Why aren't more using a Christian Plan?

[ncbill]

Short of declaring bankruptcy are these Faith Based groups contractually obligated to cover expenses of covered care? In other words, if you get some rare complicated Cancer, let's say, and the bills start approaching $1 million plus, are they contractually required to cover or is it out of the "goodness of their hearts"?

IIRC, most of these ministries do have a lifetime limit, much the same as traditional health insurance pre-ACA.

 

[athena53]

If there aren't legislated standards like we have for insurers (reserves, reinsurance, etc), then there should at least be transparency and tools for decisionmaking so people can make informed choices. We aren't talking about picking a toaster oven here, this is big money. And, to the degree that any failure of these "arrangements" results in people falling into the taxpayer-funded safety net (or cost-shifting by medical providers to paying customers/insurance companies), it's not solely a matter that affects just the individual.

Good point about how the taxpayers can end up footing the bill one way or another in case of a catastrophic loss. Years ago (I was in NJ and left there in 2003), I read a really sad story about a couple who'd had a baby with multiple health problems. They had a picture and he was about half the size he should have been, very thin, and was hooked up to oxygen. They were insured through Dad's employer but what Dad didn't know was that the employer was "self-insured"- decided to save the commissions and other expenses of paying an insurance company, and just charge employees "premiums" and pay the losses out of those funds. The costs of the baby's medical care caused the employer to go bankrupt so the money was gone.

Self-insurance by large employers can be a legitimate choice; I worked for a large insurance brokerage and they did that but they held reserves and bought "excess coverage" to protect them in a very bad year. I'm pretty sure that those choices are heavily-regulated now and that auditors must sign off on the numbers.

 

[haha]

One thing seems clear, As a nation we don't yet have any kind of health system that can cope with unlimited demand, and the resulting high prices of the services.

I personally would never have bought one of these things prior to qualifying for Medicare. My overall life experience is that if you buy a pig in a poke, you are likely to get poked.

Something will give politically. Who knows when? It's like a troubled marriage. Easy to see that it is not working, but less easy to arrive at a happy solution.


Ha

 

[samclem]

And, to the degree that any failure of these "arrangements" results in people falling into the taxpayer-funded safety net (or cost-shifting by medical providers to paying customers/insurance companies), it's not solely a matter that affects just the individual.

Good point about how the taxpayers can end up footing the bill one way or another in case of a catastrophic loss.

Also, it is possible that these plans could have spillover positive effects on the way health care services are provided. They will potentially foster the growth of a population of health care consumers who are shopping for services on the open market and looking for the best value. That could encourage more open pricing, a market for reliable data on quality of outcomes for various providers, and maybe some competition (more likely in more densely populated areas, unlikely in rural areas).

Sure, as long as we stick with the "fee for service" model (rather than "fee for actually improving the person's health" model), we'll have cost problems. But perhaps putting the patient in the driver's seat and providing good access to data will do something to moderate the number of procedures/drugs etc and the cost of each.

 

[LARS]

IIRC, most of these ministries do have a lifetime limit, much the same as traditional health insurance pre-ACA.

Makes sense, but do you know if the payments up to lifetime cap are contractual obligations?

I would assume so or why would anyone rely on this for coverage...

 

[pb4uski]

Good point about how the taxpayers can end up footing the bill one way or another in case of a catastrophic loss. Years ago (I was in NJ and left there in 2003), I read a really sad story about a couple who'd had a baby with multiple health problems. They had a picture and he was about half the size he should have been, very thin, and was hooked up to oxygen. They were insured through Dad's employer but what Dad didn't know was that the employer was "self-insured"- decided to save the commissions and other expenses of paying an insurance company, and just charge employees "premiums" and pay the losses out of those funds. The costs of the baby's medical care caused the employer to go bankrupt so the money was gone.

Self-insurance by large employers can be a legitimate choice; I worked for a large insurance brokerage and they did that but they held reserves and bought "excess coverage" to protect them in a very bad year. I'm pretty sure that those choices are heavily-regulated now and that auditors must sign off on the numbers.

It is rare for an employer offering a ASO plan (self-insured but administered by a health insurer) to not have stop-loss coverage.

 

[samclem]

Here is an extensive comparison between several of these programs and how they compare to insurance. It is from the blog of respected financial planner Michael Kitces (although it is by a guest writer):

https://www.kitces.com/blog/healthc...hm-medicare-lhs-samaritan-health-share-plans/

That's an excellent article comparing the policies and promises of the 4 major programs of this type.

Now, if we just had third-party info on their previous/present performance and an indication of their ability to perform in the future, a prospective customer would be able to make a well-informed choice.

Makes sense, but do you know if the payments up to lifetime cap are contractual obligations?

According to what I have read, these programs make it very clear that their promises/present policies are not contractual obligations.

 

[tfudtuckerpucker]

That's an excellent article comparing the policies and promises of the 4 major programs of this type.

That article references an interesting law journal article from CSU here that's worth reading. It asks "what law applies to HCSMs?"

Excerpt:
"IX. Conclusion: Observations and Analysis
In conclusion, Health Care Sharing Ministries are not some kind of scam or “part
of the problem” with America’s health care system.460 HCSMs are “part of the
solution”461 for America’s health care needs and this for several reasons. First,
HCSM membership exempts members from the individual mandate in the PPACA;
second, HCSMs are affordable for most qualifying individuals and families; and
lastly, HCSMs demonstrate the faith, values, caring, and ideals “all too often lacking
in many health insurance options available today.”462"

 

[athena53]

Also, it is possible that these plans could have spillover positive effects on the way health care services are provided. They will potentially foster the growth of a population of health care consumers who are shopping for services on the open market and looking for the best value. That could encourage more open pricing, a market for reliable data on quality of outcomes for various providers, and maybe some competition (more likely in more densely populated areas, unlikely in rural areas).

I would love to see that but it sure hasn't happened yet, even though most ACA policies, and many employer policies, have a very high deductible. I remember DH asking what the weekly treatment for his minor leg ulcer cost and they told him, "Don't worry- the insurance should cover all of it". It did, between Medicare and his supplement, but that wasn't what he asked. And the doctor who treats you for something or orders tests typically has no clue what the lab will charge, what the specialists who see the results will charge, etc. Maddening.

 

[OldShooter]

That article references an interesting law journal article from CSU here that's worth reading. It asks "what law applies to HCSMs?"

Excerpt:
"IX. Conclusion: Observations and Analysis
In conclusion, Health Care Sharing Ministries are not some kind of scam or “part of the problem” with America’s health care system.460 HCSMs are “part of the solution”461 for America’s health care needs and this for several reasons. First, HCSM membership exempts members from the individual mandate in the PPACA; second, HCSMs are affordable for most qualifying individuals and families; and
lastly, HCSMs demonstrate the faith, values, caring, and ideals “all too often lacking in many health insurance options available today.”462"

Quite funny, actually, considering the bio of the author: "Benjamin Boyd, Staff Attorney for Chief Justice Roy S. Moore, Alabama Supreme Court" (https://en.wikipedia.org/wiki/Roy_Moore)

Why do I think this might not be the most unbiased article in the literature?

 

[LARS]

According to what I have read, these programs make it very clear that their promises/present policies are not contractual obligations.

Well if that is true then for this jaded individual that is way too big a leap of faith... or is that Faith: either way never would consider as an alternative. I’d go find a job first...

 

[athena53]

Well if that is true then for this jaded individual that is way too big a leap of faith... or is that Faith: either way never would consider as an alternative. I’d go find a job first...

Trust God, and tie your camel to a tree.

 

[LARS]

Trust God, and tie your camel to a tree.

You sure you don’t have that backwards: tie God to a tree and trust your camel? ;-)

 

[samclem]

Well if that is true then for this jaded individual that is way too big a leap of faith... or is that Faith: either way never would consider as an alternative. I’d go find a job first...

It would be a big leap of faith. Not just about a collapse of that program, but if you just weren't happy with a decision they made about covering a particular ailment/injury. There's no state insurance commissioner to take a complaint, etc. I guess you'd go straight to court (though they told you up front this isn't a contract). I wonder if the membership agreements stipulate the use of arbitration in lieu of the courts? That would also make me more wary.

 

[joeea]

why would anyone rely on this for coverage...

Faith.

 

[LARS]

Faith.

No question some have it (Faith) more than others.

Still, I have an approach of "Render unto Caesar the things that are Caesar's, and unto God the things that are God's."

And to me, Healthcare reimbursement falls squarely within the realm of Caesar so to speak.

 

[Midpack]

Way late to the party, but we're actively looking at how to provide healthcare pre-Medicare. I'll be eligible for Medicare 3 months after we lose corp healthcare so I'll just buy a 90 day short term policy. But DW will have a 32 month period to bridge to Medicare. She can go with (very pricey) COBRA for 36 months, we're told ACA is down to one provider for 2019 in our state (and we may relocated anyway) and private insurance is expensive as well.

To my surprise I was talking to a healthcare broker and he mentioned faith based healthcare sharing to us - even though he gets no benefit if we go that route. It's half the cost of other options and we can meet all their requirements though our statement of faith may not be adequate. The broker says he has friends and clients who have used Liberty and Medi-Share and they're very happy with it.

Anyway, I was very surprised that a commercial broker would offer it as an alternative...

 

[MichaelB]

Way late to the party, but we're actively looking at how to provide healthcare pre-Medicare. I'll be eligible for Medicare 3 months after we lose corp healthcare so I'll just buy a 90 day short term policy. But DW will have a 32 month period to bridge to Medicare. She can go with (very pricey) COBRA for 36 months, we're told ACA is down to one provider for 2019 in our state (and we may relocated anyway) and private insurance is expensive as well.

Are you certain about the 36 months for Cobra? The typical coverage is 18 months.

As for the Christian plan, are you looking for comprehensive coverage with a broad network or are considering limited coverage and networks?

 

[Midpack]

Are you certain about the 36 months for Cobra? The typical coverage is 18 months.

As for the Christian plan, are you looking for comprehensive coverage with a broad network or are considering limited coverage and networks?

Yes, I was surprised too, but DW insists it's 36 months for her COBRA. It's the most expensive option, so I doubt we'd go that route long term if at all.

We'd be looking for comprehensive coverage with an acceptable network. Odds are we'll be relocating next year, so it's a little messy (network might be OK at one end and not the other). Thanks.

 

[Bestwifeever]

Yes, I was surprised too, but DW insists it's 36 months for her COBRA. It's the most expensive option, so I doubt we'd go that route long term if at all.

We'd be looking for comprehensive coverage with an acceptable network. Odds are we'll be relocating next year, so it's a little messy (network might be OK at one end and not the other). Thanks.

When DH went to Medicare from his Megacorp’s retiree health insurance plan (where we paid for the group rate), as a retiree’s spouse I was able to move to COBRA for a maximum of 36 months (I was on it for 20 months til I hit Medicare). ACA was just starting at the same time so I chose to bite the bullet and stay on COBRA. Crazy expensive.

 

[braumeister]

The 36 months is just for dependents, not the worker.

COBRA coverage begins the date your health insurance policy ends because of a qualifying event. For an employee covered under a qualifying event, COBRA coverage can last for 18 months from the date you elect coverage. However, dependents can receive up to 36 months of coverage if you switch to Medicare, get divorced, or die. Otherwise, they’re covered for 18 months as well.

12 FAQs About COBRA Insurance - InsuranceQuotes.org

 

[MichaelB]

Yes, 36 months of COBRA coverage is available for dependents in case of death or Medicare. The way I read Midpack's post, he loses employer coverage 3 months prior to Medicare. In that case, why wouldn't his DW be eligible only for the normal 18 months COBRA?

 

[street]

^ interesting I thought cobra only was for 18 months. Well good for her if that is your choice.

 

[MBSC]

Yes, 36 months of COBRA coverage is available for dependents in case of death or Medicare. The way I read Midpack's post, he loses employer coverage 3 months prior to Medicare. In that case, why wouldn't his DW be eligible only for the normal 18 months COBRA?

I agree. The employee must enroll in Medicare Part A prior to retirement in order for the spouse to receive an extension.

4. Pre-Termination or Pre-Reduction Medicare Entitlement

Individuals become entitled to Medicare when they enroll in Medicare Part A or Parts A and B. The mere fact that an individual is eligible to enroll in Medicare does not mean the individual is entitled to Medicare.

If an employee retires a day before becoming entitled to Medicare, then the spouse and dependent children are not entitled to an extension and will only receive an 18-month maximum coverage period.

COBRA continuation coverage may be extended for the covered employee’s spouse and children if the qualifying event (termination of employment or reduction of hours) that results in a loss of plan coverage occurs within 18 months after the covered employee becomes entitled to Medicare.

Reference: https://acadiabenefits.com/blog/wp-...xtension-of-Maximum-COBRA-Coverage-Period.pdf

 

[Midpack]

The 36 months is just for dependents, not the worker.


12 FAQs About COBRA Insurance - InsuranceQuotes.org

Yes, 36 months of COBRA coverage is available for dependents in case of death or Medicare. The way I read Midpack's post, he loses employer coverage 3 months prior to Medicare. In that case, why wouldn't his DW be eligible only for the normal 18 months COBRA?

I’ll ask her to double check. Thanks.

[Edit] She went online to Megacorp’s website, and she’s pretty sure her HR Mgr misled her. Said it’s not the first time. Thanks.