Thousands
flock to penalty-free, lower-cost Obamacare alternative. But are the faithful
being led away from reliable health coverage?
Health
insurance and healthcare policy journalist, author
July 19, 2016
As health insurance premiums rise,
so does the popularity of cheaper alternatives to covering medical expenses.
That’s one reason why healthcare sharing ministries – which can average half
the cost of traditional insurance plans – have seen a major membership surge in
the past few years.
Healthcare sharing ministries are
faith-based non-profit organizations that pool members’ money to share medical
expenses. As long as the ministry has been in existence since December 31,
1999, participation exempts members from the Affordable Care Act’s individual
mandate to have health insurance.
These organizations generally
require members to make a promise to adhere to certain biblical values and to
participate regularly in worship or prayers. As a result, some health conditions
don’t comport, leaving members to pay out-of-pocket for illnesses stemming from the use
of tobacco, alcohol, and drug addiction, for example. They typically don’t pay
for mental health services, contraceptives or abortion either.
Since the Affordable Care Act became
law, membership for healthcare sharing ministries has grown at a rapid rate.
Ohio-based Liberty
HealthShare has seen its membership expand from 100 families to
26,000. “That represents 65,000 lives, and we are adding, on average,
approximately 2,000 households every month,” says Dale Bellis, Liberty Health
Share’s executive director.
Christian Care Ministry, a healthcare sharing
ministry based in Melbourne, Florida. has seen an increase in its membership
from nearly 64,000 in September, 2013 just prior to the first enrollment period
under the ACA, to almost 212,000 at the end of June.
Estimates are that roughly a half
million members nationwide participate in healthcare sharing ministries, which
is more than double the number prior to the law taking effect.
Desire for cheaper plans fuels interest
Why the rapid growth?
“We’re all creatures of economics,”
says Bellis.
Single people signing onto the
Liberty HealthShare ministry pay $199 per month for a plan, couples pay $299
and a family plan costs $449.
Families with membership in the
Christian Care Ministry pay on average $350 per month.
Compare that to average monthly
premiums through the ACA marketplaces of $286 for individual coverage without
subsidies and $727 for family plans. That’s with annual deductibles of more
than $4,100 for single coverage and $7,760 for family plans, according to 2015
numbers from online insurance broker, eHealth.
Those numbers may look good, but
before ditching your ACA-compliant health insurance policy, here are
five things to know about healthcare sharing ministries.
1. They’re not health insurance
Although designed to help consumers
cover the cost of medical expenses, healthcare sharing ministries differ in
significant ways from health insurance policies that comply with the Affordable
Care Act.
“It’s voluntary and cooperative and
motivated by compassion and the urge to assist another person in need. That’s
really what drives it versus an insurance arrangement where there is a contract
of indemnity. That’s the essential difference,” says Bellis.
Each healthcare sharing ministry
operates a bit differently, but generally the money collected from members each
month is placed into an account. The ministry then facilitates the direct
sharing of medical costs among members.
“Each month members can see the
names of other members who have benefited from their monthly share amount,”
says Michael Gardner, director of marketing and communications for Christian Care Ministry, a healthcare sharing
ministry in Melbourne, Florida.
2. State and federal regulations
don’t apply
Consumers who face problems with a
healthcare sharing ministry, such as when a claim is paid or a service is not
covered, aren’t protected by their state’s insurance department.
According to Sabrina Corlette with
the Center on Health Insurance Reforms at Georgetown University’s Health Policy
Institute, about half the states have enacted laws that say members of
healthcare sharing ministries don’t get the benefit of state and federal
protections. That’s because healthcare sharing ministries are not health
insurance companies and do not technically offer health insurance.
That includes the guarantee that
certain services or treatments, such as preventive visits and contraceptives,
mental healthcare and treatment associated with drug or alcohol use or abuse,
are covered.
Most of these organizations do have
formal appeals processes in place, but they aren’t enforced by federal or state
law.
LibertyShare, for example, alerts
members on its website about their rights when grievances over uncovered
medical costs occur, and when attempts at resolving the dispute don’t work in
the member’s favor.
Regardless of who wins or loses,
remember who and what we are. Liberty HealthShare℠ is a voluntary association of like-minded people who come
together to assist each other by sharing medical expenses. Such a sharing and
caring association does not lend itself well to the mentality of legally
enforceable rights.
“It’s buyer beware. If you have
health costs not covered there is very little recourse for you. You can’t go to
a government agency to complain,” Corlette says.
3. Underwriting is permitted
One common practice the ACA outlawed
was the ability of health insurers to turn away people with pre-existing health conditions, or to charge them
more for coverage.
Not so with healthcare sharing ministries.
Medical underwriting is allowed and
pre-existing health conditions can be excluded from coverage.
4. There are limits to coverage
Unlike health insurance, there are
generally limits to the amount of medical expenses healthcare sharing
ministries will cover – in some cases, a maximum payout of $125,000 per
incident and $1,000,000 per diagnosis.
Although healthcare sharing
ministries report most members’ “sharable expenses” are covered, they are clear
to say there is no guarantee.
“Neither Medi-Share nor any of its
members assume any obligation to pay another member’s medical bills,” Gardner
says. Medi-Share’s policy is common among other ministries.
5. No limits on access to doctors,
hospitals
Christian Care Ministry is one of a
few organizations with a provider network it suggests members tap for care.
According to Gardner, staff is better able to negotiate a discounted rate when
members see one of the more than 700,000 providers participating with the
organization nationwide. However, members are allowed to see any provider they
wish.
In most cases, ministries will
negotiate prices on members’ behalf. And, it’s a good deal for both the patient
and providers, they say.
“Providers are thrilled, and here’s
the reason why: It’s now the patient making those choices at the counter about
the cost and care and it eliminates this huge administrative bureau that
intermediates between physicians and patients. The doctor doesn’t have to call
a gate keeper somewhere to ask if they can treat the patient in a certain way.
They love it for that reason.”
The fact that they also receive a
cash payment – typically Medicare rates with 50 percent to 70 percent added on
– also helps to get providers on board.
According to Bellis, 97 percent of
all doctors and hospitals take the reimbursement they negotiate.
Look before a leap of faith
Corlette of Georgetown University’s
Health Policy Institute says anyone considering a healthcare sharing ministry
in place of an ACA-compliant health insurance plan just needs to enter with
their eyes wide open.
“What I would say about health
sharing ministries is they are a leap of faith, both literally and
figuratively.”
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