Open enrollment has begun and we are rolling out our third recommendation as an option to consider for covering your medical costs in 2018. Health Care Sharing Programs have been around since the early 1990’s, but have rapidly grown since the introduction of the ACA and the tax penalties for not enrolling in health care that came with the law.
If individual or group health plans don’t provide the type of coverage your clients are seeking, health care sharing programs are a great option to look into. These groups are usually faith-based and are not considered insurance coverage, but they still provide a way to cover medical expenses. While it’s not for everyone, many people have greatly benefitted from programs like these. Below is a thorough explanation of what they are and how they can help.
What Are Faith-Based Health Care Sharing Programs?
These programs consist of people who are like-minded in their faith or morals. Everyone in the group agrees to join together in paying each other’s medical expenses.
Since these groups are not considered true insurance plans, people in them are not limited to the rules of typical insurance plans. This means that people in faith-based plans can see any doctor no matter what network the doctor is a part of.
Additionally, these health care sharing ministries are exempt from the requirements of the ACA mandate to purchase health insurance. These plans are exempt from the ACA penalty.
How Do Faith-Based Health Care Sharing Programs Work?
These programs work in a very similar fashion to that of employer-provided, or group, health plans. When someone enrolls, they receive a membership card, which is presented when asked for insurance cards. Consumers pay a certain monthly share (like monthly premiums) to cover their annual personal responsibility. Then, the rest of the expenses are shared among the group from their “premiums” to cover all medical expenses and injuries.
They are also similar to group plans in that people who enroll in these programs are responsible for meeting a deductible each year, which are typically much smaller than mainstream health insurance deductibles. After meeting the deductible, 100% of medical costs are covered.
These plans are different from typical health care plans in that they can decline membership or refuse to pay for certain procedures or services since they are faith-based.
What happens if a doctor refuses to accept their membership of faith-based coverage? These health care sharing plans pay in cash, so if the consumer chooses to pay out-of-pocket, they will be reimbursed.
Pros and Cons of Faith-Based Health Care Sharing Programs
Advantages of health care sharing programs are that:
- People in these groups are generally like-minded, come from the same faith background etc, so trust is more innate
- These plans are typically much cheaper in the long run than traditional plans
- Consumers can see any doctor, anywhere, no matter what network the doctor is in
- Consumers can join these groups at any time throughout the year, whereas open enrollment has a hard start and end date
Disadvantages of health care sharing programs include:
- Waiting periods for pre-existing conditions
- Limited prescription drug benefits
- Membership could potentially be rejected because it isn’t considered true health insurance
If you or your client is interested in health care sharing programs, take the next step by calling Jude Thompson Jr, Business Development at 800-960-1371 ext. 1224 for more information on this option.