Got Insurance

Whether you have health insurance or not, injury insurance might be worth looking into, especially if you love the sports for which Jackson Hole is famous.

By Brigid Mander

LAST SUMMER, A photographer friend of mine crashed on his mountain bike, an unfortunately common occurrence for Jacksonites. A badly broken arm resulted in surgery, after which he found himself on the hook for $7,000 in medical bills, despite carrying health insurance. (This was his out-of-pocket cost.) It was an alarming wake-up call and a hefty financial burden he thought he’d protected himself against. My friend isn’t alone. It can be difficult to ascertain exactly how insurance benefits work given the labyrinthine processes of an infuriatingly opaque industry.

Meet accident (or injury) insurance. “It’s a product of need, not of want,” says Matt Randall, co-founder of Spot, an injury and life insurer based in Austin, Texas, that launched in late 2019. “We see it as unraveling insurance, to create something that suits the need out there, not just what insurers want to distribute. It’s as if, say, GoPro or Red Bull were to create an insurance product.” 

Randall, an entrepreneur, along with his friend and business partner, Maria Miller, a former New York Life insurance executive, came up with the idea over dinner a few years ago. Their product has been heartily welcomed by action-sports athletes and companies. For $25 a month, an individual has access to up to $20,000 in coverage for medical bills per injury, not per year. There is no deductible, and there are no network restrictions (meaning, it covers you if you get stuck with out-of-network bills, another escape hatch for traditional insurers to shift costs to the insured person).

“Spot is ultimately a byproduct of making insurance more accessible, and offering something useful for young, active people.”

– MARIA MILLER, FORMER NEW YORK LIFE INSURANCE EXECUTIVE

Most injury insurance policies can be used with or without a regular plan, but some are better than others, so research is important. If you have no insurance, policies like the ones Spot sells will reimburse you directly for injury-related bills up to the maximum of the policy. If you do have traditional insurance, you submit to Spot the bills (or portions of bills) that remain your responsibility under your health insurance, including bills that go toward meeting your deductible, co-pays, and anything else that is supposed to come out of your pocket. Instances that injury policies don’t cover? Getting sick. 

The idea of insurance that covers injuries but not illnesses came from Miller’s time at New York Life; she was tasked to find ways to increase distribution to younger people. She realized an insurance product paired with experiences could help draw attention to ways to protect oneself from medical debt. “Spot is ultimately a byproduct of making insurance more accessible, and offering something useful for young, active people,” she says. “Even with a plan, a deductible is really impactful, especially for young people living paycheck to paycheck. Injury insurance is an incredible product, but still, not many people know about it.” 

Spot is the newest and slickest accident insurance, with a well-executed business plan, substantial backing, and a high coverage limit, but other product options are out there, too. These offerings proactively allow healthcare consumers very smart, very legal choices to fill in the huge gaps left by traditional insurance. 

SINCE 2010’s AFFORDABLE Care Act (ACA), health policy changes have benefitted many Americans and increased their access to healthcare, but have also allowed insurers to shift more costs to the insured. This is notably detrimental in the individual market, where self-employed or contract laborers, such as entrepreneurs, artists, ski and raft guides, seasonal employees, and photographers buy their policies. The Bureau of Economic Analysis estimates that, as of 2018, 11,612 people in the Teton County workforce were fully or partially self-employed. So, before even counting the seasonal or service jobs with no benefits, at least one third of the Teton County population is responsible for their own insurance. According to the Wyoming Department of Workforce Services Research and Planning Division’s 2018 survey of benefits, in the southwestern region of Wyoming, which includes Teton County, only 50.6 percent of jobs include health benefits.

While the ACA guarantees access, it doesn’t guarantee you’ll be able to afford insurance, or ensuing medical bills. According to a recent study by the American Journal of Public Health, medical debt is a primary driver in almost 67 percent of bankruptcy claims—over half a million annual bankruptcies in the U.S. Even with traditional coverage, many people find themselves underinsured and/or unable to overcome high out-of-pocket maximums in addition to potential lost income. The number of Americans with no insurance is rising again. According to the U.S. Census Bureau, in 2018—the most recent year for which data are available—the number of Americans without insurance approached 30 million. And then Covid-19 happened. In the first three months of the pandemic, 5.4 million additional U.S. adults lost not only their jobs, but also the health insurance associated with them, according to the nonpartisan healthcare consumer-advocacy group Families USA. As bad as 5.4 million new uninsured Americans sounds, it’s actually worse: The Kaiser Family Foundation estimated that, if you include the dependents of these 5.4 million workers, it’s closer to 27 million individuals who lost access to insurance in the first three months of the Covid-19 pandemic. (These numbers were expected to climb through the end of 2020.) 

According to the Congressional Budget Office, the average premium (the monthly amount you pay to retain coverage) for a 2018 health exchange plan was 34 percent higher than in 2017, before maximum out-of-pocket expenses are added. In Wyoming, maximum out of pockets start at $7,000—annually—for an individual plan. A Wyomingite who makes their monthly premiums and has the misfortune to hit their out-of-pocket max could pay between $10,000 and $30,000 for one year of health care/insurance—a combined one-two injury, the first physical and the second financial. Each year in ski towns, there are hundreds of GoFundMe campaigns established to help fully insured people cover their out-of-pocket expenses. According to Spot statistics, 57 percent of its injury claims so far have been by people with health insurance, and 43 percent using Spot alone.

For Adin Buck, a fifteen-year Jackson resident and an avid snowboarder and mountain biker, injury insurance fills a big gap between his lifestyle and his traditional coverage, which he does maintain in case of serious injuries. Even with that coverage though, he could face burdensome out-of-pocket responsibility. “I use the catastrophic plans, because they make sense for the risky stuff I do,” he says. “I’ve never had health insurance with less than a $4,500 deductible. Adventure Advocates paid out for me twice to completely cover my deductible—once when I hit a tree and needed stitches in my face, and once for an MCL injury.”

Even with traditional coverage, many people find themselves underinsured and/or unable to overcome high out-of-pocket maximums in addition to potential lost income.

INJURY INSURANCE SOUNDS too good to be true—a reasonable assumption—but the companies offering it are legitimate entities with solid backing. As a comically serial accident-prone individual who nonetheless loves high-speed sports, I’ve been a passionate proponent of injury insurance for years. I lucked out enormously when, after the second of my three ACL repairs, a friend offhandedly mentioned the existence of an accident plan with a Colorado nonprofit called Adventure Advocates. Having just been burned by Blue Cross Blue Shield (BCBS) of Wyoming on my deductible (somewhat acceptable) plus a slew of surgery-related bills arbitrarily given the infuriating assignation of “not medically necessary” (not acceptable), I dropped BCBS and signed up immediately for injury protection. I’ve carried it for more than a decade in addition to a traditional, pre-ACA United Healthcare plan with a $2,500 out-of-pocket maximum. For $24 a month, Adventure Advocates covered that deductible eight times. Over the twelve years I’ve had an injury policy with Adventure Advocates, I paid it about $3,500 and it has paid about $20,000 of my United Healthcare deductibles and out-of-pocket expenses.

For companies like Spot, the more people paying in, the better for the long-term health of the company and continued payouts. “Injury insurance is like travel insurance for a flight, which is a $36 billion industry,” says Miller. “Our backers love this model, because they’ve seen the success in the travel market. We have the monthly policies, but we use one-time event-based sign-ups to improve our widespread distribution, which mitigates risk from high volumes of payouts.” 

To make that plan work, Spot teams up with various governing and organizing bodies in sports including BMX, cycling, and running to offer one-day coverage at events like competitions, bike races, or marathons. Not only does this help raise their profile, but it also bolsters the business income overall as well.

There are other methods of protection for accidents, such as the well-known AFLAC, but these plans pay benefit amounts based on the injury rather than actual bills. (For example, there is a set amount paid for a dog bite, another for a broken leg.) Traditional health care companies, such as United Healthcare, also offer accident plans. But these require the same extensive application process and varying quotes as traditional insurance, with higher prices and a much longer list of exclusions. The new generation of dedicated injury insurances offers the same rate to everyone, a simple five-minute sign-up process, and a very short and clear list of exclusions. (Wing suiters and criminals hurt on the job, you’re out of luck.) 

Spot has quickly made huge leaps in the market and brought on board some of the biggest names in action sports to help raise the product profile. Its roster of unpaid ambassadors includes climber Savannah Cummins, skier Julian Carr, and snowboarder Travis Rice. There’s good reason these high profile athletes are on board. “Over my career, I have seen it happen again and again: Friends get hurt and are either not insured or have such a high deductible that an injury can crush them financially,” says Rice. “I appreciate Spot finding solutions where we have all struggled in the past. Energy should be spent on health and recovery, not stressing out about the financial implications, especially here in the USA, of getting injured.”

No one wants to pay another monthly bill. But let’s face it: $25 is an amount nearly all of us spend each month without even remembering where it went. Four beers at the bar? A new pair of socks? Two cocktails? Fancy coffees? The new toss-up may be not whether to buy medical coverage, but whether accident insurance is a wiser use of that $25 a month than a headache from whiskey shots is. JH