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Old 08-18-2016, 07:27 AM   #41
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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.
I don't know, to be clear a few people have mentioned this whenever the subject of health costs or money come up. Most of the time this isn't even a one on one conversation

Since I know nothing about these groups I'm simply educating myself. I might want to throw in a few cautionary statements.I'm not going to argue with them, ask them about their financial situation, or tell them about ACA rules and income. I just want them to do their own due diligence and not go blindly into something because it will save them money or has the word ministry connected to it. Wish me luck, sometimes it's hard to stand back when you think someone is making what could be a big mistake.
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Old 08-18-2016, 12:15 PM   #42
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Why use a health sharing company?

First, find me some credible evidence of claims not being paid. I looked and looked and looked. I did this research a few years ago and found one. And the facts weren't straightforward. From all that I have found, claims are paid.

Second, they are affordable. There are 4 companies (I believe) that actually qualify for the ACA exemption. I don't remember all of their names. For an individual, expect to pay $150 - $250/mo, $500 - $1000 deductible, $1MM lifetime coverage. That could be a problem and not all of them offer that high of an amount. This is for the one I went with.

As I noted, I will be able to give you some real feedback as far as claims go in very short fashion (few weeks) as our son had to have an MRI of his knee and seems he will be needing physical therapy. He is in college and very difficult to find a reasonable plan that will cover you in multiple states.

What I pay for my family's regular medical coverage. This is for me, my wife, and 3 dependents. Plan is a silver plan offered through my employer, a small company. Premiums are about $1,300/mo of which I pay about $800. My income is too high to qualify for any subsidies, although I'm not a big fan of those anyway, that would be another post. My deductible this year is $3,500, but it was $7,000 in years prior. Out-of-pocket maximum is $9,000 and it was $10,000 in years prior.

So I am paying $9600 a year for the right to pay a minimum of $3,500 more and to have a maximum cost of $9,000. (BTW the company pays a 3% tax on the entire cost of the plan so that is 3% x $1300 x 12 and comes to $468 for my policy. About another $3K for the entire company.

That is why if my premiums go up much further, I will be seriously looking at the health sharing option (assuming no hiccups with my son's expenses).

Others have noted the various subsidies and maybe even using CHIP or its equivalent. I am sorry, but my health care shouldn't be unaffordable so that you can get a low cost or free ride.

cd :O)
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Old 08-18-2016, 12:50 PM   #43
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My daughter's family (5) uses this company https://mychristiancare.org/medi-share/
Her husband recently had shoulder surgery and she had a baby.
I think they had to get preapproved for the surgery.
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Old 08-18-2016, 02:28 PM   #44
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There are 4 companies (I believe) that actually qualify for the ACA exemption. I don't remember all of their names. For an individual, expect to pay $150 - $250/mo, $500 - $1000 deductible, $1MM lifetime coverage. That could be a problem and not all of them offer that high of an amount. This is for the one I went with.

As I noted, I will be able to give you some real feedback as far as claims go in very short fashion (few weeks) as our son had to have an MRI of his knee and seems he will be needing physical therapy. He is in college and very difficult to find a reasonable plan that will cover you in multiple states.

What I pay for my family's regular medical coverage. This is for me, my wife, and 3 dependents. Plan is a silver plan offered through my employer, a small company. Premiums are about $1,300/mo of which I pay about $800. My income is too high to qualify for any subsidies, although I'm not a big fan of those anyway, that would be another post. My deductible this year is $3,500, but it was $7,000 in years prior. Out-of-pocket maximum is $9,000 and it was $10,000 in years prior.
Right here is why you should be very doubtful about the mumbo-jumbo option. Legitimate health insurers pay out at least 80% of every premium dollar they collect. In fact, if they have a loss ratio of less than 80% I believe PPACA requires them to send the insureds a check for the difference. It does not take a rocket scientist to figure out that if the true cost (across a group of policyholders) is 80% times $1300 (or $1040 per month), collecting no more than $250 a month to provide this coverage does not work.
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Old 08-18-2016, 02:38 PM   #45
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Right here is why you should be very doubtful about the mumbo-jumbo option. Legitimate health insurers pay out at least 80% of every premium dollar they collect. In fact, if they have a loss ratio of less than 80% I believe PPACA requires them to send the insureds a check for the difference. It does not take a rocket scientist to figure out that if the true cost (across a group of policyholders) is 80% times $1300 (or $1040 per month), collecting no more than $250 a month to provide this coverage does not work.
Well, all I can say is the 4 that are exempted have been around for quite some time. I can almost assuredly assume they don't have nearly the magnitude of overhead and they aren't having to make a bunch of stockholders (only members, much like a credit union) happy. Thus, the ability to not have to charge as much.

Like I said, I may in fact be signing a different tune as the bills and claims will be coming in short order. So we shall see.

cd :O)
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Old 08-18-2016, 02:45 PM   #46
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Right here is why you should be very doubtful about the mumbo-jumbo option. Legitimate health insurers pay out at least 80% of every premium dollar they collect. In fact, if they have a loss ratio of less than 80% I believe PPACA requires them to send the insureds a check for the difference. It does not take a rocket scientist to figure out that if the true cost (across a group of policyholders) is 80% times $1300 (or $1040 per month), collecting no more than $250 a month to provide this coverage does not work.
So this isn't apples to apples..there are many ACA mandated items they won't pay for including mental health care,fertility treatments,and things they are excluding on religious grounds so this is going to lower the cost.You need to say you don't drink and I think smoke, so if they find you do they won't pay your claims and so on.
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Old 08-18-2016, 02:55 PM   #47
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My daughter's family (5) uses this company https://mychristiancare.org/medi-share/
Her husband recently had shoulder surgery and she had a baby.
I think they had to get preapproved for the surgery.
Can you share more details about your daughters experience with the ministry like how long have they have been members, any issues receiving reimbursement, any unexpected problems/issues, overall satisfaction?
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Old 08-18-2016, 03:09 PM   #48
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Second, they are affordable. There are 4 companies (I believe) that actually qualify for the ACA exemption. I don't remember all of their names. For an individual, expect to pay $150 - $250/mo, $500 - $1000 deductible, $1MM lifetime coverage. That could be a problem and not all of them offer that high of an amount. This is for the one I went with.
As I understand it the deductible is by incident, not the total deductible for the year. It's possible your OOP could be a lot more than the deductible if you have a lot of incidents during the year that are less than the deductible. Is this correct?
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Old 08-18-2016, 03:35 PM   #49
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As I understand it the deductible is by incident, not the total deductible for the year. It's possible your OOP could be a lot more than the deductible if you have a lot of incidents during the year that are less than the deductible. Is this correct?
I don't believe so. I believe it is a per year, but I could be mistaken. I will go back and look over the details. If you are right, then yes, it could get quite expensive.

And yes, you do have to abide by their Statement-of-Faith. Some are more restrictive than others. For instance, some say no alcohol while others say no getting drunk.

cd :O)
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Old 08-18-2016, 03:40 PM   #50
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So this isn't apples to apples..there are many ACA mandated items they won't pay for including mental health care,fertility treatments,and things they are excluding on religious grounds so this is going to lower the cost.You need to say you don't drink and I think smoke, so if they find you do they won't pay your claims and so on.
Do you really think those things make it 75% less costly to cover healthcare expenses? I don't buy it.
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Old 08-18-2016, 03:43 PM   #51
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The deductible is per year:
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xxxx does not have deductibles or co-pays since we are a medical cost sharing ministry. However, There is an annual first dollar amount that members have agreed to not share together. We call it our Annual Unshared Amount. The Annual Unshared Amount accumulates throughout your membership year, and is $500 for a single, $1000 for a couple, and $1500 for a family. When your eligible medical expenses exceed the Annual Unshared Amount during the year, then sharing commences.
Phew. Had me scared there for a minute. So in theory, OOPM is quite low.

Another reason, I did stay with the regular medical for the family, is I have access to an HSA plan. So about $6,300 can be contributed and I don't have to pay federal taxes on that. California doesn't recognize HSAs so I do have to pay state taxes on that income.
cd :O)
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Old 08-18-2016, 04:03 PM   #52
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Do you really think those things make it 75% less costly to cover healthcare expenses? I don't buy it.
No I just said it wasn't a apples to apples comparison ..I'm not going to use the product.
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Old 08-18-2016, 04:13 PM   #53
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As I understand it the deductible is by incident, not the total deductible for the year. It's possible your OOP could be a lot more than the deductible if you have a lot of incidents during the year that are less than the deductible. Is this correct?
CHM Bronze, CHM Silver, and Samaritan are per incident. Liberty and MediShare use annual deductibles. CHM Gold is a combination of both ($500 annual deductible plus no reimbursement for incidents under $500).
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Old 08-18-2016, 04:25 PM   #54
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Can you share more details about your daughters experience with the ministry like how long have they have been members, any issues receiving reimbursement, any unexpected problems/issues, overall satisfaction?
Here is a quote about medishare from my daughter...
I've had it since 2012 and it has been a really good experience. They are easy to work with, cheaper than insurance, and provide just as good if not better coverage. There are some things they don't cover, like preventative care, chiropractic, naturopathic and I wish they did. But there's a lot of things that I'm glad they don't cover, like abortions, and they don't cover smokers. Their network is pretty big, but not everyone takes it.
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Old 08-18-2016, 05:05 PM   #55
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My roommate sells health insurance.. Here's what I recall him telling me...

1. He says that he is aware of claims being paid and hasn't heard of claims not being paid. He has had experience of insurance companies not paying claims and tells me he thinks your chances are better with Christian Sharing.

2. For some of the plans, you have to pay for an upgrade to get more than $x of coverage. This is recommended. I'd want $1m or more coverage so that something really bad can happen and I'd still be covered.

3. He doesn't make any commission on the above. He does try to sell a Critical Illness policy which pays a lump sum ($100K, $500K, etc) if you are diagnosed with something like cancer. That can be used to handle out of pocket, loss of wages, keeping bills paid while being laid up. He also sometimes sells an accident plan, especially for younger people, where he says they are more likely to get hurt. He does get commission on those.

4. Having Christian Sharing gets you out of the ACA tax for not having insurance.

As for me, I'm still paying over $400 a month for Anthem Blue Cross, but I am thinking about doing some variation on the above. I can pay cash for doctors and prescriptions for the typical year and it wouldn't come close to what I am paying in premiums.

YMMV and all DD highly recommended and reading all fine print. At some point you have to take it on "faith" that things will be covered. I'm not great at that and nor are some others in this thread. Nothing wrong with that. I'd also like to hear first hand from people who had big big bills paid by Christian Sharing.

Cheers!
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Old 08-18-2016, 05:27 PM   #56
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....2. For some of the plans, you have to pay for an upgrade to get more than $x of coverage. This is recommended. I'd want $1m or more coverage so that something really bad can happen and I'd still be covered....
If you buy and pay extra for this $1m of coverage and have a $1m claim, who stands ready to pay the $1m? What if there were a number of high dollar claims (aka adverse experience)? How much does the guarantor have in assets?

Is there a regulated entity backing that $1m of coverage to ensure that it will be paid?

I suspect that it is a promise by a large pool of individuals to pay if there are claims but if claims experience were really bad and each person got a large bill (for example, $5,000), would/could they pay?

If there were some sort of stop-loss coverage to cover claims (like large group plans that are ASO use) then that is a credible structure.
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Old 08-18-2016, 05:46 PM   #57
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If you buy and pay extra for this $1m of coverage and have a $1m claim, who stands ready to pay the $1m? What if there were a number of high dollar claims (aka adverse experience)? How much does the guarantor have in assets?

Is there a regulated entity backing that $1m of coverage to ensure that it will be paid?

I suspect that it is a promise by a large pool of individuals to pay if there are claims but if claims experience were really bad and each person got a large bill (for example, $5,000), would/could they pay?

If there were some sort of stop-loss coverage to cover claims (like large group plans that are ASO use) then that is a credible structure.
I agree with you, but.. that's insurance. The HS people make a big point of saying "this is not insurance." There's no one to stop someone suing them if there was no payment, but it's not like suing Anthem, where you know there is money to pay you once you, hopefully, win.

I think they'd say that $1m is very rare (true), and when that does happen, it's $200 divided among 5000 people. Also, a big part of what they say they do is to negotiate claims lower.

The monthly rate is supposed to be adjusted periodically and they juggle the # of claims, $ needed, $ coming from members etc. to make the math work.

The strength that they seem to have is "look, we have been doing it for x years and everything got shared and worked out OK too". I say "shared" because for some of these, you don't send your $ to the organization. Instead the organization tells you to send it to Mrs. Jones who had a claim this month..

Mark
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Old 08-18-2016, 06:39 PM   #58
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............I suspect that it is a promise by a large pool of individuals to pay if there are claims but if claims experience were really bad and each person got a large bill (for example, $5,000), would/could they pay?..........
I suspect it works until it doesn't. People were pretty happy with Bernie Madoff until they all tried to take out their money at once.
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Old 08-18-2016, 07:18 PM   #59
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Yup... it works until it doesn't... it might never fail to pay a claim... but when it does the last in line will be holding the bag.

I guess if you took an adverse claim scenario and divided it by the number of participants and the result was a sensible number then it might not be so bad... especially if you don't have a lot to lose.
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Old 08-19-2016, 06:51 AM   #60
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Yup... it works until it doesn't... it might never fail to pay a claim... but when it does the last in line will be holding the bag.

I guess if you took an adverse claim scenario and divided it by the number of participants and the result was a sensible number then it might not be so bad... especially if you don't have a lot to lose.
I'm thinking these health ministries must somehow avoid the very most expensive patients. The so called "20% who use 80% of the dollars". Not sure how it occurs, but that is the only logical explanation I can muster.
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