Consumers wonder if they can afford health care with upsurging health care costs in the 21st century, considering their premiums. The Alliance of Health Care Sharing Ministries reports that there has been a growth from 200,000 to about 530,000 in Americans who used health share plans in 2016.
Individuals and families face an increasing burden of paying insurance costs every time. Those who cannot qualify for a tax credit face the high cost of premiums and some penalty tax associated with going without insurance. But, there’s a healthier alternative that companies like to call health share programs. Shared healthcare plans, also called medical fee sharing, have the potential to lower healthcare costs for you and your beneficiaries. However, consumers need to know exactly what these plans are before committing to this program.
Here’s the information you need to know about a health-sharing program:
1. What It Is
Members pay up a part of medical expenses as being involved in a health share program like UHSM Health Share. Under this plan, you’ll need to contribute a specific share amount monthly or premium and an “unshared amount” for your health care expenses. If you don’t meet the deductible, the plan will not share your medical expenses.
The amount for a single person is usually around USD$500 or below; for a couple, it should be USD$1,000; and for a family, it could come up to USD$5,000, but it varies by plan. Prices can range from USD$60 to USD$630, depending on each plan’s inclusions. The organization is liable for all medical costs beyond that.
Religious organizations are usually associated with health sharing. They don’t demand that you adhere to any specific spirituality to engage. Still, they, however, advise and recommend you to follow an ethical and exemplary lifestyle—such as avoiding smoking, drinking, or misusing drugs, as these don’t make you a hero.
2. Different From Health Insurance
Although a pool of people sharing expenses and risks may constitute insurance, it doesn’t. Healthcare sharing programs lack several features that are key to health insurance. Here are the reasons:
- Insurance is defined as “a method or arrangement by which companies provide the guarantee of compensation for a specific loss, damage, illness, death, or other hardship in return for a premium payment.” Such a promise is absent within the healthcare sharing program disclaimers.
- As a legal contract, insurance binds the insurer to the insured. As for health share, there are no actual contracts between members and the programs or between the members themselves, so everything within these programs is ‘voluntary.’
The underlying principle of insurance is the belief that a pool of people will bear higher risks or low probability risks together rather than in isolation. Hence, health sharing programs were designed to resemble insurance in this regard, with millions of dollars of facilitated payments provided to the tune of reduced sharing for many years now. Some people’s direct experience with this program was that their medical event was handled by the program with a smooth and organized flow of procedures, ease of communication, and professionalism.
3. Fewer Legal Protections
There has been a rapid change in the health care sector along with legislative uncertainty. The overall effect can be frightening for consumers. The laws governing the treatment of policyholders don’t apply to health-share plans because the government doesn’t supervise them. There are no restrictions on them, nor are they regulated to check on their financial health. They’re not bound by the vast set of laws that protect consumers if the organization doesn’t live up to the policies or the regulatory requirements.
4. Complements Direct Primary Care (DPC)
Direct primary care programs and health sharing programs complement each other well. People pay only a monthly retainer fee for DPC instead of deductibles, so they get primary health care for a relatively low price. Lab tests, consultations, and treatments with specialists can all be considered as part of DPC. With a Direct Primary Care plan, you receive outstanding medical care because the network offers better schedule arrangements with the doctor, no waste of time, and longer time to consult a doctor.
You can rely on DPC to help you out. Some other services and emergency needs are usually not covered in the plan, so patients need to purchase a different plan to cover additional medical fees. But, this would require hefty amounts of money usually. Herein lies the power of health care sharing programs. The best part: Some health-sharing institutions provide some price-offs to those who are DPC members. Health sharing and DPC mutually cover what the other doesn’t, making them an excellent opportunity to cover healthcare needs for a lower price.
5. Who Can Benefit
Not everyone is interested in health-sharing programs, but certain demographics are better suited for them. Some of these individuals may meet the following criteria:
- Generally, health sharing programs only permit people with simple pre-existing medical conditions to be members.
- A self-employed citizen, freelancer, contractor, or entrepreneur. Health care sharing programs may be a viable alternative for those who aren’t employees of a company with health insurance plans or cannot afford ordinary health insurance plans.
- Engage in a healthy lifestyle without the influence of alcohol, cigarettes, and other vices. Enrollment to a health-sharing program is usually conditional upon good health and disqualifies any participant who engages in dangerous or risky activities.
- A consumer seeking more affordable health insurance than traditional healthcare plans. Savings up to 50% can be achieved every month by joining a health care sharing initiative as opposed to conventional health insurance.
- Running a small business or non-profit organization with employees who require health care coverage. Companies with a small staff may need an employee health care program to offer, and a health-share program is a cost-effective option.
- People who seek and receive employee health insurance coverage. Many people receive employer health insurance coverage. Employers often don’t give employees coverage for spouses or dependents, leading to very high costs. Shared health programs are cheaper and offer the best solution for the entire family.
- Freedom seekers and remote workers. Several healthcare networks offer healthcare sharing programs nationwide so that everyone can receive health care wherever they are.
Mentioned above are essential things you should know about a health sharing program. The monthly costs of health-share plans make them very attractive. However, read the terms and conditions of your insurance policy carefully before deciding to give it all up and shift to a health-sharing program instead.