Healthcare Ministries and Selfpay - Options

[Chris7]

The deductible is per year:

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)

 

[ivinsfan]

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.

 

[MBSC]

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).

 

[homestead]

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.

 

[makd]

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!

 

[pb4uski]

....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.

 

[makd]

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

 

[travelover]

............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.

 

[pb4uski]

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.

 

[travelover]

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.

 

[ivinsfan]

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.

It might be self-selection, if you have ongoing expensive medical issues it stands to reason that you might be more worried about having to pay your own bills.

If you consider yourself to be healthy and think it would be a freak occurrence for you to have large claims you might be more willing to throw the dice. After all you only have to stick with this for 12 months at a time.

 

[makd]

Also, they exclude pre-existing conditions which should get lower cost patients. Some of the following from Liberty Health Share's website could lead to a lower cost patient:

• Share one another's burdens
• Believe that our body is a temple
• Do not use tobacco products
• Do not drink alcohol in excess
• Eat foods that nourish your body not harm it
• Exercise regularly
• Worship regularly with others

With the way Obamacare is going (higher cost, poor doctor selection), these things must be growing like crazy. I'd suspect that given another year or two, we should be seeing failures and complaints if we're going to see them. If we're not, then maybe it'll be worth taking a chance.


I'm paying $400 now for worse coverage than cost $150 a few years ago, so maybe it IS possible...

 

[travelover]

Worship regularly with others

I wonder how they enforce this. Do you have to pay for your own chemotherapy if someone rats you out for missing a Sunday?

 

[ivinsfan]

I wonder how they enforce this. Do you have to pay for your own chemotherapy if someone rats you out for missing a Sunday?

The answer is you just show you have an active church membership and have a pastor or deacon verify the information.

 

[razztazz]

The answer is you just show you have an active church membership and have a pastor or deacon verify the information.

This would lead to some pretty heavy extortion material

Just like evil insurance companies. Your well-being and finances are dependant on what somebody else thinks of you. All the money you've been paying... be damned

 

[ivinsfan]

This would lead to some pretty heavy extortion material

Just like evil insurance companies. Your well-being and finances are dependant on what somebody else thinks of you. All the money you've been paying... be damned

Honestly, I think it's just a formality and might be what they need to do to get an ACA exemption/approval on religious grounds.But it is a bit murky...it's how they can exclude covering certain procedures on religious grounds.

 

[pb4uski]

Also, they exclude pre-existing conditions which should get lower cost patients. Some of the following from Liberty Health Share's website could lead to a lower cost patient:

• Share one another's burdens
• Believe that our body is a temple
• Do not use tobacco products
• Do not drink alcohol in excess
• Eat foods that nourish your body not harm it
• Exercise regularly
• Worship regularly with others

With the way Obamacare is going (higher cost, poor doctor selection), these things must be growing like crazy. I'd suspect that given another year or two, we should be seeing failures and complaints if we're going to see them. If we're not, then maybe it'll be worth taking a chance.


I'm paying $400 now for worse coverage than cost $150 a few years ago, so maybe it IS possible...

I'm assuming that pre-existing conditions are self reported on the application... but I wonder if they ever verify what is reported. They probably do get much better selection than taking all comers by excluding smokers, heavy drinkers, etc.

 

[Chris7]

The answer is you just show you have an active church membership and have a pastor or deacon verify the information.

For LibertyShare my kids had to sign an agreement to abide to the conditions. Also, had to send in a medical history. Did not need a letter from the pastor. Your word is your bond kind of thing.

I think LibertyShare may be the least restrictive and best at eventually covering pre-existing conditions (fully after 3-years). As a result, I suspect they have a larger membership base.

ACA won't fail, they'll just keep raising your taxes into oblivion to pay for it.

We'll see if the health sharing plans survive better. If not maybe you can sue the Gov't. They are the ones who gave them an exception in the law. Too bad they didn't read the thing before passing it.

cd :O)

 

[travelover]

This would lead to some pretty heavy extortion material

Just like evil insurance companies. Your well-being and finances are dependent on what somebody else thinks of you. All the money you've been paying... be damned

I agree, you could be at risk for not being religious enough, whatever that really means.

 

[razztazz]

ACA won't fail, they'll just keep raising your taxes into oblivion to pay for it

Hey man gotta pay them market rates.

 

[travelover]

........ If not maybe you can sue the Gov't. They are the ones who gave them an exception in the law. Too bad they didn't read the thing before passing it.

This isn't true, but don't let that stop you from trying to politicize it.

 

[ivinsfan]

Oh no now we are talking religion and politics, I hear the clock ticking on this thread.

I think I've learned what I wanted to from it, no known failures, but not a guarantee of payment.

I'll tell my friends, enter at your own risk and be sure you know what isn't covered before you send in your money.Also know your discomfort level, if you get a bill for 250K for a medical emergency are you okay with waiting a long time to see if they are going to help you and how much they are going to pay.

 

[pb4uski]

...ACA won't fail, they'll just keep raising your taxes into oblivion to pay for it. ...

While you are entitled to your opinion, any increase in taxes is unlikely as the electorate and politicians doesn't have much stomach for it. Hasn't happened so far since ACA was enacted and nothing is currently proposed in Congress.

 

[Chris7]

This isn't true, but don't let that stop you from trying to politicize it.

Sorry, for being a bit snarky if it seemed that way. Of course others have been throughout the thread. However, which part are you not saying is true? The ACA does in fact have a specific exemption for the Sharing organizations that existed prior to some year, I forget what the year was, something like 1996.

While you are entitled to your opinion, any increase in taxes is unlikely as the electorate and politicians doesn't have much stomach for it. Hasn't happened so far since ACA was enacted and nothing is currently proposed in Congress.

And the 3% tax that my employer pays and thankfully doesn't at this point pass on to me is in fact a new tax because of the ACA. And besides that, for those that didn't carry healthy insurance before and self-insured, are in fact now required to carry health insurance or are penalized. So call it what you want, but it is a Defacto Tax.

Going forward, I will try to keep politics out-of-it. Since these are basically faith based operations, I realize it is hard to keep religion out of out.

And please remember, I carry both. Two kids are on one of these plans, and the rest of the family are on a regular medical plan. I did the math, weighed the risks, and did what I believe made sense.

 

[travelover]

..........Going forward, I will try to keep politics out-of-it. .......

Good plan. I can already smell pig's breath.