Health care sharing networks?

[Oddball]

Does anyone here belong to a health care sharing network, also known as a health care sharing ministry? They have been used for decades by religious groups, and now there are some secular ones (Zion Health, Sedera, Knew Health). The secular ones do require that members live a healthy lifestyle, but they do not require adherence to any faith.

There are some long threads about this on the MMM forum (which I'm not on), and I'm surprised not to see anything here. There are many limitations, but for certain folks they seem to serve well enough as an alternative (or supplement) to ACA insurance plans.

But they are not insurance plans. Basically you become a cash payer at doc appointments, up to a certain amount that's similar to a deductible. Meanwhile, you contribute a monthly share to the network, basically a monthly premium. If any big surprise bills come up, the sharing network pays them. Some networks also negotiate the bills and get significant discounts. Others encourage you to do the haggling.

It all seemed kind of scammy to me at first, but the more I read and understand (including all the limitations), the more legit they appear. While I am not specifically religious, I do share the basic tenets of these plans, which is that people should help each other, shifting resources where and when needed. Also, the whole system seems far simpler and more straightforward than the maze of modern insurance, which is far pricier and often less reliable (denied claims, etc.).

I just got laid off and thus am losing my health coverage soon. COBRA costs more than my rent, and the only ACA plans that are cheaper have huge deductibles and pretty thin coverage. Makes me want to opt out of the whole system and try something totally different.

Any thoughts or experiences?

[Yppej]

I think that it is legitimate that people, including the Amish, not be compelled to purchase insurance if their beliefs prohibit it.

In your case I would wonder if the network has the financial resources to cover something expensive like a rash of covid cases, or a cancer cluster. Are these companies rated for financial stability?

Is moving to a state where you qualify for expanded Medicaid an option, or are you committed to staying where you are?

How close are you to age 65 when you can get Medicare?

What are the chances you will be quickly employed again at a job with medical benefits?

[Teacher Terry]

I would only do it if I couldn’t afford insurance.

[SteveinMN]

I found these threads on the investment forum Bogleheads; quite informative to me since I'd never heard of them before.

[iris lilies]

I have skimmed the MMM threads that touch on this topic, and the consensus seems to be that getting the healthcare networks to pay out when there’s a big need for a payout is problematic.


You say you cannot afford insurance. OK. But understand that insurance should be insuring you for the big stuff, and if you are open to paying for doctor visits under a health sharing network plan, Why aren’t you open to paying for doctor visits and small stuff etc. while paying for a insurance policy with high deductible?


In the above paragraph I said “should “ which is of course a philosophy, not a universal outlook. It is my philosophy.my main outlook is that because I have significant assets. I need to protect those financial assets with health insurance. The health insurance kicks in if I have major million dollar plus health issues and my financial resources are not depleted.


So with that in mind, I have paid for insurance and I’m still paying for insurance even though now I’m covered by Medicare. But in the last four years I’ve had three different kinds of insurance:


1) COBRA Coverage for 18 months, the maximum. Dictated by law.


2) ACA policy At half the price of COBRA


3) Medicare And supplemental at about the same price as the ACA policy.

I recently started seeing a direct care physician. Her model of service is that you pay a flat fee and you can see her as many times as necessary. Some in-house labs are covered by that flat fee, other labs are not. I get all medications from her office but I pay separately for those. I have not compared that cost to my drug plan costs but chances are my drug plan is cheaper, but at this moment I don’t care.

Opie, you might consider a direct care physician. The cost of my physician is $800 annually. You can pay by the month if you wish which means you can drop out if you wish.

I continue to be astonished by the number of people who say an ACA is “too expensive. “I would really like to know what income levels are for people who say this. I don’t mean you exclusively OP, but last weekend a group of my friends was talking about insurance and a mutual acquaintance was in a motorcycle accident, has a bad break in his leg, and has no insurance because “it is too expensive.” A woman in my group said her Aca silver plan was so expensive it didn’t cover anything. And I just thought people, what is it that you expect? Obama care was supposed to make everything available to everyone. Tok picky I think.


Would be nice if we could have a nuanced discussion of individual health insurance situations/needs and avoid the blasting of “health insurance is a right!!! “ but I’m sure we will not be able to avoid that. Sigh.

[Teacher Terry]

Many HI policies are expensive with very high deductibles. So even if people carry it they can’t afford to use it.

[iris lilies]

Many HI policies are expensive with very high deductibles. So even if people carry it they can’t afford to use it.

i guess “HI” means health insurance.

How much is a “very high deductible” in your mind?

[Teacher Terry]

The ones available here for the ACA have deductibles of 7k per year. That’s a lot of money for most people.

[Oddball]

SteveinMN, many thanks for the Bogleheads links. Very helpful.

Iris Lilies, thanks for mentioning direct care physicians. That's another thing I'm looking into. And to clarify -- sorry if my OP was not clear -- it's not that I can't afford an ACA plan or COBRA. It's that I don't like the prices and so am seeking other options that might be a better value for me. I have read enough now about health care shares to see that they might be a good match for me. Not for everyone, of course.

Yppej, as far as I know, the sharing networks, which are nonprofits, are not rated for financial stability. I wish they were. Nor are they regulated. They are on their honor. This is why I am skeptical and why I started this thread, to ask who might have any personal experience with them.

I actually read a few MMM threads (not just skimmed), and the consensus is that most folks who are on these plans are quite happy with them. One person reported a long delay in getting reimbursed, but eventually the payment came through.

I'll have until September to accept or decline COBRA. If I don't do a health share, I'll likely get a Bronze ACA plan for the rest of this year. Then in January, if I have not found a new job with coverage, I will be eligible for an ACA subsidy, making it much cheaper. Since my layoff has come midyear, I have already earned too much to get any ACA breaks.

[Tybee]

We looked into these plans about 20 years ago when we first got married and we were rejected--I think it was because we were divorced before? So we gave up.
Maybe they are more lenient now.