\n More than 2,500 Mainers participate in these groups, according to The Alliance of Health Care Sharing Ministries, a trade group. CrowdHealth has about 200 active members in Maine, the company said. <\/p>\n Kate Ende, policy director at Consumers for Affordable Health Care, understands the draw of alternative models. <\/p>\n \u201cPremiums are exceptionally high right now, and it can put coverage out of reach for a lot of people,\u201d she said.<\/p>\n Ende recently testified<\/a>\u00a0in the state legislature in support of a bill that would have capped medical costs. For example, a 64-year-old couple living in Aroostook County earning $85,000 annually would have to pay half their income for a plan through the health insurance marketplace, she said.<\/p>\n Four in 10 Maine households have gone into medical debt within the last two years, according to a Consumers for Affordable Health Care survey. Three of four had insurance at the time. <\/p>\n Insurance alternatives take many forms, but they share a commonality: they are not subject to the same rules as insurers. Many will only cover care for preexisting conditions after a waiting period. They often do not cover abortion and some won\u2019t accept smokers or people who weigh above a certain amount. <\/p>\n The plans work for routine care until a serious medical event or diagnosis emerges, Ende said. <\/p>\n \u201cThen they learn that this product isn\u2019t going to provide the level of coverage they need,\u201d Ende said. \u201cIn some cases, they can face really steep financial issues because of it.\u201d<\/p>\n If an insurance company denies a person\u2019s claim, they can appeal the denial and file a complaint with state regulators.<\/p>\n \u201cThere\u2019s a system in place to ensure that those plans are following the law, providing a certain leverage,\u201d Ende said. \u201cThat just doesn\u2019t exist necessarily for these other types of products.\u201d<\/p>\n Consumers should be \u201cwary\u201d of purchasing plans from health care sharing ministries and similar entities, said Timothy Schott, deputy superintendent of the Maine Bureau of Insurance, the state agency that regulates insurance. <\/p>\n \u201cThe Bureau will likely be unable to assist them,\u201d he said. <\/p>\n Andy Schoonover, founder of CrowdHealth, disagreed that the service is inherently riskier than health insurance, citing data showing only 32 of more than 40,000 member bills were not funded.<\/p>\n \u201cWe\u2019ve shown that the Crowd is significantly more effective in paying the bills,\u201d he said. <\/p>\n Dan Deceuster, marketing director of Utah-based Zion HealthShare, said insurance companies routinely deny coverage. Medical sharing groups similarly deem certain claims ineligible, but his group clearly states what is and isn\u2019t covered.<\/p>\n \u201cYou can sign up with a lot more confidence in our transparency, because you\u2019ll already know in advance,\u201d he said.<\/p>\n Jonathan Tibbetts, a Lyman farmer and vice president of the Maine Farm Bureau, participated in an effort to offer an alternative health care program to Maine farmers. The bureau backed legislation that would have allowed farmers\u2019 groups to offer health plans that do not have to meet insurance guidelines. <\/p>\n Many Maine farmers are uninsured because they can\u2019t afford premiums, and those with coverage can\u2019t afford to offer it to employees, Tibbetts said.<\/p>\n The legislation did not pass, amid opposition from health care companies but also concerns that the model would offer \u201ca substandard product to people who are already hard-up,\u201d said Bill Pluecker, a farmer, a state representative and the public policy organizer for the Maine Organic Farmers and Gardeners Association.<\/p>\n But to Tibbetts, it was better than going without coverage, which is what many farmers do.<\/p>\n \u201cIt\u2019s very frustrating,\u201d Tibbetts said. \u201cIt seems like there are a lot of politicians saying, \u2018We want to help.\u2019 But when you give them a solution \u2026 it doesn\u2019t go any further.\u201d<\/p>\n While that legislation failed, the conversation about how to expand health coverage isn\u2019t going away, Myall said. <\/p>\n New Mexico expanded access to Medicaid, and New York decided to offer its own subsidies for health insurance premiums. Myall said he expects Maine\u2019s next governor will likely attempt some reforms, as Maine\u2019s health care \u201cmess\u201d<\/a>\u00a0has become a hot topic among gubernatorial candidates.<\/p>\n \u201cThere aren\u2019t many people that you talk to who think the system is working really well,\u201d Myall said. <\/p>\n Swan\u00a0is aware that CrowdHealth doesn\u2019t follow the same regulations as insurance, but the family\u2019s previous plan had a high deductible and covered barely anything, she said.<\/p>\n So far, she\u2019s happy with her choice, though it hasn\u2019t been tested in a major medical crisis. She estimated the family\u2019s medical costs have been cut in half. Their monthly payments vary but are around $480. They also must cover the first $500 related to any \u201chealth event\u201d \u2013 such as a sprained ankle or illness. So the family enrolled their daughter in a direct primary care program that costs around $80 per month for unlimited visits. <\/p>\n When Swan\u2019s husband visited the emergency room last year, which can cost thousands, the family paid their $500 share and CrowdHealth covered the rest.<\/p>\n