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12/20
What is a Medical Sharing plan? Is it a good idea?
There are several “Health Care Sharing” options, but none of them provide “Credible Coverage”. Here’s how they work:
Each person or family is required to pay a monthly fee (this is NOT a premium). This monthly fee pays the health care costs of other families in the program. When you need health care, the money comes from this fund as well. In addition to their monthly fees, members are encouraged to give further money in order to help pay for the treatments of others. This is necessary because medical costs are high and the monthly fees are low.
None of these organizations will guarantee that your medical bills will be paid. This is very different from traditional insurance, and it can get very dangerous. Take this example.
Couple A needs emergency care. Upon arrival at the ER, they present their card, and the hospital discounts the bill per the prearranged discounts. The hospital sends the bill to the health share company, who then examines the bill to determine if they will share the expense. (This is a faith-based option, so several moral issues will preclude services being shared. If the health problem involves tobacco, alcohol, or a sexually transmitted disease, the bill is not likely to be covered.)
If the health share company accepts the bill and agrees to pay for the services, Couple A is required to pay the deductible. Then, the remainder of the bill is published for other members to contribute those extra dollars we talked about earlier. Obviously this will take some time!
So, after Couple A has received their emergency care, the hospital sends a bill for the remaining amount due. The sharing hasn’t been fully funded, so the couple must pay out-of-pocket and hope that their sharing community will pay for the rest of it. In the worst-case scenario, the bill may be sent to collections. The couple may be sued because they cannot afford to pay the bill while the health share company tries to gather funds.
Here’s the bottom line: health share companies can put you under undue financial risk. Traditional healthcare is available, and these insurance companies operate under laws and regulations to protect you and your family.
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One Response to “What is a Medical Sharing plan? Is it a good idea?”
A health care sharing ministry (HCSM) provides a health care cost sharing arrangement among persons of similar and sincerely held beliefs. An HCSM is a not-for-profit religious organization acting as a clearinghouse for those who have medical expenses and those who desire to share the burden of those medical expenses. Because HCSMs are not insurance companies, HCSMs do not assume any risk or guarantee the payment of any medical bill. Rather, as an alternative to traditional health insurance, a need sharing ministry is founded on the Biblical mandate of believers to share each other’s needs.
The largest of the three major HCSMs is Samaritan Ministries. Samaritan Ministries members have been sharing medical expenses for more than 17 years and the amount shared between the members each month is more than $4.5 million. Shares ($320 for a family, as of 1/10/12) are sent from one member to another and do not come to the ministry’s office. Samaritan members are responsible for the first $300 of each medical need that they submit for publication. In 2011, Samaritan Ministries reported a growth rate of 20 percent.
It is important for any individual to investigate the guidelines of each individual health care sharing ministry and make educated decisions, but to address some of the broad claims made in the blog post, I would like to speak specifically about the largest HCSM, Samaritan Ministries, and how the post reflects on it:
[From the post]“Each person or family is required to pay a monthly fee (this is NOT a premium). This monthly fee pays the health care costs of other families in the program. When you need health care, the money comes from this fund as well. In addition to their monthly fees, members are encouraged to give further money in order to help pay for the treatments of others. This is necessary because medical costs are high and the monthly fees are low. “
The amount a Samaritan Ministries member agrees to send to another member each month is determined by household size. As of January 26, 2012, share amounts are $320 for a family, $270 for a couple, and $135 for a single. Shares are sent directly from one member to another and do not come to the ministry’s office. This is direct sharing of medical needs, members to members, and there is no “fund” involved. Members are responsible for the first $300 of a need. Needs that do not meet ministry guidelines may be eligible for publication as Special Prayer Needs that members may give to in addition to their regular monthly share as a free will offering. Members are fully aware that sometimes needs do not met the guidelines to be published and that money sent to Special Prayer Needs is charitable giving and is not “because medical costs are high and the monthly fees are low. “
[From the post]”Couple A needs emergency care. Upon arrival at the ER, they present their card, and the hospital discounts the bill per the prearranged discounts. The hospital sends the bill to the health share company, who then examines the bill to determine if they will share the expense. (This is a faith-based option, so several moral issues will preclude services being shared. If the health problem involves tobacco, alcohol, or a sexually transmitted disease, the bill is not likely to be covered.)If the health share company accepts the bill and agrees to pay for the services, Couple A is required to pay the deductible. Then, the remainder of the bill is published for other members to contribute those extra dollars we talked about earlier. Obviously this will take some time!”
Samaritan Ministries members are self-pay patients and are billed that way by providers. Members are instructed to tell their provider that they do not have insurance. There are no pre-arranged discounts, but quite often members negotiate discounts as self-pay patients. In the self-pay situation, the bill(s) are sent directly to the patient and not to the office, because Samaritan Ministries is not an insurance company. When a member has a health care need, he receives health care treatment from a provider of his choice, collects the bills, and sends them to Samaritan Ministries. Samaritan Ministries verifies that the need meets the guidelines. Then, in the monthly newsletter mailing, Samaritan Ministries directs some members to send their shares to the member with the need. The member with the need receives the shares from his fellow members to pay his health care bills. The ministry guidelines state which medical needs are publishable are and which are not. Members sign off on their initial application upon joining and on an annual basis that they have read and understand the guidelines. Many members choose to join Samaritan Ministries because they do not want their health care dollars to pay insurance premiums that in turn pay for medical procedures they are morally opposed to, such as abortions, abortifacients like the morning-after pill, sexually transmitted diseases, and sex changes. As stated above, when a member has a need there is direct sharing of medical needs, member to member, and no extra dollars are required unless the member sends money to a member who has a Special Prayer Need. The publishing turnaround time is normally 30-60 days from receipt of the bills and required information.
[From the post] ”Here’s the bottom line: health share companies can put you under undue financial risk. Traditional healthcare is available, and these insurance companies operate under laws and regulations to protect you and your family.”
Samaritan Ministries members have been sharing medical expenses for over 17 years and the amount shared between the members each month is more than 4.5 million dollars. Samaritan Ministries is a 501(c)(3) nonprofit organization that falls under the oversight of each state’s attorney general. Samaritan also makes its annual financial audits available. Sixteen states have passed safe harbor laws which have defined HCSMs, like Samaritan, as legitimate, not-for-profit ministries that are not subject to the state’s insurance codes. HCSMs were similarly recognized in the new federal health care law.
Here’s the actual bottom line: There is no argument that traditional insurance is available. And traditional insurance companies are for-profit entities and, when possible and applicable, deny claims, which keeps profits high. So there is also a financial risk for those who choose traditional insurance, which is the individual’s right to choose. Samaritan Ministries believes Jesus Christ is the Ultimate Provider for all of life’s needs. Individuals and families have the primary responsibility for their own health and decisions related to seeking health care. When they have burdens that are greater than they can bear, we firmly believe that the body of Christ, at the local church level first, and then in a broad corporate sense, should bear one another’s burdens to fulfill the law of Christ (Galatians 6:2). Our monthly newsletter seeks to teach these principles as an integral part of our Christian worldview, not only to our members, but also to all the Body of Christ, to whom we minister by example and exhortation.
Roughly 70 percent of new members come from word of mouth, so before making a decision about joining a health care sharing ministry such as Samaritan Ministries, the wisest course of action is to speak to someone at the ministry directly and to those who use health care sharing to meet their medical needs.