The CARE+ Plan:
A Compelling Choice for Statutory Employees
This is a budget-friendly healthsharing solution designed for individuals who are statutory employees, rather than business owners or independent contractors.The CARE+ plan is closely based on our popular HSA Secure plan . It provides all the same protections against medical emergencies and catastrophic medical expenses as that plan but at a slightly lower monthly cost.
However, unlike the HSA Secure plan, the CARE+ plan does not include preventative care. At this time, the CARE+ plan is also not compatible with health savings accounts (HSAs).
The CARE+ Plan At a Glance
- Designed for W2 employees or people not working
- One of the lowest-cost health sharing plans available in Colorado
- Great protection against unexpected major medical expenses
- One of the lowest-cost health sharing plans available in Colorado
- Does not include wellness visits or preventative care
- Free, unlimited telehealth visits
- Mental health/counseling benefits available
- Secular: No religious affiliation or other requirement for membership
Note to Self-employed Individuals, Business Owners, and Independent Contractors
The CARE+ Plan vs. Health Insurance
Where the HSA Secure plan is built for business owners, entrepreneurs, and people with self-employment income who want to contribute to a health savings account (HSA), the CARE+ plus plan is designed for employees, early retirees who don’t yet qualify for Medicare, and those who are between jobs for whatever reason.
The CARE+ plan provides all the same protections against medical emergencies and catastrophic medical expenses as the HSA Secure plan – and does so at a slightly lower monthly cost.
Unlike the HSA Secure plan, the CARE+ plan is not compatible with health savings accounts (HSAs). However, CARE+ still offers powerful protection against potential catastrophic health care costs, provides significant benefits for counseling and mental health services, and includes free, unlimited visits with board-certified physicians via telehealth.
However, unlike the HSA Secure plan, the CARE+ plan does not include preventative care. The emphasis with the CARE+ plan is on protecting you against major unexpected and catastrophic medical expenses.
For basic preventative care, you should be prepared to pay out of pocket with the CARE+ plan. However, you could combine the CARE+ plan with a Direct Primary Care plan which gives you unlimited access to a primary care doctor for one affordable monthly subscription.
To learn more about combining a healthsharing plan similar to the CARE+ with a Direct Primary Care membership, read the link above, or click here to speak with an expert Personal Benefits Manager.
Let’s dive deeper into the benefits of the CARE+ plan and how it compares to traditional health insurance.
How the CARE+ Plan Compares to Connect for Health Colorado Health Insurance
While the CARE+ plan and health insurance both help protect individuals and families against unexpected high healthcare costs, there are important differences between them.
First, understand that the CARE+ plan is not health insurance. Instead, it’s a health sharing plan, a non-profit association of like-minded individuals who voluntarily agree to share one another’s medical bills.
Since it’s not health insurance, the CARE+ plan administrators have much more freedom to design the plan to maximize efficiency and affordability.
Healthsharing At a Glance
- Run by non-profits
- ACA exempt. Subject to general state contract laws, but not to laws specific to insurance. Not subject to state insurance commissioners.
- Not eligible for subsidies. But priced 40-50% lower than ACA insurance to begin with.
- Typically 40% to 50% less expensive per month than traditional unsubsidized health insurance. Around $600/month +/- for a family of four.
- No tax deductions for individuals. Businesses can deduct costs as business compensation expenses.
- Many healthsharing organizations are faith-based. Some, but not all, require a religious affiliation.
- May impose a waiting period before costs related to treatment of pre-existing conditions are shareable.
- Members can enroll at any time of the year. However, unlike health insurance, healthsharing plans like CARE+ may do medical underwriting on new applicants.
VS
Traditional Health Insurance
- Product of for-profit insurance corporations
- Regulated by Affordable Care Act, state insurance commissioners
- Eligible for premium subsidies under the Affordable Care Act
- Average unsubsidized cost is $1200+ for a “Silver” plan for a family of four.
- Health insurance premiums are tax-deductible for individuals.
- No religious component or affiliation required
- Pre-existing conditions covered immediately
- Must sign up during open enrollment period (Nov. 1 – Jan. 15th in most states) or special enrollment periods due to life events
Who Should Consider the CARE+ Healthsharing Plan?
The CARE+ healthsharing plan may be a good fit if:
- You are a W-2 statutory employee rather than a small business owner or self-employed independent contractor;
- You are an early retiree, a stay-at-home parent, or otherwise are not currently working
- You want or need a plan to help you pay for major medical events, such as hospitalizations, ER visits, or critical illnesses
- Your employer does not provide you with a group medical plan of their own
- You want a plan that costs much less out of pocket each month than a traditional health insurance plan
- You can afford to pay for routine or preventive care
- You don’t have significant pre-existing conditions you need covered in the first 1-3 years of plan membership.
Advantages of the CARE+ Plan
The CARE+ plan has significantly lower costs per month than an unsubsidized comparable traditional health insurance policy.
As such, it’s a great match for the millions of Americans who don’t qualify for an Obamacare premium tax subsidy, or who only get a limited subsidy.
It’s very common for unsubsidized plan members to save 30 to 50 percent each month compared to the cost of an ACA-qualified insurance policy.
No cap on potential sharing benefits.
There is no maximum sharing amount for most members.
Potential sharing of catastrophic medical bills is unlimted. (Exception: sharing for costs related to pre-existing conditions may be subject to a waiting period. Tobacco users over age 50 have a $50,000 cap on cost sharing for certain conditions. See the section on smokers below).
Concierge service
When you enroll in the CARE+ plan, you’ll have an experienced healthcare concierge available to you. This concierge can help you navigate the medical system, suggest or recommend quality care providers, and help you find the best pricing possible.
When you enroll, you should schedule a welcome call with your concierge. This will help you get acquainted with how your plan works and how to get the most possible out of your CARE+ benefits.
No height-weight restrictions or “rate-ups.”
CARE+ accepts members regardless of their height and weight or body mass index.
You will not be charged extra because you are overweight or obese. However, if you have certain comorbidities highly correlated with being overweight, these could be pre-existing conditions and cost sharing may be limited or subject to a waiting period.
Disadvantages of the CARE+ Plan
Not HSA-Compatible
The CARE+ plan is not compatible with health savings accounts (HSAs). If you’re interested in a health savings account, you’ll need to consider other options.
Does Not Cover Wellness Visits or Preventative Care
The CARE+ plan is not designed to cover routine visits, “wellness visits,” or preventative care services such as mammograms and colonoscopies.
However, there is an excellent, affordable way to get access to these critical healthcare services: Consider joining a Direct Primary Care membership to cover these and other routine medical expenses.
Prescription Drugs
For those who require prescription drugs, the CARE+ plan offers a prescription drug discount plan through MyFreePharmacy.com. This benefit costs an additional $19.95 per month, but it can be cost-effective for those who take multiple medications.
For households taking just one or two prescription medications, it’s usually more efficient to pay out of pocket directly and use a discount plan like one of the many prescription discount cards available.
CARE+ Plan Mental Health Benefits
The CARE+ plan includes free mental health counseling through MSEAP.com. Members can take advantage of live 24/7 support for all household members. Meetings can be conducted via telephone or on-screen, or through an online chat service.
Members can use this benefit for counseling, life coaching, stress management, assessments, elder care and elder law consultation, and relationship counseling. The plan includes up to 12 sessions annually per individual in the household (six visits in California, limited to three visits every six months).
Who Should Consider the CARE+ Healthsharing Plan?
The CARE+ health sharing plan may be a good fit if:
- You aren’t a business owner and have no self-employment income
- You’re between jobs, a stay-at-home parent, or don’t get health benefits from your employer
- You want a plan that focuses on covering large and catastrophic expenses
- You want a plan with monthly out-of-pocket expenses that are significantly lower than those of a standard health insurance plan.
- You are financially able to cover your basic or preventative care, or join a DPC plan
- You don’t require coverage for any serious pre-existing conditions in the first three to five years of plan participation.
The CARE+ Plan and Pre-existing Conditions
If you or someone in your family has a pre-existing condition, you should be aware of the waiting period requirements of the CARE+ plan.
As with most healthsharing plans, costs related to pre-existing conditions are not typically shareable right away. There is a waiting period before the plan will fully share costs for those conditions.
Here’s how it works:
Year 1. For the first year after your membership effective date, costs related to pre-existing conditions are not shareable at all.
Year 2. For year two, cost sharing for pre-existing conditions per need request is limited to $25,000.
Year 3. For year three, sharing is limited to $50,000 per need request. For year four and beyond, cost sharing for pre-existing conditions is limited to $125,000 per need request.
Most other healthsharing plans will have similar restrictions or waiting periods on pre-existing conditions.
If you or a member of your household has one or more pre-existing conditions that require ongoing care or present a significant risk, you should consider a traditional Connect For Health Colorado health insurance policy – at least for that individual.
That’s because unlike healthsharing organizations, traditional insurance carriers must cover pre-existing conditions right away.
No Limited Open Enrollment Periods for Colorado Residents
Unlike Covered Colorado health insurance plans, healthsharing plans like the CARE+ plan don’t have limited open enrollment periods. You can sign up for the CARE+ plan at any time.
Diverse Provider Options
When it comes to healthcare coverage, many HMOs and PPOs limit their care networks. This makes it harder for policyholders and beneficiaries to find affordable non-emergency care. The CARE+ plan, however, offers an extensive network of medical providers through the PHCS Network, with hundreds of thousands of participating providers nationwide.
The PHCS Network also includes many providers located all over Colorado.
You can use your CARE+ plan with any of them, and receive your full sharing benefits.
But that’s not all – CARE+ members are also given the flexibility to see any doctor of their choice without additional fees or charges. This plan prioritizes your convenience and ensures that you receive the best possible care.
Free Telehealth Access
In today’s world, telehealth has become increasingly important for convenient, accessible medical care. CARE+ plan members have access to CirrusMD, a leading telemedicine provider that offers unlimited telephone or video visits with board-certified primary care physicians, pediatricians, and women’s healthcare physicians – all for free.
There are zero copays or additional costs for this service, and you can use your telehealth benefit anytime, 24 hours a day, 365 days a year.
The average wait time to connect with a doctor via CirrusMD is just 60 seconds. so you can receive medical attention quickly and easily.
Maternity Benefits
For those looking for comprehensive maternity benefits, the CARE+ MPB Health plan offers some of the best coverage in the industry. If you become pregnant at least 60 days after your effective membership date, all pregnancy and postpartum care for both mother and child are fully shareable, subject to a $1,000 IUA for the mother and a $1,000 IUA for the baby.
Smokers Accepted
Many healthsharing plans exclude current tobacco users, but the CARE+ plan is one of the few that accepts them. If you’re a tobacco user, you will need to contribute an additional $50 per month on top of your regular monthly sharing amount.
CARE+ Membership Options
CARE+ Members can choose from three different Member Responsibility Amounts – sometimes referred to as “Initial Unshared Amounts.” These are the amounts you must pay out of your own resources for care you receive before your CARE+ healthsharing plan will begin to pay benefits. It functions similarly to a health insurance deductible.
With the CARE+ plan,The three Member Responsibility Amounts you can choose from are:
- $1,000
- $2,500
- $5,000
If you chose a higher Member Responsibility Amount, you’ll have a lower monthly contribution requirement.
Calculation of MRA
Unlike most healthsharing plans, the CARE+ plan calculates your IUA per medical need, not per calendar or plan year.
This means that if you get sick in December and pay a $5,000 IUA to get treatment, you won’t have to pay another $5,000 IUA just because the calendar ticked over into the next calendar year. You only pay your $5,000 IUA one time for that medical condition – and you won’t have to pay another one until you’ve been symptom-free for that condition for at least 12 months.
Also, once you’ve paid for three IUAs for the same medical condition, then the CARE+ plan has an additional benefit: Your maximum IUA for that condition drops to $500 per rolling 12 month period. The CARE+ healthsharing plan picks up all your costs after that.
However, it also means that if you have two or more unrelated medical conditions within a year: (Say, you get a cancer diagnosis and you fall off a ladder in the same year) you could have to pay more than one IUA in that 12-month period.
Pay your MRA within 6 months.
Note that there’s a timeline on when you must pay your member responsibility amount to your care provider. You must cover your MRA within six months of the date you receive care. Otherwise, the CARE+ plan may deem your expenses ineligible for sharing
CARE+ Plan Prescription Drug and Pharmacy Benefits
CARE+ members have access to an excellent prescription drug program.
The cost for this program is an extra $19.95 per month. If you or a member of your household regularly take prescription drugs, this benefit can pay for itself many times over.
The CARE+ Health Concierge can assist you in locating the best prices out of all the available choices (including foreign mail order pharmacies).
What To Do When You Need Care
CARE+ is not an insurance policy. That means that as far as medical providers are concerned, you’re an uninsured, cash-pay or self-pay patient.
Many providers offer discounts to cash payers. Under recently-enacted federal healthcare price transparency regulations, hospitals must disclose their pricing for common procedures on their websites, including any discounts they provide for cash-pay patients.
These discounts can be significant, ranging from 10% to 80% savings compared to the price they charge fully-insured patients, or the “sticker price” for that procedure.
So when you present yourself for care as a CARE+ member, tell the office manager that you are a cash-pay patient whenever you are receiving care. Request the provider’s “best cash price,” which is often 10% to 80% less expensive than what your insurer would typically charge.
This makes better use of your IUA funds. It also helps keep healthsharing costs in check for other plan members.
When you pay, the only up-front amount you should be paying is your remaining IUA. . There should be a cap of three incidents per household per year, and a maximum of $1,000, $2,500, or $5,000 per incident – depending on the IUA you selected.
Paying for Emergency Care with the CARE+ Plan
ER and urgent care costs are shareable, but you still have to pay your IUA before the CARE+ plan will begin sharing costs.
You should visit the closest ER if you have a genuine medical emergency. Inform the ER department’s finance representative that you pay with cash and request their best cash pricing.
Pay the IUA owed or set up a payment schedule with the provider. Then submit the total cost for sharing to the CARE+ plan.
Remember, under the CARE+ terms of service, you must complete your payments to your provider within 6 months of receiving care.
Note: CARE+ only shares ER costs related to actual emergencies, or when you have a reasonable belief that the medical condition could be an emergency threatening life, limb, eyesight, or disability.
That means you don’t want to go to a hospital ER department for a paper cut. But it also means that if you have symptoms and you have a reasonable belief you could be experiencing a heart attack, you can go to the ER, and CARE+ will still share amounts over your IUA even if it turns out to be something else.
How to Submit a Medical Expense for Sharing
MPBHealth maintains a web portal through which you can submit your bills for sharing. Submit your sharing requests and supporting documents as soon as you can.
Note that some elective or non-emergency medical procedures require pre-authorization.
If you have questions, contact the CARE+ concierge desk at MPB health. They can walk you through any pre-authorization requirements and help you find quality providers that still have great outcomes at a reasonable price.
How To Sign Up for the CARE+ Plan
Enrolling in CARE+ takes just minutes. There are two ways to sign up:
OPTION 1
OPTION 2
You can enroll yourself and your family online. Click here, and follow the instructions:
- Enter your name and DOB on the first page.
- Click the “add spouse” or “add children” buttons on the screen, if applicable, and add their names and dates of birth as needed.
- When all dependents have been added, scroll down to the bottom of the page and click “UPDATE.”
- Select your desired Initial Unshareable Amount (IUA) from the drop-down menu. The higher the IUA you choose, the lower your monthly membership contribution will be. When you’ve reviewed the pricing for each IUA option and made your selection, click “Continue.”
- Complete your contact and Social Security number information. Note that you’ll also need to complete these fields for each of your dependents. To edit your dependent entries, click the “pencil” icon next to each of their names. When complete, click “Save dependent.”
Repeat until you’ve finished entering this information for all members of your household who will be on the plan. - Scroll down and review the CARE+ plan’s Statement of Principles. Click “Yes” or “No” on each one as appropriate.
- Review the Health History section. Make sure you understand the CARE+ plan limitations on sharing for pre-existing conditions, pregnancies, and other exclusions. Click “Yes” or “No” on each paragraph as appropriate.
- Complete your payment information.
- Check the “I’m not a robot.” box.
- Complete a digital signature by clicking and dragging your mouse or touchpad.
- Type your name out in the box by your signature. .
- Click “Submit.”
- Go back and fix any error messages.
- Verify that your application was successfully transmitted.
Tip: Sign up by the 20th of the month to get an effective date as of the 1st of the next month.
Your membership will take effect on the first of the next month if you enroll by the twentieth of the current month.
Once you’re signed up, you should call the CARE+/ MPB Health concierge for a 30-minute orientation call. Take advantage of this orientation opportunity so that the process runs as smoothly and seamlessly as possible. It may help clear up a lot of uncertainty, and save a lot of time and effort later on.
You’ll also be hearing from us. ColoHealth is here to be your resource and advocate for as long as you are a CARE+ enrollee.
Conclusion
If you’re not a business owner or self-employed, the CARE+ plan may be a great low-cost healthsharing solution for you. This plan is designed for individuals who are W-2 statutory employees, and it provides all the same protections against medical emergencies and catastrophic medical expenses as the HSA Secure plan, but at a slightly lower monthly cost.
While the CARE+ plan does have some limitations, such as no coverage for preventative care and limited pre-existing condition coverage, it can still be a great option for those who want to save money on healthcare costs. With low monthly costs, no height-weight restrictions, unlimited telehealth visits, and great maternity benefits, the CARE+ plan may be the perfect fit for your needs.
Frequently Asked Questions about the CARE+ Plan from MPBHealth
What is the CARE+ Plan?
The CARE+ Plan is a healthsharing program offered that allows members to share in each other’s medical expenses.
Members contribute a set amount each month, and when medical needs arise, the funds are shared among the members who have submitted eligible expenses.
How does the CARE+ Plan work?
The CARE+ Plan works by bringing together a community of like-minded individuals who want to share in each other’s medical expenses.
Members contribute a monthly share amount, and when they have eligible medical expenses, they submit them to MPBHealth. Once the expenses are verified and approved, they are shared among the members who have submitted eligible expenses for that month.
What is the PHCS Network?
The PHCS Network is a nationwide network of medical providers that includes doctors, clinics, and hospitals.
The CARE+ Plan uses the PHCS Network to provide members with access to a wide range of medical providers. Members can use any provider in the network without needing a referral, and they can also see any doctor of their choice outside of the network with no additional fees or charges.
What is the IUA?
The IUA, or Initial Unshareable Amount, is the amount that members are responsible for paying before their medical expenses are shared among the community.
The IUA for the CARE+ Plan is $1,000 for both the mother and baby for all pregnancy and postpartum care that begins at least 60 days after the effective membership date.
What if I am a smoker?
The CARE+ Plan is one of the few healthsharing plans that accepts current tobacco users.
However, tobacco users have to contribute an additional $50 per month over and above their regular monthly sharing amount. If you’re a tobacco user and over the age of 50, some sharing provisions under the CARE+ Plan will be restricted. Cost sharing for cancer, stroke, heart conditions, and pulmonary diseases will be limited to $50,000 for smokers and other tobacco users over age 50.
What if I have pre-existing conditions?
The CARE+ Plan does not exclude members with pre-existing conditions.
However, pre-existing conditions are subject to a 12-month waiting period before they become eligible for sharing. During the waiting period, members are responsible for all medical expenses related to their pre-existing condition.
Is there a limit to the amount of medical expenses that can be shared?
There is no limit to the amount of medical expenses that can be shared among members of the CARE+ Plan.
However, there are limits to the amount of expenses that can be shared for certain medical conditions, such as cancer, stroke, heart conditions, and pulmonary diseases. Members should refer to the CARE+ Plan guidelines for more information.
How do I enroll in the CARE+ Plan?
Enrolling in the CARE+ Plan is easy. You can visit the MPBHealth website to complete an online application.
Once your application is approved, you will receive a welcome packet with instructions on how to set up your membership account and start contributing your monthly share amount. Please note that you must enroll by the 20th of the month to get an effective date as of the 1st of the following month.
Health Insurance Instant Quote
HEALTH INSURANCE INFORMATION
- Plans approved and authorized under the Affordable Care Act
- Covers Pre-Existing conditions
- Low cost subsidized plans available to those earning
< 400% of the federal poverty level - Unlimited lifetime benefits
- Available during open enrollment (November 1 – January 15), or if you qualify for a Special Enrollment Period
Healthshare Instant Quote
HEALTH COST-SHARING INFORMATION
- Not health insurance, but a way for like-minded individuals to share medical expenses
- Waiting periods on pre-existing conditions
- May exclude sharing for certain conditions or activities
- Enroll any time
- Much lower monthly cost than unsubsidized health insurance