compare Health share membership
As an insurance agent, I’ve seen a growing interest in health share memberships as an alternative to traditional health insurance. These programs are based on the voluntary sharing of medical expenses among members with similar ethical or religious beliefs. However, it’s crucial to understand the key differences between health share memberships and traditional insurance before deciding.
What is the Health Share Membership? It’s Not Insurance
Health share plans, also known as Health Care Sharing Ministries (HCSMs), are a form of health coverage where members who typically share a religious belief make monthly payments to cover the expenses of other members. These plans are not considered health insurance and are mainly unregulated, providing limited benefits. They are often attractive to healthy individuals due to their lower costs than traditional health insurance.
Health share plans qualify as 501(c)(3) charitable organizations rather than insurance. They are subject to regulation at the state and federal levels. Still, they are not regulated by the Federal Insurance Office, the Centers for Medicare & Medicaid Services, or the Department of Insurance. Many states have passed laws that exempt health-share plans from laws and regulations governing health insurance.
Health share plans can come up with their own processes for distributing money to members who file “claims.” Some plans even have members giving money directly to each other to cover medical bills. Since many health-share plans don’t cover wellness visits or preventive care, members pay for those entirely out-of-pocket. Other plans may offer unique features, such as wellness visits, preventive services, or specific programs for certain faith groups.
However, it’s important to note that these plans can pose risks to consumers. Because they often provide limited to minimal benefits, they may not provide adequate coverage in the event of a serious health issue. Furthermore, because they are not regulated in the same way as traditional insurance, the specific terms and definitions will vary depending on the plan. Therefore, it’s crucial for potential members to thoroughly investigate any plan and weigh the benefits against the cost carefully.
Cost and Pricing Structure
Health share memberships often have different pricing structures compared to traditional insurance. They may include member contribution, co-share, and personal responsibility amounts. For instance, netWell Healthshare offers affordable member contribution amounts, while Medi-Share memberships have some of the highest personal responsibility amounts, ranging from $3,000–$12,000, depending on the membership.
Adding family members to your health share plan will also increase the monthly cost. For example, United Refuah HealthShare offers one membership type, varying prices based on the number of members.
It’s important to note that while health share plans can offer more flexibility and potentially lower costs, they may also come with certain limitations. For instance, some health share plans may have restrictions and payment caps relating to pre-existing conditions. Additionally, because health share plans are not considered insurance, members may have little or no legal protection if a claim isn’t paid, coverage is denied, or the organization goes bankrupt. Therefore, it’s crucial to thoroughly research and understand the specifics of any health share plan before joining.
Health share plans may have variable coverage, deciding to pay on a case-by-case basis. They may also limit how much they’ll pay, covering expenses until they meet a set dollar amount. Some plans may have specific sharing caps or limitations on pre-existing conditions.
For instance, unlike traditional insurance, which typically covers pre-existing conditions immediately upon enrollment, health-sharing programs may have stricter restrictions. Some programs may exclude coverage for pre-existing conditions altogether, while others may offer limited coverage or require a longer waiting period.
Choosing the Right Plan
Choosing the right plan is crucial, as picking the wrong one can lead to unexpected coverage gaps that might end up costing you. For example, the Christian ministry Altrua HealthShare has four membership levels: Ruby, Sapphire, Emerald, and Diamond. Monthly costs and shareable services vary widely between Altrua HealthShare’s gem memberships.
It’s also important to note that state insurance departments do not regulate health share programs, and coverage for specific medical services is not guaranteed. Therefore, when considering a health share program, carefully review the organization’s Statement of Beliefs or guidelines to ensure they align with your values.
Network Requirements and Claims Process
Health share and traditional insurance plans differ significantly in network requirements and claims processes.
Regarding network requirements, health share plans typically do not have any. This means members are free to visit any doctor they choose, unlike traditional insurance plans that often limit coverage to in-network providers. This flexibility can be beneficial for individuals who have specific doctors they prefer or who travel frequently.
The claims process for health share plans is also different from traditional insurance. In a health share plan, members “share” medical costs. As part of a health share plan, you are responsible for paying a specific share amount each month (similar to a premium) as well as an “annual unshared amount” for your expenses (similar to a deductible) that your medical expenses must exceed before the plan shares your expenses.
Health share plans typically do not require members to file claims when processing medical bills. Instead, medical providers submit bills directly to the health share organization, which then processes the bills for eligibility. Eligible medical bills are then shared among members, who contribute towards paying these bills.
In contrast, traditional insurance plans follow a more complex claims process. After a healthcare provider delivers a service or procedure, they submit a claim to the insurance company for reimbursement. The insurance company then checks the claim for completeness, accuracy, and coverage under the insurance plan. If the service is covered, the insurance company pays the provider either the entire cost or a portion of it, depending on the benefits included in the health insurance plan.
Customer Service in Health Share Plans
Customer service is a crucial aspect of any service industry, and health share plans are no exception. The quality of customer service can significantly impact a member’s experience and satisfaction with the plan.
Health share plans are provided by organizations whose members share medical costs. These organizations often strive to provide high-quality care and service to their members. For instance, some health share plans have received high member reviews and boast a 98% customer satisfaction rate year after year.
However, the quality of customer service can vary among health share plans. Some members have reported attentive and kind customer service. In contrast, others have reported issues with their health share plans not covering treatments and paying their medical bills, leading to financial jeopardy.
It’s important to note that the Department of Insurance does not regulate health share plans like traditional insurance products. This means that health share plans don’t need to meet the same requirements as insurance, such as paying for claims promptly. As a result, some members have experienced delays or difficulties in getting their medical bills shared.
When considering a health share plan, it’s crucial to research and understand the specifics of the plan, including the quality of customer service. Reading reviews from current and former members can provide valuable insights into the customer service experience. Additionally, potential members should consider contacting the Health Share organization directly with questions or concerns to gauge their responsiveness and willingness to assist.
Comparison with Traditional Insurance
Health share plans and traditional insurance differ significantly in structure, benefits, and potential drawbacks.
Health share plans are provided by organizations whose members “share” medical costs. As part of a health care sharing plan, you are responsible for paying a certain share amount each month (similar to a premium) as well as an “annual unshared amount” for your expenses (similar to a deductible) that your medical expenses must exceed before the plan shares your expenses. These plans are not insurance, but they count as insurance under the Affordable Care Act (ACA), which means they can provide more affordable healthcare benefits while avoiding the tax penalty for going uninsured.
One of the main advantages of health share plans is their lower cost. Monthly costs of health sharing are usually much lower than insurance premiums. However, these plans aren’t required to cover pre-existing conditions, such as cancer, diabetes, or lifestyle-related conditions like smoking. Those who have these conditions may be declined membership or won’t have the conditions fully covered.
On the other hand, traditional insurance is a contract between an individual and an insurer. Health insurance companies charge premiums for their policies to make money. The monthly premiums that policyholders pay help to drive profits for these firms. Health insurance programs are bound by the ACA mandates, which dictate that all individuals must be accepted into plans, including those in poor health or those with pre-existing medical conditions.
Regarding choice, health insurance plans often restrict the choice of physicians and hospitals that policyholders can visit. They also place a limit on the types of medications that are made available. In contrast, health share plans do not restrict the type of doctor or specialist members can visit.
One of the primary concerns is that health share plans are not insurance products, meaning there are no guarantees for payment. This lack of guarantee can pose a problem, especially in the event of a large claim that needs to be covered.
Health share plans also have limitations on coverage. For instance, they often exclude coverage for pre-existing conditions and do not provide the minimum health benefits mandated by the Affordable Care Act. They can also place annual or lifetime caps on payments, which could be problematic in a catastrophic health event.
Another potential drawback is the lack of regulation. Health share plans are not subject to the same standards and consumer protections as health insurance plans. This means they can decide their processes for money distribution to members who submit claims, and they are not legally mandated to pay claims.
Health share plans also often have restrictions and rules based on their faith-based nature. For example, some do not accept smokers, most do not share expenses for drug rehabilitation, and some require regular church attendance.
Finally, the solvency of health share plans can be a concern. These plans typically have fewer members than traditional insurance plans, which means there are limited resources to be shared amongst the group. This could pose a problem if a large claim needs to be covered.
Health Share Organizations
Zion HealthShare is a non-religious health share organization that provides a community for members to contribute towards each other’s medical costs. Members can work with any provider without network restrictions, and the organization does not have annual or lifetime sharing maximums. Zion HealthShare offers two primary membership types: Direct and Essential, with costs determined by age group, initial unshareable amount (IUA), and the number of household members.
Christian Healthcare Ministries (CHM)
Christian Healthcare Ministries (CHM) is the nation’s original health cost-sharing ministry, founded in 1981. CHM shares 100% of eligible medical bills and has satisfied nearly $10 billion in members’ healthcare costs. Members can choose from one of four programs that best fit their needs, with no membership restrictions based on age, geographic location, or health history.
Medi-Share is a nonprofit health care sharing ministry of Christian Care Ministry, Inc. Members voluntarily share each other’s medical expenses and encourage one another. Medi-Share offers high-quality, affordable health care that aligns with Christian values, with no annual caps or lifetime limits. Members can access 24/7 telehealth services and choose from various program options.
United Refuah HealthShare
United Refuah HealthShare is the first and only Jewish HealthSharing Organization. After members meet their Annual Pre-Share Amount, United Refuah HealthShare shares 80% of eligible medical expenses, with the member responsible for a 20% Co-Share. The 20% Member Co-Share is limited to an annual Co-Share Maximum.
Altrua HealthShare is a Christian ministry with four membership levels: Ruby, Sapphire, Emerald, and Diamond. Monthly costs and shareable services vary widely between Altrua HealthShare’s gem memberships.
OneShare Health is a Christian Health Care Sharing Ministry that offers various program options to fit members’ needs. Members voluntarily share each other’s medical expenses and support one another through prayer and encouragement.
Samaritan Ministries is a Christian health care sharing ministry where members share each other’s medical expenses. Members send their monthly share directly to other members in need, fostering a sense of community and support.
Liberty HealthShare is a Christian health share organization that offers various membership levels. However, some members have reported issues with coverage and payment of medical bills.
Sedera is a health care sharing community that offers an alternative to traditional health insurance. Members contribute to a sharing pool and receive assistance for eligible medical expenses.
Impact Health Sharing
Impact Health Sharing is a health care sharing ministry where members share each other’s medical expenses. The organization aims to provide an affordable, community-driven alternative to traditional health insurance.
It’s essential to research each health share organization and understand their specific guidelines, costs, and coverage options before deciding which best suits your needs.