Healthcare Coverage… another Option

Love it or hate it, the Affordable Care Act has created a conundrum for some families and individuals.  While many will be eligible for subsidies from the government to help pay for premiums, there is a sizable cohort who earn too much income to get much assistance, yet aren’t wealthy by any stretch of the imagination. And if they do obtain coverage through either an employer or the marketplace, both the share of premium required of the employee and out-of-pocket costs (like deductibles and copays) have increased dramatically over the past 15 years. And boy… now in 2016, premiums and deductibles have gotten REALLY expensive in many states.

Many believe that they are stuck with the following choices:

• Buy expensive insurance, or
• Go uninsured – risky and results in penalties

But what if I told you that expensive insurance or paying the penalty were not your only options?

There is another option available that isn’t widely advertised by the insurance companies or the government.  What if I told you that this option is totally legit, and has actually been around for a couple decades?

Healthcare sharing ministries like Christian Healthcare Ministries and Samaritan Ministries offer a faith-based alternative to insurance. That’s right – they aren’t technically insurance products.  Instead, groups of individuals band together and share costs.  Everyone makes a relatively low monthly sharing contribution, and all of your costs above a certain dollar amount for those in need of medical care are shared among the members.

I only learned about these programs when I had begun to consider leaving my current job to become self-employed with Lauren.  Naturally, one of the biggest sources of apprehension in leaving my job was the loss of health insurance.  It was a seriously scary thought. But one of Lauren’s blogging friends Rachel mentioned that their family has participated in Samaritans Ministries for years and was very pleased. I was intrigued.

But I was skeptical – if this wasn’t an insurance plan, then how would this satisfy the individual mandate?  Wouldn’t I still have to pay the penalty for not purchasing health insurance?  At this time, I worked as a health care actuary, and am well versed in the mechanics of the ACA having read the law, all regulations, and presented to numerous clients about the law’s impact on them and their employees.  So I was VERY surprised to learn that being a member of a religious sharing ministry is a valid exemption from the individual mandate penalties.

And how does the “plan” work?  If we look at Christian Health Ministries as an example, there are several tiers that you can participate in.  But in contrast to typical health insurance plans, there are no copays or coinsurance, but there is sort of a “deductible”.  Each tier in the sharing program has an out-of-pocket cost for each incident or illness (varies by tier) and then 100% of the remainder of costs is shared among them members – and nothing else is required from the participant.  For the Silver tier, this out-of-pocket cost per incident is $1,000… which means that the participant would be on the hook for most doctor visits. But at a total monthly cost of $85.00, it can be a great deal if you are relatively healthy.

I recently had to use this when I had a health scare a few months ago… and yup, they covered just like they said they would. Not only that, they were SUPER helpful. I called them numerous times to make sure I was submitting my bills correctly, and an actual person answered the phone every single time and immediately helped me. VERY impressive.

When’s the last time you got that service from an insurance company? Or the government?

As for our kids (who go to the doctor more frequently) – we have purchased a more traditional health insurance plan.

Keep in mind that religious sharing ministries are faith-based, and may have certain requirements on lifestyle (like smoking) and might not cover everything that a typical insurance plan would.  So if your belief system doesn’t line up with theirs, then it probably isn’t the right fit.

For many, including my family, it has truly been a great solution.