Last fall, Rose Swan and her husband saw rising health care premiums on the horizon and decided it was time for a change.
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.
“We were paying $600 a month for nothing,” Swan said.
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 alternatives to health insurance that have proliferated in recent years.
Swan’s 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 – often linked to religious groups – that pool resources to cover members’ health expenses, direct primary care subscriptions and health plans for farmers that don’t follow traditional insurance rules.
“It really reflects people feeling so squeezed by traditional insurance products that they are willing to take more of a chance,” said James Myall, senior economic policy analyst at the Maine Center for Economic Policy.
Such organizations don’t offer the same consumer protections and aren’t regulated the way insurance plans are, experts warn.
“It’s completely rolling the dice,” said JoAnn Volk, a Georgetown University professor who has extensively researched health sharing organizations.
It’s difficult to say how many people belong to health sharing groups and similar organizations, Volk said.
A report from the Government Accountability Office from 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.
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.
Kate Ende, policy director at Consumers for Affordable Health Care, understands the draw of alternative models.
“Premiums are exceptionally high right now, and it can put coverage out of reach for a lot of people,” she said.
Ende recently testified in 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.
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.
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’t accept smokers or people who weigh above a certain amount.
The plans work for routine care until a serious medical event or diagnosis emerges, Ende said.
“Then they learn that this product isn’t going to provide the level of coverage they need,” Ende said. “In some cases, they can face really steep financial issues because of it.”
If an insurance company denies a person’s claim, they can appeal the denial and file a complaint with state regulators.
“There’s a system in place to ensure that those plans are following the law, providing a certain leverage,” Ende said. “That just doesn’t exist necessarily for these other types of products.”
Consumers should be “wary” 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.
“The Bureau will likely be unable to assist them,” he said.
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.
“We’ve shown that the Crowd is significantly more effective in paying the bills,” he said.
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’t covered.
“You can sign up with a lot more confidence in our transparency, because you’ll already know in advance,” he said.
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’ groups to offer health plans that do not have to meet insurance guidelines.
Many Maine farmers are uninsured because they can’t afford premiums, and those with coverage can’t afford to offer it to employees, Tibbetts said.
The legislation did not pass, amid opposition from health care companies but also concerns that the model would offer “a substandard product to people who are already hard-up,” said Bill Pluecker, a farmer, a state representative and the public policy organizer for the Maine Organic Farmers and Gardeners Association.
But to Tibbetts, it was better than going without coverage, which is what many farmers do.
“It’s very frustrating,” Tibbetts said. “It seems like there are a lot of politicians saying, ‘We want to help.’ But when you give them a solution … it doesn’t go any further.”
While that legislation failed, the conversation about how to expand health coverage isn’t going away, Myall said.
New Mexico expanded access to Medicaid, and New York decided to offer its own subsidies for health insurance premiums. Myall said he expects Maine’s next governor will likely attempt some reforms, as Maine’s health care “mess” has become a hot topic among gubernatorial candidates.
“There aren’t many people that you talk to who think the system is working really well,” Myall said.
Swan is aware that CrowdHealth doesn’t follow the same regulations as insurance, but the family’s previous plan had a high deductible and covered barely anything, she said.
So far, she’s happy with her choice, though it hasn’t been tested in a major medical crisis. She estimated the family’s 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 “health event” – 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.
When Swan’s husband visited the emergency room last year, which can cost thousands, the family paid their $500 share and CrowdHealth covered the rest.
The company publishes a summary of members’ funding requests on its website. According to this data, Mainers submitted 63 requests for coverage in the first three months of this year involving conditions including asthma, endometriosis and a torn calf muscle. All were fully funded.
Swan’s family is seeing far more of its healthcare care costs reimbursed now, including physical therapy and visits to a naturopathic doctor.
“So for a family that’s fairly healthy and fairly young, I think it makes a lot of sense,” Swan said. “We feel like it’s a way better deal.”
