Questions to Ask If You’re Considering a HealthCare Sharing Ministry

With the Affordable Care Act (ACA) driving premiums on individual health plans out of reach for many families, we’re getting more inquiries on HealthCare Sharing Ministries. These are programs administered by religious affiliated organizations in which members agree to share healthcare costs, much like the mutual aid societies of earlier generations.  The growing interest in “med share” programs comes from that fact that monthly contributions are often significantly lower than premiums for health insurance.  And, members in some med share programs are exempt from ACA tax penalties levied by the IRS on the uninsured.

Because these plans aren’t insurance products, we won’t offer an opinion here on their merits. But as professional risk managers, we do want to offer some questions to ask when considering enrolling in one of these programs.  Specifically:

  1. Who’s in charge? What organization is offering this med share program? Does the website for the sponsoring organization list the names of the executive leadership and board members, provide bios outlining their qualifications, and give telephone, email and physical contact information?
  2. What happens to my money? Does the sponsoring organization publish professionally audited annual financials? When reviewing insurers, we always check to make certain a carrier has reserves that are sufficient to pay large claims.  How does the med share plan you’re considering prepare for catastrophic exposures?
  3. How are my medical bills paid? Med share programs do not guarantee payment to providers. Your shared monthly contribution is held in escrow and paid out to providers following a set of payment rules created and administered by the organization.  Are these rules and timelines for paying providers clearly defined and provided to potential members in writing?  Does the organization provide a consumer bill of rights, and a transparent process for resolving disputes?
  4. What does my doctor think about this program? Your providers may have never heard of a med share program. Will they refuse to provide services?  Do they consider a med share member uninsured and bill full retail cost for services?
  5. Do I have a “Plan B”? Keep in mind that an employer group health plan may prohibit you from enrolling outside of the annual open enrollment period. Similar gatekeeper enrollment rules hold true for ACA-compliant individual health plans, as well.  Leaving a med share plan once you’ve joined may pose a unique set of challenges.

Human nature has shown us that when we don’t know what to ask, we end up relying on the one question which we know has a clear answer; how much does it cost? We hope that the questions in this blog post will help to start a conversation that leads to a clear understanding of what you’re buying, and perhaps put the cost question at the back end of the discussion where it belongs.

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About Kevin Guss

Kevin J. Guss is a Consultant with our Private Client Benefit Services, specializing in providing individual health coverage (on and off-exchange), Medicare supplements, life, LTC and disability insurance to clients of J.W. Terrill and strategic partners. With more than 22 years of industry experience, Kevin counts many retired professional athletes, celebrities, business leaders and prominent members of the community among his clients. He has a Group Benefits Associate designation from the Wharton School of the University of Pennsylvania, a Past President of St Louis Association of Health Underwriters and a current board member of the MO Association of Health Underwriters.

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