By Emily Bazar
July 28, 2017
Martin
Estacio was shelling out $800 per month for a health plan that didn’t fit his
two-state lifestyle.
The
retired San Bernardino firefighter lives between Oklahoma and California. But
his health insurance policy, purchased in Oklahoma, didn’t cover non-emergency
care outside the state.
So
Estacio dropped his plan this month and took a leap of faith. He joined Christian
Healthcare Ministries (CHM), an alternative to health insurance
that offers a religious approach to covering medical bills.
Health
care ministries such as CHM are essentially cost-sharing programs. Members’
monthly fees are applied directly to other members’ medical bills, no matter
where they live in the U.S. Members also pray for each other, and often send
notes of support and encouragement.
“What
led me to look into it was financial,” says Estacio, 58. “When I started to
realize it’s based on biblical principles where you help your brother out,
that’s what really clinched me.”
A health
care sharing ministry is primarily a “community of faith,” says Michael
Gardner, spokesman for Christian Care Ministry, which operates the Medi-Shareprogram. Medi-Share has roughly 300,000
members as of June, he says.
But
let’s be clear: Christian health care ministries are not insurance. You must
attend church regularly. You must agree to abstain from certain behaviors, such
as “sexual immorality” and
drug abuse. Preventive care, routine prescriptions and mental health care may
not be reimbursed. Forget about abortion. Coverage for your preexisting
conditions will likely be limited — at least initially.
Estacio
pays $150 per month for his membership, plus quarterly payments of about $30
that offer him a higher level of reimbursement.
He’s
responsible for the first $500 on each medical incident before the ministry’s
sharing kicks in, but only for allowed services. CHM’s list of non-covered
services includes “psychological treatment,”
medical supplies and equipment, immunizations, maintenance prescriptions and
bills related to drug abuse.
“You
have to try to live a good lifestyle,” Estacio says. “You can’t be drinking and
smoking. It’s on you.”
Membership
in health care sharing ministries has ballooned since passage of Obamacare, in
part because the health law provides an exemption for
members. If you belong to a qualified health care sharing ministry, you don’t
have to pay the Obamacare tax penalty for not having insurance.
About 1
million Americans participate nationwide, according to the Alliance of Health Care Sharing Ministries.
Texas has the most members; California places second.
There
are more than 100 ministries across the U.S., though the vast majority are
small Mennonite churches, says alliance President Dave Weldon, a doctor and former Florida
congressman. The three largest ministries are CHM, Medi-Share and Samaritan Ministries International, he says.
All the
ministries are Christian at this point, though Weldon says there’s an attempt
to start a Jewish sharing ministry.
“It’s
our Christian practice of how we bear one another’s burdens,” says James
Lansberry, executive vice president of Samaritan Ministries, which has about
227,000 members nationwide.
Samaritan
members, who share about $23 million a month, mail their monthly fees directly
to other members facing medical bills, along with notes of support, Lansberry
says.
Each
ministry works differently, but you can generally expect to pay a monthly
membership fee. You may be responsible for all of your own routine and
preventive medical costs in addition to paying a set amount before
reimbursements kick in.
“In
effect, they become sort of like catastrophic programs,” Weldon says. “But
that’s true for a lot of plans on the Obamacare exchanges as well.”
Unlike
catastrophic insurance plans, there’s no contract with health care sharing
ministries, he says. That means there’s no guarantee that your bills will be
covered.
“However,
most of them have always paid their members when they have medical bills,”
Weldon says.
Because
there’s no guarantee, and because the ministries limit coverage, Sabrina
Corlette has two words for you: “Buyer beware.”
“Read
the fine print,” says Corlette, research professor at Georgetown
University’s Center on Health Insurance Reforms. “Make sure
you truly understand what you’re getting with these plans.”
Coverage
Caps And Covered Services
Some of
these ministries put dollar limits on coverage, a practice that Obamacare ended
for most commercial health plans.
“If
you’re fairly young and fairly healthy, you may never face that,” says Janet Coffman, associate professor of health
policy at University of California-San Francisco. But “some people have
catastrophic illnesses that may cost millions of dollars.”
Most
health care sharing ministries don’t cover preventive care such as mammograms,
colonoscopies and birth control, and some don’t cover mental health care,
addiction treatment and other services, Coffman says.
Since
monthly fees are generally less than health insurance premiums, members can
save money on those costs, says Medi-Share’s Gardner.
“Because
it’s so much less expensive, I can be a good steward of my finances and set
some money aside,” he says.
Preexisting
Conditions
Health
care sharing ministries aren’t required to cover preexisting conditions.
As a
result, “a lot of these plans have waiting periods or limitations”
on them, says Coffman.
You may
have to wait one to three years — or longer — to be reimbursed for preexisting
conditions. And you may face a limit on reimbursement.
Providers
‘Willing To Take Cash’
Medi-Share
has a network of providers with which it has negotiated rates, though members
are not limited to it, Gardner says.
Samaritan
does not have such a network.
“Patients
are treated by providers as cash pay,” Lansberry says. “Members make their own
choice.”
In
these cases, if you have a doctor you want to keep, would she be willing to see
you as a cash customer?
“We’ve
never had trouble with members losing their doctors,” Lansberry says. “Doctors
are almost always willing to take cash.”
But
remember: You may have to cover the entire cost of the bill and wait for
reimbursement.
“Should
you have to be hospitalized, could you afford it upfront?” Corlette asks.
The
ministries encourage you to negotiate for lower prices with providers, though
they usually go to the bargaining table for you when the bills are large.
Right
To Appeal
Health
care sharing ministries are not regulated by government agencies that
oversee commercial health insurance.
If you
don’t agree with how much you’re being reimbursed — or whether you’re being
reimbursed at all — your only recourse will likely be an internal appeals
process.
State
regulatory agencies wouldn’t have any power to help you, says Janice Rocco,
deputy insurance commissioner at the California Department of Insurance.
We
“encourage people to obtain commercial health insurance, which they know they
can count on if they have a serious health crisis in the future,” she says.
Estacio
hasn’t had to request reimbursement from his health care ministry yet, and he
has money set aside for health care expenses that wouldn’t be eligible for
reimbursement.
But
he’s not worried.
“I’m confident,”
he says. “I have faith in it.”
Emily
Bazar: ebazar@kff.org,
@emilybazar
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