Anyone have experience with health care sharing ministries?
August 1, 2015 9:23 AM Subscribe
Are any of you familiar with or had experience with any health care sharing ministries?
We are considering joining one of the plans because of sky-rocketing insurance costs. I'm not necessarily looking for your opinion on the morality part of the plan, which I know several posters will disagree with. I'm looking for actual experience with the plans. Are they reliable?
From this Q&A at Consumer Reports, which is from 2011, but still:posted by rtha at 9:37 AM on August 1, 2015 [1 favorite]
Depending on your situation, health insurance is more affordable and easier to get now thanks to the ACA than it used to be. You can use this link to browse the marketplace in your area without filling out a full healthcare.gov application. It's also worth giving the marketplace hotline phone number a call and discussing your situation with people whose entire job is finding affordable health insurance for you.
I don't have any personal experience with healthcare sharing ministries, but this doesn't sound like it's a great idea at all. Prices for a family of your size (reading your profile info) are more than $400 a month. Other info I found says that ministries serve over 450,000 people and share $430 million in costs per year. Assuming they pay out perfectly and don't take out any money for administrative overhead, that comes to only about $955 in healthcare costs paid out per person each year. For insurance that flat out won't get accepted many places. Sounds pretty crappy to me. Hope no one gets sick.
If I were you, I'd exhaust my options with regular insurance plans before paying into a system that's designed to fly under governmental oversight (and therefore might pull the rug out from under me at any moment).
posted by phunniemee at 9:44 AM on August 1, 2015 [3 favorites]
I don't have any personal experience with healthcare sharing ministries, but this doesn't sound like it's a great idea at all. Prices for a family of your size (reading your profile info) are more than $400 a month. Other info I found says that ministries serve over 450,000 people and share $430 million in costs per year. Assuming they pay out perfectly and don't take out any money for administrative overhead, that comes to only about $955 in healthcare costs paid out per person each year. For insurance that flat out won't get accepted many places. Sounds pretty crappy to me. Hope no one gets sick.
If I were you, I'd exhaust my options with regular insurance plans before paying into a system that's designed to fly under governmental oversight (and therefore might pull the rug out from under me at any moment).
posted by phunniemee at 9:44 AM on August 1, 2015 [3 favorites]
Response by poster: We have exhausted our efforts with health insurance options. We live in a state where Blue Cross has a monopoly. We currently pay close to $1200/month with a $6500 per person deductible. So we are essentially paying for catastrophic care. So on top of our expensive premiums, we are now paying cash for all our doctor visits. I am putting off a colonoscopy because I will have to pay cash for the roughly $2000 for the procedure.
It is terrifying to rely on an unregulated organization like this for my healthcare but I cannot find a single instance where someone's bills weren't covered. I'm trying to do my homework and ask several places not associated with these networks what they look like in the real world.
posted by davenportmom at 9:58 AM on August 1, 2015
It is terrifying to rely on an unregulated organization like this for my healthcare but I cannot find a single instance where someone's bills weren't covered. I'm trying to do my homework and ask several places not associated with these networks what they look like in the real world.
posted by davenportmom at 9:58 AM on August 1, 2015
Response by poster: I read all these reviews as well. I'm really looking for real life instances of people using one of these companies.
posted by davenportmom at 9:59 AM on August 1, 2015
posted by davenportmom at 9:59 AM on August 1, 2015
I haven't used one myself, but I've worked on juggling medical paperwork for someone who used one of these. Getting the sharing ministry to actually pay for anything was actually worse than dealing with a pre-ACA insurance company, and they capped out pretty low on what they would pay for long-term care after a car crash. They were also more limited than insurance companies in negotiating prices downward, so the patient got billed at the listed rate for everything, not the with-insurance rate, which is lower for most procedures even before the insurance company actually pays anything. It was a lot more work overall to deal with it than with a standard insurer (which is not to say that insurance company wrangling is sunshine and roses, because obviously it's not.)
Though given the lack of standardization and regulation, these organizations may vary widely. I would ask to take as close a look at the financials of such an organization as they'll let you, and if they can't come up with a way for you to do that without disclosing protected patient data (that is, if they can't give you some kind of up-front reassurance that they'll help pay for your care) I would count that as a giant red flag. These sharing ministries have even more incentive than insurance companies do not to accept members with pre-existing health conditions, and they've got nothing like the ACA to make them do it.
It stinks living in an ACA-avoidant state. Good luck finding a solution.
posted by asperity at 10:27 AM on August 1, 2015 [2 favorites]
Though given the lack of standardization and regulation, these organizations may vary widely. I would ask to take as close a look at the financials of such an organization as they'll let you, and if they can't come up with a way for you to do that without disclosing protected patient data (that is, if they can't give you some kind of up-front reassurance that they'll help pay for your care) I would count that as a giant red flag. These sharing ministries have even more incentive than insurance companies do not to accept members with pre-existing health conditions, and they've got nothing like the ACA to make them do it.
It stinks living in an ACA-avoidant state. Good luck finding a solution.
posted by asperity at 10:27 AM on August 1, 2015 [2 favorites]
Are they reliable?
This is from Christian Healthcare Ministries: "CHM does not guarantee or promise that your medical bills will be shared or assigned to others for financial gifts. Whether any CHM member chooses to share the burden of your medical bills will be entirely voluntary. As such, CHM should never be considered as a substitute for an insurance policy. Whether you receive any financial gifts for medical expenses and whether CHM continues to operate, you are always liable for any unpaid bills."
This is not insurance. It is organized as a 503(c)(3) charity. Your "premiums" are considered donations to the charity and payments to you are considered charitable gifts. The ministry is under no legal obligation to pay you a single dollar. You are depending on the charity of others. They may chose not to cover your bills at their whim.
Here are some things to consider:
1. No coverage for pre-existing conditions
2. No coverage for preventative care or out-patient services.
3. Lifetime cap. If your bills are too high, they can simply stop paying.
4. You have to pay all of your medical bills out of pocket and later send in bills to seek reimbursement from the ministry. This could mean tens of thousands you must be able to fund from your own pocket.
5. Since you are paying out of pocket, you will typically pay full retail prices for your healthcare which can be double or more the discounted prices that real insurance companies get.
Have you checked to see if you are eligible for an Obamacare subsidy on real insurance?
posted by JackFlash at 12:22 PM on August 1, 2015 [3 favorites]
This is from Christian Healthcare Ministries: "CHM does not guarantee or promise that your medical bills will be shared or assigned to others for financial gifts. Whether any CHM member chooses to share the burden of your medical bills will be entirely voluntary. As such, CHM should never be considered as a substitute for an insurance policy. Whether you receive any financial gifts for medical expenses and whether CHM continues to operate, you are always liable for any unpaid bills."
This is not insurance. It is organized as a 503(c)(3) charity. Your "premiums" are considered donations to the charity and payments to you are considered charitable gifts. The ministry is under no legal obligation to pay you a single dollar. You are depending on the charity of others. They may chose not to cover your bills at their whim.
Here are some things to consider:
1. No coverage for pre-existing conditions
2. No coverage for preventative care or out-patient services.
3. Lifetime cap. If your bills are too high, they can simply stop paying.
4. You have to pay all of your medical bills out of pocket and later send in bills to seek reimbursement from the ministry. This could mean tens of thousands you must be able to fund from your own pocket.
5. Since you are paying out of pocket, you will typically pay full retail prices for your healthcare which can be double or more the discounted prices that real insurance companies get.
Have you checked to see if you are eligible for an Obamacare subsidy on real insurance?
posted by JackFlash at 12:22 PM on August 1, 2015 [3 favorites]
The program called Samaritan is pretty cool. My insurance agent, of all people, has used it for their family for about a dozen years.
It works by having members directly pay each other with each monthly 'premium' and one payment a year goes to the non-profit organizing it. So, if you pay $400/mo, you're paying $4,400 a year out in 'benefits' directly to other members and $400 a year in administrative overhead, which is a ratio that compares pretty well to just about every insurance company besides Medicare. (There are a couple other small fees, but that's ballpark accurate.) A lot of the 450,000 mentioned above are children and healthy adults who typically don't have many needs.
If you don't pay your monthly reimbursement, you're basically discontinuing your insurance, so people pay. They relist anything that doesn't get reimbursed (occasionally needed once, very rarely twice.)
I know several people who use one of these ministries and they have never had an issue getting paid beyond paperwork headaches (as mentioned, nothing new.) Usually people either use a credit card and get reimbursed, work out a payment plan and pay it early when they get reimbursed, or just keep in contact/ask for itemized bills until they're reimbursed and pay.
It's not for people who need the option to sue to feel comfortable, but the people who like it really like it and come out ahead financially. The attitudes of people who like these programs remind me of people who prefer freelancing/contracting to W2 employment, if that helps.
posted by michaelh at 12:31 PM on August 1, 2015
It works by having members directly pay each other with each monthly 'premium' and one payment a year goes to the non-profit organizing it. So, if you pay $400/mo, you're paying $4,400 a year out in 'benefits' directly to other members and $400 a year in administrative overhead, which is a ratio that compares pretty well to just about every insurance company besides Medicare. (There are a couple other small fees, but that's ballpark accurate.) A lot of the 450,000 mentioned above are children and healthy adults who typically don't have many needs.
If you don't pay your monthly reimbursement, you're basically discontinuing your insurance, so people pay. They relist anything that doesn't get reimbursed (occasionally needed once, very rarely twice.)
I know several people who use one of these ministries and they have never had an issue getting paid beyond paperwork headaches (as mentioned, nothing new.) Usually people either use a credit card and get reimbursed, work out a payment plan and pay it early when they get reimbursed, or just keep in contact/ask for itemized bills until they're reimbursed and pay.
It's not for people who need the option to sue to feel comfortable, but the people who like it really like it and come out ahead financially. The attitudes of people who like these programs remind me of people who prefer freelancing/contracting to W2 employment, if that helps.
posted by michaelh at 12:31 PM on August 1, 2015
The program called Samaritan is pretty cool.
Samaritan says: "Whether anyone chooses to send you money to assist you with your medical
bills will be totally voluntary. This publication should never be considered to be like an insurance
policy. Whether you receive any money for medical expenses, or whether or not this publication
continues to operate, you will always remain liable for any unpaid bills.
This is not a legally binding agreement to reimburse you for medical expenses you incur, but is an
opportunity for you to assist other Christians in need, and when you are in need, to present your
medical expenses to other Christians as outlined in these Guidelines. The monetary assistance you
may receive will come from other members, not from Samaritan Ministries International."
posted by JackFlash at 1:45 PM on August 1, 2015
Samaritan says: "Whether anyone chooses to send you money to assist you with your medical
bills will be totally voluntary. This publication should never be considered to be like an insurance
policy. Whether you receive any money for medical expenses, or whether or not this publication
continues to operate, you will always remain liable for any unpaid bills.
This is not a legally binding agreement to reimburse you for medical expenses you incur, but is an
opportunity for you to assist other Christians in need, and when you are in need, to present your
medical expenses to other Christians as outlined in these Guidelines. The monetary assistance you
may receive will come from other members, not from Samaritan Ministries International."
posted by JackFlash at 1:45 PM on August 1, 2015
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