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There are many ways to design plans around this nowadays. With Obamacare making health insurance guaranteed issue (they have to cover you), you really would just try to foot the bill for at most 12 months before you could go on a marketplace insurance plan. While it might be gaming the system, it's now law.

Nowadays, health insurance is really "assurance" sprinkled in with a doctor subscription (as daniel-cussen mentioned). With that in mind, a hypothetical plan design would collect premiums that bundle reserves, a concierge medicine program, like HealthTap, and critical illness insurance, cancer, and/or accident insurance. These insurances only cover specific incidents for the immediate term. Once someone triggers one of these events, you could push them onto the exchange where the larger risk pool would then cover it on an ongoing basis.

Whether or not that would be ethical is up to you...

From an economical standpoint, depending on your area's availability (read urban centers), you could likely put together this entire package for a collective and pay the ACA tax for less than an ACA approved plan.




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