Some years ago when I arrived at a new pastorate, I was handed a health care “bill” by the financial secretary. She didn’t know what it was and left it to me to figure out. Seems my predecessor made some kind of arrangement with one of the lay members to enroll the member in a Christian health cost sharing deal. Thus, the church was “billed” for a contribution because some anonymous member of the sharing group, not the guy in my church, had surgery and we were supposed to pitch in on the bill.
That was my first exposure to a religious health cost sharing group. I ditched the bill. The layman, who was always seemed to have a list of reasons why his church should pay his bills, had moved on to another church anyway.
Here’s a Wall Street Journal story from June that I have been sitting on for a while.
As Sharing Health-Care Costs Takes Off, States Warn: It Isn’t Insurance
Religious organizations where members help pay each other’s medical bills have grown from niche insurance alternatives to operations bringing in hundreds of millions of dollars, an increase that is also driving more consumer complaints and state scrutiny.
More than a million people have joined the groups, known as health-care sharing ministries, up from an estimated 200,000 before the Affordable Care Act, which granted members an exemption from the law’s penalty for not having health insurance. The organizations generally provide a health-care cost-sharing arrangement among people with similar religious beliefs, and their cost is often far lower than full health insurance.
I know some people that do this health sharing. I never was comfortable with it. Seems to me the business model cannot possibly work on any large scale. Maybe Obamacare stymied this market but, according to the WSJ, the niche is growing. None of the people I know who are in this kind of non-insurance have complained about the system; so far, so good seems to be the word.
The idea of fellow Christians pooling their bills and resources and sharing them has an inherent appeal. I’m wary and am glad My health care costs are covered by the combination of public and private insurance. I’d hate to have a million dollar hospital bill and depend on what looks like largesse from unknown fellow Christians.
Money is still a root of all kinds of evil…and there’s a lot of money in this.
…so, someone educamate me on why I should not be wary. And what do my younger colleagues do for health insurance these days?
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There are predictable replies to the skepticism I’m expressing here. Let’s see how many I am guessing right on.
Commercial links embedded in comments to this will be deleted.
I get my insurance through my day job, a full-time endeavor at a local factory.
I am with you brother. Insurance is a contract and if you don’t have a signed contract you don’t have any insurance.
Not necessarily. Many CHM’s operates as an intermediary for the contract that members sign between one another, not the CHM. They referee to determine what claims are eligible for sharing from the escrow account where membership dues are deposited. Plus, they can be sued for things like impartiality or breach of contract, etc. If they don’t play fair they don’t get members. If they don’t get members, they won’t make money. Especially since most of them don’t market through insurance brokers- they rely on word-of-mouth referrals and some web advertising.
The love of money….
I used one of these for a few years. One reason I joined is that I needed something to cover my wife and me while we were still on the mission field. Once we got here I still needed at least catastrophic coverage, but I was also unemployed. Going on medicaid is a no-no when you are petitioning someone to become a US citizen–you sign something stating that you will not use any form of government assistance.
It was affordable and they did reimburse me for every medical expense that they were supposed to (including the expenses related to the birth of our son–they cover 100% of maternity expenses if you are a “gold” member).
The biggest disadvantage of it is you are basically dealing with hospitals, doctors, etc as if you are uninsured. Some doctors/hospitals don’t want to deal with self-pay patients. This also means the bills come directly to you. In many cases you can have such bills cut in half by negotiating and paying them outright. The problem for me was having to cash flow medical expenses. They usually took 3-4 months to pay them back, and having to cash flow medical bills for that long was not easy on my salary.
I switched to “Obamacare” this year because I knew we had more medical expenses coming and I just couldn’t keep paying upfront for them (even if I would get reimbursed).
Not every CHM operates on a reimbursement basis. The one I represent operates like a PPO. The membership cards have instructions for providers on how to submit the bill to the plan. But, that’s why I only represent that one company. There’s another one I’m looking into, though. They’re a bit of a newer player and they also work a lot like regular insurance.
I have been curious about that as well. Sounds good upfront but I don’t know anyone who does it. Would love to hear some responses from those who participate. Looks like we had one comment. I’ll stick with Guidestone for now.
I have never been comfortable with it either… but I have heard reports of how it has worked tremendously well for some people.
Not that I would dare to correct the venerable plotter… But you have done this in a couple of your post… I chalked it up originally to perhaps a typo… But you did it again here:
“Money is still a root of all kinds of evil…and there’s a lot of money in this.”
Actually it is the *love* of money that is the root of all sorts of evil… It is not money itself.
Well, I’ve got you, Stephen the Second, and Dave Brumbelow around to correct me, so why bother to get it right. 😉
Oh, lol! I didn’t see all that!
Sorry to pile on – albeit unintentionally.
Hey, I’m just glad to see you keep up with your important blog reading.
Tough day for the book of James, the Plodder misquotes him and David R shares what James would say today to be relevant for our times. You know others have thought it was “a right strawy epistle.”
On the other hand you are quite the raconteur. I guess 80 years of life experiences equip you with an arsenal of anecdotes.
By the time I’m 80, I’ll be absolutely insufferable with anecdotes.
My immediate family and I have been with a Christian sharing ministry for over 20 years. We are extremely satisfied and by the way they advertise themselves as an alternative to insurance. They tell me they are not insurance. When I quit UPS and became a full time pastor the only affordable healthcare was Medi-Share and I am thankful for them. They are not a scam.
Whether join a health cost sharing group or take out insurance with an established, reputable, and well-regulated insurance company you are in effect health cost sharing. The insurance companies charge enough to build a large reserve so that they are able to take from others to have enough to pay the bills that their policies cover and to cover a profit for themselves. Some people have shown that they have the expertise to by-pass the profit motivated insurance companies and deal directly with the need. They, in effect, are able to utilize the funds, the goodwill of their members, and the faith of their people to make it work.
The insurance companies depend of their people paying up each month. If there is a shortfall they will declare bankruptcy and the government would need to step up in some way to pay the bills. I have not experienced it in healthcare, but I have seen some companies that insure real estate go belly-up after a major catastrophe and people are left with nothing. Because of regulations and being required to have a large reserve fund, which was built up my charging their clients more than their bills, it is not likely that we would see a dramatic failure.
I have never been a member of a group, so I don’t say that I understand it that well. I went through a time when my commercial insurance went up so dramatically in cost that I could no longer afford it. I set up a special account with my bank and invested the previous premium each month. For four years we had no insurance, paid all the bills up front, and ended up with a fairly good cash balance on hand when we qualified for Medicare. I found most doctors and hospitals were understanding and would often allow us to pay less. After all, they had not billing expense and had no delay in receiving their funds. On hospital did not cooperate. In fact, they charged more than double the amount that the insurance had paid in the previous year for routine annual test.
I know of a number of people who are a member of these groups. I am told that their doctors, hospitals, etc., gladly welcome those served in this way. I claim no expertise, but this proves to be much cheaper, Those participating in these groups are not restricted by the percent of coverage that the ObamaCare and commercial companies place on their policies.
I don’t claim any expertise. These are observations. I am thankful for those with the expertise to make a way for people to be served more efficiently.
I wouldn’t put it quite this way but the issues are fairly easy to identify. Thanks for the observations.
For the love of money is a root of all kinds of evil, for which some have strayed from the faith in their greediness, and pierced themselves through with many sorrows. -Timothy 6:10 NKJV
David R. Brumbelow
A curmudgeonly note here. I don’t feel right about having any of these sharing ministries pushed or listed in comments. If they want to advertise here, check with Dave Miller for a special sharing deal. It’s sufficient to say that such a concept worked well for your or didn’t, no names or links please.
You can easily find these things. Read the WSJ article for one.
The WSJ article isn’t available to non-subscribers.
I am not a preacher, nor am I involved in one of those plans. But I did spend nearly 50 years in the insurance business, so there’s that ….
I would not touch one of those plans. The big problem, as I understand it, is lack of accountability. And there is a form of insurance company that is similar: It’s the Reciprocal Insurance Exchange, and when they are organized and supervised by the states’ Insurance Departments, their financial stability is pretty well guaranteed. Insurers are required to have enough reserves to in reserve to do that, and if they maintain sufficient reserves, they can issue non-assessable coverages.
I personally would not be involved with one of the exchanges you mention.
I appreciate your expertise in the area, Bob. Thanks for the comment.
We use one of these. We’ve never had to file on it yet because in each incident you pay the first five hundred out of pocket, then they reimburse the rest, up to 100 thousand or more, but above 100 thousand costs extra per month. Dave Ramsey supports it and says, “they’ve always been solvent and have always paid their bills.”
The huge potential downside is a morals clause, I.e. if your teenager decides to go out and drink and gets in a car wreck, they will not reimburse you. So far so good for us, and we haven’t had to ask the church to cover the enormous increase in our premiums each year.
We’re going generic on the names, Tony. I’m glad you have had good experiences. There are a lot of years up to MediCare age, a lot of stages in life. Stuff happens.
William, in the title you have “or illegal insurance,” but unless I misread, you said little or nothing about its legality. Is there some reason you suggest it might be illegal?
I am really unsure why he even wrote this article. There is nothing illegal about these sharing programs. People just need to research them before they buy in.
It’s probably an unrealistic expectation here but read the WSJ article. And caveat emptor to you too, but there is an expectation that government regulates this industry and consumers, to no one’s surprise, don’t research this stuff.
Read the WSJ article. I used “illegal” coupled with “insurance.” There are technicalities involved and things vary by state. A couple of examples are given where state insurance regulators took steps to shut down some of these that weren’t considered “legitimate health sharing organizations.” One could see where in a lax regulatory environment this could be a great risk to consumers. Church folks are some of the easiest marks in the world for some scheme that traffics on the label and language of Christians and churches. Consider my title provocative, not accusatory towards all of this health care niche.
Thanks. It appears that you have to have a subscription to read the WSJ article.
BTW, I am not surprised that unscrupulous persons have figured out how to use the idea to scam people.
I know you don’t want names, but here is a very recent filing by the Texas Department of Insurance against Aleria. Some of these companies pay up to 40% in commission ( most health insurance companies pay less than 5%), leaving very little to pay claims with, when the company goes under there is no protection for the policyholders
https://www.tdi.texas.gov/news/2019/tdi05172019-faq.html
Here is an article from the Houston Chronicle on Aleria
https://www.houstonchronicle.com/business/article/Complaints-against-faith-based-health-share-14089868.php?utm_campaign=CMS+Sharing+Tools+%28Premium%29&utm_source=facebook.com&utm_medium=referral
I am a full time pastor and I requested the church drop my insurance with GuideStone and just give me a raise so I could be part of a health sharing organization. It saved the church 50% in health insurance premiums and saved me several thousand dollars a year in out of pocket expenses. I love the organization I am with and have zero desire to go back to health insurance. I pay significantly less out of pocket and every penny has been paid. Numerous families in our church are with the same organization, and I have never heard the slightest complaint. I whole heatedly recommend it.
I’ll admit that I am not overly familiar with the national cost-sharing programs, thought I have known a few friends who use it, and have good things to say. So that, here are my questions to question your skepticism:
1. You said you can’t see how it could work on a large-scale. Is t that the ONLY way it could work? (Different than your local-church example).
2. How different is it, really, than a for-profit insurance company? Is it not simply a non-profit insurance company? Is not regular insurance ALSO a form of cost-sharing?
3. As for relying on the generosity of other Christians, perhaps I misunderstand how these national programs work…are large expenses not simply covered by the “premiums” (they don’t call them that) of the participants?
I have it. I hate it. The only reason I have it is because the elders and the congregation voted on using this as the healthcare for the pastoral staff and non-ministry full time staff. They take forever to send in money to pay for your bills. This can leave you in a serious bind because the hospital expects money to start coming in and so you’re left to pay it out of pocket and waiting anywhere from 4-7 months for the reimbursement money to come in.
If the hospital is owned by a for-profit company, chances are pretty good they’re not going to do anything for you until you either pay the bill up front, or put up a sizeable deposit. Most hospitals are aware of the existence of these kinds of plans and are willing to work with you if the plan is reputable. But if the expenses are big, the reimbursements can be painfully slow. And it won’t be worth the cost to you if you have a pre-existing condition, like diabetes or a history of cancer because there is a long list of costs for problems they won’t cover. I can see where you might save a little bit of money, not a lot, over insurance if you don’t have a pre-existing condition and your medical issues are routine. But a good HMO from a non-profit provider connected to a not-for-profit hospital system will save you money in the long run over a share plan. And you don’t have to worry about what they will and won’t cover.
To bad the author of this article did not even mention the prayer aspect of the Christian medical sharing programs. If only this article were well researched instead of what appears to be just opinion. Where’s your background? Oh yeah… you once received some vague bill, from a vaguely mentioned entity, dealing with someone who didn’t even attend your church.
I have been blessed through being a member of one of these Christian Medical Sharing programs.
I do know that they have high standards and that your shared monthly amount does not go towards some procedure that is contrary to scripture!
You cannot say that about medical insurance!
How many Christians with medical insurance have co-funded abortion!
Members of the medical sharing programs are asked and encouraged to pray for each other.
I believe in prayer and it’s power to help and heal! Do you?
Or are you trusting in the state funded government to provide for you?
Another benefit is that it removes the profiteering from your misfortune. Insurance companies are designed to make money… from your sickness.
As a member we negotiated for a cash payment with the doctor and would often get a greatly reduced rate over what they charge insurance.
As stewards of the Lords resources, we would make better choices of our health and medical facilities. I truly believe that Christians take less risks and make wiser choices in life. I know that is my opinion, but it appears to be a good stereotype.
My wife and I had three children born while using the medical sharing program. 2 were emergency c-section. EVERYTHING was covered. How much would your Insurance co-pay have been?
How many people have a favorable opinion of health insurance? Probably less than half. I wouldn’t write an article to defend that…
We are called to take care of one another… and I trust my Christian brothers to do that.
Quite a lecture. Most of us don’t need to pay a company to be the recipient of prayers. Take your complaints up with the wsj. I thought it was an interesting article.
William, Thanks for addressing this topic. It’s unfortunate that the WSJ article refers to these as illegal plans. They are alternative plans, and they are legal for what they do. We have some pastors in Montana who use them and are pleased with them. I’m impressed that they work, too, but they do. There are some problems with them, though. One is that they still use pre-existing conditions exceptions. The ones I’ve seen exempt coverage for as much as three years for pre-existing conditions. The other challenge that concerns me has been raised here already. The cash flow issue is a big concern. People in these plans have to spend their own funds and then wait to get reimbursed. I haven’t had anyone say they haven’t eventually recovered their expenses, but it can be hard. The Montana Convention has created a pastor emergency fund to help pastors with emergency expenses. I’ve tapped those funds on a couple occasions since I’ve been here to help our guys through those first couple of months while they wait for money to start coming in. While these plans aren’t perfect, they are a whole lot better than having no insurance. Every pastor should take a look at them before they decide to go without insurance. Barrett
These plans might be good for healthy families but they do not cover people with pre existing conditions and have little of no coverage for prescriptions. Having a huge base of healthy people on the plans is why people can afford them. By law it can not be called insurance.
I have been part of a health sharing plan for many years. I can’t imagine going back to regular insurance, its just so expensive in comparison. Im not sure what it is now, but many years ago when I was shopping around, Guidestone cost double what my sharing plan did.
Within a few months, I see my wife and I getting on one of these plans. I have looked a little but full research will begin early October. Unless a windfall comes and I can pay out of pocket and not worry about insurance, this looks like a good option. Finding the right one is probably key. I’ll check to see which ones DR refers and go from there.
I will only have a few options
1 – No Insurance – I can afford these premiums but the deductible is 100%
2 – Full Insurance – Not really an option – can’t afford
3 – Shared plan – Will still be pricey until I find a job but best buy for where I am at.
4 – Just say I am not sick – Played that song a few times and it cost me more in the long run.
We use one of these because my employer-offered insurance is unaffordable. I think it does work on a large scale; a million people is pretty large. I imagine there are legal protections involved preventing such from withholding care for a medical event covered in their policy.
If you are in one of the cost sharing programs, even if you are sure your company will not pay, always give them your cost sharing (or insurance) card.
Let them do the checking.
You may be surprised at your bill being significantly reduced.
David R. Brumbelow
I am part of a med-sharing group. It does not promote itself as insurance, but I have found the coverage to be better than any insurance plan I have been part of in the past – partly due to the fact I could not afford the higher premiums required for a lower deductible.. No through the roof premiums and deductibles on my group share plan.. I recently had a fairly expensive surgery in which two related shots were almost $6,000 alone. I was reimbursed 100% for the entire surgery bill including physical therapy.
I am not speaking for or against insurance versus group share – just sharing my own experience in which everything has been handled in a most professional and honorable manner.
The downside is it does not pay up front, rather it reimburses you.
Most of the plans work well, if you’re relatively healthy and don’t have pre-existing conditions, seek medical care from not-for-profit providers who are willing to be more flexible negotiating costs and if you have a big enough cash flow to pay out of pocket and wait up to 90 days for reimbursement. If the plan is slow to pay or there’s a discussion and decision to be made about what they’ll pay you can get unexpectedly stuck with the bill. My pastor was on one and it worked for he and his wife until he had colon cancer. Then the bills mounted and the reimbursements came slowly along with an increasing number of uncovered expenses. He needed a complicated surgery that required the knowledge and skill of a transplant surgeon and the facilities of a first class hospital and he wouldn’t have been able to access that on the share plan. Fortunately, the church secured group health insurance and he was able to have the surgery.
I’ve looked into a share plan, but with diabetes, and a history of colon cancer, I’d wind up paying significantly more in expenses than my insurance premiums and copays cost on my HMO plan, and I don’t have the cash flow to pay up front costs for tests and procedures that can easily run into tens of thousands of dollars. Like most things, there is a segment of the population for which something like this may work for a period of time, but it is complicated.
The difference in costs that hospitals and medical providers can give depending on whether you are insured or self-paying is a clear sign that we need comprehensive health care reform that’s for sure.
It seems to me that you could have written. almost the same article if you had taken out Christian Medical cost sharing an inserted Home Schooling. A lot of media types might have cast that as the same kind of “illegal” education. Perhaps other issues might be as flexibly substituted.
With that said. you asked a questions about experience and wariness.
My experience is not personal but I have several friends who use a medical cost sharing plan and have been delighted. Their experience has been great… frankly better than mine with traditional, regulated, inspected and approved conventional insurance.
As for being wary…I might substitute wise for wary. I have never been able to sign up for the cost sharing plans because they are not a contact to pay. However much I don’t like our current system of insurance, there is still a contact to pay which I could enforce if push came to shove. Anyone who signs up for any plan should investigate how satisfied other consumers have been with the system and for how long. Not to do so is foolish.
Brother William, I have been with one of these plans since 1994 and have never had one problem. Gall Bladdet in 98, broke leg in two places in 2001, my children, and my wife’s surgery, and my son had serious surgery costing thousand of dollars and they have always pay! Great partnership!
I average les than $1000 a year in medical expenses. I can pay (family rate) $1000 plus per month for health insurance with a high deductible. Got in to a sharing program for $300ish per month. No preventive care coverage, but a local urgent care does physicals with blood/urine work for about 250-300, whereas my former primary care physician charged $450 for physical and $270 for tests. So if you don’t have chronic issues, it’s a savings. It does take 4 months to get reimbursed, but in my case it is more affordable/better stewardship. I’m not thrilled with it but it works so far.
I’m in the business of health insurance and Medicare Health Plans. I’m certified to enroll in the Federal Marketplace and I represent a Health-Sharing Ministry. There were a few I looked into, but I landed on one as most of them don’t go directly through brokers for marketing. I have more clients on the CHM than I do in the Marketplace. The only issues I’ve had are administrative ones that were a product of unforeseen, massive enrollment requests as a consequence of several carriers abandoning the Marketplace in a relatively short period of time. They are clear about what is and what isn’t covered and the plan designs are pretty straight forward. Plus, they cost a fraction in premiums compared to unsibsidized marketplace plans and the coverage is far superior. They are simplified issue plans, so they do ask some health questions. But I have several diabetic clients on the plan’s because it’s way cheaper to pay out of pocket for their diabetic supplies and still have coverage for everything else than it is to pay high premiums for high-deductible plans. Even my clients that qualify for $0-premium plans aren’t benefiting because the deductibles start at $6,800 in my region with next to no cost sharing before it’s met. If someone has low enough income to not have to pay much for their plan, a $6,800 deductible is useless insurance. Even the Silver plans that have a 2k-3k deductible aren’t much good for them.
The CHM I work with is nice because it works like a PPO in terms of networks. If a doctor isn’t in their network, they will still share the cost at and reimburse the doctor whatever Medicare does for office visits for the year plus 25%. Plus, since they bypass the enormous administration costs that come with negotiating prices with carriers by not actually contracting with any providers at all, members typically get the cash discount. Cash discounts can be as high as 70-80%. That doesn’t mean you pay cash and get reimbursed (though many CHM’s work like that), it simply means they give you the same discount they give cash payers since it’s a lot less work for the provider’s office.
Technically and legally speaking, the CHM I represent is only a third-party entity that determines what is eligible for sharing according to the membership agreement. The membership agreement is a legal contract members have with one another, not with the CHM entity, allowing the CHM to act as a fiduciary referee.
I’ve seen it help my clients time after time. They definitely are not for everyone, but for those that enroll, it works well. In fact, when my wife leaves her job and loses her health coverage, I’m going to enroll her in the plan. I enrolled my uncle in it (who is also in the business- we’re a family brokerage) for a couple years before he was Medicare-eligible.