Robin Carlton pays about $650 a month for a plan on the Missouri health insurance exchange that covers him and his two teenage kids.
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鈥檛 in any hurry to investigate a new type of coverage that might be cheaper than his marketplace plan: farm bureau health plans.
鈥淎lthough I鈥檓 not a fan of rising costs, I鈥檓 not going to sacrifice coverage for my kids to save a buck,鈥 Carlton said.
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 found that many returning marketplace enrollees reported higher costs this year.
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.
Health policy experts say such concerns are giving new legs to alternative forms of coverage 鈥 for instance, farm bureau plans.
As of this year, 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.
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.
But because states have passed laws exempting from health insurance requirements, they don鈥檛 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.
Crucially, farm bureau plans don鈥檛 have to accept everyone who applies for coverage. People must pass underwriting first, a process in which plans evaluate applicants鈥 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.
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 than unsubsidized marketplace plans, plan managers say.
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.
鈥淲e鈥檙e trying to present another option,鈥 he said.
Sowing Choices
In 2026, with the expiration of enhanced premium tax credits, average ACA premium payments were estimated to for subsidized enrollees who retained their marketplace plan, according to KFF.
Last year, was one of four states that passed laws permitting farm bureau health plans. The others were , , and .
Although the number of states offering them has ticked up in recent years, farm bureau health plans aren鈥檛 new. Tennessee has been offering the coverage . Tennessee鈥檚 Farm Bureau Health Plans administers the plans in 10 of the 14 states that permit them.
In Missouri, the farm bureau offers 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.
Hawkins said he鈥檚 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.
It鈥檚 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鈥檛 cover any for at least six or 12 months. In addition, plans may exclude coverage of any benefits related to a 鈥渒nown risk鈥 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.
鈥淧eople don鈥檛 like that we underwrite, but if we did everything like the ACA, we鈥檇 be just like an ACA plan,鈥 said , general counsel and chief compliance and privacy officer at Tennessee鈥檚 Farm Bureau Health Plans. 鈥淲e鈥檙e trying to be an option for folks that would otherwise not have coverage.鈥
Staying Rooted in Coverage
Under the Missouri law, once someone is covered by a farm bureau plan, they can鈥檛 be kicked off or charged a higher rate if they get sick. That鈥檚 also true for the nine other states where Tennessee administers the plans, Beard said.
鈥淲e do not contractually have the right to raise premiums or cancel plans based on [an individual鈥檚] health experience,鈥 he said.
And yet, 鈥渋t can be really confusing to people鈥 because the plans look like insurance products, but they don鈥檛 have the same protections, said , principal for policy development, access to, and quality of care at the American Cancer Society Cancer Action Network.
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.
鈥淲e鈥檙e just concerned that there鈥檚 going to be more people enrolled in these plans now because there鈥檚 so many more states that are allowing them,鈥 Howard said.
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鈥檚 high-risk pool, which was often the only option for people with preexisting conditions.
Meanwhile, policy experts share Howard鈥檚 concerns.
Insurance companies in the ACA marketplaces 鈥渉ave to offer maternity coverage, and they have to give you benefits on day one for a preexisting condition, and they can鈥檛 charge you more because you have that condition,鈥 said , 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鈥檛 get into farm bureau plans.
Farm bureau plans 鈥済et to use, you know, the standard market as a high-risk pool, essentially, if they want to,鈥 Lueck said.
Still, with the huge jump in premiums that many people are facing for ACA coverage, it鈥檚 easy to understand the appeal of farm bureau plans.
鈥淚鈥檓 not saying it鈥檚 a good thing that states have abdicated their regulatory responsibility here,鈥 said , co-director of the Center on Health Insurance Reforms at Georgetown University. 鈥淚鈥檓 just saying that there are a lot of people out there who are struggling, who need health care, and simply can鈥檛 afford the premiums in these ACA marketplaces anymore.鈥
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