USHealth/Freedom Life – What is it?

Open enrollment is coming up and many of you will soon be searching for new coverage. As you are researching plans and talking to an endless stream of sales agents, it’s likely that you will find yourself looking at a policy through USHealth/Freedom Life at some point. Most people have never seen these plans or heard of these companies, so I’m making this post to clarify what these plans are, who they are for, and most importantly who they are NOT for.

First some disclosures. I am a full time Writing Agent for USHealth. It is my job to sell these plans and obviously for that reason, I have some biases towards them. However, that also makes me an expert on them. I know what they cover and I know what they don’t cover. I’ll be the first one to tell you if you are not an ideal customer for these policies. I’m not here to self-promote, I’m here to educate and answer questions. I should also note that I received mod approval before I made this post since I know self-promotion is a bannable offense on this subreddit.

I’ll start out by saying EVERYONE’S first choice for health insurance should be an ACA plan through the marketplace (Obamacare) or an employer sponsored ACA compliant plan. USHealth plans are designed for the people who have already researched those options and for one reason or another, decided it wasn’t the right fit for them. How do you know if it’s not the right fit? Well, the 5 most common types of clients I encounter are as follows:

I make too much money to qualify for a subsidy on the marketplace and any halfway decent plan is ridiculously expensive. 

I am self-employed and my income is impossible to predict. I have gotten screwed on my taxes before because I misjudged how much I was going to make when I applied and got a subsidy I didn’t qualify for. 

My employer wants me to pay nearly half my paycheck to cover my spouse and kids on their plan and I couldn’t find anything I liked on marketplace either. 

I need/want a PPO because I travel for work and need my benefits to travel with me (truck driver, travel nurse, etc) but there are no PPOs available on the ACA in my state. 

I don’t want that Obamacrap. I’m a red blooded American and I don’t need no government in my insurance (Yes, that one is real and I get it more often than you might think. There’s a reason the majority of states we sell in are red).

In contrast, these are the type of people who USHealth plans are most certainly NOT for:

I get insurance through my job. It’s super cheap and the coverage is great. Sounds obvious, but I can’t tell you how many people I talk to every day that want to “explore their options” when they have a $0 deductible PPO for $79 per month through their employer. No dude, you’re already in the best possible position. Stick with that.

I qualify for a massive subsidy on the marketplace and can get a plan for super cheap or free. That’s great, go with that. I’ll even help you pick one and sign up for it. I am licensed and CMS certified so get paid for that too. 

I qualify for Medicaid or Medicare. Great, then go sign up for that. I’ll give you the phone number.

I have a really expensive medication I need covered. One of the things USHealth plans lack is good RX coverage. Minor medications under $75 are covered decently well but expensive ones are not. If you can’t get it for cheap through GoodRX or a manufacturer coupon, then USHealth plans are not for you. 

I have a major pre-existing condition or upcoming procedure that I need coverage for. First of all, USHealth plans are underwritten so you’d likely be declined if this is the case for you. If you can somehow get approved, it’s unlikely the plan will cover what you need since you’d probably have to hide it on your application to get through underwriting. ACA compliant plans are the only ones that will cover you. It might be expensive, but it’s really your only option.

I’ll add a caveat to that last one. Not every pre-existing condition is “major”. Minor conditions like GERD, high BP, or hypothyroidism are approvable and covered on USHealth plans, so long as they are disclosed on your application (more on this later).

Now, let’s break down the corporate structure to clear up any confusion about who is actually insuring you. USHealth Group is a company that employs around 4,000-5,000 writing agents like myself to sell insurance products that are underwritten, issued, and managed by Freedom Life (depending on your state, it may be called National Foundation Life or Enterprise Life instead). 

These products utilize the United Healthcare Choice Plus PPO network. UHC owns these companies, so in a sense, these are UHC policies but that really just means you can see UHC doctors and go to UHC hospitals on them. In practice, Freedom Life is the company that will underwrite you and manage/pay your claims while you are on the plan.

The flagship products are called PremierAdvantage, PremierChoice, and SecureAdvantage. Most states offer two of these plans, but some only offer one. All three of these policies are medically underwritten, meaning you do need to qualify for them based on medical and prescription history. They are VERY strict about who they accept. It’s important to remember that your application can be declined if the company deems you too high of a medical risk. If you are declined, there’s not much recourse you have to dispute that. Trust me, agents don’t want declines either so a good agent will tell you if you’re not the right fit for this plan. We don’t get paid commission for declines, and the amount of declines and cancellations we get affects the commission we earn on other applications, as well as our eligibility for bonuses.

PremierAdvantage and PremierChoice are generally priced about the same or less than bronze level policies on the marketplace. These are $0 deductible fixed indemnity policies with a MAJOR MEDICAL RIDER. This rider is called PremierMed and it comes in the form of a one-time use $3k or $4k max out of pocket that can be applied retroactively. If you’d like to use this rider, you have to activate it. Once you do, your $100k medical bill will be run through your insurance again, you will pay your $3k, and Freedom Life will cover the rest at 100%. They will continue to cover you at 100% until the next open enrollment period. However, once you activate, your premium will go up to around the same as a gold level marketplace plan for the remainder of the year and once OE comes around, they will not allow you to renew your plan.

SecureAdvantage is a little different. It’s a more traditional deductible, co-insurance, max out of pocket plan, similar to what you might find on marketplace. It will be a bit more expensive, likely around the same as a high end bronze or a silver marketplace plan. It’s more customizable, in that you can choose your deductible, co-insurance, and max when you sign up. Price will vary based on the selections you make. The advantage of SA over PC and PA is that it’s guaranteed renewable to the age of 65. There’s no upgrading or getting kicked off at the end of the year, regardless of how much you use the coverage. That’s why it’s more expensive up front. PA and PC defer the cost of major medical until you actually need it, and SA gives it to you up front along with guaranteed renewability.

When it comes to getting approved for these plans, Freedom Life is very strict and this strictness is what allows them to offer these plans at a lower price. The ACA is expensive because they HAVE to accept everyone. Imagine how expensive your car insurance would be if you told the company you’d get into an accident every year when you signed up. The underwriting guidelines for these plans are EXTENSIVE. It’s far too complicated to get into here but I’ll generalize. There are some conditions that are considered standard approvals, there are some that are considered automatic declines, and there are some that are considered approvable but only under certain circumstances or if a certain amount of time has passed. Some conditions are standard on their own but declines when combined. Some are considered standard but only if you are a certain age. Not only that, you can also be declined based on your height and weight ratio or even your occupation if it’s considered “dangerous”. 

You’ll have to disclose any medical conditions and medications you currently have or have had in the past on your application. If you disclose something and get approved, then that will be covered for you. If you choose not to disclose something to increase your odds of approval, then Freedom Life reserves the right not to cover that for you for the first 12 months of your policy. Additionally, they won’t just take your word for things most of the time. While reviewing your application, they may pull prescription records on you or request medical records from your doctor. I’ve even heard of them pulling DMV records on someone to see if they’ve ever had a DUI. It costs them money to take those extra steps so they don’t always do it but they often do and they may find something you tried to hide.

Finally, there are some things that are never covered on these plans, no matter what. The biggest ones are pregnancy/maternity, substance/alcohol abuse, and mental health.

These plans are not for everyone, in fact I’d argue that they are not the right plan for the vast majority of people. I made this post to educate people about who they are for. I am well aware of the stigma surrounding private market insurance in general. I won’t argue that stigma is not earned because I’ve certainly heard some horror stories. I can’t speak to other private market plans, but when it comes to USHealth, most of the horror stories I’ve heard are just because the agent who sold the policy didn’t properly explain how it works or put someone on it who had no business enrolling on that plan. For the right type of client, these plans can be a perfect fit but for the wrong type of client, it’s the worst thing you can do for them. 

I’m happy to answer questions in the comments. I will be as open and honest as I can be with my replies. I only ask that you are respectful. Thank you.