Healthcare sharing plans have been around in the United States for many years. Also called “healthcare sharing ministries,” they have long been popular among insular faith communities. Amish, Mennonites, and others who do not generally seek conventional healthcare often make use of them.
In 2010, the Affordable Care Act made it possible to extend such plans to a broader population.
As before, healthcare sharing plans are usually adopted by people who share certain religious beliefs. In theory, these people band together to share “burdens,” usually defined as large and unexpected costs of healthcare. The level and frequency of sharing differs by plan but is often up to the individual.
“MediShare,” which markets itself as “A Christian health ministry,” is one of many different healthcare sharing plans now available to consumers. These plans may be available in different communities, states, and regions, including Central Florida, and they can all set their own rules and standards.
Let’s take a closer look at these plans and what they really mean for healthcare consumers.
A MediShare Plan Is Not Insurance, and You May Receive $0 for Your Healthcare Bills
It is a point of contention around many health insurance policies that procedures can be denied or that coverage may not amount to what the policyholder expected. However, all health insurance policies are alike in that they define certain types of coverage that the policyholder is guaranteed to receive.
Healthcare sharing plans do not. You may receive $0 for a medical bill you believed would be covered.
Healthcare sharing plans often market themselves as “freedom from insurance.” There is some basis to this: Healthcare sharing plans are not insurance. You do not have access to the benefits of health insurance as a result of participating in a healthcare sharing plan.
So, what is it that you actually contribute and receive in a MediShare plan?
Each member of a healthcare sharing plan will have two figures to keep track of:
- Annual Household Portion (AHP): This is how much you pay before any bills will be covered.
- “Monthly Share”: This is based on age and household size and is paid on a monthly basis.
You may notice that an “Annual Household Portion” has the same function as a health insurance deductible. Likewise, a “Monthly Share” that you pay to remain in good standing is very similar to a health insurance premium. But while the amounts you pay to a health insurance provider guarantee you a level of covered care in accordance with the policy documents, these contributions do not.
Here are some ways a healthcare sharing program differs from a health insurance policy:
1. Well Visits, Routine Care, and Preventive Care May Not Be Covered
Conventional health insurance policies, including the policies offered on the Affordable Care Act market, must all conform to some basic standards. These standards provide for routine and preventative care in a wide variety of situations, even if someone elects to purchase an inexpensive Bronze plan.
Many healthcare sharing programs have not chosen to provide financial help for any basic health needs. From standard annual checkups to seasonal vaccinations, you should not assume in advance that a healthcare sharing program will provide you with any financial assistance whatsoever.
2. Chronic Health Conditions May Not Be Covered or May Be Covered at Penalty Rates
Healthcare sharing plans are not required to abide by laws covering health insurance products. As a result, they can freely restrict the care available to those with pre-existing conditions, require people with pre-existing conditions to pay more, or subject them to other programs and requirements.
For example, MediShare requires members with diabetes, heart disease, and certain other conditions to participate in something called a Mandatory Health Partnership. This includes a $99 per month fee. Eliminating the fee requires ongoing submission of health information for as much as three years.
3. The Annual or Lifetime Limit on Care for a Single Need May Be Much Lower Than with Insurance
Each healthcare sharing program defines its own annual and lifetime limits for a single financial need. This is similar in concept to how health insurance policies have lifetime limits. But where insurance may hold limits in the high millions, it is not unusual for healthcare sharing programs to be in the thousands.
Even people in perfect health today may find themselves with no benefits later on.
4. Care You Believe Is Covered May Not Be Covered Due to the Surrounding Circumstances
According to MediShare itself, “MediShare is a healthcare sharing program where Christians share their financial resources to pay each other’s medical expenses. […] Resources are shared directly between members. There is no pooling of funds as practiced by insurance groups.”
Depending on the healthcare sharing program you choose and the belief system that supports it, you can be denied benefits for virtually any condition or treatment deemed “unbiblical” or not in keeping with other members’ beliefs. In cases like these, there is often no appeal and you are on your own.
Because healthcare sharing programs generally operate by having you pay for a treatment out of pocket, then submitting information about your financial need to the program, you can find yourself facing 100% of a bill you thought would be defrayed with member contributions.
In some cases, you may be required to explain how a disease was contracted or how an injury was received in order to participate in sharing. Not only does this not guarantee any coverage, but the information you submit also may not be protected by HIPAA disclosure laws and can end up in public forums.
A Local Health Insurance Broker at Choice Healthcare Can Help You Find a Policy You’ll Love
Here in Central Florida, your local health insurance brokers are waiting to help you find the perfect policy for you. You can get a policy that meets your healthcare needs and fits in your budget. That gives you peace of mind you simply can’t find when submitting bills for reimbursement as in a sharing plan.
Choice Health Insurance Brokers is an independent service, not an insurance agency. We have built relationships that allow us to find and compare the best Central Florida health insurance options. We will walk you through all of your options so you can make an informed decision.
Sharing sounds nice. But the problem with it is that the others doing the sharing can cease to do so at any time – including when you need it most. With a voluntary association such as a healthcare sharing plan, you have no guarantee that your medical bills will get paid.
Some of these plans may say they cover 100% of “eligible” care, but eligibility can mean many things!
Real health insurance is not sharing: It is a contractual relationship that obligates a health insurance company to cover certain care as defined in writing. No one can deny you coverage based on the way they personally feel about your medical needs. That protects you and your health.
Contact us to find out more or get started.