Not eligible for Medicare and beset by almost unaffordable healthcare premiums, I am considering something called a Healthcare Sharing Ministry. They make it a point to state that they are NOT healthcare insurance but act very much like it and offer a significantly lower cost. They refer to IRS 501 c (3) and are apparently acceptable under the Affordable Care Act.
Does anyone here KNOW anything about HSMs - pros and cons - and could offer any insights, preferably based on experience?
Since the OP is asking for advice, let’s move this to IMHO.
Colibri
General Questions Moderator
They aren’t kidding when they say they aren’t insurance. From what I can see, they don’t even really act like insurance except on the surface . You make a monthly payment to the fund , based on the number of members, the level of membership, possibly your health. Those funds are pooled and then sent to members who sharing requests have been approved. In some programs, you send your payments to a central office which disburses the funds and in others you are directed to send your payment to a particular member. They are not-contractually obligated to pay anything and are free to not cover conditions or treatments that do not align with the ministries’ beliefs - for example, pre-natal care for unmarried women. Although some have negotiated discounts with providers, there is no such thing as a “participating provider” and there aren’t standards like “We pay 80% of the customary fee after your meet your deductible of $1000” Instead, what they seem to do is use the money they took in in say December to pay the sharing requests received in December. From what I was able to figure out when I looked into them, there are two methods. One was that the ministry paid requests in full until the money ran out ( not sure if it was based on the amount of the bill or the date received) so that you either got the whole request covered or you got nothing. The other method was to figure out that the money received in December covered a certain percentage of the requests received in December (say 50%), then every request was covered at that percentage.
They aren’t quite insurance, and they aren’t quite charity - I guess the best way to describe them is a larger, more organized version of groups like the Amish who don’t believe in insurance but will all chip in when one of their group has high medical bills.
My BFF works for a small business; his health insurance is provided for him and his family at no cost to him, but they only pay claims for hospital admissions. :eek: NOTHING done outpatient is covered AT ALL. (I didn’t realize that was allowed under the ACA, but apparently it is.) He’s Catholic, and I gave him some information about this; IDK if he’s looked into it. He’s married and has 3 kids, two of them in college, and this can get expensive.
(How expensive? All of my breast cancer treatment, from the mammogram to the two lumpectomies, radiation, hormone therapy, etc., were done as an outpatient, and last time I checked, my insurance had paid about $56,000 for all of this treatment - and this after the insurance negotiations. Were this to happen to one of them, they’d be on the hook for all of it. :mad: )
Here’s how it works: You pay the bill, and then submit the bill to this share organization and get reimbursed. There are some things they won’t pay for, and because they are not officially insurance, they can decide to cover or not cover whatever they want. The most common things not covered are substance abuse treatment and elective abortions, although IMNSHO even if a woman having one of those is insured, she probably won’t put it on her insurance anyway. They also have caps, often as low as $100,000 but still, it would be better than nothing.
If you wish, you can also submit prayer requests. AFAIK, you do not have to pass any kind of religious test or prove church affiliation if you sign up.
The ones I looked at did require you to sign a statement of belief. The most liberal one was a simple statement that you believe in “a god.”
These plans are more like what used to be catastrophic care. As far as I’ve ever seen, pre-existing conditions are not covered by these plans. Minor issues that need prescriptions for maintenance, for example, are paid out-of-pocket. Ouch.
Remember that they are ministries and not businesses, so they have different rules and different plans. If you don’t like the rules, find something else and stop whining.
Since this is IMHO, I’ll throw out my NSHO: Don’t ask us, ask your health care provider(s).
About a decade ago, my wife started at a new job and one of her new colleagues offered her a “Supplemental Insurance” card right after she became a permanent employee. The colleague said it only cost her $10 to join, so she signed us both up and handed over a $20 bill. A couple months later, she went to her regularly-scheduled dental appointment and presented her card, saying, “My insurance will cover the regular billing and my coworker said this would cover my copay for the office visit.”
The team behind the front desk passed the card around and told her, “We’ve never heard of this company before and the phone number and web address go nowhere.”
We did not renew that particular “coverage.”
–G!