This article explores how the Patient Protection and Affordable Care Act (ACA) impacts HealthShare membership, and whether belonging to one could result in penalties under the ACA.
Are HealthShares ACA-compliant?
In short, HealthShares are not ACA-compliant. However, many were considered exempt from the ACA, and it may not matter for some members since the individual mandate is no longer federally enforced.
Congress passed the Patient Protection and Affordable Care Act (ACA) in 2010, and the law has undergone many changes since then. At one point, not having health insurance led to financial penalties, but the government repealed that part of the law in 2017. However, residents of some states may still be fined for not having ACA-compliant healthcare. As of September 2022, these include: California, the District of Columbia, Massachusetts, New Jersey, Rhode Island, and Vermont.
HealthShare members in states with no mandate
For most HealthShare members, the ACA is likely not a concern. If prospective or current members that live in a state without an individual mandate decide to join a HealthShare and opt out of health insurance, there is no tax penalty. Although ACA-compliant insurance plans do offer advantages such as required preventive care and no restrictions for pre-existing conditions, individuals often turn to HealthShares due to the high cost of health insurance. While joining a HealthShare is not recommended for those who would be better served by traditional insurance, members without pre-existing conditions and who can afford to wait for reimbursement can benefit from the peace of mind and financial flexibility that HealthShares can provide.
HealthShare members in states with a mandate
The optimal choice largely depends on individual circumstances. If budget is a major concern, it may be worth determining whether the tax penalty will be cheaper than adding basic health coverage to your healthcare cost strategy. If health is a major concern, seeking a basic health plan to supplement a HealthShare membership may be more beneficial. Healthcare.gov offers catastrophic health plans, but these require that citizens receive exemptions to use those plans. Information about the exemptions process can be found here.
If a HealthShare combined with even the most basic MEC health plan is still too costly, but more comprehensive health care is desired, consider pairing a direct primary care (DPC) membership with a HealthShare. While this won’t meet MEC standards, it will facilitate easier access to preventive care.
Bronze-level plans on healthcare.gov cover the 10 essential benefits but often have high deductibles in exchange for lower monthly costs. Some states have healthcare exchanges that help residents find local plans, which are typically more affordable than those in the federal marketplace. However as of 2022, fewer than half the states have a healthcare exchange. The exchanges for those states with standing individual mandates can be found below:
This article aims to clarify how the Affordable Care Act may impact HealthShare memberships. While it may not be a significant concern for most, those impacted should take the time to find the best possible solution.
