Health Share Membership
As a principal agent at Blake Insurance Group, I’ve had the opportunity to witness the evolution of the health insurance industry. One of the most intriguing developments in recent years is the rise of Health Share Memberships. These programs are emerging as a flexible and effective alternative to traditional health insurance, offering potential cost savings and a unique approach to healthcare coverage. This article will delve into Health Share Membership, its cost implications, and how it compares to traditional health insurance.
Understanding Health Share Membership
Health Share Memberships, also known as medical cost-sharing programs, are not offered by insurance companies but by recognized medical cost-sharing organizations, sometimes called Health Care Sharing Ministries (HCSMs). These programs work by members paying a monthly fee to participate. When a member needs medical care, they submit their medical bills to the Health Share program, which then shares the cost of the medical expenses among its members.
Unlike health insurance plans, health care sharing programs are not required to share in pre-existing conditions. In most cases, there will be at least two years before pre-existing conditions are fully eligible for sharing. Each Health Share has its membership requirements. Members must attest to a code of ethical or religious beliefs, pledge to live a healthy lifestyle, and agree to follow their community’s rules.
Costs and Savings
One of the most appealing aspects of Health Share Memberships is the potential for significant cost savings. Many members can save as much as 50 percent compared to traditional health insurance plans, making health share ministries a much more affordable option for many. For instance, a family that might pay around $1,872 monthly for a traditional health insurance plan could save $936 or more by switching to a health-sharing plan.
However, it’s important to note that, unlike traditional health insurance premiums, health-sharing contributions are not tax-deductible. This means that while the monthly contributions may be lower, they do not offer the same tax benefits as traditional health insurance premiums.
The cost of Health Share plans can vary greatly depending on factors such as the specific plan chosen, the age of the members, and the number of members on the account. For example, Health Share Plans can cost anywhere between $78 to $199 a month for an individual in their twenties and between $516 to $1,750 a month for a family with the adults being in their fifties or sixties.
Potential Tax Implications
Currently, contributions members make to health-sharing organizations for their membership fees are not deductible for federal income tax purposes. This is because, while health sharing is a lower-cost alternative to medical insurance, they are not insurance plans themselves. Therefore, your contributions to a health-sharing ministry or program don’t qualify for the same tax treatment.
However, it’s worth noting that the U.S. Department of the Treasury and the Internal Revenue Service have issued proposed regulations that would make amounts paid for memberships in a health-sharing plan as medical expenses. If these regulations are adopted, it could change the tax implications of Health Share Memberships in the future.
Types of Coverage
Health Share Memberships offer a unique approach to healthcare coverage. Unlike traditional insurance plans, these programs do not have a predefined list of services they guarantee to cover. Instead, they decide on a case-by-case basis what medical expenses they will share. This flexibility allows Health Share Memberships to adapt to the needs of their members, but it also means that coverage can vary significantly between different programs.
Some Health Share Memberships, such as Zion HealthShare, offer comprehensive coverage for a variety of medical services, including urgent care, lab work, radiology, and physical therapy. Others, like Solidarity HealthShare, provide coverage for some preventive care, including one wellness exam per year. However, it’s important to note that Health Share Memberships are not required to cover pre-existing conditions, and many impose waiting periods before costs to treat these conditions become fully shareable.
In addition, because most Health Share Memberships are faith-based, they often limit their coverage to services that align with their religious beliefs. For example, some programs may not cover certain types of mental health counseling or wellness exams if they do not align with the community’s shared beliefs. Therefore, it’s crucial for potential members to thoroughly research and understand what types of medical expenses are covered by a Health Share Membership before enrolling.
Eligibility and Enrollment
Eligibility for Health Share Membership is typically based on the standards outlined by the specific health sharing organization. Unlike traditional health insurance programs, which are bound by the mandates of the Affordable Care Act (ACA) to accept all individuals, including those in poor health or with pre-existing medical conditions, Health Share Memberships are not mandated by the ACA.
Most Health Share Memberships require potential members to attest to a code of ethical or religious beliefs, pledge to live a healthy lifestyle, and agree to follow their community’s rules. For example, membership in health-sharing ministries often requires an agreement to avoid tobacco and drug use, usually as part of living a healthy lifestyle.
Enrollment in a Health Share Membership involves choosing the share program level that best meets the individual’s medical and financial needs. Once accepted, members make a monthly contribution to the program based on the program chosen.
It’s important to note that while Health Share Memberships can provide significant cost savings, they do not offer the same tax benefits as traditional insurance. Therefore, potential members should consider their healthcare needs, lifestyle, and financial situation before enrolling in a Health Share Membership.
Comparison with Traditional Insurance
Health Share Memberships and traditional insurance plans differ significantly in costs, coverage, and operation.
Health Share Memberships are often more affordable than traditional insurance. A study by Health Markets showed that these plans can cost as much as half of traditional insurance premiums. This is primarily because Health Share Memberships operate on a cost-sharing model where members contribute monthly shares into a collective pool, which is then utilized to pay for the medical expenses of other members. This shared responsibility model can lower costs for members who do not require frequent healthcare services. However, it’s important to note that Health Share plans do not qualify for premium subsidies under the Affordable Care Act (ACA).
In terms of coverage, Health Share Memberships do not guarantee coverage for all medical expenses, unlike traditional insurance. They decide on a case-by-case basis what medical expenses they will share. This means that they do not always provide the same level of coverage, particularly for pre-existing conditions or high-cost treatments. Moreover, Health Share plans are not required to cover the same minimum essential benefits as ACA health insurance plans, making them less comprehensive than traditional insurance.
The operation of Health Share Memberships also differs from traditional insurance. Health Share plans are non-profit entities where members share medical costs, while traditional insurance involves paying premiums for coverage. Health Share Memberships are community-based alternatives to traditional health insurance, where members pool their financial resources to share eligible medical expenses.
Pros and Cons of Health Share Membership
Health Share Memberships offer several advantages and disadvantages that potential members should consider.
**Lower Costs**: Health Share plans often have lower costs than traditional insurance. Members contribute a specific monthly amount based on their chosen program, usually less than an insurance plan’s cost.
**Flexibility**: Health Share plans offer flexibility regarding contributions and membership. Members can choose the program that fits their needs and budget.
**Additional Benefits**: Some Health Share plans offer additional membership bonuses such as dental and vision discounts, disability sharing, and free telehealth.
**Community Support**: Health Share plans foster community among members. Members can encourage one another through personal notes of encouragement, fostering a sense of community and family.
**Limited Coverage**: Health Share plans do not guarantee coverage for all medical expenses. Certain pre-existing conditions, such as diabetes, may require a member to pay an additional monthly amount and standard membership fees.
**Specific Rules**: As many Health Share plans are faith-based organizations, they can have specific rules associated with membership. This typically means there are no procedure payouts against the organization’s beliefs.
**Limited Resources**: Health Share programs generally have comparatively few members, which can pose problems. A small group of members means there are limited resources to be shared.
Shared Savings Program
The Shared Savings Program is a voluntary program that encourages groups of doctors, hospitals, and other healthcare providers to come together to provide coordinated, high-quality care to their Medicare patients. The goal is to ensure that patients, especially the chronically ill, get the proper care at the right time while avoiding unnecessary duplication of services and preventing medical errors.
When an Accountable Care Organization (ACO) succeeds in delivering high-quality care and spending healthcare dollars more wisely, it may be eligible to share in the savings it achieves for the Medicare program, also known as performance payments.
Benefits of the Shared Savings Program
**Promotes Accountability**: The Shared Savings Program promotes accountability for a patient population and coordinates items and services for Medicare Fee-For-Service beneficiaries.
**Encourages Investment in Quality Services**: The program encourages investment in high-quality and efficient services.
**Financial Incentives**: The Shared Savings Program provides financial incentives to healthcare providers to improve health outcomes and reduce costs. If savings are achieved based on an expected total cost of care target, those shared savings are shared with CMS.
**Reduces Administrative Burden**: Participation in the Shared Savings Program can reduce the administrative burden for healthcare providers.
**Saves Money for Medicare**: The Shared Savings Program has successfully saved money for Medicare while continuing to support high-quality care.
Health Share Plan Options
Zion HealthShare is a nonprofit health-sharing organization that offers comprehensive coverage for various medical services, including urgent care, lab work, radiology, and physical therapy. Each member has one shareable wellness visit per membership year, including standard lab work. Zion HealthShare has a simple pricing structure based on member age and the number of people included in the membership. Members can choose between three Initial Unshareable Amount (IUA) options they must pay before a bill can be shared.
Solidarity HealthShare is a health-sharing organization that caters to Catholics and provides coverage for some preventive care, including one wellness exam per year. The Solidarity ONE plan is their most comprehensive program. It offers prescription drug cost-sharing, unlimited mental health visits, wellness visits, preventative care, lab testing, access to alternative medicine, life-affirming fertility care, and no network restrictions. Solidarity HealthShare aims to provide comprehensive, quality care at a cost-effective price.
Medi-Share is a Christian-based, non-profit medical expense-sharing program. It offers one plan option: an annual physical with limited labs, unlimited telemedicine, virtual mental health, and no lifetime or annual sharing limits. Medi-Share has a range of Annual Household Portion (AHP) levels, allowing members to choose the level that best suits their needs. The program aims to provide community support among its members while sharing medical expenses.
Altrua HealthShare is a Christian-focused, nonprofit medical cost-sharing community based in Austin, Texas. It has over 24,000 members and has reportedly shared more than $100,000,000 of its members’ medical expenses since its inception. Altrua HealthShare offers memberships nationwide, but some sharing options may not be available to members in all geographic locations or jurisdictions. The annual limit is $150,000, and the lifetime maximum limit is $1,000,000. However, it has strict rules and restrictions on sharing pre-existing conditions. Any condition for which a member has received medical advice or treatment during the ten years before their membership start date is considered a pre-existing condition.
HSA Secure is a low-cost HSA-qualified healthcare sharing plan. It is the only health-sharing plan from a significant health-sharing organization that allows members to make tax-deductible contributions to a health savings account. This is because the HSA Secure plan combines a special HSA-qualified minimum essential coverage (MEC) insurance plan with a low-cost catastrophic healthshare. It covers eligible medical expenses defined in the program’s guidelines, including doctor visits, laboratory tests, and hospital stays, after you pay your initial unshared amount.
Liberty HealthShare is a Christian membership-based, non-profit organization that facilitates the voluntary sharing between members to pay each other’s medical costs. It serves about 90,000 members from its Ohio base. Liberty HealthShare places restrictions on sharing for pre-existing conditions. No costs for these conditions are shareable until the member reaches their second membership year. However, there are no limits on pre-existing conditions in the fourth year of membership. Because Liberty HealthShare does not have a recommended provider network, members can choose their providers.
Samaritan Ministries is a well-established HealthShare with over twenty-five years of serving its members. This HealthShare is deeply rooted in the New Testament Church, but most Christian denominations are welcome. What makes this HealthShare unique is the member-to-member connection fostered by the sharing format. Members receive sharing assignments that allow them to know precisely who their share will go to, how much of their share will be assigned to that member’s need, and what need that fellow member is experiencing.
United Refuah HealthShare
United Refuah HealthShare is the first and only Jewish HealthSharing Organization. Its mission is to give back control, freedom, and flexibility to its members, allowing them to use the doctor and hospital of their choice. After members have met 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. Once this maximum is reached, eligible expenses are shared at 100% up to $1,000,000 per incident. United Refuah HealthShare does not limit members to a specific provider network, allowing them to choose their preferred healthcare providers.
OneShare Health is a Christian Health Care Sharing Ministry that offers a unique path to affordable health care. It provides a range of ACA-exempt medical sharing programs for members to choose from, catering to the varying needs of individuals and families. OneShare Health does not restrict its members to an In-Network/Out-of-Network requirement for physicians and facilities, allowing them to choose their preferred healthcare providers. The organization also offers services such as a prayer hotline and monthly videos featuring their on-staff chaplain.
It’s important to note that while health share organizations can provide a valuable alternative to traditional health insurance, they are not insurance companies and do not guarantee coverage. Before joining, potential members should carefully review the terms and conditions of any health share organization.
The best plan for an individual or family will depend on their specific needs, including age, zip code, smoking status, and choosing a health share that only shares catastrophic expenses or a more comprehensive program. Therefore, it’s crucial for potential members to thoroughly research and understand the features of each Health Share plan before enrolling.