Healthcare Ministries and Selfpay - Options

[ivinsfan]

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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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]

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]

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]

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]

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.

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]

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]

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]

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.

 

[ivinsfan]

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.

 

[Chris7]

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)

 

[homestead]

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.

 

[brewer12345]

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.

 

[Chris7]

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)

 

[ivinsfan]

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.

 

[zinger1457]

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?

 

[zinger1457]

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?

 

[Chris7]

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)

 

[brewer12345]

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.