The rising cost of health care and the difficulty in finding suitable health care coverage is a reality millions of Americans are facing today. According to a USNews report, it is estimated that nearly 2.6 million families lost their health insurance plan during the enactment of the Affordable Care Act as their plans were not compliant with the rules of the new Act.
This growing need for affordable health care has increased the interest in the concept of HealthShare or Medical Cost Sharing. Although some of the largest health sharing organizations have been around since the early 80s, this is an idea and principle that many have never heard of before.
Members of HealthShare organizations are groups of people with common ethical or religious beliefs who join together to share in each other’s medical expenses.
Members of the group are committed to paying a monthly amount towards eligible medical expenses that the group may have.
HealthSharing is not insurance. Unlike plans under the umbrella of traditional health insurance, HealthShare plans have considerably more flexibility in some areas. The plans do not typically have approved networks of doctors or hospitals. There is no PPO or HMO plan. They can typically choose any doctor if they have a need.
Medical Cost Sharing groups are not regulated by State or Federal rules and are not required to provide coverage that is at the same level with other health plans. There is also no guarantee of coverage for expenses, the groups decide which types of procedures will be covered and, as a group, they collectively contribute to cover the expenses.
Requirements for Medical Cost Sharing organizations
Under the Affordable Care Act “Individual Mandate” every American is required to have health insurance. There are a few exceptions to the act, one of those being having membership in a “Health Care Sharing Ministry”.
According to this article on Wikipedia which summarizes parts of the ACA. In order to qualify the ministry has to meet certain rules:
- They must be formed as a non profit 501(c)(3) organization
- Members must have common ethical or religious beliefs in common
- The organization cannot discriminate membership on the basis of employment or state of residence.
- They must have been in practice since December 31, 1999.
- The cannot cancel members due to development of a medical condition while members.
- The organization is required to an annual audit by an independent Certified Public Accountant. The audit is required to be publicly available upon request.
Guidelines of who can join a Medical Cost Sharing group
Those looking to join a HealthShare group will find that there are a few requirements. Unlike insurance plans, there is no medical underwriting but there are membership guidelines.
Most groups have health and lifestyle guidelines which include:
- Individuals and families both can join.
- Members must observe the group’s religious /ethical standards. Most of these ministries are Christian based therefore members are required to live a life that is consistent with Christian values.
- Maintain a healthy lifestyle.
- Abstain from smoking.
- Refrain from illegal drug use.
- Avoid the use of prescription drugs that is not consistent with the prescribed intent.
- Refrain from sex outside of marriage.
- Eat healthy and exercise regularly.
Typical medical expenses covered by HealthShare plans
Once a member is enrolled in the program, there are no waiting periods except for pre-existing conditions and maternity coverage. Typically, most plans will cover:
- Inpatient or Outpatient hospital expenses for medically diagnosed conditions.
- Urgent care, clinic and emergency room services.
- Physician fees for the treatment or prevention of illness or injuries.
- Ambulance fees incurred in the prevention of serious jeopardy to the member’s life of health.
- Chiropractic care is covered with a limited number of annual visits.
- Maternity is covered with some limitation such as length of membership before conception and there is normally a capped dollar amount on benefits.
Medical Expenses Not Covered
Each plan has their own guidelines however there are some common exclusions that most plans seem to have:
- Pre-existing medical conditions generally not covered until a waiting period has passed.
- Pregnancy Termination
- Mental health care
- Drug or Alcohol rehab
Deciding if a HealthShare plan is for you.
Having healthcare coverage is essential, especially for families. Many who find themselves without employer provided plans have to face some decisions; buy coverage from the traditional insurance providers, choose a HealthShare plan or go without coverage altogether.
The cost of each needs to be carefully considered. While traditional health insurance is more expensive, the coverage can be far more comprehensive. HealthShare is a viable alternative for those who are financially unable to invest in traditional health care. HealthShare will give the members peace of mind that there is coverage, and in the event of a catastrophic illness, there is a safety net for them. Going without any coverage is a last option and can prove to be extremely costly.
If you want to get more information about our HealthSharing coverage, call 1-800-948-4256 to speak with one of our HealthShare advisors.