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Friday, January 26, 2018

Folders, Pamphlets and Forms…Oh My

Over the last two weeks, we’ve received a couple pieces of what the marketing folks might call “collateral” welcoming us to Liberty and SavNet. For those keeping score (none of you) we have not received our membership cards. As I’ve said before, I’m not sure it really matters if we have them but it’s an interesting measurement of efficiency to monitor how quickly new members receive these. Ultimately, it matters how quickly payments are processed so there’s no reason to jump to any conclusions. While we wait I’m proud to show off the folders, pamphlets and forms you’ll receive as new members. Hold on to your seats.

There are two obvious things you’ll be thinking as you review this picture: (a) My photography skills are outstanding – I must just have one of those eyes and (b) Why do I even care? Well, you shouldn’t care that much but if you are anything like me you like to know what you’re getting into when you try something new – in that spirit, I want to share as much as possible so you can make an informed decision. A few notes on what’s included:
  • Our welcome folder was the first set of information we received. It includes a welcome letter, refer a friend ad and your 2017 Guidelines (which apparently must be the same as your 2018 Guidelines). Also included are a few forms:
-       Authorization for Release of Medical Information – This form authorizes Liberty to get access to your medical related information. Essentially, you are authorizing your healthcare providers to provide Liberty with access to your medical records, bills, etc. to help with case management. It may sound intrusive but I can see why it would be necessary for Liberty to have these agreements in place.
-       Medical Expense Need Agreement – This is a form that basically says I won’t use the money I receive for medical bills to address other expenses. Basically, I won’t be a jerk, submit false bills, all that stuff.
-       Medical Expense Processing Form – This is the form that needs to be filled out and submitted to Liberty any time you are submitting bills for a medical need.  
-       Provider Information – This is a form you can use to “nominate” your healthcare providers to be part of Liberty’s recommended providers list. I would assume Liberty uses this information to contact the provider, let them know one of their patients is now with Liberty, and try to negotiate discounted rates. Given our situation, it is unlikely I will use it (our healthcare provider is familiar with Liberty). 

When I saw these forms I thought we had already signed off on a few of them as part of the application process but we sent them back nonetheless.  

  • A few days after receiving our welcome folder we received a pamphlet from SavNet. This is a nice summary of what the SavNet Health Savings Program provides including the discounts on dental, vision, chiropractic and hearing services. Keep mind this is a separate SavNet program than the discounted prescription program. We have separate dental insurance which works out well for our family of 5 so I’m not sure how often we’ll use this but it’s nice to understand how it all works. If we wanted to forgo our dental insurance and change our dental providers to a SavNet provider, a routine check check-up, under SavNet would be $37 according to the information we received. For a family of 5, receiving 2 check-ups a year like us, that’s $370. For now we really like our providers and the estimates SavNet provides are…well…estimates. Nonetheless, it’s nice to know it’s there if we need it.

So that’s what you can expect in your welcome folder, pamphlets and forms. Not as scary or exciting as lions, tigers and bears but good to know if you are considering Liberty.  

Wednesday, January 10, 2018

Interesting Information in our First Liberty Newsletter

Liberty sends members a monthly newsletter with articles of interest, reminders on Liberty practices and other information helpful to members.

One piece of information we thought was particularly interesting was found at the bottom of the newsletter. I’ve often wondered, as have many people who are aware we’ve joined Liberty, how much money Liberty receives in shares in a given month and how much they pay out for medical expenses. At the bottom of the newsletter Liberty provided this information. Obviously, if the amount of money Liberty pays out is much higher than what we receive, this could eventually lead to higher monthly share amounts or higher unshareable amounts. Below is the information from December: 

First off, I think it’s great that Liberty is this transparent with members about what is received and what is paid out. After all, the members serve as the community and this isn’t traditional insurance. It will be interesting to see how these numbers change. If there’s a month that deserves an asterisk it’s one where payments of medical expenses (paid out) exceed what was shared (paid in) by $9M. Liberty is able to review this information in the context of past months and similar periods so they have far better information to determine if this is a trend or not. Nonetheless, I appreciate the transparency and thought it was an interesting piece of information to share from the newsletter. 

It’s Officially 2018 and We’re on to Liberty…Membership Cards and an Initial Trip to the Pharmacy

When the clock struck midnight on the east coast our traditional health insurance officially expired and our stint as Liberty Healthshare members began. As our family traveled back from our holiday destination my wife and I did have a moment where this sunk in. It wasn't a bad feeling, it was just an acknowledgment that we’re under a new system and prepare for the change. We are actually excited about seeing how things work.

As we turned to the new year I was interested in receiving our Liberty Healthshare member cards. Similar to traditional insurance, these are the cards Liberty suggests you provide to your healthcare provider instructing them where to send bills and coordinate payment. In my conversations with my primary healthcare provider, it sounds as if they won’t care if I have this card or not – they don’t view Liberty as an insurer so they’ll just send me the bill. Nonetheless, I’m interested in trying it out and would like to receive the card. If I don’t receive the card by the end of next week I’ll give Liberty a call. It’s a little concerning to have to check in on something like this so early.

On another note, we did receive membership cards for the SavNet program. The SavNet program provides discounts on prescription drugs and other healthcare services including dental, hearing, vision and chiropractic services. While this is not insurance, it does provide discounts when you present the cards at eligible providers. We’ve found most pharmacies in our area work with SavNet. Membership in SavNet is included in the $449 family monthly sharing amount.

There are two cards that Liberty sends to you – the Pharmacy Program and the Health Savings Program. To be clear, the Health Savings Program is not equivalent to the Health Savings Account. It is what is presented at participating dental, vision, hearing and chiropractic providers.

Within the last few days, my wife had to pick up a routine prescription at our local drugstore. I had not informed her we received the SavNet card yet so she paid for the prescription as a self-pay customer. She received a self-pay discount at the pharmacy and her cost, for this routine prescription, was approximately $15. We had done research prior to joining Liberty to understand what the unsubsidized cost would be for this prescription and this experience was in line with our expectations. It will be interesting to see what the cost is with the SavNet card. My wife said our cost for the prescription under our past plan was approximately $7-8.

We’ll let you know when we receive our Liberty Healthshare member card and if it means anything to our providers. Stay tuned.

Wednesday, December 27, 2017

First Glance at our ShareBox

The mythical ShareBox. What is it and how does it work? The ShareboB is essentially your central point of interaction with Liberty. The funds that you contribute are deposited into your ShareBox then distributed to those with “claims” by Liberty. Below is what your initial ShareBox will look like and we will continue to share the features we utilize as it happens. 

A few notes on what we’ve noticed already:

·       Annual Unshared Amount – As we’ve noted the plan we signed up for has a $1,500 annual unshared amount. Think of this as your deductible in a traditional health insurance plan. This is the section where you will be able to see how much you’ve spent against this amount. The first $1,500 in qualifying medical expenses you spend each year are not shared through Liberty and are paid out of pocket. We will see this section change and the unshared amount increased as we spend on medical expenses without reimbursement.

·       ShareBox Activity -  This is where you see what you have contributed, or “shared”, recently. The $135 that you see above is a recognition that we have paid the initial enrollment fee from Liberty. We will see activity in this section each month as we pay out share amount.

·       Medical Expenses – This is where, I assume, we will see, and be able to track, expenses that we have submitted for reimbursement. You will also be able to submit your bills for reimbursement directly through the “Submit Bill/Receipt” section. If you have interest in hearing how the process of submitting a bill works directly from Liberty I’ve provided a link to the tutorial video below.

That is an initial preview of the ShareBox from Liberty HealthShare. You can expect to see much more about how this works as we incur expenses and interact with Liberty. 

Sunday, December 17, 2017

December 15 has Come and Gone

Just a quick note to share the fact that December 15, our deadline for signing up for an individual health insurance plan, either on-exchange or off, has passed. We had reached our decision the weekend before but I’d be lying if there wasn’t a bit of last minute discussion on whether we sign-up for a back-up plan. That said, we moved forward with Liberty and are looking forward to a good experience. We anticipate some level of inefficiency as we learn the process, and our providers get used to it, but are hopeful that Liberty proves to be the right option for our family. We look forward to sharing so others might be able to learn through our experience!

Acceptance and Getting Started

Our approval to Liberty arrived with little fanfare in an e-mail on the Monday following the weekend we submitted our application. You will receive an e-mail below with your member number (removed in the image below) and your effective date. Your enrollment in Liberty begins on the first day of the month following your approval date. In this case we were approved on 12/11/2017 so our effective date was 1/1/2018, which works out perfectly with the expiration of our current plan. Your new friends Olivia and Ronnie welcome you with a brief video explaining what to expect to start your membership (essentially your membership cards will be coming soon, but nice people, that Olivia and Ronnie!).

A day after the initial approval information you can expect to receive an e-mail with a bit more information on your membership. The e-mail below arrives and provides more information about your membership. It essentially summarizes the fact you’ll have cards arriving in the mail, what to do if a medical need arises and how payments will be processed.

Under the “More questions about your account?” section there is a link to access your Sharebox as well as information on pre-existing conditions, which is consistent with what we learned prior to joining.   

While none of these e-mails are particularly thrilling our purpose here is to be as transparent with the process as possible so others considering this move understand what happens step-by-step. As of 12/17/2017 we have not received either our Liberty member cards or SavNet cards. We will share a post once we receive these items. 

Tuesday, December 12, 2017

Making a True Comparison between Liberty (or any healthshare) and Traditional Health Insurance

Given my wife and I are self-employed we have the ability to deduct health insurance premiums paid from our income when filing our taxes. However, Liberty, or any healthshare, is not insurance, thus you cannot deduct your monthly share amount as health insurance premiums. Further, with a healthshare ministry you cannot contribute to a Health Savings Account (HSA). In 2018 my wife and I would be eligible to contribute up to $6,900 to an HSA. Thus, when comparing costs you should consider the total cost of health insurance, with the tax effect, to your healthshare cost. While your healthshare cost is still likely to be less you should be fully informed on costs before making a decision. For example, when thinking through our cost options for 2018 we performed the following analysis:

Monthly Cost
Yearly Cash Cost
HSA Contribution
Tax Savings
Actual Yearly Cost
Oscar (with HSA)

A few notes on the columns above:

Liberty Monthly Cost – Our monthly cost with Liberty is not just the $450 monthly share amount. In our situation we also needed to consider a) the $60/mo. we pay for dental insurance (but would be included in the Oscar plan we were comparing to), b) the $29 a month it costs to enroll in SavNet which was an option we chose and c) the $135 enrollment fee which is just over $11/mo.

HSA Contribution – A HSA, or Health Savings Account, is an account that certain high deductible health insurance plans allow you to contribute to. It allows you to contribute money, tax free, to an account where you can invest the money or use the money for qualified healthcare needs. If you have no healthcare needs, or if you’d rather pay for those needs out of pocket, you can invest the money in your HSA to use for future healthcare needs (or even use in retirement!). These are great accounts and the plan we were evaluating with Oscar offered an HSA. In 2018 a family may contribute up to $6,900 in an HSA, while an individual may contribute $3,450.

Tax Savings – There are no tax savings by enrolling in Liberty or any other healthshare. However, with traditional insurance, you can deduct the cost of your monthly premiums from your income as well as any contributions to a HSA. To calculate your tax savings from these deductions you need to estimate an effective tax rate (the % of dollars earned that go towards taxes). Using our estimated effective tax rate we estimated we would save approximately $5,845 in taxes by deducting our health insurance premiums and contributing the full amount to a HSA, which we did in 2017. Thus, our yearly cost for the Oscar plan being developed was actually $9,623 vs. $15,468.

As you can see, despite the tax savings the Liberty cost was still roughly $3,000 less a year based on premiums alone. However, as a family we felt we were taking on risk by switching to Liberty – it was the unknown. Thus, there was probably a premium we would be willing to pay to go with traditional insurance. The question we asked after this analysis was:

Is it worth it to pay $3,000 more a year, or $250 more a month, to have the comfort any catastrophic health care needs would be covered efficiently by a traditional insurer?

Beyond Premiums

Keep in mind this analysis did not take into account actual medical costs beyond monthly premiums. For example, in our situation, we would be responsible for medical expenses up to $6,500 for an individual and $13,000 for a family. With Liberty we would be responsible for costs up to $1,500. In 2017 our family had responsibility for approximately $3,000 in medical costs (after our insurers discount with the health provider). If we incurred similar costs in 2018 we would receive an additional $1,500 in savings by enrolling with Liberty. We would be responsible for costs over $1,500 if we went with the Oscar plan, whereas costs over $1,500 with Liberty are shareable (i.e. covered).