Robin Carlton pays about $650 a month for a plan on the Missouri health insurance exchange that covers him and his two teenage kids.<\/p>\n
That monthly total is $200 higher than what he paid last year, due in part to the expiration in December of covid pandemic-era premium tax credits. But the self-employed St. Louis property manager isn\u2019t in any hurry to investigate a new type of coverage that might be cheaper than his marketplace plan: farm bureau health plans.<\/p>\n
\u201cAlthough I\u2019m not a fan of rising costs, I\u2019m not going to sacrifice coverage for my kids to save a buck,\u201d Carlton said.<\/p>\n
Carlton finds himself among a growing number of Americans who have confronted difficult choices because of rising Affordable Care Act premiums and other affordability issues. For instance, a recent KFF poll<\/a> found that many returning marketplace enrollees reported higher costs this year.<\/p>\n In addition, most expressed worry about affording routine and unexpected medical care, as well as the cost of prescription drugs. Worries were greater among those with lower incomes and chronic health conditions. And about 5% of respondents said they had switched to some type of non-ACA coverage.<\/p>\n Health policy experts say such concerns are giving new legs to alternative forms of coverage \u2014 for instance, farm bureau plans.<\/p>\n As of this year, Missouri is one of 14 states<\/a> that allow health coverage through state farm bureaus, grassroots membership organizations that advocate for the agricultural industry and rural interests. An annual membership in the bureau typically costs $30 to $50, and in many of the states anyone can join. With membership comes the option of buying into the health plan.<\/p>\n Plan details vary by state, but they typically share many features of marketplace plans, including coverage of a wide range of services, a broad practitioner network, and a way to file complaints.<\/p>\n But because states have passed laws exempting farm bureau health plans<\/a> from health insurance requirements, they don\u2019t offer many of the coverage protections provided by insurance. That means their benefits and coverage rules may be less generous or predictable than Obamacare plans.<\/p>\n Crucially, farm bureau plans don\u2019t have to accept everyone who applies for coverage. People must pass underwriting first, a process in which plans evaluate applicants\u2019 medical history and health conditions and decide whether to offer them coverage. This practice was routine before the ACA passed, and people were often rejected due to preexisting medical conditions.<\/p>\n Because farm bureau plans can turn down people with expensive chronic conditions or a history of cancer or other medical issues, farm bureau plans may be 30% to 50% cheaper<\/a> than unsubsidized marketplace plans, plan managers say.<\/p>\n As people struggle to keep family farms afloat, they may face Obamacare premiums totaling thousands of dollars a month, leading some to forgo coverage, said Missouri Farm Bureau president Garrett Hawkins.<\/p>\n \u201cWe\u2019re trying to present another option,\u201d he said.<\/p>\n Sowing Choices<\/strong><\/p>\n In 2026, with the expiration of enhanced premium tax credits, average ACA premium payments were estimated to increase by 114%<\/a> for subsidized enrollees who retained their marketplace plan, according to KFF.<\/p>\n Last year, Missouri<\/a> was one of four states that passed laws permitting farm bureau health plans. The others were Alabama<\/a>, Florida<\/a>, and Ohio<\/a>.<\/p>\n Although the number of states offering them has ticked up in recent years, farm bureau health plans aren\u2019t new. Tennessee has been offering the coverage since 1947<\/a>. Tennessee\u2019s Farm Bureau Health Plans administers the plans in 10 of the 14 states that permit them.<\/p>\n In Missouri, the farm bureau offers several plans<\/a> with varying deductibles, copayments, and annual limits on out-of-pocket spending. Many of the benefits and cost-sharing amounts look like the coverage someone might get on the state health insurance exchanges or through an employer. They include emergency care and hospitalization, physician office visits, prescription drugs, free preventive care, and dental and vision services. Members have access to providers through the UnitedHealthcare Choice Plus national network.<\/p>\n Hawkins said he\u2019s pleased with the interest the plans are generating. People could apply for coverage through the website starting Jan. 1, and by mid-March, 520 people had submitted applications, he said.<\/p>\n It\u2019s uncertain how many of those people will clear the underwriting hurdle and buy a farm bureau plan, however. Farm bureau health plans can deny coverage for any reason. Even if coverage is offered, plans in Missouri don\u2019t cover any preexisting conditions<\/a> for at least six or 12 months. In addition, plans may exclude coverage of any benefits related to a \u201cknown risk\u201d for two to seven years, depending on the issue. So people with a range of conditions, such as diabetes, high cholesterol, heart problems, or successfully treated cancer, may be turned down or have to pay out-of-pocket for any related care for at least a year and possibly as long as seven years.<\/p>\n \u201cPeople don\u2019t like that we underwrite, but if we did everything like the ACA, we\u2019d be just like an ACA plan,\u201d said Jason Beard<\/a>, general counsel and chief compliance and privacy officer at Tennessee\u2019s Farm Bureau Health Plans. \u201cWe\u2019re trying to be an option for folks that would otherwise not have coverage.\u201d<\/p>\n Staying Rooted in Coverage<\/strong><\/p>\n Under the Missouri law, once someone is covered by a farm bureau plan, they can\u2019t be kicked off or charged a higher rate if they get sick. That\u2019s also true for the nine other states where Tennessee administers the plans, Beard said.<\/p>\n \u201cWe do not contractually have the right to raise premiums or cancel plans based on [an individual\u2019s] health experience,\u201d he said.<\/p>\n And yet, \u201cit can be really confusing to people\u201d because the plans look like insurance products, but they don\u2019t have the same protections, said Anna Howard<\/a>, principal for policy development, access to, and quality of care at the American Cancer Society Cancer Action Network.<\/p>\n Someone with a history of cancer would be unlikely to get approved for a farm bureau plan in the first place, Howard said. If they were accepted, the services they might need would likely be excluded from coverage, she said.<\/p>\n \u201cWe\u2019re just concerned that there\u2019s going to be more people enrolled in these plans now because there\u2019s so many more states that are allowing them,\u201d Howard said.<\/p>\n Carlton, the self-employed property manager, knows firsthand how underwriting can limit coverage options. Before the Affordable Care Act required that anyone be accepted regardless of health status, Carlton, who has diabetes, had to buy coverage through his state\u2019s high-risk pool, which was often the only option for people with preexisting conditions.<\/p>\n Meanwhile, policy experts share Howard\u2019s concerns.<\/p>\n Insurance companies in the ACA marketplaces \u201chave to offer maternity coverage, and they have to give you benefits on day one for a preexisting condition, and they can\u2019t charge you more because you have that condition,\u201d said Sarah Lueck<\/a>, vice president for health policy at the Center on Budget and Policy Priorities. This creates an uneven playing field for insurers and drives up premiums for the people who can\u2019t get into farm bureau plans.<\/p>\n Farm bureau plans \u201cget to use, you know, the standard market as a high-risk pool, essentially, if they want to,\u201d Lueck said.<\/p>\n Still, with the huge jump in premiums that many people are facing for ACA coverage, it\u2019s easy to understand the appeal of farm bureau plans.<\/p>\n \u201cI\u2019m not saying it\u2019s a good thing that states have abdicated their regulatory responsibility here,\u201d said Sabrina Corlette<\/a>, co-director of the Center on Health Insurance Reforms at Georgetown University. \u201cI\u2019m just saying that there are a lot of people out there who are struggling, who need health care, and simply can\u2019t afford the premiums in these ACA marketplaces anymore.\u201d<\/p>\n Are you struggling to afford your health insurance? Have you decided to forgo coverage? <\/em>Click here<\/em><\/a> to contact KFF Health News and share your story.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n