I learned recently about an alternative to purchasing a PPACA-compliant health insurance plan. There are three organizations whose members are exempted from PPACA penalties (see pages 107 and 128), Samaritan Ministries, Christian Health Care Ministries, and Medi-Share. As PPACA is currently written, no similar organizations can now be started, but these three are grandfathered in.
How They Work
These three organizations have some very specific requirements, including a declaration of faith, in order to be eligible. Medi-Share's declaration of faith requires that you and any adult children on your plan sign a statement indicating you believe that
- “the Bible is God's written revelation to man and that it is verbally inspired, authoritative, and without error” and
- “that man… because of sin was alienated from God [and can be saved from that alienation] by accepting God's gift of salvation by grace through faith”
Christian HealthCare Ministries requires you to attend church regularly. These organizations may require an endorsement from an ecclesiastical leader. None of them allow you to smoke or use drugs, nor abuse alcohol nor prescription drugs. They also do not pay for medical problems caused by not living by these “biblical principles.” This includes abortions or maternity (and presumably pediatric) care for children resulting from extramarital sex. There may be an additional charge if you are overweight or particularly unhealthy.
Every month you pay a “share” instead of a premium. These shares range from as little as $37 a month to as much as $7-800 a month, but are generally significantly cheaper than comparable health insurance. The more you elect to be responsible for each year, the lower your premium. Your share is either sent directly or indirectly, to someone who had a need the month before. It generally goes to someone who had a significant health expense the month before. If there is more money shared than needed, it is used to pay expenses for the current month, then if there is still money remaining, it is rebated to members. If there is less money shared than needed, it is pro-rated (i.e. you don't get all of your health care paid for). There are caps on how much you can get reimbursed, such as $250,000, without joining a special program with additional requirements and fees. There are severe limitations on pre-existing conditions that may never go away.
What I Like
There are a number of things I like about this model of paying for health care. I like the idea of eliminating the health insurance company, its expenses and its profits. I like the idea of getting the patient and the doctor closer together, without the middleman. I like the idea of feeling responsible for my own bills and those of others in my community. I like the idea of not having to pay for at least some of the poor health care related decisions made by other people in my “insurance pool.” I like the community pressure to not spend more than you need to on health care. It reminds me of a story about an Amish man who had to be cardioverted for an arrythmia. A dozen members of his village showed up in the ED to pay the bill before he left. He elected not to be sedated for the cardioversion due to the additional expense. “It only hurts for a minute, Doc,” he would say. However, the more I think about these organizations, the less I like them. I can come up with 8 reasons not to join one.
1) The Discrimination Factor
If you don't fit these organizations' rather narrow view of Christianity (Catholics, Mormons and others who consider themselves Bible-reading Christians don't qualify, nor do Jews, Muslims, Atheists etc), you're just out of luck. (although I've been told Catholics are okay and in fact the person who brought it to my attention is Catholic.) The fact that these organizations have been granted an exception to PPACA is ridiculous since there is no provision for a similar religious or non-religious organization to get the same exception. This is frankly unfair and ought to be illegal. Either everyone should be able to start an organization like this or members of this organization shouldn't be exempt from PPACA penalties.
2) Lack Of Preventive Care Coverage
One of the reason PPACA-compliant plans cost more than a similar health care insurance plan is that these insurance plans provide preventive care. You're on your own for this with these three organizations. Most don't allow you to “share” costs below a certain amount, such as $3-500. You can burn through a lot of money at less than $500 per need. Immunizations aren't covered. Frugal folks tend to skip a preventive visit when they actually have to pay for it, which may lead to more health problems and costs down the road.
3) You Become A Self-Pay Patient
I see self-pay (i.e. no-pay) patients every day, about 20% of my patients. Aside from the irritation of being required by law to take care of their emergencies while knowing only about 3% of them will actually pay me anything, the main difficulty I have with self-pay patients is getting them follow-up care, especially from specialists. I talk to the specialist on the phone, he agrees that the patient can easily be seen in clinic in a few days, so I discharge the patient from the ED with the number for the clinic. He calls the clinic the next morning and is asked “What is your insurance?” When he informs the clinic that he doesn't have any, he never sees the doctor (and the doctor usually never even hears about him.) He is left in the unenviable position, every time he needs any non-emergent health care at all, of trying to convince the front desk folks that he is really going to pay them. That usually means “cash on the barrelhead.” You show up with a credit card, a check, or a stack of Benjamins or you're not seen. To make matters worse, the highest bills my billing company sends out are sent to the self-pay patients. They might get a small discount for paying promptly, but that discount isn't nearly as large as that which insurance companies have negotiated for their members.
4) No Catastrophic Coverage
The point of health insurance is to keep you from having to declare bankruptcy in the event of unexpected health care costs. These plans limit you to just a few hundred thousand dollars for a health care problem. It doesn't take long for a chronic illness, or a particularly severe acute illness or injury, to surpass that sum. Imagine a 30 day trauma ICU stay or a preemie requiring months of NICU care. You're still going bankrupt because you don't have real health insurance. One of the best parts of Obamacare is that it eliminates idiotic insurance plans (like the one my Aunt had when she was diagnosed with pancreatic cancer. The maximum annual benefit was $2000. Yes, you read that right, just $2K.) Some of the features of these sharing plans aren't much different from many bad insurance plans in the past. There is no guarantee that your health care needs will actually be paid for. There is no contract.
5) Pre-existing Illness Limitations
Another great aspect of Obamacare is the elimination of pre-existing illness limitations. My wife was once turned down for health insurance because she had a single episode of cystitis. That needed to go. However, these plans don't cover pre-existing conditions, not even after a year. If you have rheumatoid arthritis when you join, none of your expenses related to that will ever be paid for. A significant societal issue with this philosophy is that the healthiest people aren't part of the insurance pool, so costs go up on those who are in it. Essentially, someone ends up having to pay more for health insurance because he doesn't believe Moses parted the Red Sea.
6) The Fine Print
Reading the fine print reveals all kinds of interesting issues with these sharing plans. For example, if you're hurt on someone else's property, they want you to sue the property owner to pay for your care instead of sharing it. They also only allow you to share the first 120 days of medications you may need for the rest of your life. There are serious limitations to psychiatric coverage. Gastric bypass isn't covered. If your child wasn't wearing a legally required helmet, you can't share the expense of a head injury. If he was injured in a water skiing accident where the driver of the boat was operating recklessly, you're out of luck. ADHD treatment? Not covered. Self-inflicted injuries or injuries resulting from a criminal act? Not covered. They also encourage home births and VBACs by allowing you to share the entire cost of care (instead of the amount above and beyond $300.) My point is there is an awful lot of subjective stuff in the fine print that you wouldn't necessarily see in a comparable insurance policy. Just like with disability insurance, the more exceptions there are, the more likely you are to disagree with the organization about whether any given expense should be covered.
7) Unfair to Physicians
Christian Health Ministries, rather than encouraging its members to pay their physician bills in a manner fair to the doctor, suggests the following:
“Tell your doctor you are self-pay but an organization may help with your bills later. Ask for a bill reduction. Please don't make full payment up front. Apply for any available financial assistance. Set up a payment plan with your providers.”
Basically, the modus operandi is to inappropriately acquire the assistance that hospitals, doctors, the government, and community organizations have set up to assist the poor. Now, I'll be the first to admit that our health care system is screwed up, but I'm confident that the solution isn't to have those who have the means to pay their bills avoid paying them by pretending they can't because they chose to pay shares instead of premiums. That doesn't seem like a very Christian way to run an organization to me. Frankly, if I were running a private clinic, and a patient told me they were a member of one of these organizations, I wouldn't be offering any discount at all, and certainly wouldn't feel a need to provide free care. I'd give them the full-rate bill and tell them to send it to their sharing organization and encourage their organization to contract with me to guarantee payment in a timely manner if they would like to pay the lower insurance company rates.
8) No Subsidies and No Tax Deduction
People who have sufficient money to pay insurance premiums without subsidies are going to prefer the guarantees that real insurance provides. Those who don't have sufficient income may be attracted to the lower price of one of these sharing organizations. However, those are exactly the same people who qualify for subsidies from the government to help pay for them. You don't get those to help you pay your shares. Nor can a business or the self-employed deduct the cost of his shares like he could with health insurance premiums.
Overall, I don't think I can recommend this approach to paying for health care to readers or to patients. I think that buying real health insurance is going to be a much better option, no matter what your income level or religious beliefs.
What do you think? Do you take this type of “insurance?” Do you use it? Comment below! (Keep comments civil or they will be edited/deleted.)
I would very much disagree with your point #7.
There is NO “fair” amount for your services. It’s all a negotiation. Doctors engage in price-discrimination all the time, and patients are perfectly right to negotiate back.
Negotiation and applying for assistance meant for the poor are two separate things.
If you are poor, then applying for assistance meant for the poor is a good thing. If you’re not poor and you apply I would guess that your request would be rejected. I suppose it would be a little extra paperwork for whoever is running the assistance program, but I don’t see the harm in asking people to look into the programs to see if they qualify. Am I missing something?
General return from billing in the the ortho world is about 35%. Everyone knows that no matter what field you are in, what you bill and what you actually expect to get are two very different things, no matter if you are poor, wealthy self pay, or insured. It only makes sense for these companies to encourage their participants to play by the same rules everyone is using. You have to admit, this is not set up to “hurt physicians” but to get participants to do upfront, what all other insurances do anyway. Our clinic provides discounts to self pay patients anyway.
Doctors prices are usually set by using the fee schedules set up by the insurance companies.
I have run doctors offices for 30 years and trust me, the fees are set by the insurance companies. The doctors raise their fees a little each year because the insurance company raises the allowed amount. If the doctor does not raise them then they loose money they could otherwise get if they charged less. Example: If the doctor normally would charge $50 for a service then they bill that amount the insurance company will only pay them a percentage of that mount, let’s say $42.67. If the fee schedule of the insurance company raises the price of that service to $57.29 and the doctor doesn’t raise his, then he continues to get $42.67 for that same service. He looses money and when you spread this over all his services it adds up. So… don’t blame the doctor. Put the blame where it goes – the insurance company. Trust me, the single biggest event at the beginning of every new year at the doctors office is reviewing these prices and trying to keep up so finances can continue to thrive. Big business insurance companies have the costs of healthcare by the “ear” guiding all that happens.
I disagree. Wife just had a shoulder surgery. Docter was 12k. But, for self-pay was 3400 bucks. That is what he would have gotten from insurance. So why the 12k to begin with ? why not charge 3400 and be done? There are doctors that are starting to refuse insurance, because of the games that insurance play. But that IS the doctors job. They are the providers of the service, and they should have stood up to insurance a looooonnnnggggg time ago. But, that comes back to you and I – the consumer. Most people look at their co-pay, or deductible as the “cost”, never checking the actual cost and/or negotiating. Get rid of the middle man, and get rid of corrupt doctors who just “follow the insurance plan”. Let the true free market come into play (like lasik) and you WILL see a drop in prices.
This statement is 100% correct. I’ve been rural / solo for 29 years. I’ve NEVER set a patient care fee and serve 17 insurance companies + MC and MA. We increase “the so-called charge” by the cost of living each year(2.5%), but are never assured we will even receive this. The ACA, due to its massive cost shifting and a patient care change from commercial insurance to government assisted programs and government level reimbursements, …brought with it a literal 40% loss in revenue over two years,…never to be seen again. I am hear as I believe God called me to serve here, but with further government intervention, regulation, and controls…it may come to an end sooner than I’d planned. FOR THOSE WHO DO NOT UNDERSTAND THE “CHARGES”….they are not set by the provider, and for some strange reason, they are far more than the provider receives. If I have a cash paying patient, I just accept whatever the insurers give me from this person. I’d much rather list my own fees, fairly compete with others, and get the middle man completely out of the picture (insurance / government / MC )….but it is just not going to happen. And if the left has its way….the massive central government will take it all over. Hello socialized, degraded, wait in line, hope you get seen sometime soon… medicine.
You don’t want to start a DPC practice?
I’m not sure I understand the entire DPC picture, but if it means each and every patient pays a monthly fee to be my patient(s)….this would erase a patient population or two which I desire to provide care for…. MA and MC. I realize these are care groups which do not pay well and bring a level of complexity, but I feel it is outside my calling to create a panel based upon ability to pay, whether done purposefully, or by default. Am I not understanding DPCs?
A DPC practice can be set up pretty much any way you want it to be, but the heart of it would be a membership structure. You may want to check some options with the folks at http://www.dpcsummit.org/home.html or at https://www.dpcfrontier.com/.
On the other hand, if you believe it “may come to an end” the way it is, you won’t be able to serve those populations you’re concerned about at all.
Great post!
why?
Thank you for posting this. I know some very nice people who are in one of these plans, and I worry about them if something serious happens. I looked into getting the group examined by the insurance commissioner, but it appears they have a religious loophole and are untouchable.
WCI, love your site and your book. Just thought I’d chime in as I just joined one of these. First off, I am a board certified ER doc, married, with six kids. Everyone is healthy. I have been a member of Samaritan for literally less than a week now so obviously my experience is limited however I have been researching these for about a year. I think a couple things should be clarified. First off, they do accept mormons at least, I am one and they gave me no trouble with it. I dont know about catholics or jewish etc but their requirement is just a belief in Christ, not any specific religion. I joined as an attempt to minimize expenses. My fee for Samaritan is roughly $300 a month. My current BCBS insurance was $800 a month without any OB coverage. I just had a baby 8 weeks ago and paid almost $8,000 cash for it. To add OB coverage would have been an extra $600 a month on my current plan which is why I opted out of it. I also had a $5000 deductible and a HSA. Basically for my healthy family for which myself or colleagues care for majority of our health problems I was getting nothing out of my health insurance. The way Samaritan works is that I have three visits of up to $300 each to pay and then everything else is shared. That is only a total of $900 out of pocket for the year above the “premiums”. I think for young physicians with healthy families this would make a lot of sense. I still qualify for an HSA. When I told the OB and hospital I was paying cash I had no difficulties and they gave me a 60% discount plus 5% discount for paying bill in full. Obviously my situation if different from most self pay patients but I quickly learned that the hospitals and OB were very willing to work with me when they learned I would actually pay my bill. Of course a catastrophe could happen to anyone at anytime which could exceed the maximum payout, however you can’t insure against everything. Just my 2 cents….
I also know a Catholic who had no trouble enrolling.
I’m also a Mormon and my wife has been a member of Christian Healthcare Ministries for about 6 months. They’re very nice, and all the fine-print I read (after much research) seemed fine. I also contacted them multiple times with questions, which they kindly answered. Before joining, I contacted several other healthcare sharing ministries (not just 3 you listed), and they’ll accept many types of Christians.
We signed my wife up for the $150/mo gold plan, which covers maternity. If you negotiate a discount (like the insurance companies do), that applies to your $500 responsibility. So I could pay nothing by getting a 40% discount (which is the standard discount insurance companies seem to get based on my family’s own past EOBs).
Christian Healthcare Ministries also has a program that removes the limits for any catstrophies, just like modern insurance plans. It costs like $50/yr, or something like that.
And pre-existing conditions are only temporarily not-covered. I think it takes two years of membership to be eligible to get your condition covered.
I like the idea of self-pay patients. I want to shop around for healthcare whenever possible — call up a provider and ask for the cost of this checkup, lab, broken bone, dental checkup, etc. And I don’t have to deal with any in-network or out-of-network nonsense! I’m in Poland right now, and I’m pretty sure I’m covered if an accident happened (though I think I’ll double check that right after I post this…).
I don’t like the discrimination either, and wish the ACA would let other religious organizations like these be created — but that’s the law’s fault, not their organizations. People should be able to band together and share their costs AND decide who is allowed in. But again, I agree that the current law/situation is discriminatory and bad.
Oh, and I’m a graduate student in mechanical engineering and make enough to not be eligible for subsidies on healthcare.gov. This was the best option for our situation.
Thanks for sharing your experience.
Yes, you are covered anywhere in the world that they accept cash for payment. You simply must get a receipt with a medical code listed. Just in case someone reading this is wondering how that search of yours turned out 😉
Dr Randall, I have also have been checking into some of the christian ministries since my current ins co will be cancelling me on 3-1-2016. what state are you in and I was told I would not be able to keep and have had for 9 years
Dr. Randal, I have a question. My husband, myself and our 18 yr old are also members of Christian Healthcare Ministries and are very happy with this solution. Being overall healthy and paying the maximum – little under $500 a month in our contributions for unlimited coverage for all 3 – we save at least $800-900/month by not having to pay for ACA plan. We are pushing 60 and our coverage on the Marketplace is several hundred dollars more than our mortgage! Not sure where it all got the name “Affordable”. However, we do pay for our annual physical, occasional dr. visit, screening etc., as you know (anything that is under $500/person of our annual responsibility). I am in the process of finding an HSA friendly bank where we would open an HSA account to further maximize savings for all the out-of-pocket medical services. I keep hearing that our plan doesn’t qualify – (hence the issue of “fairness”). You said that you can still keep your HSA account. Can you please advise? Thank you very much.
When M. Taylor says that “I still qualify for an HSA”, I would like a clarification. It is my understanding that to “qualify for an HSA” you must be covered by a “qualified HDHP – High Deductible Health Insurance Plan.” Since Medi-Share is not “insurance” how can someone still qualify for an HSA??
Pholler
That’s correct. You do not qualify for an HSA if you are using MediShare. There’s a bill though:
https://mychristiancare.org/medi-share/public_content/medi-share_and_hsas.aspx
To clarify, you can contribute to an HSA if you already have one. You will not, however, be able to take advantage of the HSA tax deductibility against your gross income. Still a great option, especially if you invest your HSA money wisely.
No, you can’t contribute to one unless you have a qualifying HDHP. But you can still spend the one you have. If you think you can contribute to one without an HDHP and just not deduct the contribution, I’d like to see you cite a reputable source for that info because I’ve never heard it and have read just the opposite on irs.gov.
https://www.irs.gov/publications/p969
Qualifying for an HSA
To be an eligible individual and qualify for an HSA, you must meet the following requirements.
You are covered under a high deductible health plan (HDHP), described later, on the first day of the month.
You have no other health coverage except what is permitted under Other health coverage , later.
You aren’t enrolled in Medicare.
You can’t be claimed as a dependent on someone else’s 2016 tax return.
Contributions to an HSA
Any eligible individual can contribute to an HSA. For an employee’s HSA, the employee, the employee’s employer, or both may contribute to the employee’s HSA in the same year. For an HSA established by a self-employed (or unemployed) individual, the individual can contribute. Family members or any other person may also make contributions on behalf of an eligible individual.
I know this is a bit old, but just in case someone else was curious about healthcare sharing programs and HSAs I had a bit of light to shed on the situation.
If our whole family with a healthcare sharing organization then we would not qualify for a HSA. There is however a loophole.
My husband and children are covered by an approved HDHP insurance policy through his employer. I am not. I am a part of Christian Healthcare Ministries. Since he has an approved HDHP insurance policy with my kids he can contribute the maximum family amount. I am not covered by an approved HDHP.
Thus I do not have insurance, but I am apart of a healthcare sharing group, but our family still has an HSA which we are actively contributing to.
As a side note. The only reason my husband/kids are on a HDHP is because his employer pays for it. Otherwise, he would definitely join the same organization I am with, even with no HSA. That being said we contribute the maximum amount to our HSA despite not using most of it, knowing that in the future we may no longer be eligible to contribute to a HSA, but we would still have access to the funds. We see this as a great alternative to contributing extra to a retirement account as the money becomes available for non-medical expenses at age 65.
I hope that helps anyone who is curious.
That is correct, but I think your situation is relatively rare.
My situation probably is rare, but it isn’t common for one spouse to work and one to stay home. Typically employer health coverage is not free for the family, but often is for the employee. Anyway, I thought it was worth mentioning for anyone who may have one spouse staying at home.
Hi Craig, I see this was written in 2014. I’m curious if you are still with them and how it’s going? Thanks!
I think you are missing the boat. Each person should have the right to choose what type of coverage they want and if a health share works for them then great! I am an administrator for a private practice and both our doctors and staff use a health share program. We encourage our patients to do the same. For us we will never return to regular insurance unless forced against our wills. One of our employees had 45k of hospital bills and the health share paid all but $300. There is not an insurance company out there that would have come close to this, especially one with a low monthly cost!
Thanks for sharing your experience. I’m not sure I agree that each person should have the right to choose what type of coverage they like. That was part of the issue Obamacare fixed- all these plans that you and I both know aren’t really health insurance. Such as my aunt’s (now dead from pancreatic cancer) whose plan paid a maximum of $2000 toward her treatment. That didn’t even cover the ED visit where she was diagnosed.
Your aunt’s plan was terrible, I’m sorry for your loss and frustration with that. But forcing everyone onto one-size-fits-all coverage is not the answer and pretty close to what Canada and England have. Not working out so well for them. We should absolutely have the right to choose.
I dont know about canada, but england’s national health care system is second to none in the world.
UK health care system second to none LOL!!! I had an appendicitis in London during a business trip and it was the worst health care I have ever experienced or seen. Average care was worse than you see in free county hospitals for the poor in the US. Either Brits are delusional or they eat up the propaganda from the health service without question. Either way many Brits buy health insurance on their own because they don’t have any trust the government provided system. Bottom line, their system would not work in the US, not even by a long shot as most Americans would not put up with such a horrific system.
Well Jeff luckily we have large scale studies and large scale review of results across entire populations to back up what Bob is saying.
One person’s opinion doesn’t hold much wait. You could be serious, you could be a right wing person just out to backup your political viewpoints.
When one looks at verifiable results and studies that examine overall health care systems the USA system does not rank very high.
I guess that’s why, when given a choice of all the facilities in the world, foreign royals continue to come to the US for treatment? Not to mention regular folks who simply can’t get the treatment they need in a timely manner in their own countries, so they come to the US pay cash.
In case anyone ever comes across these comments in the future, know that Jeff is correct about how poor the health-care is in Britain. His experience is indicative of a failing system run by politicians who publish false data about how great the NHS is. Anyone that has first hand experience, like Jeff and I, knows what the reality is on the ground. The NHS facilities are derelict, and the staff are overworked. British patients don’t get the treatment they require, but don’t know because they’ve never been to a system outside the UK. This is the truth. Don’t believe false statistics. Healthcare in the US is far superior. Our problem in the US is about prices, collusion, market fixing, and politics, not healthcare.
Dr. Dahle, Thanks for writing about health care sharing ministries. We at Samaritan Ministries wanted to clarify a few things in your post.
3. You Become a Self-Pay Patient
More and more doctors are going out of their way to accommodate cash-pay patients, according to The Self-Pay Patient by Sean Parnell. He cites two online directories of cash-pay doctors: The Association of American Physicians and Surgeons and SimpleCare. In his book, Parnell offers a multitude of options for cash-pay patients.
We also find health care facilities are willing to work with our members on payment arrangements and are very responsive to discount requests because it lessens their administrative burden. I have found that to be the case personally. My family and I also appreciate this setup because Samaritan members are not restricted to network physicians. We have also been able to find reasonably priced health care so that we are not taxed financially and nor burden other Samaritan members.
4. No Catastrophic Coverage
>>“These plans limit you to just a few hundred thousand dollars for a health care problem.”<>“There is no guarantee that your health care needs will actually be paid for. There is no contract.”<<
You are correct. This is one thing that sets health care sharing ministries apart from insurance. We state this upfront in several places on our web site and our literature. Also, currently 28 states recognize health care sharing ministries as non-insurance health care options for people of faith.
While there is no “guarantee,” we trust that other members will do what they agreed to do when they joined: share our health care burdens. That trust—in God and in the Body of Christ—has been well-placed. Samaritan’s members are now sharing more than $9 million per month in medical expenses. Health care sharing ministries have been around since the early 1980s, and Samaritan is nearing its 20th anniversary. SMI has never been taken to court by a member.
On the other hand, there is no guarantee with health insurance that your health care needs will be paid for, either. Insurance companies can deny claims or only agree to pay a portion of the cost.
5. The fine print
Many services that are not publishable through our ministry as regular needs can often be shared as Special Prayer Needs. An SPN is an unpublishable need (or the unpublishable portion of a need) that is communicated to the members on the share slip with a request for donations to assist with paying the unpublishable bills. Members give to an SPN above and beyond their assigned monthly share if they choose to. In addition, we provide our members with information on many discount pharmaceutical programs.
7. Unfair to physicians
Regarding billing arrangements, here is what Samaritan Ministries suggests to its members. We encourage our members to be straightforward with their situation:
“You explain to your care providers (doctors, hospitals, etc.) that you do not have insurance and that you are a self-pay patient. The providers send their bills directly to you. You organize the bills, complete a Need Processing Form, and submit them to Samaritan Ministries. We will publish your need in our newsletter mailing, and the members assigned to your need will be asked to send their monthly shares directly to you through the mail. You then use the money you receive to pay your bills” (“Guidelines for Health Care Sharing,” page 11, November 2013. Also viewable as the answer to question 27 on our FAQ page.)
Thank you for stopping by and providing some clarification and personal experience.
Like others above, I think you are missing the boat here.
Fine print and denial of payment — happens all the time with insurance !!
Self pay — the way it ought to be actually. People ought to take some personal responsibility for their own care and their own bills. (I hate to accuse you of being jaded by your experience as an E.R. doc who gets stiffed 97% of the time by self-pay patients, so I’ll just throw out that possibility and if the shoe fits go ahead and wear it, if not then mea culpa)
Limited benefits — again the way it ought to be !! Yes I said it!! Show me another form of insurance that doesn’t have specific caps (Auto insurance capped at replacement value of the vehicle and 500,000 for liability. Homeowners insurance also capped at replacement value plus the contents inside are capped too. Life insurance capped at that thing called the death benefit. Malpractice insurance capped by the policy, and awards are capped by state law in many places.
What the hell is so wrong with bankruptcy anyway — it’s not fun and it’s not nice and it’s a last resort, but if you rack up $2M in healthcare expenses the choice is bankrupt the individual or bankrupt the insurance company or bankrupt the country. I say bankrupt the individual (although I’d love to see some insurance executives get a zero salary when their company goes belly up)
Bankruptcy laws are different in every state, but they are written in many states such that you get to keep your home (and sometimes even a basic vehicle, but not a brand new BMW). All your other debts are forgiven –except medical school loans and a few others ;(
I don’t wish bankruptcy on my friends or even my enemies, but it’s a lot more humane than debtors prison !! I am fully aware that if the cap is exceeded, then the patient becomes a dreaded “self-pay patient” once again, and relies on the kindness of the medical establishment — so be it.
Pre-existing conditions is a tough one. I’ll not argue with you on that one. But that doesn’t mean healthy people shouldn’t go ahead and investigate these plans.
That’s is my $0.02
ps — I do enjoy your blog and read it often. We just disagree a little bit on this one. No biggie.
It’s a controversial topic for sure. I found myself with very mixed feelings on it.
Sure… and we should not force emergency departments and hospitals to provide EMTALA care for people who dodge their fiscal responsibility by refusing to be insured and running to bankruptcy every time they have a medical bill.
Bankruptcy isn’t fun, but sticking the hospital and physician with the bill from your care is somehow morally acceptable now.
Protect your home in bankruptcy
http://www.alllaw.com/articles/nolo/bankruptcy/how-protect-your-home-bankruptcy.html
Last week I had a patient come in with an acute illness. He informed me he was a member of one of these Christian cost-sharing programs, so was now a self-pay patient, and asked not only for a discount, but a written receipt from me stating what the discount was and what the usual charge would be, and that if he submitted that receipt, the “usual” amount would be applied to his “deductible”. I felt that would be a risky thing for me to do–because of contracts with other insurers including Medicare, we are prohibited from having different charges for different payors. My long-time patient was annoyed by my refusal to give him such a receipt because the cost-share plan had specifically instructed him to request it. Is this typical?
I don’t know that I’ve ever had a patient in one of these plans.
I’m the author of the book ‘The Self-Pay Patient’ and run a blog by the same name, and it appears the author of this piece has several serious misconceptions about health care sharing ministries.
For example, one of the sharing ministries doesn’t even require that members be Christians, just that they agree people ought to be able to worship (or not) as they please (that’s a simplified summary. And while the others do require that one be Christian, there is no prohibition on Catholics, Mormons, or any other denomination that I’m aware of.
And depending on the ministry one joins, there is coverage available that is essentially unlimited. It’s also worth noting that illnesses and injuries that, in real costs, exceed $250,000 are exceptional and rare (thankfully). Even a heart attack or most cancer treatments come in well under $50,000.
As for self-pay patients asking for discounts, in large part this is because most doctors and especially hospitals have a history of dramatically overcharging the uninsured or anyone else who’s self-pay (Google the term ‘chargemaster’ some time). If your cash-pay prices are roughly similar to what you’d get from Blue Cross or Aetna, they’re probably close to a ‘fair’ price. If you discover that they’re 2, 3, even 4 or 5 times what the big insurers pay, well, can you blame a self-pay patient for asking for a discount, especially since you don’t have to deal with all the insurance paperwork in order to get paid? And some members of ministries do just pay cash at the time the bill is presented, especially in primary care (which often isn’t covered).
I’d encourage the author and skeptical readers to really look at the ministries, or for that matter any other self-pay option. You might be surprised to learn how easy it can be to opt for this route, and how much money can be saved while still having protection against major medical expenses and access to affordable, quality care.
Thank you for sharing your experience. By way of counterpoint, when a doctor sees an Aetna patient, he knows he’s (most likely) going to be paid. I personally collect about 3% of what I bill for self-pay patients. I basically work for free every Friday as that’s about 20% of my patients. While I applaud those self-pay patients who actually pay, in my experience, they’re pretty darn rare.
I am a member of Samaritan Ministries, and have just recently needed to see a doctor and a surgeon for a serious condition. I told everyone I was self-pay, they told me what the bill was and that it was required up front, I paid it, and now I deal with SM. If you have such a hard time getting self-pay patients to pay you, perhaps you should require it up front.
You know I’m not legally allowed to do that in the emergency department, right?
Members of these Christian Healthcare sharing groups also agree to pay their bills in a timely fashion (as would be the “Christian” thing to do) no matter what the group agrees to share. So, as an emergency department worker, you should hope for more of these types of cash payers.
Wow. Emergency department “worker” feels even worse than being called a provider. The appropriate term for my profession is emergency physician, but that profession is mostly a well-paid hobby to me at this point.
Every year we look at health sharing and run the numbers, so my current opinion on it is quite a bit softer than the hard edge in this post written years ago.
lol- so sorry. I think I read it in an earlier response… “emergency department worker”…. It wasn’t meant as an insult. The more I re-read it, the funnier it is… ha. Again, I apologize.
Thanks for the article. Very helpful considerations. I would like to clarify point #5. One of the attractions to Christian Healthcare Ministries for my wife and me is that their Gold plan, in fact, does cover pre-existing conditions. My wife and I need this plan anyway because we desire maternity coverage. This is taken from their website:
“In the first year of participation, bills incurred for a pre-existing condition are eligible for sharing up to $15,000.
In the first two years of participation, bills incurred for a pre-existing condition are eligible for sharing up to $25,000 ($15,000 during the first year plus $10,000 during the second year).
In the first three years of participation, bills incurred for a pre-existing condition are eligible for sharing up to $50,000 ($15,000 during the first year plus $10,000 during the second year plus $25,000 during the third year).
After the third year of participation, the condition will no longer be considered pre-existing.”
Granted it is not immediate full coverage, but it would cover a large amount of pre-existing conditions. I have one that never cost’s me close to $15,000 a year. So there is a pathway to joining that includes those who aren’t perfectly healthy.
I can’t speak for the other organizations. Thanks for the blog.
While that’s great, the point of insurance is to guard against financial catastrophes. I can come up with $15,000. $200,000 is much tougher.
Your perspective is interesting and surprising. I am a member of Samaritan Ministries and I would like to address a few of your points.
Members of health care sharing ministries are very good about paying their bills. They pay doctors faster than most insurance companies, and certainly faster than medicare and medicaid (and typically more than medicare and medicaid). I’ve seen both sides as I’ve worked in medical billing and my father is a doctor and he thinks the HCSM model is wonderful. To not have to deal with the bureaucracy of insurance companies? To not have to ask permission to treat your patient? To get paid timely and be able to avoid burdening his staff with yet another pile of insurance paperwork? It’s utopia for a doctor!! He couldn’t give a discount fast enough for those patients and hates the nonsense of insurance companies. He has even toyed with the idea of opening a cash only clinic because insurance and medicare are eating up so much of his time and resources. He longs for the days when medicine meant treating his patients instead of fighting bureaucrats and bean counters. Sharing ministries are a breath of fresh air! It makes no sense to charge more for a self pay person when the self pay patient who is going to pay (or already has paid up front) gives you way less headache than the insurance man. If you are blessed enough in your practice to be cushioned from that nightmare then consider yourself very lucky. I once spoke to a hospital billing manager who said it’s illegal to charge more to a self pay patient than one with insurance, but maybe that’s a state by state thing.
I’m very sorry the pain of nonpay patients has disheartened and jaded you, my father doesn’t like that either (neither do we taxpayers). But please don’t lump members of HCSMs into that category… members pay their bills, and pretty quickly. They want fair pricing, fair treatment and will treat you fairly in return. They are self pay, but they do PAY.
The sharing ministries DO have plans for catastrophic issues. I am a Samaritan member and their highest need to date was $1.5 million and everything was paid for because the member was part of Save to Share, which pays those higher bills. CHM and Medishare also have provisions for the bigger bills and have paid some whoppers in their time, too.
You mention the fine print. Yes, members must adhere to a set of rules about living responsibly and issues arising from un-biblical living are not paid for. What is wrong with that? What is wrong with requiring people to take responsibility for their actions? That attitude of “cover everything no matter what I do” is part of what’s sinking our country. At some point we must take responsibility for our actions. I don’t want to pay for someone’s bills who was injured while driving drunk or robbing a bank. That person should know better. It doesn’t mean we don’t support them with love and prayer, but life’s choices have consequences. As for preventative and pre-existing care, sure it would be great if everything was paid for. But that’s what insurance is offering and I can’t afford their crazy premiums or co-insurance rates as a result. Insurance used to be exactly what HCSMs offer today. They paid for the big things, people paid their own checkup bills. Now we’re all so “entitled” with our thinking that we want everything paid for and someone else to pay for it. I prefer the model offered by the healthcare sharing ministries. And I’d ask you to show me an insurance plan that doesn’t have fine print. The insurance plans I rejected offered me the fine print promise of NOT paying for a bunch of stuff until I’d nearly bankrupted myself if I had a medical issue because the deductibles, co-insurance and premiums are so high. Insurance companies are a racket of fine print and only give headaches and leave their customers with giant left over bills. Listen to your patients talk about how much they hate it. And as has been pointed out in other comments, the ministries do have some options for those with pre-existing conditions, but you’re right, it’s not exactly the same as what insurance plans offer. The starting premise is just different between insurance and these ministries. Insurance companies look for reasons not to pay, and those contracts you mentioned are referenced all the time as a reason NOT to help a patient. These ministries can’t offer contracts, but they work from a standpoint of Christian relationships and caring. They work to help the member get those payments instead of working against them. If a need is submitted that doesn’t meet the regular guidelines, the ministries have donation pages of their newsletters where other members can donate and step in to help fill the void. Insurance offers nothing like that, you’re just on your own. It’s a group of people who care about each other as members, instead of being on a lonely island fighting against insurance attorneys. Very different relationships.
Paying for some medical services up front isn’t just for the self pay group anymore. Are you aware that patients with insurance are being asked to pay up front also? Hospitals know about their huge deductibles and are having lots of them prepay something, too, for fear of not being paid that large difference. Having insurance doesn’t save people from that.
As for tax deductions and subsidies, I still pay less with my Samaritan family rate share than I would with health insurance, even with subsidies and deductions for being self employed. That isn’t true for everyone, but it’s not one size fits all. Insurance is crazy expensive, and requires me to pay for coverage I don’t need. And for many members, it’s less about the savings and more about the biblical nature of it (members do not want to pay for abortions, for example).
I agree that other ministries should be allowed to form, but I didn’t write the law. These ministries are not a good fit for everyone, but they are a viable option for many in a sea of choices. What works for one will not work for another. The three HCSMs which are exempt are enough different from each other that people have options and can find one which best fits their family’s needs, or perhaps they choose regular insurance instead. Still having the freedom to choose is a valuable commodity in this country, one I hope we don’t lose. The ministries are growing in popularity and I encourage you to learn more about them and see how they can actually be a benefit to your practice. I hope your experience with the members as patients will only be positive and grow and that you will keep an open mind if a health care sharing member walks through your door. Thanks for your time.
Thank you for sharing your experience.
What’s unbiblical about having a condition that requires more than 4 months of medications?
What’s unbiblical about having a psychiatric condition (which isn’t covered per B.28)?
Why is SNF care not covered?
Ectopic pregnancies aren’t covered until rupture occurs? Um, ok…
Single mother (single unit) pregnancies aren’t covered… period. I didn’t realize that the Bible blamed the woman for rape.
Your comment, although mildly inflammatory, does show the importance of reading the fine print and really understanding the difference between health sharing and traditional insurance.
My husband and I have been members of Christian Healthcare Ministries since early 2014. They have already shared over $17,000 on different medical incidents for us and are currently sharing my maternity bills, with more bills in the pipeline awaiting reimbursement (as a matter of fact, I have already received full reimbursement to pay my doctor and hospital long before my due date). I would like to address your points speaking from my personal experience. I can only talk about CHM which we belong to, however, to my knowledge, much of what Samaritan Member above mentioned hold truth for all such Ministries. So here we go:
1) Discrimination: Not an issue with CHM as far as I know. Yes, you have to be Christian and live a responsible lifestyle (which most Christians would anyway), but there’s no denomination limitations. We are Eastern Orthodox and were welcomed like any other Christian denomination. Like Sean Parnell mentioned above, there are certain Ministries that allow membership to anyone of any religion.
2) Lack of preventive care coverage: the logic behind that is that preventive care is a cost that can be predicted and budgeted for, hence members can take responsibility for it. It is true that CHM for example doesn’t share funds for incidents totaling less than $500 (before discounts) for their top tier plan, but this is no different to any insurance plan with a deductible (with deductibles as high as $5,000-10,000, having a $500 ‘deductible’ feels like a great bargain, no?). I should also add (though it’s already been addressed in other comments) that any discounts offered by medical providers are applied towards your $500 personal responsibility. In my case, I’ve always been able to obtain way in excess of $500 in discounts in each incident I have submitted for sharing (and not by harassing providers, I assure you, I just ask them to apply whatever discounts they’d typically apply to a self-pay patient, and many of them happily do, especially for higher bills), so by the time I am reimbursed by CHM, I am left with a whopping $0 out of pocket expense. Also, in the case of CHM, if a member has already met their $500 personal responsibility amount either through paying for it or through discounts, any subsequent incidents within the same year that total over $500 qualify for 100% sharing from the first dollar. Not sure if this is the case with their lower tier plans though, we have their highest tier plan (Gold) and I know this is the case with us.
3) No comment other than we do pay our medical bills and are actually required to in order to remain Ministry members. The Ministry has the right to ‘kick us out’ if they find out that we have not used funds they have sent for the purpose they were sent for (i.e. paying our medical providers). In the meantime, we are encouraged to set up payment plans to reassure our providers that we are willing to pay our bills and will be paying, or for lower amounts ($1,000 and below) we can pay upfront if we want. I have actually paid upfront more often than not and reimbursed by CHM later, even for amounts higher than $1,000 when ‘prompt payment’ discounts were extended to me. The only times I’ve set up payment plans were for higher bills that I couldn’t obtain discounts for, so I wanted to give the CHM Bill Reductions staff the chance (and time) to possibly negotiate a better price on my behalf (which they have been able to do on a couple bills).
4) No Catastrophic coverage: this is not accurate. These plans are all about getting help with higher and catastrophic medical expenses vs. smaller, predictable expenses (like routine check ups) that can be budgeted for. Again speaking about CHM, they have a $125K per illness cap that they share, however they also have an additional optional program called Brother’s Keeper that offers UNLIMITED coverage to top tier plan members for any expenses exceeding $125K, as well as up to $1MM coverage to members of lower tiers. That is per illness, not lifetime, so it’s quite generous. Participation in this additional program is highly encouraged and extremely affordable. It consists of only a $40/year admin fee per family, as well as a quarterly amount determined by the Ministry based on current quarterly needs of the program. The average quarterly amount is $25/person (so a family would pay $75 per quarter on average, since only the first child counts as a separate member, with all subsequent children being added to the plan for free, so you never pay for more than 3 members). During the time we’ve been members, the quarterly amounts we have been asked to contribute have never been over $32/person and they have been as low as $10-12/person at times for the whole quarter.
5) Pre-existing illness: CHM doesn’t deny anyone or charge extra based on pre-existing conditions (which insurance companies are still allowed to do, even under the Affordable Care Act, if a prospective member attempts to enrol outside open enrollment periods without a ‘qualifying event’). Their top tier plan (a mere $150/member per month) actually offers $50,000 in pre-existing coverage in the first 3 years of membership and full coverage thereafter. Needs exceeding the $50K maximum or for people with pre-existing conditions in lower tier plans are normally posted on the Ministry’s Prayer Page distributed with their monthly newsletter. This allows for voluntary donations from other members, and such needs stay on the Prayer Page until fully covered by donations. It can take a few months (maybe 6-8 for an average need) depending on the amount of the need, but those needs ARE fully covered in the end.
6) Fine print: we have actually found them to be very upfront and transparent about what they do and don’t cover. And yes, they do encourage personal responsibility and there is no ‘no matter what’ coverage. This is one main reason why their monthly rates are so low, and in the case of CHM, they have only gone up (modestly) only ONCE in their 35 years of operation. This is pretty significant. Keep in mind that many of the things they don’t cover (which insurance companies are obligated to) are things that are not compatible with the Christian lifestyle anyway, such as abortions, illegal substance abuse etc. As for actually suing another person for accidents happening in their property, I doubt this is accurate. Rather, they request that if insurance is available, that insurance is billed first and then they can step in and cover the rest if needed (same goes for auto accidents, workplace accidents with worker’s comp etc. by the way). I don’t see how this requirement is unfair.
7) No such requirement as obtaining free care, and a physician’s practice can definitely set their own policies for checking patients’ income and ability to pay if financial assistance is requested. Also, while personally I have never asked for ‘insurance equivalent discounts’ I always ask for providers’ self-pay or cash price, which is fair to set at a lower rate if we’re talking about ‘cash’ payment at the point of service (no different to a ‘prompt pay’ discount) vs. awaiting payment from insurance companies, Medicare, Medicaid etc. than can take 3 months or longer and no insurance paperwork other than a written break down of services provided and what each was billed for. It’s a win-win for both doctors and patients. It is of course within a physician’s rights to charge full rates, just as it is a patient’s right to shop around for the best value for money service in non-emergency situations (which we are also encouraged to do, and it makes total sense). Also, this recommendation applies more to hospital and similar bills that are much more likely to be high, rather than to physician bills. As mentioned above, CHM is happy for members to pay a bill lower than $1,000 upfront even if no discount was extended, which is what the vast majority of physician office visits/office services would fall at (surgeries may be the only exception to that). The only reason why they ask members to set up payment plans for bills that are higher than that (unless a big discount has already been obtained, in which case you can again pay it in full) is to give them time to contact the provider and possibly negotiate a better price on those higher bills. Insurance companies do exactly the same kind of negotiation, so hardly something unfair or unheard of to anybody.
8) No subsidies and no tax deduction: my husband and I fall in this category where we made barely too much to qualify for any subsidies but still found traditional insurance plans quite unaffordable and bad value for money. So what were we to do? Even without claiming our monthly shares off of our tax returns, the difference in savings was still quite stark, so we chose to take that trade off. Donations made through CHM’s Prayer Page to share into other people’s needs (something we try to do on most months) are tax deductible like any other charitable donation. Also, speaking of subsidies, just a couple of months ago there was this big debacle with thousands of tax payers being required to return part of the money they had been given in subsidies after submitting their tax returns. We were really glad we didn’t have to worry about that. It should also be noted that health cost sharing Ministries are legally exempt from the ACA tax penalty, so what members don’t get to deduct from their tax returns, they save from not actually having to pay the tax penalty.
I hope this helps add light to a few things and clarifies any misconceptions.
Thanks for sharing your extensive experience. And for typing all that. That’s a serious comment!
I am seriously considering one of these plans. I am a physician, but am finding that my $2,100 Obamacare premium a little steep. We have health issues, and i know there will be some periods of exclusion. But I will be paying $25,000 in premiums, plus $8-12,000 in deductibles/co-insurance. So with a major loss, I put out up to $37,000 in personal expense. We have done something like that twice, once for breast cancer, once for a CABG, and a Thyroid nodule. That compares to somewhere around $11,000 total for one plan I saw, 1/3 of which was the deductible. Pretty much a no brainer, especially since the premiums alone for BC are TWICE the stop loss value for the ministry insurance. And…we are still fighting noon-payment of cancer bills from last year!!! There is no perfect path, but this one seems to have some merit! At least until a single payer system arrives. But THAT will be the final straw to a nearly bankrupt nation.
I know how you feel, My monthly premium went from $750 or so pre-Obamacare, to ~$1000 this year, and now $1250 next year! Makes you think twice about these health sharing plans doesn’t it?
I too am a physician…and my comments are below. It’s outrageous. The ACA is simply another method of “taxing” some to pay for others. We are faced at having to pay $32,800 next year before BCBS gets involved at all with our health care. $1856 / mo…..and $13,000 deductible. We just cannot do this.
Why does health insurance pay for the things it does? Why do we all pay for the harmful decisions of others? Tobacco use… alcohol use… sexual activity outside of a monogamous/marital relationship…. drug use…. abortions…. sex changes…. plastic surgery for cosmetic needs…. $14,000 per month medications…. $3500 MRIs for non-life threatening boo boos where surgery is not an option…. and possibly even basic primary care (my world)….
If auto insurance covered tires, wipers, transmission work, oil changes, radiator work, etc….it would be very expensive. If it covered a desire to change the paint color, to soup up the engine, to transport it to another country….it would be even more expensive.
The ACA….was always a means to make some pay for the health care of others, but not through their sharing of risk. No, through a form of forced taxation….to subsidize or give health care to others. Step one toward socialized single payer health care.
We are members of CHM as well and we feel it is a very credible and caring organization. It is what “health care coverage” should be….
While this kind of coverage has its shortfalls…..try this on for size…..
23 years we have BCBS and never fail on a payment. ONE YEAR AGO…with the launching of the ACA….to keep our policy our family premium went up $600 / mo…..and our deductible went from $4500 to $7000.
12 months later (this coming January)…..our family insurance is to once again go up $600 more dollars per month! AND, our deductible is to go up to $13,000!
So this coming January the our family of 3 persons…..will have to pay $1856 Per Month….and our deductible will be $13,000.
i.e, we will have to pay $32,800 before BCBS begins to help. YOU CALL THIS AFFORDABLE?
Christian Health Care ministries will allow us to pay around $600 / month….which leaves us with $1200 per month to put toward uncovered primary care costs….or save….or share with others in need. Sure, it discriminates, but who said all discrimination is wrong.
Some should perhaps learn to discriminate right from wrong / safe from unsafe / just from unjust / wise from unwise….so that health care costs for others might be less! Temperance, proper eating, heterosexual monogamy, no illicit drug use, no tobacco use, no adultery, etc…pays off for ALL.
My family can either go with the new ACA-affected (49% increase) and pay $1856 per month for a $13,000 deductible….or we can go with one of the top three Christian Health Care organizations. WHAT WOULD YOU DO?
I know how you feel. My health insurance went up 30% last year and another 25% this year. It’s got me eyeing these organizations again as well.
There can be no other reason for these huge increases over the past 14 months,….but the ACA’s design to massively increase the premiums of the few in order to give to the many. For over 23 years we had our BCBS policy and we’d see 10% to as high at 17% increases, but 49% in 2015 and 2016?! And our deductible having to go from $4500 to $13,000?!! Discouraging…
I’m a dentist. In 2012 I paid $600/mo for 5 people. This plan was cancelled. Then 2013 Aetna was $1000/mo. 2014 was $1200/mo. Now I’m looking at $1600/mo and I only have two choices in my county. That’s for the highest deductible – same deductible as in 2012. Our state just announced that they have cancelled our co-op plan, which was the cheapest option. So now I get to choose between Aetna (we tried them in 2013 – over an hour hold times if you try to call) and Rocky Mtn. Both around $1600 a month for a bronze plan with HSA.
I can’t believe this, but I’m seriously considering one of these plans. It looks like if you join the Gold plan with CHM that there is unlimited benefits and it will be $750 a month for 5 people, plus a small quarterly fee $125. If there is a chronic long term disease, then you can always switch to an ACA plan during open enrollment.
The biggest question is will this plan payout a million bucks for a heart/lung transplant? My guess is yes…
This is how health insurance should be. Let me have an incentive to take care of my health and associate with other people that do the same.
Can’t blame you a bit. They’re getting more attractive all the time, aren’t they!
Actually, with CHM, the costs caps @ three memberships – so $450 per month (assuming that the participants: meet the membership requirements, are members of your family, are claimed as dependents on your tax return).
The $1,500,000 surgery would be covered if you participated in the optional “Brothers Keeper” program ($40 per year plus a per member per quarter charge of approximately $25 – so somewhere in the neighborhood of $340 additional dollars per year).
We have been members of CHM for 18 months now. It boils down to this: It works, and it is affordable. Without CHM we would have a $1400+ monthly premium and a $5000 deductible – actually we wouldn’t have insurance at all – with CHM we have a $450 share and $500 deductible. Next year we are adding “Brothers Keeper”
I’m a small business owner and I’m planning on joining CHM or Samaritan Ministries. I’ve done a lot of reading/research and it would appear to me members do NOT quality to use a Health Savings Account (HSA) which I have already setup from previous insurance coverage. There is a bill in the House of Representatives that would change the IRS code to allow this, https://www.congress.gov/bill/114th-congress/house-bill/1752/titles but at this time it appears it is not allowed.
Thanks for sharing that info.
I have joined Liberty Healthshare effective January 1, 2016. I am 60 yrs old, not working, living off a bit of savings and some meager stock dividends. My premiums were to increase to $700/month February 1, 2016 and at that rate I would be broke by the time I am eligible for medicare and SS. My dividends and interest amount to about $900/mo. I live in Texas and there are no subsidies available for someone in my circumstances. Actually no subsidies period in Texas. I guess I could go be a Walmart greeter but can’t stand on feet too long Not eligible for disability either. I am sunk without the lifeboat of LHS. I am sure it will work out very well from my research.
So DOC, you like a 60 yr old living on $200/mo after paying outrageous premiums and very high decductibes/copays? Have you been to the store lately and how about ac/heat and other bills? Do you DOC live on $200/mo to pay ALL of your bills???
I didn’t think so. You need to become more informed on different state laws, etc before crucifying Christian Health Share Ministries~~~
P.S.-I opted for the Liberty Complete at $199 per month. WOW, I just got $500 ++++ per month back to pay bills! The +++++ is an indication of deductibles and copays I used to have with BCBS of TX
Glad you’ve had a great experience and that this works for you. I’m sorry you thought the purpose of this post was to “crucify” these ministries.
I think you’re misinformed as to how PPACA works. At your level of income I believe you should qualify for Medicaid in many states. If Texas, like Utah, hasn’t expanded it, then you’re in the same situation many Utahns find themselves in where they don’t get a PPACA subsidized plan, but also don’t get Medicaid. Terrible place to be in a broken system.
No Cassie, I don’t live on $200 a month to pay all my bills. I don’t even live on $900 a month. I have spent a great deal of time in my life planning, working, and purchasing insurance to avoid ever being in that situation. I’m sorry you are in it and am glad that a health sharing ministry has been able to be part of the solution to this problem for you.
BTW-I was in Wal-mart last night. The greeter was seated. You might look into whether that is an option for you. Even a few hundred dollars a month in income would make a dramatic change in your life.
[Ad hominem attack removed. I’m not sure why you thought those types of comments would be acceptable here.-ed]
My family has been a part of Christian Healthcare Ministries since the 1980’s. We have the gold plan. It has paid for 5 babies two by cesarean. We use it more like major medical used to work. We pay all our everyday bills even those for sports injuries and small emergencies. We do that because the monthly fee is so reasonable. We plan for a few thousand dollars to pay ourselves even though they would be covered and we would be reimbursed. When I call someone has ALWAYS been courteous and helpful. It also reimbursed us for a major accident.$45,000.00 after asking for a % off. I could have a discount if I paid before we left the hospital otherwise tough sugar molasses. We have good credit and put it on a card. How long before the hospital would have been paid by an insurance company and what percent would that discount be? When we got a settlement and reimbursed CHM they sent a lovely thank you and said it would be added back into our lifetime benefit.
Before when we had a traditional insurance and I had some serious health issues the paperwork the doctor filled out three times was “lost” in the mail. The third time he handed it to me to mail. I was sick and fighting to get well without the strength to fight them too. Needless to say they never paid any of it. We paid out of pocket and took loans to cover the expenses.
All of this is important, but not as important as receiving a name every month to pray for and send a card to. I corresponded with a family for years because of this connection. A merry heart doeth good like a medicine. p.s. I don’t mind the CAPTCHA code I think they keep the eyes and mind sharp. I just failed yours twice. Here I go again.
Thanks for sharing your experience. Sorry about the CAPTCHA. You wouldn’t believe the problems it prevents.
Thank you for this post. I found it quite interesting, and the discussion in the comments section was even better. It’s nice to get the point of view of health care providers. I didn’t know, for instance, that self-pay patients pay at such a low rate. Do their bills just go to collections and ruin their credit (assuming they have credit to begin with)?
Anyway, my primary reason for posting here is to take a minute to correct a couple factual errors from the post.
First: the post states there are 3 ministries that exempt you from the tax penalty. There are actually 5, and they are: Christian Healthcare Ministries, Liberty HealthShare, Samaritan Ministries, Medi-Share, and Altrua HealthShare. (Altrua was actually founded a year after the cutoff deadline, but they remedied this by merging with a smaller but older health sharing group.) Also of note is “Medical Cost Sharing, Inc.” which offers to pay a part of your tax penalty every year.
Regarding the “Discrimination” factor, yes, while some of the organizations have a strict Trinitarian credo, I’ve found that at least two (CHM & Liberty) are compatible with my belief (Mormon). In fact, Liberty HealthShare should be compatible with almost anybody who believes in a deity. Their statement of belief reads along the lines of, “We believe that our personal rights and liberties originate from God and are bestowed on us by God, and are not concessions granted to us by governments or men. We believe every individual has a fundamental religious right to worship the God of the Bible in his or her own way.” Aside from the “God of the Bible” bit, it reads a lot like the Declaration of Independence. For CHM, I actually talked to them and asked them directly if “Mormon” was OK and they said yes.
Other corrections have been mentioned by others. I would encourage the author to re-read Sean Parnell’s comment above, as he is probably the most knowledgeable person in the room on this subject.
Thanks again for the post!
There are some very good comments from both sides of the issue here and I thank everyone who posted as it has helped me as I research Christian Health Care Sharing.
As JDT stated “If auto insurance covered tires, wipers, transmission work, oil changes, radiator work, etc….it would be very expensive. If it covered a desire to change the paint color, to soup up the engine, to transport it to another country….it would be even more expensive.”
Why is health insurance and the costs of maintaining ones own health not considered a cost-of-living expense in this country? We all pay for our own auto and homeowners insurance and marketplace competition keeps the prices reasonable. Auto insurance is for when the car is significantly damaged or totaled. Not to replace the wiper blades.
Health insurance should be for the heart attack, the cancer, the appendix about to burst – not for the routine physical, or immunization or dental cleaning.
My husband and I are self employed and we have paid our own insurance premiums and funded our own HSA since 2006. Back then the premiums for two of us were $130 per month with a $3650 deductible (payable with our HSA money). Ten years later the premium is $562 per month with a $5600 deductible (I signed up for $3650 but the government raised it every year, due to cost of living increases that our salaries didn’t keep up with). I looked into the ACA plans and they would be even higher than what we are paying now. Presently our health insurance costs are 13% of our GROSS income not what we get to keep after all the taxes! How on earth is a family earning the median income in the US of $52K supposed to afford one of these plans that cost $12000 a year (if you add premiums and the funding of an HSA)? Not to mention that half the population makes less than the median.
There has to be a better way and one thing I like about the health care sharing is that there is a level of accountability to one another when sharing expenses. One of the biggest problems in this country is that very few are willing to be personally responsible for themselves. To me the best solution would be health care sharing AND the tax deduction for money we put into an HSA. That people could pay their bills in a timely manner and put the money back in the HSA when they received funds from their sharing plan.
An income of $52K gives you big subsidies toward your premiums.
“An income of $52K gives you big subsidies toward your premiums.”
Well, I have just finished working through the government website for application, and after two (very friendly and helpful) phone calls have confirmed that this statement is NOT true in the state of Louisiana. Our income is within that range, and we definitely get NO subsidy. $1200 to $1600 per month for high deductible plans??? We are so grateful to friends for sharing their experience with these Christian cooperatives. Praise the Lord that I won’t be working only to pay for my high deductible premium payment!!!
The subsidies aren’t state specific. According to this, for a family of four with an income of $52K, the subsidy is over $4K. I see that as a big subsidy toward your premiums.
http://www.financialsamurai.com/subsidy-amounts-by-income-limits-for-the-affordable-care-act-obamacare/
Whether that’s better than a Christian health sharing program or not I’ll leave for you to decide.
Anna, in my researching to decide on a plan, I discovered you are not allowed to contribute to HSA if using one of these share plans. As well as not being able to
deduct the monthly share if you are self employed. Double ouch!
Thank’s for this blog!!!!
Yes, losing both of those would have a big effect on me. That would raise my taxes by about $8K a year.
I am debating joining one of these plans. Just wanted to say how much I appreciate your not only writing this post to begin with, but also monitoring and replying to the comments for… good grief, almost two years now. It’s been very helpful to get a glimpse of how these arrangements may affect the practice; I for one want to maintain the best possible relationship with my favorite doctors.
In some ways they’re becoming more and more attractive each year. I think my deductible this year is something like $9K and I’m paying premiums of $1K a month for my family of 6. Beats me how someone making $50K a year can afford something like that. Even with the downsides of these sharing plans, if they can cut that cost in half, then they’re going to be attractive to many.
The government taking an active (controlling) role in healthcare has nothing to do with caring about the citizens of this nation, whether they are poor, “median income,” or wealthy. And it has nothing to do with “spreading the wealth.” Follow the money. This is a Trojan Horse designed to take over total control. Once the government is taking our money in the form of a tax, it is their money. Do you think “they” (those who have the job of deciding what health care you are entitled to) will be anxious to spend it on YOU? Don’t you think they will be able to find much more worthy things to spend it on? It isn’t like that hasn’t happened with other money they mandate we will turn over to them. Our retirement (social insecurity) for instance. The city of Galveston, Texas, withdrew all their city employees from federal social security and started their own retirement program. Comparing like years/pay grade, a retiree in the city program received $2,500/mo vs. a retiree in the federal program with $500/mo. These are old figures, from about 1996. Bet the disparity hasn’t improved.
We need to pay attention to the lessons from England and Canada. Years ago my dad met a man from Canada while he was getting lasik eye surgery. The Canadian paid significant taxes with the promise that the “government” would take care of him and he would not have to pay for his own health care. Instead, he had to pay for a trip to the United States and pay for his surgery. Lucky him, he had the money. Not all Canadians do. Oh, and how about their 10 month waiting period to get permission to be admitted to the maternity ward?
A woman I knew (we attended the same church) was from England. She was married, living in the United States for about 10 years, and had three children when her mother called her from England, all excited because she had been notified that her daughter could have the surgery she needed. Imagine her surprise to find that the surgery had been taken care of a decade before England could manage it. By the way, there was a report a year or so ago about a study done in England in response to the problem of patients waiting long periods of time after being brought in to the emergency by ambulance before being seen by a doctor. The solution? The ambulances were instructed to circle in the parking lots until they were notified by hospital staff that they could drop the patient off at the emergency room door. I wonder how many patients no longer needed the services of a doctor. Perhaps the undertaker, though.
I realize this is dripping with sarcasm, but I am continually amazed at the seeming inability of this supposedly intelligent country full of citizens to get a clue as to what these politicians are up to. Obamacare is progressing just as I expected, and will continue to do so, including increases in costs and control, until there is no more personal health care choice. This will harm everyone. Poor people will not be better off, nor will anyone else. Five decades ago my mother said to me, “Whatever government touches, government destroys.” She may have gotten that from some other source, but I have never known it to be inaccurate. I just retired and the “premiums” I have had quoted to me are ludicrous. I am just thankful that these sharing options exist, (though I am sure “they” will get rid of them as soon as they have consolidated their control.)
The cost sharing philosophy seems to be gaining respect based on this blog over the past two years. I want to complement the blog writer, The White Coat Investor, for the responses that show that you have an open mind and are not just interested in defending your originally negative opinion. Freedom is so much more than being able to do and say whatever we want. It is also being responsible for the consequences of what we do and say. When we demand privilege while refusing responsibility, we will lose the freedom to do or say anything that doesn’t align with the authority that desires to exercise control over us.
I’m so happy to have stumbled across this blog post and 2 years’ worth of follow up comments. I’ve been curious about the healthcare sharing ministries for a couple of years but haven’t know anyone personally who was using them, therefore I couldn’t get comfortable with the idea. Anyway, I called our insurance broker this week because I’m just so disgusted with our current plan ($700/month + $10,000 deductible and it’s being canceled this year). I was shocked when he told me that he is switching his family to Medi-Share next month! Read that again: HE IS AN INSURANCE BROKER and he has decided a healthcare sharing ministry is a better option for his family. That was all I needed to hear to feel completely comfortable making the change. Furthermore, I posted a rant on FB this week regarding price gouging by a local lab (our insurance is no help in the situation), and one of my friends informed me that she’s been with CHM for a few years and has had a wonderful experience with them, including a $40,000 surgery bill for her son that was paid in full.