Healthcare sharing ministries good or bad? Early retirement health insurance options?

[RetMD21]

The healthcare ministries are a gamble. Nyt had an article about people who hit limits of had problems. https://www.nytimes.com/2020/01/02/health/christian-health-care-insurance.html

Samaritan Ministries has a 250 k cap (vs none for insurance)

Eight-year-old Blake Collie was at the swimming pool when he got a frightening headache. His parents rushed him to the emergency room only to learn he had a brain aneurysm. Blake spent nearly two months in the hospital.

His family did not have traditional health insurance. “We could not afford it,” said his father, Mark Collie, a freelance photographer in Washington, N.C.

from the NYT article. Sure you can save money month to month with a ministry and most folks will not have a devastating event but if you do you may be out of luck.

 

[ivinsfan]

Samaritan Ministries has a 250 k cap (vs none for insurance)



from the NYT article. Sure you can save money month to month with a ministry and most folks will not have a devastating event but if you do you may be out of luck.

Most plans have riders you can buy to up your limits.

 

[zinger1457]

Samaritan Ministries has a 250 k cap (vs none for insurance)
from the NYT article. Sure you can save money month to month with a ministry and most folks will not have a devastating event but if you do you may be out of luck.

Samaritan offers different priced plans, some with no caps.

 

[samcat]

This post is about Christian Healthcare Ministries. Sorry it is so long.

We joined CHM three years ago because our insurance costs were outrageous. The kicker was that my husband had a prostate procedure done. Anthem covered it but they put the whole amount we paid under "coinsurance" and not deductible so we thought we were going to satisfy the deductible and we didn't. I looked back and hardly anything we paid was credited to the deductible - all coinsurance. So, we had paid out a lot of money that year for coinsurance but still would have to satisfy the deductible.

I checked Covered California for 2021. If we were to get the cheapest insurance possible, it is $20k per year with just a yearly physical not subject to the deductible. We'd have to pay $7k per person in order to have the insurance company pay anything else!

We gave up traditional insurance 3 years ago and went with CHM. We currently pay $172 each for a gold policy that covers us up to $125k per incident. An incident is one illness (i.e., I go to the doctor because my stomach hurts. I then go back because it still hurts. Turns out it is my appendix and I have it removed. That is all one incident). We pay an extra $420 per year to give us unlimited coverage per incident. So, we have unlimited coverage. Our yearly total is $4,500.

The gold policy includes 100% coverage for all incidents over $500. We self insure the small stuff - everything under $500. Office visits, vaccines, prescriptions not related to an incident (birth control, anti depressants, blood pressure, etc. - daily medicines), physicals, etc. There are things they don't cover and that is all spelled out in their guidelines so there should be surprises. There is no deductible. If your out of pocket costs are $1,000, you get a check for $1,000.

We can go to any doctor we want - there are no networks. No worrying about if you go to the hospital and one of the doctors you see is out of network.

I had to have two colonoscopies in July two weeks apart. The total cost was about $9k. The self pay cost was $4k. I paid the $4k, submitted the receipts to CHM and received a check for the full amount six weeks later. No questions asked.

A couple years ago, I had itchy legs. I couldn't get into see a dermatologist quickly so went to urgent care. They gave me a treatment...it didn't work. I went back to urgent care, got another treatment and it didn't work. Finally got into the dermatologist who gave me two prescriptions which cured me. Submitted a claim for over $800 and got a check no questions asked. I felt guilty about the urgent care charges but no one questioned them.

It is easy to get discounts from healthcare providers. They give insurance companies discounts and offer us a similar discount. i.e., the facility fee for my colonoscopy was $2900. They gave me a cash price of $925 - a $1900 savings!

I do call around to get the best price on some procedures (especially ones that I know I have to have again and again). For my mammogram, I do not go to the clinic where my doctor is. I go to a stand alone place. The full cost is $650. I get it for $350. A mammogram at my doctor's clinic was $650 for the cash price. Just ridiculous.

For lab work, we use www.walkinlabs.com. We order the labs online, a doctor at the website prescribes them, we take the form to the lab, get the blood drawn and get the results a day or two later. All for cheap! I had rhabdo a couple years ago. My clinic wouldn't authorize a blood test for my CK levels without coming in to see the doctor. I found walkinlabs.com, ordered the test and had an urgent call the next morning that my CK levels were way too high and I needed to immediately call my doctor. The site works great!

Pre-existing conditions - they do not cover pre-existing conditions outright. The gold program has a provision where they will cover up to $15k of expenses in the first year, $10k in the second and $25k in the third for a total of a cumulative $50k in the first three years. After that, there are no pre-existing conditions. If you do have costs for pre-existing conditions that exceed these amounts, there is a prayer page where other members can donate to help offset your costs.

Also, there are a few "non christian procedures" they don't cover. Births from unwed mothers, abortions, drug abuse, self-inflicted. The abortion part bothers me so we make a large donation to Planned Parenthood every year. I've had to come to terms with it.

Our son used CHM for cobra coverage when he was between jobs. He had it for a couple months but never even used it.

CHM has been around for 40 years. They have paid out billions in claims. I know someone is going to say it is not guaranteed. They have a good track record.

They publish a magazine each month with stories of what incidents they have covered. This is the link.

https://chministries.org/resources/heartfelt-magazine/

I am happy to answer anyone's questions. The haters are going to hate but if you have serious questions, let me know.

 

[samcat]

Great come back and fill us in. It's always about people's personal bias on subjects like this. For example, if you make a claim for something that is listed as non-covered from the get go..how does that translate into CHM "denying" your claim?

Just wrote a very long post. In regards to your question, if something isn't covered, you probably get a letter stating that it isn't covered. I would not submit something that isn't covered. If I had a question, I would call first. For example, they do not cover a hysterectomy without a disease present. I would call to see if that was covered before I had the procedure done. From reviewing the guidelines, it seems like anything urgent is covered.

 

[RunningBum]

I appreciate the insight, samcat. I didn't know anything of the unlimited coverage option until it was mentioned here today.

 

[GTFan]

Gotta love the folks here saying we're haters just by pointing out the risks and lifestyle restrictions inherent in these plans.

Facts are what they are, there's no emotion involved. It's a simple tradeoff and we're pointing out those trades vs. traditional insurance, that's all.

 

[samcat]

Gotta love the folks here saying we're haters just by pointing out the risks and lifestyle restrictions inherent in these plans.

Facts are what they are, there's no emotion involved. It's a simple tradeoff and we're pointing out those trades vs. traditional insurance, that's all.

Have you read all the comments? One post wrote the following and then they expanded on it in another post further down. People write comments without even having experience with the situation. And, I posted about this maybe a year ago and got skewered so I was just assuming I would get more.

Responding to the post quoted below, we care about our health and the health of our loved ones and have found CHM to be a perfect solution. We are not putting our health at risk.

Healthcare ministries are not health insurance. If you can understand that, then you can begin to understand and extrapolate what the issues are.

Bottom line - if you care about your health or the health of your loved ones, stay away from them. Penny wise pound foolish - the savings are nowhere near worth the risks you take. The healthcare ministry will not pay out on a big claim. You get a bad case of cancer where treatments and surgeries can easily run well over a couple $100k and watch how it doesn't get paid. There are enough stories out there proving the point, just search for them.

 

[njhowie]

Have you read all the comments? One post wrote the following and then they expanded on it in another post further down. People write comments without even having experience with the situation. And, I posted about this maybe a year ago and got skewered so I was just assuming I would get more.

Responding to the post quoted below, we care about our health and the health of our loved ones and have found CHM to be a perfect solution. We are not putting our health at risk.

__________________
"Healthcare ministries are not health insurance. If you can understand that, then you can begin to understand and extrapolate what the issues are.

Bottom line - if you care about your health or the health of your loved ones, stay away from them. Penny wise pound foolish - the savings are nowhere near worth the risks you take. The healthcare ministry will not pay out on a big claim. You get a bad case of cancer where treatments and surgeries can easily run well over a couple $100k and watch how it doesn't get paid. There are enough stories out there proving the point, just search for them.

I wrote it and stand by it. Again, it's not as if I made baseless claims. I did the research, and what I posted was the results and conclusions of that research. It's there for anyone to investigate on their own and arrive at their own conclusions.

If you and others are okay with buying something to replace insurance which is not insurance, then again, go for it and all the best to you all.

I'm happy that it's worked out so well for you. I wish you further continued success with it.

 

[ivinsfan]

I wrote it and stand by it. Again, it's not as if I made baseless claims. I did the research, and what I posted was the results and conclusions of that research. It's there for anyone to investigate on their own and arrive at their own conclusions.

If you and others are okay with buying something to replace insurance which is not insurance, then again, go for it and all the best to you all.

I'm happy that it's worked out so well for you. I wish you further continued success with it.

You made it personal when said people using this don't care about the well being of their families. Your research was balanced toward the negative. Do you ever research HI companies with "real" insurance" that deny claims and control with doctors you use, you'd find plenty of stories.

 

[sengsational]

There are plenty of cherry-picked horror stories in both insurance based and alternative solutions, I'm sure.

 

[njhowie]

You made it personal when said people using this don't care about the well being of their families. Your research was balanced toward the negative. Do you ever research HI companies with "real" insurance" that deny claims and control with doctors you use, you'd find plenty of stories.

Sorry you took it personally, as I did not target anyone, it was a broad statement of my opinion...based on my research. Neither you, nor anyone else has to accept anything I say, as is the case with every single person/post on this site.

Please don't tell me what my research was based on, because you have absolutely no idea. I went in with a very open mind as I was specifically doing the research with the intent of going in that direction instead of continuing with traditional health insurance.

My last post on this thread.

Best to you.

 

[RetMD21]

There are plenty of cherry-picked horror stories in both insurance based and alternative solutions, I'm sure.

but the worst case scenarios are sort of the point, right? A dozen people posting that they are satisfied having paid a few thousand a year and has a few hundred in paid claims doesn't address the concern about the "ministries"

 

[ivinsfan]

but the worst case scenarios are sort of the point, right? A dozen people posting that they are satisfied having paid a few thousand a year and has a few hundred in paid claims doesn't address the concern about the "ministries"

Obviously you have a bias, you've made the same post half a dozen times.

 

[Poopycat]

A couple of interesting twists:

When we first spoke with the physician in October (?) prior to the surgery we asked how much the procedure would be (I fully expected him to say he had no idea since he does one part, the hospital does theirs etc) but he was quick to say $50k all in, I was pleasantly surprised that he had an idea and that he would share that with me but even if it's 2x that amount we will be okay with it.

Three days ago my wife calls the hospital trying to find out how much we owe and asks for the itemized bill they tell her it's $172k+(only the hospital portion and that doesn't include the doctors, labs etc), my wife told them that the estimate they gave us was $59k the lady was quick to say it was only an estimate and that they aren't done with it yet...

I called this morning and spoke to another lady in the billing department today the bill is $48k.

This will be a bumpy ride.

It should be illegal for medical providers to not provide a firm quote for a medical procedure, especially a serious one like surgery. Yes, I know that many providers can be involved, but it’s ridiculous that one time you are told the cost will be $50K, and then the next week it’s $172K, and oh, today it’s $48K.

When you take a car in for a repair, you pretty much know the price up front. Maybe the price will fluctuate a bit depending on garage, whether the technician finds another issue, etc. but you know the ballpark figure. Maybe emergency care wouldn’t be as clear, price-wise, but in this case you know what your surgery is going to be, and barring complications (certainly hope it goes smoothly for you), the provider should be able to give a price range at the very least. But sadly, medical providers don’t appear to be held to any pricing standards.

 

[RetMD21]

Obviously you have a bias, you've made the same post half a dozen times.

I am biased in preferring coverage for large expense. I am willing to learn so if anyone can explain how they can be sure that the "ministries" would cover a large expense

 

[CaptTom]

I think the term "ministries" is the first red flag for me. While I have great respect for those with sincere faith, a LOT has been done by scammers, thieves and especially those with political agendas to take advantage of that faith.

Next is the simple fact that the whole purpose of insurance is the mitigate the risk of a ruinous financial loss. I insure my house against fire, and my vehicles against serious accidents. Both of these could cause me major financial problems, even though I hope they never happen. So I insure against them.

Medical insurance is a bit different. I don't have insurance coverage which pays for routine maintenance on my house or vehicles. But I do have medical "insurance" which pays a good portion of my routine medical costs. I didn't design this system, it's just the way things work today.

So let's break that out. One part of medical insurance is simply paying up front for routine care. Some people do the same thing with their heating bills. They pay one monthly fee for a year of oil or gas, to avoid the big price spike in winter. The better you can budget, the less you need this sort of program.

The other part covers less likely, but much more expensive care. Cancer treatments, major surgery, accidents, etc. To me, that's the important part of medical insurance.

From what I've read, the program we're talking about here is only the first part, and not the second.

I could see that program being helpful for those who have trouble budgeting for routine care, and don't feel the need to cover catastrophic costs. Basically, they're either wealthy enough to self-insure for major medical expenses, or have little to lose from a bankruptcy due to a huge medical bill.

For those in the second group, I should point out that they still have insurance against major medical expenses. In the end, they'll get the care. But the costs will be carried by the rest of us who do have real insurance or the ability to pay. This is not a moral judgement, just the way our system works today.

Personally, I chose to keep my real insurance.

 

[sengsational]

...

I'm not sure that your thinking aligns well with my research into Sedera. I'll talk a bit about the concepts below, but if I use the word "you" it doesn't mean you in particular, just "a person in such a situation".

Flat payments over time for something you know you'll need in contrast with paying for something that's expensive (and might not be needed) is a great way to think about it.

"Real" insurance is the latter. But from what I read on the Sedera site, they appear to fit the latter, and exclude the former.

The difference, from what I can tell (I'm no expert but spend some hours reading), is that insurance is "contractual", and cost sharing is more of a "best effort".

It looks like they use the term "sharable" for things you might make a claim for. There are lots of up-front, "know before you buy", NOT sharable things. "Not Sharable" includes routine things.

Because the same people that might opt for a cost sharing organization solution might also opt for DPC (direct primary care), maybe that's where the confusion arises. This IS a way to smooth out costs over time. With a DPC provider, you pay a monthly amount, no matter if you go to the doctor or not. They'll take care of the day-to-day simple doctor visit stuff without a separate bill. There are lots of things they don't do, of course. If expensive and "sharable", then it falls to the cost sharing scheme, which you may or may not have. Two completely separate arrangements. You could have a DPC and traditional insurance, DPC and cost sharing, or DPC and self insure.

There are things that are expensive and not sharable. Those are spelled-out in the documentation you read before signing-up. If you can't live with the restrictions (pre-existing conditions, illegal activities, etc), then don't sign-up.

Of course there is a gap between a cost sharing scheme and traditional insurance, but I suspect that for people where a cost sharing scheme is a good fit, the chances of falling in the gap are small. Not zero. If you want a more air-tight medical payment scheme, then traditional might be for you, no problem with that. That's what I do at the moment. I'm basically buying the max out of pocket. So, if I don't have some horrific health event, the insurance is worthless. The same could be said about fire insurance, except that fire insurance isn't $20,000 per year.

So, only because the tax payers of this country are paying my health insurance bill am I "paying" for the max out of pocket. If they weren't, I'd be on a cost sharing plan. And I'd generate a "life event" and hop on the ACA if the cost sharing wasn't working for big expenses.

 

[GTFan]

Obviously you have a bias, you've made the same post half a dozen times.

A 'bias' based on facts? This isn't the fake news you're looking for.

 

[braumeister]

Thanks for the interesting discussion.