Healthcare sharing programs

[Devil's Advocate]

Anyone use health care sharing programs such as Medi-share? A Christian ministry program.


https://mychristiancare.org/medi-share/ ... tedSharing

Looks interesting. My Wife carries the health insurance in our family. She is looking to quit in January. My employer has fairly expensive health insurance plan. Will cost me $1200 per month pretax. This health care sharing program would have 10500 deductible with monthly premiums of $250 approximately. Our family does not use health care so far. No pre existing conditions. There are some exceptions to be aware of . However it sounds like it may be an option.

Anyone have any direct experience?

DA

[highercall]

I have been a member of medishare for 20 yrs. Never used it the first 15 yr. However in the past 5yrs I had several knee and shoulder surgeries and lyme disease. For the most part I have been very satisfied and appreciated their follow up and concern for my recovery. I have recommended medishare to several other people.

[runner3081]

Make sure to know exactly what you are buying. We see patients (not an MD, on the admin side) with these plans come in every once in a while and it always ends up being a bit messy and frustrating for the patient because they have no clue what they signed up for.

The ones I have seen are essentially a rebate type of program. You pay the entire amount to the hospital/clinic up and then submit to the sharing plan for a level of reimbursement.

Fortunately, I think the concept is easy for many Bogleheads to grasp, but it hangs up a lot of people - just as high deductible plans do. Many people just see a lower premium and jump for it, not having $5k or more to sit around before meeting a deductible or to pay while waiting for reimbursement.

Looking at this plan for a few seconds, it doesn't look terrible, however and I would certainly have no issues with it, depending on what the rates were.

[Rupert]

There are many prior threads on this topic. You should search for those. The threads always end up being shut down because they become too political. I don't believe we really need to debate their merits again in a new thread.

[47Percent]

There are many prior threads on this topic. You should search for those. The threads always end up being shut down because they become too political. I don't believe we really need to debate their merits again in a new thread.

Ditto.. Ditto.. Ditto...

Medishare has the dubious distinction of being a premixed cocktail of Politics and Religion.
Also not being in line with BH general philosophy, the discussion about it gets heated and shut down quickly.

[Daryl]

I'm confident that this community can a great discussion on this topic. The most important thing to consider with these plans is that they are not "insurance" in the traditional sense. There is no risk transfer. The patient is responsible for 100% of the medical costs incurred. They may seek reimbursement from other members; however, ultimately, the plan is not responsible for ANY medical costs incurred.

[Tycoon]

There are many prior threads on this topic. You should search for those. The threads always end up being shut down because they become too political. I don't believe we really need to debate their merits again in a new thread.

Ditto.. Ditto.. Ditto...

Medishare has the dubious distinction of being a premixed cocktail of Politics and Religion.
Also not being in line with BH general philosophy, the discussion about it gets heated and shut down quickly.

No worse than Tesla and Bitcoin topics, or indexing for that matter.

[Phineas J. Whoopee]

Any reimbursement relies on other plan members voluntarily paying it.

If one were in a very close relationship where everybody could trust everybody, such an arrangement might reliably work, as long as there was enough money among all the participants.

I leave it as an exercise for the reader to determine whether wider communities in which people haven't even met each other are reliable in this sense.

PJW

[Nate79]

I would first check on the exchange how much her insurance would be. Otherwise these health sharing programs get VERY high reviews from their consumers. Investigate them but I would not be scared of them that is often evident on this site. Certain ones have a very long history and are very popular.

[Devil's Advocate]

I'm confident that this community can a great discussion on this topic. The most important thing to consider with these plans is that they are not "insurance" in the traditional sense. There is no risk transfer. The patient is responsible for 100% of the medical costs incurred. They may seek reimbursement from other members; however, ultimately, the plan is not responsible for ANY medical costs incurred.

I do understand that they legally/technically have no responsibility to pay for medical costs incurred. However practically and pragmatically they do (after the "deductible" is met). Researching online they do have excellent reviews from their members. A few complaints on BBB that sound like billing issues. I would suspect regular health insurance would have more complaints from their customers.

DA

[Devil's Advocate]

Any reimbursement relies on other plan members voluntarily paying it.

If one were in a very close relationship where everybody could trust everybody, such an arrangement might reliably work, as long as there was enough money among all the participants.

I leave it as an exercise for the reader to determine whether wider communities in which people haven't even met each other are reliable in this sense.

PJW

I understand your viewpoint. However the majority of their members have no complaints with reimbursement. This arguement kind of reminds me of the annuity argument. Such as the risk of the insurance company going bankrupt and not paying your monthly
Payment. Yes, a risk. But highly unlikely.

DA

[michaeljc70]

It isn't insurance and there is no guarantee they will pay. If a higher than normal number of people in the pool get sick in a year with serious stuff and they run out of money, you will be on the hook. There is a reason it is less money.

People are saying the chances of this happening are low. The chances of having one of these very expensive medical incidents is also low. But aren't those the exact type of incidents insurance is for? Chances are my house isn't going to burn down, but if it does, I want to be sure it is covered.

All that being said, I guess it is better than nothing.

[Devil's Advocate]

It isn't insurance and there is no guarantee they will pay. If a higher than normal number of people in the pool get sick in a year with serious stuff and they run out of money, you will be on the hook. There is a reason it is less money.

Ok...I've got 40k in our HSA. Save 10k/yr on premiums. Is it worth that risk?? I dont know.

DA

[Devil's Advocate]

The other thing to consider is with normal health insurance not excluding pre existing conditions if something bad did happen that was catastrophic and not covered just get on the exchange and apply for normal insurance. If that initial catastrophe drained the HSA and did bankrupt an individual, your home and retirement funds cannot be touched. Where is the risk??
DA

[michaeljc70]

It isn't insurance and there is no guarantee they will pay. If a higher than normal number of people in the pool get sick in a year with serious stuff and they run out of money, you will be on the hook. There is a reason it is less money.

Ok...I've got 40k in our HSA. Save 10k/yr on premiums. Is it worth that risk?? I dont know.

DA

I just had a minor, outpatient surgery (1.5 hours) and it cost almost $50k if I didn't have insurance.

I wouldn't want to take the risk and I am very healthy (first surgery or time in the hospital in my life). I didn't see what your situation was (self employed, retiring early, etc). Ideally this can be mitigated another way (ACA subsidy, part time job for one spouse, full time job with insurance, etc).

On the positive side, the deductibles on the sharing programs are much lower on average than on ACA plans.

[Phineas J. Whoopee]

...
I understand your viewpoint.
...

It isn't a viewpoint. It's a legal and financial fact.

PJW

[Devil's Advocate]

...
I understand your viewpoint.
...

It isn't a viewpoint. It's a legal and financial fact.

PJW

Yes
Sorry I misspoke

[delamer]

The other thing to consider is with normal health insurance not excluding pre existing conditions if something bad did happen that was catastrophic and not covered just get on the exchange and apply for normal insurance. If that initial catastrophe drained the HSA and did bankrupt an individual, your home and retirement funds cannot be touched. Where is the risk??
DA

You need an open season or a qualifying event to purchase through the exchange.

Having catastrophic expenses is not a qualifying event. You could have many months of non-coverage.

[Devil's Advocate]

The other thing to consider is with normal health insurance not excluding pre existing conditions if something bad did happen that was catastrophic and not covered just get on the exchange and apply for normal insurance. If that initial catastrophe drained the HSA and did bankrupt an individual, your home and retirement funds cannot be touched. Where is the risk??
DA

You need an open season or a qualifying event to purchase through the exchange.

Having catastrophic expenses is not a qualifying event. You could have many months of non-coverage.

Point taken...

[Rupert]

The other thing to consider is with normal health insurance not excluding pre existing conditions if something bad did happen that was catastrophic and not covered just get on the exchange and apply for normal insurance. If that initial catastrophe drained the HSA and did bankrupt an individual, your home and retirement funds cannot be touched. Where is the risk??
DA

You need an open season or a qualifying event to purchase through the exchange.

Having catastrophic expenses is not a qualifying event. You could have many months of non-coverage.

Point taken...

And you need to keep an eye on that case in Texas, wherein the current administration has decided not to defend the pre-existing condition provisions of the ACA. Personally, I wouldn't bank on being able to buy insurance that covers pre-existing conditions in the future on the ACA exchange.

[ThankYouJack]

OP, what did you decide?

I’m guessing you need to be Christian (or lie which I’m not willing to do) to join a Christian one? But it could be an option for my wife and kids. Are there any secular healthcare sharing programs?

https://mychristiancare.org/medi-share/ ... nTestimony

[michaeljc70]

OP, what did you decide?

I’m guessing you need to be Christian (or lie which I’m not willing to do) to join a Christian one? But it could be an option for my wife and kids. Are there any secular healthcare sharing programs?

https://mychristiancare.org/medi-share/ ... nTestimony

These plans are literally only allowed because of a religious exemption to the ACA. However, some are pretty loose. Some will call your church to verify. Some just require agreeing with a statement that you believe in x, y and z. If you are an atheist, then no, there are no health care sharing programs.

Trinity Healthshare is the least stringent I've seen. It is even open to unmarried couples and same sex couple. You have to agree to:

-We believe that our personal rights and liberties originate from God and are bestowed on us by God.
-We believe every individual has a fundamental religious right to worship God in his or her own way.
-We believe it is our moral and ethical obligation to assist our fellow man when they are in need, according to our available resources and opportunity.
-We believe it is our spiritual duty to God and our ethical duty to others to maintain a healthy lifestyle and avoid foods, behaviors, or habits that produce sickness or disease to ourselves or others.
-We believe it is our fundamental right of conscience to direct our own healthcare, in consultation with physicians, family, or other valued advisors.

I haven't used any health sharing service, but have done a little research on them.

[willthrill81]

It isn't insurance and there is no guarantee they will pay.

That's true, but I have not heard of a single instance on this forum at least of someone who didn't get reimbursed from one of the 'major' HSMs for a 'covered' expense. Granted, that's very anecdotal, but it might be a distinction without a practical difference.

Where it seems that people can get into trouble with HSMs, HDHPs, etc. is in simply not knowing what their 'plan' covers. For instance, I confess that I was not aware that the out-of-pocket maximum on our HDHP did not automatically apply to non-network providers. If we had a medical emergency while traveling in another state, we could be on the hook for $100k or more. Thankfully, we have access to another, better HDHP that we'll be switching to during open enrollment.

My point is that HSMs are not necessarily 'bad', and healthcare insurance is not necessarily 'good'. People need to understand the pros and cons.

[ThankYouJack]

These plans are literally only allowed because of a religious exemption to the ACA. However, some are pretty loose. Some will call your church to verify. Some just require agreeing with a statement that you believe in x, y and z. If you are an atheist, then no, there are no health care sharing programs.

Trinity Healthshare is the least stringent I've seen. It is even open to unmarried couples and same sex couple.

I haven't used any health sharing service, but have done a little research on them.

Great, thank you Michael. I appreciate the feedback!

[michaeljc70]

It isn't insurance and there is no guarantee they will pay.

That's true, but I have not heard of a single instance on this forum at least of someone who didn't get reimbursed from one of the 'major' HSMs for a 'covered' expense. Granted, that's very anecdotal , but it might be a distinction without a practical difference.

Where it seems that people can get into trouble with HSMs, HDHPs, etc. is in simply not knowing what their 'plan' covers. For instance, I confess that I was not aware that the out-of-pocket maximum on our HDHP did not automatically apply to non-network providers. If we had a medical emergency while traveling in another state, we could be on the hook for $100k or more. Thankfully, we have access to another, better HDHP that we'll be switching to during open enrollment.

My point is that HSMs are not necessarily 'bad', and healthcare insurance is not necessarily 'good'. People need to understand the pros and cons.

Well, that is very anecdotal. All it takes is bad luck/timing (a lot of big claims they don't have funding for in short time frame). They aren't subject to all the reserve requirements that insurance companies are. I buy insurance to cover catastrophes that would have a large impact on my finances. I want it to be there when I need it.

If you think about it, a health sharing program has almost all of the costs regular insurance does. Yes, you don't have an insurance company making money, but insurance company profits are a few percent of all healthcare costs. As you indicated, you have to know what you are getting. The rates are often low because a lot of these plans don't cover as many things and for as high of amounts. Some also have 2 year waiting periods on pre-existing conditions which the ACA doesn't have.

[willthrill81]

It isn't insurance and there is no guarantee they will pay.

That's true, but I have not heard of a single instance on this forum at least of someone who didn't get reimbursed from one of the 'major' HSMs for a 'covered' expense. Granted, that's very anecdotal , but it might be a distinction without a practical difference.

Where it seems that people can get into trouble with HSMs, HDHPs, etc. is in simply not knowing what their 'plan' covers. For instance, I confess that I was not aware that the out-of-pocket maximum on our HDHP did not automatically apply to non-network providers. If we had a medical emergency while traveling in another state, we could be on the hook for $100k or more. Thankfully, we have access to another, better HDHP that we'll be switching to during open enrollment.

My point is that HSMs are not necessarily 'bad', and healthcare insurance is not necessarily 'good'. People need to understand the pros and cons.

Well, that is very anecdotal. All it takes is bad luck/timing (a lot of big claims they don't have funding for in short time frame). They aren't subject to all the reserve requirements that insurance companies are. I buy insurance to cover catastrophes that would have a large impact on my finances. I want it to be there when I need it.

If you think about it, a health sharing program has almost all of the costs regular insurance does. Yes, you don't have an insurance company making money, but insurance company profits are a few percent of all healthcare costs. As you indicated, you have to know what you are getting. The rates are often low because a lot of these plans don't cover as many things and for as high of amounts. Some also have 2 year waiting periods on pre-existing conditions which the ACA doesn't have.

Even apart from this forum, I cannot easily find any instances of where expenses that were explicitly stated to be covered by the HSM were not reimbursed, albeit sometimes with a longer than needed waiting period. The problems with HSMs seem to be when people think that they work just like insurance and pay no attention to the stipulations, non-covered events, etc.

If HSMs were as problematic as some here make them out to be, there would be many thousands of people across the country raising a huge stink, major exposes of bad practices, and people marching in D.C. to change or ban HSMs.

Those that view HSMs as being 'risky' can just avoid them. It's as simple as that. But many people have been very happy with their HSM for many years, including those who 'filed claims'.

[sawhorse]

My biggest concern with healthshare ministries is that they often have very limited coverage for prescription drugs. Sometimes they'll cover 45 days or 3 months of a prescription for a new condition, and after that, you're on your own. Sometimes they don't offer any coverage at all. Prescription drugs are by far my biggest medical expense.

I think that healthshare ministries tend to be unpopular on this board because most Bogleheads are risk averse. If you're more risk tolerant and don't have pre-existing conditions, they can be a viable option.

[Emilyjane]

Googled health sharing ministry breast cancer and found this instance of problems.

https://www.google.com/amp/s/abc7chicag ... y/5464137/

I had breast cancer this past year. Total charges were ~$500,000. I was quite glad to have real insurance— premiums of $1000/month looked good in comparison.

[willthrill81]

Googled health sharing ministry breast cancer and found this instance of problems.

https://www.google.com/amp/s/abc7chicag ... y/5464137/

I had breast cancer this past year. Total charges were ~$500,000. I was quite glad to have real insurance— premiums of $1000/month looked good in comparison.

As noted above, that's why it's important to do your research on the front-end, whether an HSM or an insurance company.

[Devil's Advocate]

OP, what did you decide?

I’m guessing you need to be Christian (or lie which I’m not willing to do) to join a Christian one? But it could be an option for my wife and kids. Are there any secular healthcare sharing programs?

https://mychristiancare.org/medi-share/ ... nTestimony

Sorry for the late reply TYJ,

I opted to get health insurance thru my employer for myself. My wife and kids are doing health sharing ministries. I am not Christian or religious either and have no qualms about lying to them to apply. However this particular program wouldn't cover injuries or conditions related to non Christian activities i.e. alcohol use and since that is a vice of mine I didn't want to break a leg tailgating or some other random accident while imbibing and not have coverage. Therefore I pay for my own insurance and family is covered thru the ministry. It's still cheaper than family plan. We haven't had any use if it yet so I cant really comment on the coverage.

DA

[ThankYouJack]

Thanks all for the feedback. Based on it and my own research, I think we'll go the more traditional route of regular insurance.