There is an option for healthcare coverage that is gaining in popularity among Americans that might seem new, but it’s not. This category of coverage has been around for decades, but hasn’t been so much in the public eye as they have been since health insurance premiums have risen sharply in the last five years.
At first blush, their promise of good healthcare coverage that is much cheaper than comparable coverage from traditional health insurance plans. I often get asked about it because people have heard a radio ad or talked to a relative raving about it. After learning about it, sometimes they find they’re a fit, and sometimes not.
There are several dozen health sharing plans available and they range from very cheap, to more expensive. Generally, though, benefit-for-benefit, they are less expensive than comparable health insurance plans.
So, are you a fit? Do you wonder if this might be a good option for you to consider? To help you answer that question, let me share a few things about this category of health coverage that may help you decide.
They aren’t insurance.
Health Sharing plans are religious organizations with exempt status which limits the way they operate in somewhat the same way churches are limited. As such, they don’t use insurance terminology. What insurance would call a copay, a health sharing plan might call a visit fee. What insurance would call a deductible, a health sharing plan might call a sharing amount, or sharing portion, or member responsibility. You aren’t a policy holder, making a claim, but a member of an organization, presenting a need for eligibility determination.
They aren’t regulated by a Department of Insurance
Because they aren’t insurance, they are not regulated by any state or federal department of insurance, but that doesn’t mean that DOI’s can’t get involved and report an organization to the state’s attorney general, which has happened on occasion. This is important to know in case you have a dispute with a health sharing plan. Their member guides are often detailed and you should be very familiar with them before you decide if a plan is right for you.
They aren’t obligated. (and neither are you!)
If you read the fine print for any health sharing program, you will hear wording that says something like, “Your monthly contribution is voluntary.” and then again, something like, “There is no guarantee of payment of your eligible need. Any unpaid bill is the responsibility of the patient.” While this can be unsettling, there are hundreds of thousands of people who don’t have a problem with it because they know why wording like that exists.
As a religious, exempt organization, by law there can be no obligation or compulsion. If you donated a thousand dollars to a church to be used for the stained glass window, and they use if for the organ, you can’t sue the church because by definition, your contribution is voluntary and by law there can be no quid pro quo, otherwise it would be a business transaction.
This is probably the most important thing to remember about a health sharing plan. Each organization’s member guidelines spell out important expectations between members and the organization. Health sharing plans with detailed rules regarding member conduct are there for a reason. If they stipulate you must be a non-smoker, (or more vaguely state you must refrain from doing harmful things to your body) and you get lung cancer from smoking, they may not consider your condition an eligible need, and you will have little to no recourse.
They aren’t for everyone.
The critical component of membership in any health sharing organization is agreement with a statement of beliefs, or ethics, or standards. Sometimes these can be very specific, such as you must be a Christian, or a Catholic specifically, or Jewish, etc. Others are rather general such as you must believe in a God and that everyone has a right to worship God in his or her own way.
The memberships are best suited for healthy people. If you have a chronic condition that requires frequent hospitalization, surgery, or expensive medications or durable medical equipment, these plans are not for you. Likewise, if you live a very irreligious lifestyle, you could find yourself with a medical condition that the health sharing plan will refuse to cover.
They can be a cheaper, better option for many people.
An individual health insurance plan with a major carrier that offers a reasonable deductible and office visit copays can easily run well over a thousand dollars a month for a family of four. Sometimes it can be more than two or three thousand dollars a month. A typical health sharing plan that offers some of the same things can range from five hundred dollars a month, (sometimes less) to just over a thousand dollars per month (which offers more sharing options.)
For a healthy family who really only uses coverage for preventive care and the occasional flu or knee scrape, these plans can save thousands of dollars in premium costs per year. Since many health sharing plans use some version of the PHCS Multiplan doctor network, they have access to doctors and facilities nationwide, which is not the case even with many Blue Cross plans in the U.S. today.
I have many clients who are on health sharing plans and they love it. They’re not perfect, just like regular health insurance carriers aren’t perfect, (I have the same number of complaints for them) but they save money and have access to great doctors and facilities. If we have a discussion about whether health sharing is right for you, I will be candid with you. In any case, it’s only one of many options you have and probably didn’t know about.
