As healthcare costs rise, health care sharing ministries (HCSMs) are getting a lot of attention—not all of it good—as an alternative to traditional health insurance. Open to people who share religious or ethical beliefs, they aren’t insurance companies. Rather, they seek to help members share and reduce healthcare costs.?
- Health care sharing ministries (HCSMs) are cost-sharing organizations, not insurance companies, and are intended to help cut medical costs for members.
- Membership is open to people who share religious or ethical beliefs, typically Christian.
- HCSMs are controversial: They aren’t required to cover or pay medical care costs or to follow Affordable Care Act (ACA) mandates.
How Health Care Sharing Ministries Work
Health care sharing ministries (HCSMs) are membership groups whose members share religious or ethical beliefs and pay monthly dues that are, in turn, used to pay the medical costs for other members. Essentially, members make monthly payments similar to premiums, and those funds are used to pay medical expenses for others in the ministry.?
Health Care Sharing Ministries vs. Traditional Health Insurance
On the surface, HCSMs may look like insurers. Members pay monthly for coverage, must meet a predetermined amount before receiving benefits, and may be required to see in-network medical providers. HCSM members may also receive assistance paying for medical expenses. However, key differences exist that should be understood and considered before choosing this option.
Unlike health insurers, HCSMs aren’t legally bound to pay claims according to terms to which parties have agreed to follow. HCSMs don’t have to follow the same coverage requirements as Affordable Care Act (ACA)-compliant health plans. Because HCSMs aren’t providing insurance, they don’t have to comply with ACA mandates. For instance, they don’t have to cover preexisting conditions, preventive care, reproductive care such as birth control, or services for substance use disorders.
HCSMs can require members to follow specific lifestyle requirements to receive assistance with medical costs
For instance, you must not use tobacco and must limit alcohol intake and engage in sexual relations only with your spouse (as defined by the HCSM). In addition, you may be prohibited from participating in high-risk activities such as rock climbing, skydiving, and bungee jumping.
HCSMs aren’t regulated by state insurance agencies or federal entities
Because oversight of HCSMs doesn’t exist, members are unable to turn to their state insurance commissioner if they have a dispute over an unpaid medical bill. However, some HCSMs have appeals processes in place if a medical expense is denied for payment (or sharing).
Benefits of Health Care Sharing Ministries
Although HCSMs aren’t insurance companies and don’t provide the same coverage as traditional medical insurance, they may have advantages for some people.
Monthly HCSM payments may be lower than traditional medical insurance premiums
Because you’re not paying for traditional medical insurance—which requires coverage for things like preventive care, preexisting conditions and reproductive care—a monthly HCSM payment (or share amount) is usually less than a monthly insurance premium. Still, under the ACA, many families qualify for healthcare subsidies.
HCSMs don’t have individual and/or family deductibles
Traditional health insurance plans include a deductible that must be paid out of pocket before medical benefits are paid out. With an HCSM, you pay what’s called an annual unshared amount. This is the out-of-pocket amount that you agree to pay for eligible medical expenses before your medical bills are “shared” for payment.
The annual unshared amount, which resets each year, is typically lower than a traditional health plan deductible. For instance, with Solidarity HealthShare, the annual unshared amount is $750 for an individual, $1,500 for a couple, and $2,500 for a family.
Members might receive assistance on medical bills even if they aren’t?eligible for premium subsidies through the ACA Marketplace
Although you still would need to pay for your own preventive care plus your annual unshared amount, you might receive assistance from an HCSM to cover any major medical expenses due to illness or injury.
Example of Health Care Sharing Ministries
As of 2021 107 HCSMs have been certified by the U.S. Department of Health and Human Services. One example is Medi-Share, which is a nonprofit HCSM of Christian Care Ministry Inc. If you are a member with a $3,000 annual household portion (AHP), or annual unshared amount, you would pay your medical bills out of pocket until you reach $3,000. That’s when your benefit kicks in.
It’s important to note that only eligible medical bills as defined by the HCSM apply to the AHP. For instance, if you see your doctor for preventive care, that bill doesn’t count against your AHP. However, if you get sick and see your doctor, that bill is eligible and would apply to your AHP amount. Once you meet your AHP, all eligible medical bills are submitted for sharing and payment.
Another example is Solidarity HealthShare, which covers some preventive care. Like Medi-Share, you pay an annual unshared amount before eligible medical expenses are shared for payment. However, one wellness exam per year is eligible for sharing, which might include certain screening labs (such as hemoglobin A1c or lipids) and services such as mammograms and colonoscopies.
What are health care sharing ministries (HCSMs)?
Health care sharing ministries (HCSMs) are groups whose members share religious or ethical beliefs and contribute a monthly amount that is, in turn, used to pay for the medical costs of other members. They aren’t insurance companies and don’t provide health insurance in any form.
What are the pros and cons of HCSMs?
HCSMs may provide an affordable way to receive assistance with paying your medical bills. Typically, the monthly share amount as well as the annual unshared amount (similar to a deductible) are less than the premiums and deductibles of traditional health insurance coverage. Because HCSMs aren’t providing insurance, they don’t have to comply with Affordable Care Act (ACA) mandates. For instance, they don’t have to cover preexisting conditions, preventive care, reproductive care such as birth control, or services for substance use disorders.
How much do HCSMs cost?
The amount that you pay to join an HCSM program or plan depends on your household size, age, marital status, where you live, annual unshared amount, and the program or plan that you join. Typically, the costs are lower than those for traditional health insurance, although for the lower price, members probably won’t be covered for everything paid for by traditional insurance.
The Bottom Line
If you are considering an HCSM, it’s important to shop around to see which medical services are covered and which aren’t, what your annual unshared amount would be, and how much the HCSM charges for administrative, application, program, and other fees. In addition, you should review the HCSM’s membership requirements to see if these are terms to which you are willing to agree to join. Failure to adhere to these terms could result in a denied application or membership cancellation.