In a recent episode of my podcast, Veronika and I discussed how health coverage works and what’s changed since President Trump took office and introduced alternative insurance options.

This article is especially useful for those of you who are navigating U.S. healthcare for the first time—or simply trying to make sense of the alternatives.

What Did Trump Actually Change?

When it comes to healthcare, President Donald Trump, who was elected two years ago, set a goal for himself. One of his main objectives was to change the healthcare system—not just by making amendments to the Obamacare law, but by trying to overhaul it more significantly.

Unfortunately, up to this point, he’s faced a lot of resistance in Congress, primarily from Democrats, and possibly a small percentage of Republicans as well. So far, he hasn’t been able to make major changes—with one major exception: he eliminated the penalty for people who refuse to buy health insurance through the Obamacare marketplace.

As a result of that change, alternative health insurance plans began to appear on the market. These plans are not part of Obamacare. Obamacare still exists and functions the same as before—but these new plans exist separately, outside of that system.

Actually, these new plans are quite similar to the plans that existed before Obamacare. Back then, they were considered traditional insurance plans—this was even before President Clinton introduced healthcare changes that led to the group insurance models we know today, which cover treatment for chronic conditions.

Just a quick note: we may refer to these newer alternative plans as “TrumpCare,” just for clarity. So if you hear us use that term from time to time, please don’t be confused—it’s not official terminology, just a way to distinguish these plans from Obamacare.

How Are These Alternative Plans Limited?

The main difference is that yes, these alternative plans are limited, but they’re designed to meet the needs of healthy individuals. If someone has chronic illnesses, these plans don’t provide coverage for them. For example:

• Psychiatric conditions are not covered
• Cancer treatment is not covered
• Conditions related to heart disease, high cholesterol, or high blood sugar are also not covered

What If You’re Diagnosed After Buying the Plan?

Here’s how it works: If someone buys the insurance and is later diagnosed—say three or four months after the policy begins—the insurance will not cover that condition during the first 12 months.

However, if the person keeps the plan and continues coverage, then starting from month 13, the insurance company will begin to cover expenses related to that newly diagnosed condition.

What About Pregnancy and Childbirth?

Maternity is a separate issue. Most women who are planning to give birth are generally healthy, but insurance companies still don’t want to assume the risk of childbirth.

Why? Because complications can occur during delivery, and sometimes babies are born with serious health issues. So these plans don’t cover childbirth.

However, here’s what does happen:

• About two months after giving birth, if the mother is healthy and the baby is healthy, they can both be enrolled in an insurance plan
• From that point on, the policy will cover things like check-ups, vaccinations, and routine care for the baby

What Do These Plans Cover?

These plans offer limited coverage for medical visits. Depending on the plan and the company, some offer:

• Up to 10 doctor visits per year
• In some cases, 11 visits per year

Keep in mind—not all alternative plans are the same. It really depends on the company offering the plan. Some companies offer better coverage, while others are more limited.

Do Prices Vary Based on Coverage?

Exactly. For example, one company might offer the same basic coverage to everyone, but the price varies depending on the plan limits. Let’s say someone is hospitalized:

• One plan might cover up to $3,000 per day
• Another plan might cover up to $5,000 per day

It all depends on which plan you choose.

What Are Daily Hospital Costs in Pennsylvania?

That’s actually very easy to check. You can simply go to Google, search for any hospital, and type in: “How much does a semi-private hospital room cost per day?” You’ll get an answer.

On average here in Pennsylvania, the cost for a semi-private room is between $2,500 to $3,500 per day. And that does not include:

• Intensive care units (ICU)
• Surgery or operations

All of that is charged separately.

Do These Plans Cover ICU and Surgery?

It depends on the plan you choose and also the company. Some companies won’t even cover ICU rooms. But others will. For example, I know of a company that can cover ICU costs up to $10,000 per day—up to a maximum, if I’m not mistaken, of 30 days per year.

Do These Plans Work Nationwide?

Let me give you a comparison:

• If you buy insurance through Obamacare and end up with a closed HMO network, your coverage will be regional—limited to where you live. Outside of that region, it may only cover emergencies.

• A PPO health insurance plan through Obamacare offers a more open network. But even then, it might not apply in all states.

Now, with alternative plans:

• Some are true PPOs with open networks
• Some provide nationwide coverage
• You can buy your insurance in Pennsylvania and use it in Florida, California, or any state
• You can see a doctor anywhere, and your insurance will cover it

Are Emergencies Covered?

Yes, emergencies are generally covered. If someone is in a car accident, the auto insurance or travel insurance will initially cover emergency expenses. After that, if the person is admitted to a hospital, their health insurance—even an alternative plan—will start covering the costs.

So even if the accident happens in California, Chicago, New York, or Florida—your alternative health plan will step in after auto coverage to pay for:

• Operations
• Hospital visits

Children under 18 can get coverage with their parents. To purchase insurance individually, they must be 18 or older.

What Do These Plans Actually Cost?

Let’s compare:

• A healthy couple in their 40s with two children might pay around $550/month for an alternative PPO plan
• That same family under Blue Cross via Obamacare might pay $2,500/month

Same provider network, big difference in price. Why? Alternative plans are for healthy individuals. Obamacare includes high-risk individuals, which raises costs for everyone.

Are These Plans Based on Income?

No. Only Obamacare plans—those under the ACA—are income-based. They’re called Qualified Health Plans. If you qualify, the IRS provides a subsidy or tax credit. That can lower your monthly premium from $3,000 down to $1,000 or less.

If you choose an alternative plan, you can pay just $700/month—even if you earn $500,000/year. These plans are not income-based.

Can Students or Tourists Get These Plans?

Yes, in some cases. If you have a U.S. address, many companies allow you to buy insurance—even if you’re on a student or tourist visa. Someone from Russia or Belarus who just arrived can usually purchase a plan. And if they’ve only been here a couple of weeks, we can offer them tourist medical plans with limited coverage.

Who Are These Plans Really For?

These alternative plans, which came about under Trump, are for people who:

• Are confident in their health
• Don’t want to overpay for insurance
• Want protection in case something major happens unexpectedly

When choosing health insurance in the U.S., consult with a broker. eHealth helps you choose a plan that:

• Won’t bankrupt you
• Actually fits your needs

The key factor is that anyone purchasing health insurance must be informed. Before making any decisions, gather enough knowledge to be confident. That’s why we do this—so every client or potential client is as informed as possible.

The more you know, the easier it is to choose the right plan.

And for our Russian-speaking community, we know it’s often difficult to communicate with English-speaking brokers. That’s why Veronika is here, interviewing me—so we can reach everyone in the Russian-speaking communities of Pennsylvania, New Jersey, and New York.

If you have questions or want help selecting a plan, give eHealth20 a call at 215-690-5006. We’re here to help you make the best decision for your health and your wallet.