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Three approaches for managing pre-Obamacare healthcare costs

(This is part of a six-story package on household finance. Lou Carlozo is a Reuters contributor and the opinions are his own.)

By Lou Carlozo

New York (Reuters) - Having just earned his master's degree in written communication, Eric Kaplan should feel triumphant. But his academic success has been tempered by a failure outside the classroom: He can't find health insurance he can afford on his earnings as a freelance writer.

Like many other Americans waiting for key provisions of the Affordable Care Act to kick in, Kaplan, 32, of Chicago, is adopting a novel strategy for protecting his health. He applied for another master's degree, this time in social work, because his target school offers health insurance to students.

Without the lure of the affordable insurance, he's not sure that program would be his first choice.

"It's a peace-of-mind issue," says Kaplan, who believes the health care act will make things easier for him when it is fully phased in, in 2014. "I'm lucky in that I don't have any major health issues, but facing the year ahead, I worry a lot about accidents and sickness."

Kaplan is one of many people trying alternative strategies to get them through one more year of healthcare coverage before the new law takes effect - though it's not clear that the new law will make insurance affordable for everyone who needs it.

Roughly one in three Americans put off medical care for themselves or their family in 2012 due to the cost, according to a Gallup poll released in December. That's the highest level since Gallup started tracking such figures in 2001, when the figure was just 19 percent. And there is an estimated 50 million Americans who no longer have health insurance.

There are a number of temporary approaches, says Carrie McLean, senior manager of consumer health insurance for ehealthinsurance.com.

Some people pay significant sums to keep the policies they had at their last jobs, via so-called COBRA benefits (named for the Consolidated Omnibus Budget Reconciliation Act, which created them.) Others are buying short-term plans or catastrophic-only coverage, seeking state policies, buying plans through professional organizations or, in many cases, simply gambling that they could get through a year without insurance.

"If you are healthy and don't have insurance, it is tempting to lift out that expense from your budget," McLean says "But it's not a good idea to go uninsured in 2013."

Though he knows the risks, Kaplan plans to gamble until he matriculates or finds a full-time job.

"I'm arming myself with Airborne to get through 2013," he says, going without insurance until he either starts his new program in the fall or lands a job with benefits. "I really find myself being extra germaphobic."

GOING NAKED

Mindi Sue of Santa Monica, California, is consciously going without insurance, too. The self-employed publicist gave up her coverage as she saw clients cutting back and monthly retainers getting scaled down during the last recession.

Instead, she started paying out of pocket for doctor visits only when she needed them. It worked, and "saving almost $4,000 a year made a huge difference in my personal and business life," she says.

Of course, that only works if Sue doesn't develop a catastrophic illness or injury.

"If anything happens to me beyond a yearly doctor's visit that requires ongoing care, I'm going to be in a financial hole trying to pay it off," says Sue. She says she's confident that she would get emergency care even if she showed up at a hospital without coverage.

Sue says she plans to get through 2013 by staying in fabulous shape and playing competitive sports five times a week, though she concedes that carries risks, too.

"I continually call the major insurance companies to get quotes to see if there are plans that fit into my budget," she says. "If I can get coverage that is reasonable and realistic, I'll definitely purchase it, but at the moment, I'll continue to risk it."

RELIGIOUS COLLECTIVES

Then there's John Ellis, a certified public accountant in Long Beach, California. Laid off from his job in 2009, it was the first time in his career he had to pay for health insurance by himself.

"It was a shock," recalls Ellis, now 58. After COBRA ran out, he had to pay $700 a month for health insurance.

Desperate for an alternative, Ellis checked out Christian Healthcare Ministries after hearing a news report about it in early 2011. The program -- a cost-sharing collective nonprofit that is not a state-regulated insurance plan -- caters to conservative evangelical Christians, and Ellis had to get a letter from his pastor to verify that he regularly attends church.

Still, the model is controversial. Religious-based collectives may have requirements that exclude some participants who do not adhere to particular beliefs or lifestyles. (In October 2012, the state of Kentucky shut down a similar plan called Medi-Share after a multiyear legal battle in which the state claimed the program was sold like insurance but wasn't a bona-fide state-regulated insurance plan.)

Now paying $150 a month, Ellis gets basic coverage that does not include vision or dental. Maintenance check ups for his pre-existing condition are covered. Prescriptions are not covered though a discount card helps cut some costs. It's a "good deal" that should get him through 2013, he says.

And possibly further. Ellis is inclined to stick with his plan, and the Affordable Care Act exempts from its mandatory coverage requirement people who participate in religious cost-sharing groups like his.

(Follow us @ReutersMoney or at http://www.reuters.com/finance/personal-finance Editing by Chelsea Emery, Linda Stern and M.D. Golan)

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