If you’re one of the thousands of households in Wyoming who don’t have proper health care coverage, we understand. It’s a confusing marketplace, and when you’re trying to decide between things like major medical, short-term health insurance, health share plans, and more, the amount of choice and the confusing rules can be overwhelming. But our insurance experts are here to help. This article briefly but concisely describes all of the different options you have available to you as a Wyoming resident. By the time you finish reading it, we hope you’ll know what you need to know to make the right decision for you and yours – or you can reach out and contact us for more help.
Major Medical Insurance in Wyoming
The state of Wyoming doesn’t have its own state exchange, which means you’ll have to go to HealthCare.gov if you want to file an application for coverage via the Health Insurance Marketplace. For people who cannot get qualifying health care coverage through their employer, the Health Insurance Marketplace is usually the first option people go to for insurance. It was established by the ACA shortly after its passage back in 2010 and has been offering Americans affordable, comprehensive healthcare since 2014.
When you fill out an application on HealthCare.gov, you’ll answer a few simple questions about your household size, your current health status, and your expected annual income. From there, they will determine whether or not you are eligible for coverage, and whether or not you’re eligible for a subsidy. These are two very different things, which we will discuss later on.
But first, let’s discuss why someone might prefer ACA coverage over employer coverage, short-term health insurance, or similar plans. To start, ACA coverage is guaranteed issue. Once your application is accepted on HealthCare.gov and you start shopping around the Health Insurance Marketplace, you cannot be rejected for coverage by any of the companies who sell insurance on the exchange. This is even true if you have a pre-existing condition. You also cannot be charged higher monthly premiums, unless one of these four factors makes you a riskier investment for your insurance company:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
Another reason ACA major medical coverage is preferred is due to the guaranteed Essential Health Benefits that each plan must come with. These benefits offer you the type of comprehensive, preventive care that medical experts agree is necessary for optimal health and wellness. Those benefits include:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
Now let’s talk about the subsidies. Federal subsidies are available for anyone who makes at least 138% of the federal poverty limit. If you make less than that, or if you make above 400% of the federal poverty limit, you won’t be eligible for a subsidy. You can still qualify for ACA coverage and shop around the marketplace, you just won’t receive any financial help in the form of a premium tax credit. The premium tax credit is a payment made from the government to your insurance company which substantially lowers your monthly premium. All you have to worry about is paying the remainder of that monthly premium in order to stay in good standing with your insurance provider.
|Household Size||Annual Income (138% of FPL)|
Unfortunately, there are a minority of states who have chosen to refuse federal funds to expand Medicaid to some of the neediest families in their borders – and Wyoming is one of them. This means that there is a coverage gap for people who are making more than the maximum income limit to qualify for Medicaid in Wyoming, but less than the 138% poverty limit to qualify for a federal subsidy. Until legislators in Wyoming decide to change the law, people who fall into this income gap will have little choice other than to pay full price for ACA coverage, or to search for alternative options like the ones we are about to discuss below. On the other hand, if you do make less than the maximum income threshold for Medicare in Wyoming, you should visit the Wyoming Department of Health Website for more information on how to qualify and apply for Medicaid. For most individuals, being low income isn’t enough – there are other qualifications you must meet if you want to have access to this particular type of affordable healthcare.
Short Term Health Insurance in Wyoming
If you’re looking for short-term health insurance in Wyoming, you’ll be happy to know that these plans start by offering you a full 364 days of coverage with the option to renew for up to 36 months. On top of that, your monthly premiums could cost up to 1/3 less compared to an unsubsidized Health Insurance Marketplace plan. Short-term health insurance is familiar to most people who are familiar with the way private health insurance has functioned in America for the last several years, so you won’t be confused by any new rules or different practices. Lastly, you’ll have access to many of the same benefits you would get through the ACA, and you may be able to negotiate for extra benefits if you’re willing to pay an extra premium. But some companies still won’t sell you basic needs like mental health counseling or substance abuse treatment due to their expense, so be prepared for that.
Those are the upsides of short-term health insurance. But you might still want to take a look at the caveats before you make a final decision. Medical underwriting is a big part of short-term health insurance. This means your insurance company will evaluate your health before they decide whether or not to cover you. If you have pre-existing conditions, you could get rejected for coverage; or you could be charged exorbitantly high monthly premiums for it. Those monthly premiums will be in addition to very high deductibles which you must pay out-of-pocket before your insurance company will start helping you with your medical costs. And if you require too much medical care or if that care gets too expensive, there will be caps to the amount of benefits you get on both an annual and lifetime basis. So now that you know the pros and cons of short-term health insurance, we can evaluate some of your other options more effectively.
Christian Health Plans/Health Share Plans in Wyoming
Short-term health insurance isn’t the only game in town if you’re looking for comprehensive health care coverage outside of the ACA. There are also Christian health plans, AKA health share plans. These plans have a lot in common with short-term health insurance, especially in Wyoming, where the rules default to the federal standards for short-term health insurance. But one thing Christian health plans have that short-term health insurance doesn’t is a religious exemption for the individual mandate. That isn’t so important now since there’s no longer an individual mandate on the federal level; however, states are free to pass individual mandate laws anytime they wish. And if Wyoming ever decides to pass one, it could make Christian health plans more competitive with short-term health insurance.
Short-term health insurance and Christian health plans actually have a lot in common. For example:
- These plans are NOT guaranteed issue
- They will likely have unlimited out-of-pocket costs
- Almost all plans come with lifetime and annual benefit caps
- These plans do not include all of the guaranteed Essential Health Benefits
- Their monthly payments can be up to 33% less expensive than unsubsidized ACA health insurance premiums
But there are also several differences between these two types of coverage. For one, you won’t be paying a monthly premium, you’ll be paying a monthly share amount. And you won’t be paying co-pays, deductibles, or co-insurance; instead, you’ll be paying an “unshared amount” or a “personal responsibility amount”. Despite the name change, these payments basically still serve the same purpose. You won’t have consumer protections for short-term health insurance, because they aren’t regulated by the federal government due to their religious status. If you ever have a dispute and your claim is denied, you’re most likely out of luck. Also, due to the religious nature of these organizations, you will likely have to follow certain participation guidelines in order to remain in good standing. Some guidelines include: attending a specific church on a regular basis, declaring a specific religious faith, the cessation of tobacco use, and more. But if you do happen to be a particularly religious person, you may find more value in a health share plan then you would short-term health insurance from a private company.
Fixed Indemnity Plans in Wyoming
If you’re thinking about a fixed indemnity plan as your main source of health insurance coverage, you might want to rethink that decision. Fixed indemnity plans fall short of major medical because they require medical underwriting, they have caps on your annual and lifetime benefits, and the biggest difference is the payout. With fixed indemnity, you only get a fixed amount of money paid out per claim; with major medical, on the other hand, you get a fixed percentage of the total cost paid out per claim. Think of it this way: would you rather get $75 paid out on a $350 doctor bill? Or 75% of that $350 doctor bill paid? The answer to that question is, essentially, the difference between fixed indemnity and major medical (or short-term health insurance, or a health share plan) in a nutshell.
With fixed indemnity, your claims are paid out on a per day, per week, per month, per visit, or per event basis, depending on your plan. Also, depending on your plan, your indemnity plan could include hospital benefits, doctor visit benefits, or even some dental benefits. Since they don’t pay out as much as regular insurance does, the monthly premiums tend to be a lot cheaper. You can also go out-of-network if you need care from a provider who is outside of your HMO or PPO. That’s why most people usually use fixed indemnity plans in order to supplement whatever type of healthcare coverage they already have – it’s rarely ever purchased as a replacement.
Discount Cards in Wyoming
Medical discount cards can be a great way to alleviate some of the burden of your out-of-pocket costs – but not always. It all depends on whether or not you can actually find a good deal. These cards aren’t closely regulated by any particular government institution, so some providers will try to bend the rules in order to make a profit at your expense. They might lie to you and say that their medical discount card is a form of or equivalent to major medical coverage. This is 100% not true. The best that a medical discount card can do is offer you slight discounts at the register if you purchase products or medical services from a qualifying provider. But you won’t be able to file a claim with your medical discount card company, they won’t reimburse you for any of your expenses that you pay out-of-pocket, and they won’t pay out a fixed percentage of your total medical expenses the way that major medical coverage is supposed to.
When you start shopping around for a medical discount card, take a look and see if there are any free options in your area first. Programs like GoodRx or state-based discount drug cards may only be limited to prescription costs, but it can still save you a pretty penny on the drugs you need. Next, try to find a medical discount card with a modest membership fee and a good deal of discounts and participating providers. But don’t just take the company’s word for it – do your own research and make sure that the discounts they offer and the providers they claim to work with are actually legitimate. Then make sure that the cost of the membership won’t cost you more than what you might save with discounts. Otherwise, what’s the point? If everything falls into place, then enjoy the savings.