Health Share - why not?

[pacergal]

My son had the heath share ministries insurance for one year, in an attempt to save money on premiums.
He liked the idea, but did not like the process and the many steps he had to take to get reimbursed. They did not pay for any dr visits, prescriptions, etc.as they said they would. It was not the "easy" process for reimbursement as they stated. He did get reimbursed a few times after writing many letters and appealing for funds. He ended up paying more for health care that year than if he had stayed on ACA.
I am unable to recall the exact one he was on.
He went back with ACA afterwards.

 

[Montecfo]

We have too much income to qualify for ACA subsidies when we retired 8 years ago. My husband was on Medicare but I would have 12 years to go before reaching Medicare age. I did seriously look at Health Share and decided against it. I even spoke to my PCP and specialists and they all told me that they would bill me and it would be up to me to file a claim against the Health Share organization. The risk of having a catastrophic medical event and Health Share refusing to pay was just not worth it. My premium this year is about $16K and I have 3.5 years to go before reaching Medicare age. I simply bite the bullet.

I think people sometimes overreact to the cost of health insurance under Cobra or unsubsidized ACA.

But it is just a cost to plan for. And it does not last forever.

So I say set aside that money.

 

[MichaelB]

I agree with the view that the OP has made a choice and should go ahead and implement.

The health share ministries discussions remind me of some sayings, such as “there’s no free lunch” and “if it looks too good to be true …”.

There are only 3 ways health care offerings can be designe that are less expensive than large company group insurance (which is the lease costly private option). First, reduce the coverage and limit high cost services. Second, restrict the policy to only healthier people and exclude the less healthy. Third, put a cap on reimbursements.

If a policy option is less expensive, it is doing one (or more) of those three things. The third, a cap on payments, is the most talked about (cash discount!) because it sounds like a real tactic, but in reality is unlikely, because it's impossible to prove and providers are not at all likely to give health share policy holders preferential prices. The reality is the coverage has to be restricted in some way that is meaningful and significant. That restriction is not clear or evident, which IMHO is a great concern.

 

[euro]

I did a lot of digging on healthcare ministries, and would have gone that route if it hadn't been for the ACA going into effect.

The fact that some have allegedly been caught with their hand in the cookie jar is to be expected because A: that happens, and B: they're taking business away from companies that can spend lots of litigation bucks.

People here are generally very conservative, so wouldn't want to risk any possibility of a huge medical bill. And you might get caught-out if you had a sudden onset medical issue, but depending on your luck, it might happen during ACA open enrollment and you'd jump in when you needed it! On average you'd have to deal with the ministry for less than 6 months. And they'd have to stiff you to be what people are talking about as the risk.

As to the huge medical bills, don't pay a dime until all the bills are presented to you. Then ask that they price the services with Medicare rates "just as a reference", or somehow find out that number. Then go to the entities and get agreement on a price, with the starting point the Medicare price. Play each entity off each other; tell the hospital mega that the physician mega has agreed to 10% over Medicare, and you're waiting for the hospital to play ball. Once you get the bottom line, in writing with assurance that it will clear the debt, write your checks. It's likely they'll send it to collections. Write one "drop dead" letter (see Clark Howard) and ignore all other attempts at communications. The medical mega will pull the account back out of collections if you are ready to write a check.

The straightforward process you outline sounds fine in theory and fairly straightforward. However, it makes me think that you may not have had to deal with a really complicated health situation. When you are dealing with something like a breast cancer diagnosis that involves many biopsies, tissue analysis, genetic tests, surgery, radiation, chemotherapy, etc etc. you will discover that you are not just dealing with one or two bills that you can argue over. Rather, you literally deal with dozens and dozens of individual bills (example a surgery involves pre-surgey contrast agents, surgery facility, anesthesiologists, surgeon, pathology labs, and several more that I'm forgetting). Each generates a separate invoice. Do you really think you are going to haggle with each individual biller on top of, say, chemotherapy or radiation that just started, etc? I can assure you that it is complicated enough to just make reasonably sure all (or most) of those individuals and facilities are at least in your approved provider network. Uness you are superhuman, you are simply not going to be able to haggle over invoices for dozens of providers simultaneously. At least, speaking for myself, I cannot. If you are up to it, then good on you, but trust me, you are an exception.

 

[ERD50]

I agree with the view that the OP has made a choice and should go ahead and implement.

The health share ministries discussions remind me of some sayings, such as “there’s no free lunch” and “if it looks too good to be true …”.

There are only 3 ways health care offerings can be designe that are less expensive than large company group insurance (which is the lease costly private option). First, reduce the coverage and limit high cost services. Second, restrict the policy to only healthier people and exclude the less healthy. Third, put a cap on reimbursements. ...

And it would seem that with the 80/20 style rules in place now, there just isn't that much to cut out (w/o the options you mention)?

Rate Review & the 80/20 Rule

The health care law provides 2 new ways to hold insurance companies accountable and help keep your costs down: Rate Review and the 80/20 rule.

www.healthcare.gov

 

[Sunset]

OP - How much extra do you have to pay if someone else in the Health Share option gets extremely sick, the expensive kind. Or are the extra payments unlimited.

What do you expect the others to pay as extra ?

Seems to me, someone who pays $2.5K for a CAT scan is not a healthy person who can take the risk of remaining healthy.

 

[Act2]

I had an interesting talk once with a young gentleman who really wanted to go the health share ministry route instead of employer group PPO. But his fall back plans were naive. He was sure he could just show up at the charity hospital and they would treat him and his brood free of charge if his health share didn’t pay. But he made good money; his income was such that it was clear any hospital would bill him. He thought it was a smart financial move to skip
real insurance; everyone else saw it as a big risk. But, of course, it was his risk to take.

 

[MichaelB]

And it would seem that with the 80/20 style rules in place now, there just isn't that much to cut out (w/o the options you mention)?

Rate Review & the 80/20 Rule

The health care law provides 2 new ways to hold insurance companies accountable and help keep your costs down: Rate Review and the 80/20 rule.

www.healthcare.gov

Exactly

 

[Montecfo]

I had an interesting talk once with a young gentleman who really wanted to go the health share ministry route instead of employer group PPO. But his fall back plans were naive. He was sure he could just show up at the charity hospital and they would treat him and his brood free of charge if his health share didn’t pay. But he made good money; his income was such that it was clear any hospital would bill him. He thought it was a smart financial move to skip
real insurance; everyone else saw it as a big risk. But, of course, it was his risk to take.

Some of the stats about health coverage show that a good chunk of the market that can afford coverage nevertheless skips it. Bad plan.

 

[pb4uski]

So far haven't seen any comments where someone actually had a bad experience with a health share besides Liberty. One bad actor in the industry is hardly enough to discredit all.

Countrywide mortgage and others screwed many yet we still have home loans being sold. Gov't oversight didn't help that train wreck.

The naysayers are a bit like the Reo Speedwagon tune:

Heard it from a friend who
Heard it from a friend who
Heard it from another you been messin' around

Good luck to you... if you do proceed despite the sage advice here I hope that it works out for you.

 

[jim584672]

Risking your life savings on a pinky promise doesn't seem wise to me.

If you are in one and get sick remember Medicaid can be retroactive 90 days, just be eligible in the retroactive period and live in a state with Medicaid expansion.

 

[RetiredHappy]

Risking your life savings on a pinky promise doesn't seem wise to me.

If you are in one and get sick remember Medicaid can be retroactive 90 days, just be eligible in the retroactive period and live in a state with Medicaid expansion.

The problem is that if you show up in a hospital and have no insurance, they will ask you about your income. If you truly have no income, they will give you a Medicaid application form while they treat you. if Medicaid declines the application because you do not meet their low income requirement, you are on the hook for the entire bill. Don't count on health share ministry to pay the bill.

 

[MichaelB]

The problem is that if you show up in a hospital and have no insurance, they will ask you about your income. If you truly have no income, they will give you a Medicaid application form while they treat you. if Medicaid declines the application because you do not meet their low income requirement, you are on the hook for the entire bill. Don't count on health share ministry to pay the bill.

This may apply to your location but it is not the way in other parts of the country.

Medicaid is not available to all low income people. Many not for profit hospitals have agreements where they will charge lower prices (2x Medicaid) to “qualified low income individuals” but make no effort to determine income levels so they can charge the higher price.

Health care providers in the US have exorbitant “list” prices, multiples higher than their insurance reimbursement rates, and aggressively pursue debtors. They have little incentive to negotiate or grant prices that are in the same ballpark as their insurance reimbursement rates.

 

[GenXguy]

Risking your life savings on a pinky promise doesn't seem wise to me.

If you are in one and get sick remember Medicaid can be retroactive 90 days, just be eligible in the retroactive period and live in a state with Medicaid expansion.

OP is single and has 80K to 120K annual income. That's way above the medicaid expansion threshold.

 

[Aerides]

So far haven't seen any comments where someone actually had a bad experience with a health share besides Liberty. One bad actor in the industry is hardly enough to discredit all.

Countrywide mortgage and others screwed many yet we still have home loans being sold. Gov't oversight didn't help that train wreck.

The naysayers are a bit like the Reo Speedwagon tune:

Heard it from a friend who
Heard it from a friend who
Heard it from another you been messin' around

Not a lot of folks here might have had experiences with them, period. So your sample isn't going to be helpful.

But that alone is saying a lot. This group tends to favor anything that is more cost effective, even if there are slight quality drop offs or issues. Cheaper phones, cell plans, alternatives to cable, and the best way to get health insurance costs down are discussed at length. If healthshares were a no-brainer alternative to HI, you can bet you'd get a lot of positive comments. Many of us have looked at them and decided, nah.

But if you still want to go ahead, go for it. The beauty of almost any health plan is you can change each year. Personally I like the idea of somewhat fixed costs, even if they are high (that's by design for me as I want an HSA eligible plan so I get a HD plan).

 

[Montecfo]

It is not something I would do but I would consider it if the situation was right.

But to just assume something terrible will happen and the plan won't pay the claim is not right either. That would be very uncommon-or it would be reflected in the reviews that are out there, which are generally quite good.

Of course there are things they don't cover as is true with any plan. And you can't get a cancer diagnosis, join, and expect payments. As in n everything, know the rules and know what you are buying.

 

[RetiredHappy]

This may apply to your location but it is not the way in other parts of the country.

Medicaid is not available to all low income people. Many not for profit hospitals have agreements where they will charge lower prices (2x Medicaid) to “qualified low income individuals” but make no effort to determine income levels so they can charge the higher price.

Health care providers in the US have exorbitant “list” prices, multiples higher than their insurance reimbursement rates, and aggressively pursue debtors. They have little incentive to negotiate or grant prices that are in the same ballpark as their insurance reimbursement rates.

What I described in my post above is how it works in our state, wrt to hospital emergency room visit. They would treat you without health insurance but will give you a Medicaid application form. If Medicaid approves it, you are now on Medicaid and Medicaid would take care of that hospital bill. If Medicaid declines, then the hospital will send you the bill.

 

[zinger1457]

I like the health share model where you tell provider you are a uninsured cash payer - they tend to give generous discounts. A few weeks ago with no insurance I had a CAT scan done cash price paid in full price was $2,500 that is about 3X less than I paid when insured by Optum as an employee a few years ago!

Unlike ACA health insurance that has to cover pre-existing conditions the health share ministries do not and likely won't.

 

[Koolau]

What always turned me off is the whole idea that members can refuse to pay for certain treatments on religious/moral/personal grounds.
I'm sure that very idea actually appeals to some people. A lot of people in this country are very quick to judge illness as personal weakness. I know a lot of people here begrudge that the ACA covers pregnancy and birth control and mammograms, and I don't need to have that hassle in my life, even though two of those three are no longer relevant to me personally.

Heh, heh, I'm three for three in the "not needed" ACA coverage.

 

[LakeRat1]

I have been retired for 10+ years, since I was 52. When my cobra ran out after 18 months, I looked into Obamacare Plans and quickly found that our insurance would jump from $900+ to over $1300 Per month..... I spent quite a bit of time reading and contacting people and medical professionals about healthshare plans ...... We opted to go with CHM - Christian Healthcare Ministries --- DW is 8 years older than I am, so when she turned 65 she cancelled her plan and is on Medicare..... I still have 3 years to go .... 10 years ago we paid approximately for the two of us $150 per month each, then another $25 quarterly, or something like that..... Today I am paying $267 per month...... I figure I have saved out of pocket over $50k the past 10 years ...... I also had 4 friends join that retired early ..... Two of these friends have actually had to utilize the service and were reimbursed the entire amounts..... Both had major heart attacks and had to have by pass surgeries..... I am sold on CHM and recommend to everyone ...... Do your research, talk with people that have actually had to use the services, talk with Drs as well...... My annual office visit went from $180 with insurance to $75 Per visit .... plus the lab work, which is less than $60...... Fortunately, I am a healthy phat guy and have not needed any medical treatments the past 10 years ..... I am not worried at all should I get sick, CHM will be there for me

 

[LakeRat1]

Unlike ACA health insurance that has to cover pre-existing conditions the health share ministries do not and likely won't.

CHM .... Has a sliding scale for pre-existing conditions

 

[sengsational]

If you are up to it, then good on you, but trust me, you are an exception.

I am exceptional
In all seriousness, I don't think I said wrangling the bills would be easy. What I outlined is a process that could be employed, and that I have employed with success. Not from my death bed or in a chemo brain fog, but from a considerably expensive and complicated intervention. So, yes, I know that billing entities are like roaches, for every obvious one, theres many more lurking. If you are patient, and just ignore all the bills until they're threatening collections, you should have most everything. I was lucky that it was a fixed time span, with a definitive end date. Someone with ongoing care faces a more difficult problem since the billing entities don't make it easy to settle-up on specific services on specific dates. Rather, they just "apply a credit" to your account. That's what you want to avoid. You want to settle to zero, and on that date, all services to date are considered paid in full (back to the letter you got them to write).

Is this how you want to spend your last days? Probably not. But if you get caught out and have to self-pay before starting an ACA policy on January 1, and you might be able to avoid the worst bankruptcy inducing pricing they call "charge master"