Healthcare Ministries and Selfpay - Options

[ivinsfan]

Quote:

Originally Posted by zinger1457 Maybe the 'con' should be stated that there is no guarantee of payment to the member. A couple of the ministries that I've researched require the member to submit the medical bill and if approved send the check to the member. It doesn't seem like they ever get involved directly with the care provider except to maybe verify a bill. The way I understood it is the member pays the medical provider then waits for the payment from the ministry to come in. Probably not a big issue for typical office visits but what about a major medical event that can quickly approach $100K? One thing I never came across in my research are stories of members not receiving payment from a ministry for a valid medical claim. Has anyone come across anything different? Please share.

They will negotiate directly with the provider to get a discounted rate on your bill. The can't guarantee you a discounted rate, but say most people do get them. If you don't then in theory would pay everything up to your policy limits but limit is about 125K, frighteningly easy to run a bill much higher then that number.

You are correct they don't pay the provider directly they pay you. Because at the end of the day you are the responsible payment party not them.

[photoguy]

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Originally Posted by ivinsfan I will continue to pay for traditional insurance, but have more then a few friends that are getting desperate over the cost of insurance.

With subsidy HC premium should be capped at no more than 10% of income. Plus there are generous cost sharing subsidies to limit max OOP.

Perhaps a better strategy might be to help with budget and income management around the relevant thresholds? And also double checking that services are billed correctly

Or are they falling into the hole between Medicaid and the bottom of the subsidy limit?



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[RobbieB]

This stuff is for people who are so broke they can't afford insurance. They'll still go broke one way or the other.

[ivinsfan]

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Originally Posted by travelover Independent of the religious affiliation, I think it is fair to ask if one can depend on this coverage to keep one from going bankrupt if one has a major medical issue. Most of us here have a lot to lose. We wring our hands over annuity issuers who are for the most part backstopped by state governments, yet these don't seem to have reserves that an insurance company would be required to have.

In a word NO you can't count on not going broke, they have limits on all type of payments and IMO they aren't high enough.They don't claim to have reserves they work on cash flow.

[razztazz]

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Originally Posted by Dash man "Hope and pray, Mumbo jumbo" If you don't see that as insulting those who believe...I feel sorry for you. Enjoying life!

Take the religious aspect out of it. Could be organized by a bowling league. It's based on a "hope and pray" model. And did I read someone here is actually calling for "regulations"? Heaven forefend . Oh the humanity. A spoonful of sugar does indeed help the medicine go down

[ivinsfan]

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Originally Posted by photoguy With subsidy HC premium should be capped at no more than 10% of income. Plus there are generous cost sharing subsidies to limit max OOP. Perhaps a better strategy might be to help with budget and income management around the relevant thresholds? And also double checking that services are billed correctly Or are they falling into the hole between Medicaid and the bottom of the subsidy limit? Sent from my Nexus 5 using Early Retirement Forum mobile app

I agree with you,but 150 a month per family unit is a Heck of a lot cheaper then 10% of your income for HI. Remember the OOP comes in addition to the premium and can add up fast. Ironically adding the word Ministries to the company make it seems less risky to some of them.

[photoguy]

What family size and income level are they at?

When I put in a family of 4 at 40k I see enhanced silver plans starting at$139/month in covered California

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[foxfirev5]

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Originally Posted by LakeRat1 Current Situation: Me - Age - 54 DW - Age - 62 Florida Residents Income from Taxable Income (IRA & SS) - 110k Florida Blue - $1132 Per Month, with a $6800 Deductible Each Health Care is just so expensive, we are in pretty good health, normally go to the doc once or twice a year for prescription maintenance drugs - Asthma inhaler, arthritis, gerd, and high cholestrol...... We are looking at joining in with the Christian Healthcare Ministries, after reading some of the posts on this forum: Pros and Cons your thoughts please ?? Pros - Less Expensive - No penalty from the IRS Cons - No guarantee of payment to the care providers - Not and insurance program -?? You thoughts are greatly appreciated Are there others out there in our same situation, if so what are you doing ??

Have you ever watched American Greed? I love my church but would not go there for investments or health insurance. There are too many unknowns and with your income there's no need to get too aggressive. In either investments or expenses. Also, for the first time there are actually affordable options, not cheap but affordable for people with adequate income.

[ivinsfan]

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Originally Posted by photoguy What family size and income level are they at? When I put in a family of 4 at 40k I see enhanced silver plans starting at$139/month in covered California Sent from my Nexus 5 using Early Retirement Forum mobile app

I don't have that information, but some of them would be w-2 workers who have maybe bronze plans through work that dont exceed the 10% level...it might be 9% but the plan might come with a 6000 out of pocket they don't have the option to use the exchange but they could use this program and not pay a penalty for no insurance.So if you made the 40 you mentioned it could cost close to 4000 a year with huge OOP exposure. That's not 139 bucks a month.

Everyone can't go to the exchange for relief.

[zinger1457]

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Originally Posted by ivinsfan In a word NO you can't count on not going broke, they have limits on all type of payments and IMO they aren't high enough.They don't claim to have reserves they work on cash flow.

As I recall the ministries I researched had different levels or options that could increase the claim limit to $1M or more.

[pb4uski]

To be fair, the concept is not particularly new except it covers health insurance rather than life insurance... fraternal benefit/mutual aid societies have been around for over a century. However, at some point these mutual aid societies were required to be regulated like other insurers for the protection of the public.

The origins of a club that I have belonged to for over 25 years was as a mutual aid society for families of men who worked in the granite industry and, back in the day, regularly died of silicosis. When it had to become regulated it instead reverted to be a social club.

The concern would be that this health care cost mutual aid society, despite its good intentions, would collect a lot of money in premiums and not have sufficient resources to pay claims should it have a run of adverse claim experience. Unlike regulated insurers, these organization have no reserving or capital requirements and are not subject to state protection because they are not regulated. If one were to fail, in retrospect it might look like a Ponzi-scheme.

If you don't have a lot to lose and can't afford ACA health insurance, it is certainly better than going self pay, especially since it not only provides some unregulated protection but also avoids the penalty. IMO, if you have a lot to lose you could be wiped out if you happen to be a claimant just as the organization is running out of money. I have a lot to lose so to me the risk far outweighs the premium savings benefit. OTOH, if my net worth were small and I could not afford ACA health insurance, it might be a possibility.

Another alternative to consider that is frequently overlooked is buying catastrophic ACA coverage even if you are over 30 which you can do if the lowest cost bronze plan premiums exceed 8.15% of your household income.... however, catastrophic premiums are not significantly less than bronze plans in all states... in my state there is no age rating so catastrophic premiums are about 40% less than bronze premiums.

[brewer12345]

[QUOTE=pb4uski;1770277]To be fair, the concept is not particularly new except it covers health insurance rather than life insurance... fraternal benefit/mutual aid societies have been around for over a century. However, at some point these mutual aid societies were required to be regulated like other insurers for the protection of the public.

The origins of a club that I have belonged to for over 25 years was as a mutual aid society for families of men who worked in the granite industry and, back in the day, regularly died of silicosis. When it had to become regulated it instead reverted to be a social club.

The concern would be that this health care cost mutual aid society, despite its good intentions, would collect a lot of money in premiums and not have sufficient resources to pay claims should it have a run of adverse claim experience. Unlike regulated insurers, these organization have no reserving or capital requirements and are not subject to state protection because they are not regulated. If one were to fail, in retrospect it might look like a Ponzi-scheme.
[QUOTE]

Ding, ding, ding! We have a winnah! Those important words should be emblazoned a mile high:

PONZI SCHEME

There is no reason these religious affiliated plans should not be regulated as fraternals or mutuals. That is in effect what they want to be, minus the capital, reserves, oversight and, you know, ability to withstand a minor squall.

[pb4uski]

I was actually trying to soft-pedal a Ponzi comparison because I'm not totally sure it would be fair but it certainly might look that way with 20/20 hindsight if one of them were to fail spectacularly.

While I agree with you that they should be regulated just like fraternals and mutual aid societies because substantively that is what they are, I'm not quite as skeptical about them as you are.

[ivinsfan]

And one needs to remember these places aren't run for free and have people in charge who collect salaries..This is actually a concern to me as far as skimming.

[zinger1457]

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Originally Posted by brewer12345 There is no reason these religious affiliated plans should not be regulated as fraternals or mutuals. That is in effect what they want to be, minus the capital, reserves, oversight and, you know, ability to withstand a minor squall.

It's needed but I don't know of any business out there who's pleading for the gov to provide more oversight and regulations. Unfortunately those measures are usually added after the fact, when a business has been found guilty of wrong doing.

[meierlde]

Of course it should be noted that until recently most blue cross blue shield plans were mutual insurance organizations with no shareholders either. However they felt they could not attract the executive talent without paying more than a mutual insurer could pay so they changed into shareholder owned companies. It should be noted that State Farms parent company is State Farm Mutual, and once in a blue moon if you are a policyholder direct from the company you do get a dividend. Nationwide at least is also at the top of the legal pyramid a mutual company. (It started out as Farm Bureau Mutual btw). So the mutual model does work, but apparently not so much with healthcare given the coops that have failed in the ACA.

[photoguy]

Quote:

Originally Posted by ivinsfan I don't have that information, but some of them would be w-2 workers who have maybe bronze plans through work that dont exceed the 10% level...it might be 9% but the plan might come with a 6000 out of pocket they don't have the option to use the exchange but they could use this program and not pay a penalty for no insurance.So if you made the 40 you mentioned it could cost close to 4000 a year with huge OOP exposure. That's not 139 bucks a month. Everyone can't go to the exchange for relief.

I see. If they are not eligible for the subsidy on the exchange, can they use CHIP to cover their kids at least? In some states I think it goes as high as 300% of the FPL.

[LakeRat1]

Does not appear that anyone is utilizing this group for healthcare ......

[brucethebroker]

If your motive is to save money on your insurance payments, why not start a small business (from a hobby?) and write off the premiums for self and spouse? With your stated income, maybe a 20%-30% tax reduction? Lots of other "goodies": car and travel ded., SEP, etc.

Also, do you have an HSA, each? (If not, you may need to change plans to find one with an acceptable deductible.)

[travelover]

Quote:

Originally Posted by brewer12345 There is no reason these religious affiliated plans should not be regulated as fraternals or mutuals. That is in effect what they want to be, minus the capital, reserves, oversight and, you know, ability to withstand a minor squall.

As of late, the government has been very careful to back off once the word "ministry" is used. My neighbor runs a dance school out of her home. The township was going to shut her down until it suddenly became a "dance ministry". Now we live with all the extra traffic and parked cars on the street.