Is this enough health coverage? is it even really health coverage?

August 23, 2006 11:32 PM

Health Insurance question: My father is in his upper 50's and his wife is in her early 50's. They don't have health insurance, but they do have a "health cost sharing plan." I think it's hooey. But they think it's great. I'm worried they are going to get sick and be in alot of trouble without some real health insurance.

So they have coverage with Christian Care Medishare, I think this whole program stinks to high heaven. Am I wrong? I've searched around to see if I can find anything wrong with the system, but since it is "not health insurance" I don't even know what to look for. How do you rate health coverage that's not health insurance? We are in Texas if that makes any difference.

posted by bigmusic to Health & Fitness (16 answers total)

I read a lot of the website, and I don't understand it at all. What is "sharing medical costs among members"? What exactly is an "eligible need"? And what is the relevance of all this Christian stuff -- I bet they won't "share" abortions, but what else does it mean?

I can't believe that the confusion is unintentional. I agree, Bigmusic, that it really seems like it would have to be a scam of some kind -- but, of course, they make it very hard to determine just what it is.

Perhaps you could ask your parents to explain it to you? In detail, exactly what they pay, and what benefit they receive. Have they ever had significant medical expenses that were, um, "shared"? How did that work out?

If, as might be the case, they don't seem to really understand it themselves, perhaps you could gently point that out to them?
posted by Methylviolet at 11:58 PM on August 23, 2006

This is intriging.
Maybe it is not a scam, but as the Christian Newsletter share program shows, and the state of Kentucky argues, it is completely unregulated, and there is nothing to prevent these outfits from scamming people.
posted by Methylviolet at 12:18 AM on August 24, 2006

Their phone number is 1-800-PSALM23.

Psalm 23 is the one that famously reads:
"Though I walk through the valley of the shadow of death, I will fear no evil"

That is not encouraging from someone involved in medical care. Get them actual health insurance.
posted by dendrite at 1:41 AM on August 24, 2006 [1 favorite]

Since there does not appear to be any clear statement of what assistance, if any, the program can be counted on to provide it seems safe to assume your parents cannot have been sold on the basis of this program's benefits; a remaining option is that this program's 'Christian' basis is what has appealed to them, and as there are no other apparent options it seems safe to conclude that they have bought into this program because it is 'Christian'.

As an irrational decision I doubt you will have much luck convincing your parents to drop it. If I were in your shoes I would first make a good-faith effort to get them to drop it, and, failing that, explictly tell them that you think they are willfully being scammed, and consequently they are hereby on their own, medically, should it prove to be a scam -- if they are typical boomers they will wind up trying to get you to bail them out after, child-like, they have squandered their reserves, and you will want to have given advance notice that they cannot turn to you for assistance if they continue with this foolishness.

Finally, you will want to consider and decide in advance how much assistance for what kinds of medical care you are willing to actually provide them should it come to that -- regardless of the above paragraph and what you say to them previously you may want to assist them in the future, and if that is the case it is better to be prepared.
posted by little miss manners at 2:37 AM on August 24, 2006

Attention – This program is not supported by an insurance company, nor is it offered through an insurance company. This program does not guarantee or promise that your medical bills will be published or assigned to others for payment. Whether anyone chooses to pay your bills is entirely voluntary.

This publication should never be considered a substitute for an insurance policy.
posted by sophist at 2:46 AM on August 24, 2006

Ah crap i posted too early... i also meant to link to this rather interesting Washington Post article on the organization. It is surprisingly positive.
posted by sophist at 2:53 AM on August 24, 2006

They need to meet with a credentialed insurance agent who can explain to them the difference between their current situation and how health insurance works. Like lay out a few scenarios: what happens if one of them goes on cholesterol-lowering medication, to what happens if one of them gets cancer. Maybe they think they can't get regular real health insurance? Do either of them have a pre-existing condition? Are they on a severely fixed income?
posted by FergieBelle at 5:01 AM on August 24, 2006

Mutual assistance plans are common among immigrants and others not fully integrated into mainstream America. For example, a family or group of friends may pool their funds, rather than use banks. Just because this is unfamiliar to us and unregulated by the state, it isn't necessarily a scam.
posted by Carol Anne at 5:42 AM on August 24, 2006

Could be a scam. On the other hand, normal insurance companies are already pretty close to being evil scams.
posted by fleacircus at 5:58 AM on August 24, 2006

I know people that use this. It's been around for years.
posted by konolia at 6:02 AM on August 24, 2006

From the health provider's perspective, these plans are undependable. As a courtesy to the patient we'll file a claim, but if it is denied there's really no recourse, since this is an unregulated entity. The most recent case I remember involved several weeks in the hospital and a bill of over $100K. The "plan" determined it was not a covered condition; a real insurance plan would have been legally required to cover it.

The plan's newsletters don't tell their members about the denied claims, but give plenty of examples of assistance they've provided, feeding members' faith in the plan. The WaPo article linked above by sophist and Methylviolet is good, and you can offer it to your father and his wife to read. But keep in mind that the people who participate in these plans are guided by faith, not facts.
posted by Snerd at 6:12 AM on August 24, 2006

Agree about the 'stinks to high heaven' part, totally. I could throw out dozens of things that are disgusting about this, but let's stick to answering the question.

One possible approach: the website lists monthly 'program options'. Why not compare what investing those amounts in a personal, non-shared savings account would get? Maybe sit them down with a professional finanical advisor? Investing the money properly could work towards having a guaranteed nest egg for emergencies.

Another question, that I don't know the answer to: whenever I go to the doctor, the first thing they ask for is my insurance card. They want that card and the number on it. Would this plan be accepted in the same way? Would it be accepted if they travel to another state or region?

Do either of them have a pre-existing condition?

One of the linked articles mentions that some of these plans do not cover pre-existing conditions.
posted by gimonca at 6:18 AM on August 24, 2006

I wish I could find a citation, but I've read that Christian scams are among the fastest growing, because the devout tend to have faith not only in God, but also in other self-proclaimed Christians. Even the lying ones.
posted by croutonsupafreak at 6:30 AM on August 24, 2006

This page on their site refers to "eligible need sharing" and states that they pay either 80% or 100% of "eligible needs" with this footnote:

Please note eligible need requirements in the Guidelines book.

...which naturally leads to the question, what's in the booklet?
posted by Robert Angelo at 10:37 AM on August 24, 2006

I just read that Washington Post article linked above; it really does raise a lot of concerns. I especially noticed that MediShare policy of dropping members who do not accept their appeals process or seek arbitration or redress in court.

Another question that occurred to me is what is the tax status of payments to the organization (are they charitable donations? probably not. insurance, if you are self-employed? probably not). And what is the tax status of payments you receive -- is it income? is it a gift? is it reportable?

Hmmm...
posted by Robert Angelo at 10:47 AM on August 24, 2006

Here are their guidelines.

Among other things, it would appear that smoking tobacco is an anti-Christian activity.
posted by dansdata at 3:35 PM on August 26, 2006