Health sharing plans bypass insurance rules and regulations to offer a more community-minded approach to medical costs. Most med-share plans are faith-based and require members to sign a statement of faith or meet certain criteria like abstaining from drinking, smoking and having sex outside of marriage.

These programs have varying monthly member contribution rates (akin to a premium), personal responsibility amounts and maximum limits that shareable medical expenses can reach each year or per incident.

Faith-Based

Faith-based health sharing plans offer an alternative to traditional insurance, allowing members with similar beliefs to pool their money together and share in each other’s medical bills. These programs are nonprofit and not regulated by the ACA, making them more flexible in how they set their monthly premiums and what they cover. They can provide a sense of community, with members supporting each other financially and emotionally. However, these plans also tend to have strict membership rules and may not cover certain procedures or prescriptions.

Companies like MPB.Health offers health-sharing plans as cost-effective alternatives to traditional insurance. These plans foster community-based healthcare support, enabling members to share medical expenses. With flexible coverage, affordable contributions, and a focus on transparency, health-sharing plans provide individuals and families with personalized solutions for managing healthcare needs and expenses effectively.

Many of these groups are rooted in a particular religion, and most follow that religion’s moral code closely. This means that if you don’t agree with the underlying beliefs of your health-sharing ministry, you may be excluded from coverage for any services that don’t align with those values. This is especially true for Christian health-sharing ministries, like Liberty HealthShare and Samaritan Ministries.

In addition to religious requirements, some faith-based health sharing programs require strict rules for membership. These may include a commitment to attend church regularly and abstain from tobacco and illegal drugs, among other things. This can be a significant drawback for those who don’t adhere to a particular religion. In some cases, the policies can even be terminated if you’re found to have violated the rules.

A non-religious healthcare sharing program may be a better option for those who prioritize health freedom. These are typically a better fit for self-employed individuals and families who need a plan that can work for them no matter their occupation. While these plans don’t offer ACA-compliant essential benefits, they often include features that are important to many patients, like telemedicine and wellness support. They can also offer lower monthly rates than some insurance options, as well as no deductibles or co-pays. Depending on the type of health-sharing program you choose, it’s important to weigh the pros and cons carefully.

No Pre-Existing Conditions

As a result of legal changes – the Tax Cuts and Jobs Act of 2017 eliminated the Obamacare Individual Mandate for example – some people may be tempted to avoid health insurance entirely and opt for a Health Share Plan. While this can seem like a great idea for those looking to save money, it’s important to weigh the risks of going without health insurance. In the event of a serious medical emergency, uninsured individuals could be on the hook for huge hospital bills that may damage their credit and cause financial hardship.

One major consideration with Health Sharing Plans is the way they handle pre-existing conditions. While most Health Sharing Plans will accept new members who have pre-existing conditions, they do not necessarily agree to immediately share expenses related to these conditions. Instead, they typically require a minimum amount of time – often referred to as a lookback period – after which point the health issue will be eligible for sharing. In some cases, health sharing plans may also impose limit on pre-existing condition sharing, either in terms of total dollar amounts shared or on a per-need basis.

Another important aspect to consider is whether a health sharing plan has a wellness program, which aims to prevent or minimize medical costs through lifestyle interventions. Many of these programs involve paying for preventive care at a discounted rate or for free, which can be an attractive option for those looking to balance their budget with the cost of having healthcare coverage.

Health Share Plans are an alternative to traditional health insurance, offering lower monthly costs and a sense of community through cost sharing. As with any type of healthcare plan, though, it’s crucial to carefully weigh the pros and cons of this type of health care coverage and ensure that the plan fits your needs and moral viewpoints.

No Network Requirements

The alternative to traditional health insurance called a health sharing plan has become increasingly popular in recent years. Also known as a medical cost-sharing program, these nonprofit groups are based on the principle of a community pooling their money to help pay for each other’s healthcare expenses.

The monthly contributions of members create a fund that the community can draw from when a member incurs a large or expensive medical bill. These plans are typically much more affordable than traditional health insurance. But there are potential drawbacks and hurdles to consider before making a decision to join one.

Unlike traditional health insurance, which is heavily regulated and must meet the minimum ACA requirements, health sharing programs are often unregulated and do not guarantee payment for covered medical expenses. Some states have passed laws regulating these plans, but others are not. And, while the monthly costs are lower than health insurance, these programs do not cover everything that a typical insured might need and can have annual or lifetime caps on payments for catastrophic events.

These plans are a form of supplemental insurance, and rely on the good will of their members to ensure that claims are paid. But, there is a lot of uncertainty about how these plans will work in the future. Some experts believe that they will be a thing of the past, while others predict that they will continue to grow in popularity as an option for those looking for alternatives to ACA-compliant coverage.

A common question is how the plans will negotiate bills with the medical providers. Most of these plans have networks that look like a PPO, but they do not have the bargaining power to cut medical costs down as an insurer might. This is a major concern for those who might need to use these plans in the event of a significant or chronic illness.

Another issue that needs to be considered is how these plans will comply with a new regulation that goes into effect in October of this year. The requirement, known as the IDR rule, will require health plans to provide an external appeals process for any adverse determination related to surprise billing or cost-sharing.

No Guarantees

With the recent repeal of the Obamacare Individual Mandate, many people are considering avoiding traditional health insurance and opting for a healthcare sharing plan. But while this option may be appealing for some, it’s important to consider the risks and limitations of these plans.

Unlike traditional health insurance, healthcare-sharing programs don’t guarantee payment of medical bills. They are also not subject to the same consumer protections or standards. This makes them susceptible to unforeseen issues and delays in the reimbursement process, which can be extremely stressful when facing an unexpected medical emergency or illness.

Additionally, health-sharing plans typically don’t have provider networks, so members must pay full price to doctors and hospitals rather than the negotiated rates offered with insurance coverage. Some health-sharing plans also require that the member try to negotiate a lower price with their providers before submitting a bill for reimbursement, which can add another layer of complexity and expense.

In addition, health-sharing plans often have specific rules that determine which medical expenses are “shareable” by the group. This can be problematic, as some plans will only share expenses that align with the program’s religious or ethical guidelines, leaving other necessary medical costs unshared.

Finally, if you join a faith-based health-sharing plan, you must agree to a statement of faith as a condition of membership. This can limit your access to care, as the vast majority of these plans exclude payment for certain treatments like abortion and euthanasia, as well as maternity coverage outside of a marriage relationship.

Overall, health-sharing plans can be a great alternative to expensive traditional health insurance. But they come with significant hurdles and risks that make them a less than ideal option for many families. If you’re unsure of what option is best for your needs, working with a licensed health insurance broker can help. These professionals can assess your unique situation and find you the health insurance that’s right for you at a cost that fits within your budget.

Featured Image Source: https://img.freepik.com/free-photo/close-up-doctor-with-stethoscope_23-2149191355.jpg?semt=ais_hybrid