Medical cost-sharing programs have been in existence for nearly four decades. But it wasn’t until 2010 and the passage of the Affordable Care Act, also known as Obamacare, when interest in these health insurance alternatives began to explode.
The goal of Obamacare was an ambitious one. To succeed meant increasing the number of insureds by millions of individuals while simultaneously reducing health insurance premiums.
While the numbers of covered individuals have indeed increased, the promise of lower premiums has yet to be fulfilled. The cause for both – mandates.
The Affordable Care Act ushered in a set of ten essential health services every health plan must cover. Benefits include emergency care, pregnancy, and prescription drugs, just to name a few.
Each requirement intends to make previously optional or non-existent services available to more individuals. These ten essential health services were sold as the minimum standard each American should expect from their health insurance provider.
For the most part, it is a very noble list.
However, the mandates didn’t end there. Tucked away within the approximately 20,000 pages of the Affordable Care Act, two mandates can be linked to the reasons health care sharing ministries have become so popular.
- The individual mandate
- Mandatory access to birth control
As a way to pay for the additional services now covered within each health plan, every taxpayer must provide proof of coverage, or face a fine. This has led many young and healthy individuals not wanting or necessarily needing insurance to find a lower cost alternative.
Enter health care sharing ministries.
Sharing not insurance
Double-digit growth of health care sharing ministries in recent years shouldn’t have come as a surprise. With the exemption of religious ministries from Obamacare, it would appear Christians have the perfect alternative.
There are dozens of regional healthcare ministries that provide an option which not only aligns with their religious beliefs, but has also reduced their cost of coverage.
Instead of premiums, members of a healthcare ministry contribute “shares” to a general fund. The fund then is used to pay for eligible expenses after meeting individual financial obligations, similar to deductibles.
Savings of these shares, over normal insurance premiums, can be substantial. Upwards of 40% or more in some cases, thus, answering the question of how ministries can save families such a large sum each month. However, whichever plan you choose, make sure you read the eligibility requirements.
Being exempt from the Affordable Care Act also means health care ministry programs are exempt from the mandated requirements. This means each ministry can choose who they allow into the program.
From a health perspective, acceptance into a program may be denied if you:
- Use tobacco
- Do not limit alcohol consumption
- Have a preexisting condition
Effectively, health care ministries eliminate potentially known costs of care for pre-existing conditions. Further, they exclude lifestyles which may lead to increased medical costs. Together, each ministry is able to reduce the expected expenses their funds may need to pay.
Living a clean life is a common goal of most religious organizations and their congregations. Abstaining from tobacco and alcohol is usually met with little objection. However, it is the exclusion of preexisting conditions which presents a hurdle many may not so easily overcome.
Rules and religion
Beyond strict health and lifestyle restrictions, health care ministries also are allowed to impose religious requirements for acceptance into their programs. Most ministries do, and participants are expected to follow certain rules including:
- No sex outside of marriage
- No contraception use
- Regular church attendance
For the Sunday church goer, such rules are rooted in core beliefs and are hardly an obstacle. But for those who consider themselves a part-time Christian, a health care sharing ministry would require a renewed commitment to their faith.
The rules for services covered under a ministry program also vary from one organization to the next. Like pre-existing conditions and birth control, exactly what is covered is left to the specific plan offered.
The lure of lower premium costs in the form of share payments can be offset by certain out-of-pocket expenses members are expected to pick up. Small medical expenses, most prescriptions, and practically all forms of preventative care are excluded from health sharing programs. For individuals with higher than average health maintenance costs, total out of pocket expenses may exceed those of traditional insurance plans.
Decisions and dollars
Determining whether a health care sharing ministry is right for you is both a financial and faith-based choice. Disagreeable mandates within the Affordable Care Act make the decision easy for some. While for others, it is simply a matter of dollars and cents.
For those who qualify, the availability of health care sharing plans offered up one thing everyone needing insurance coverage could benefit from – a choice.
If you want to get more information about our HealthSharing coverage, call 1-800-948-4256 to speak with one of our HealthShare advisors.