Medical Cost-Sharing Plans: All You Need to Know

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Medical cost-sharing plans are referred to as healthcare ministries. They’re not run by insurance companies; instead, they’re run by nonprofits. Members donate a set amount to a group fund every month.The fund pays a portion or all of a large medical bill received by a member. Which expenses can be shared is determined by the plan’s requirements.

Before the plan pays out, however, the member must contribute a percentage of the cost. This amount, referred to as the member’s “personal responsibility” or “annual household part,” works in the same way as a health insurance deductible. Because the monthly expenses are often lower, some prefer these programs to health insurance. In order to keep costs down, several plans encourage members to see healthcare providers who have previously agreed to discounted prices. Other plans let members see any doctor they like, but the compensation is limited to a “fair and reasonable” amount less than the doctor’s usual fee.

Many, but not all, of these programs are related to churches or groups of people who share similar values. The organizations have no contracts and are not legally liable for medical expenditures.

According to the Alliance of Health Care Sharing Ministries, more than 1.5 million Americans are members of religion-based cost-sharing organizations. 

Is Medical Cost-Sharing a Viable Alternative to Health Insurance?

The smaller monthly payments appeal to supporters of medical cost-sharing.

These are referred to as “share amounts” in the programs. For a single person, monthly charges might be as little as $100. A bronze-level plan from the health insurance marketplace, on the other hand, costs around $330 per month on average, though government subsidies can bring that cost down significantly.

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Because the plans or their members pay healthcare providers directly, cost-sharing plans can often achieve lower treatment pricing. Furthermore, these plans may include coverage for items that traditional health insurance does not. Medical care abroad, burial fees, and adoption charges are just a few examples. 

Some members like being a part of a group of like-minded people. Only those who agree to follow certain lifestyle or spiritual requirements are eligible for medical cost-sharing programs. Many organizations will pray for sick members.

  • Before I join a medical cost-sharing plan, what questions should I ask?
  • If you’re thinking about joining a health-cost-sharing plan, you should think about the following:
  • These are the guidelines for living a healthy lifestyle as part of the plan?
  • It will my out-of-pocket expenses be?
  • What does the policy promise to cover, if anything?
  • Is the plan acceptable to my doctor?
  • Is there a provider’s network?
  • What cost-sharing restrictions apply if I have a pre-existing condition?
  • Is the plan responsible for paying my medical bills? Or do I pay for them and then be reimbursed by the insurance company?
  • What can I do if I disagree with a choice about sharing?
  • When Does a Member’s Coverage Get Suspended by the Plan?

Medical Cost Sharing vs Health Insurances

Now, lets do a quick medical cost sharing plans comparison from health insurances and why they are the best?

Affordability

Health insurance plans are extremely costly, and their costs have been steadily rising over time. In 2019, a family of four would pay $20,576 in annual health insurance premiums. These charges do not include any out-of-pocket payments that health insurance policyholders are responsible for.

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Members of health-share ministries, on the other hand, can save a lot of money. In fact, when compared to standard health insurance plans, many members can save up to 50%, making health share ministries a far more affordable alternative for many.

Organizational Objectives

Health insurance firms are for-profit corporations that charge premiums for their plans. The monthly premiums that policyholders pay help these companies make money.

Health share programs, on the other hand, are non-profit organizations that do not accept payments from members in order to make a profit. Instead, the funds are deposited into the health sharing plan, where they can be used by active members who require financial support for authorized medical care.

Medical Expenses: Eligibility and Payment

The Affordable Care Act (ACA) requires all persons, even those in poor health or those with pre-existing medical conditions, to be accepted into health insurance policies. The ACA, on the other hand, does not require health share ministries. As a result, membership eligibility is determined only by the standards set forth by the particular ministry.

Members of the health share ministry will no longer be required to pool their contributions into an insurance pool that does not choose members based on their lifestyle or health status. As a result, they have the option of splitting the expense of medical care with other like-minded people.

Health insurance programs limit the number of doctors and hospitals that policyholders can visit in order to keep expenses down. They also restrict the types of drugs that can be prescribed. Members of health share ministries, on the other hand, are not restricted in the type of doctor or expert they can see.

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While both health insurance plans and health sharing ministries exist to assist Americans in covering the costs of medical care without having to pay in full, there are important variations between the two that must be acknowledged. 

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