Health care sharing networks?

[Oddball]

Does anyone here belong to a health care sharing network, also known as a health care sharing ministry (https://en.wikipedia.org/wiki/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 (https://www.google.com/search?sitesearch=bogleheads.org&q=health+ministry) 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.

[SteveinMN]

One other point that probably bears making: if you switch plans in mid-year/before open enrollment, you may find that deductibles reset themselves. So if you were maybe $2-3,000 into a deductible with your old plan and you switch to another one, that $2-3,000 may not (likely won't) count toward your new plan.

My wife and I chose to go with COBRA when she retired in May because there would be no issue that we could keep our existing practitioners/insurance and either finish courses of treatment or at least have some time to find a new doctor or whatever. We know what our medical expenses/pay-ins have looked like over the past few years; for us, resetting deductibles pays us a month or two of COBRA and makes some lower-cost alternatives a wash financially.

[ApatheticNoMore]

you would lose me at unregulated, but maybe if I had no other options, or as a supplement to a high deductible cheapest ACA or equivalent plan.

[Tammy]

Do these plans qualify as having health insurance coverage under the law?

[iris lilies]

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.

A major piece of your puzzle is how much in healthcare services you consume each year. Are you insuring for known costs or are you insuring against catastrophic things you can’t predict, possibly catastrophic? That’s a rhetorical question you don’t have to answer, it’s just what strikes me when I read your post.

[Oddball]

you would lose me at unregulated, but maybe if I had no other options, or as a supplement to a high deductible cheapest ACA or equivalent plan.
Unregulated bothers me too, but so does the fact that even an ACA plan can deny coverage per service with little recourse.

The work coverage I'm about to lose has a tiny $250 deductible and covers a lot of stuff. I've been paying peanuts for it -- $120 a month, and that includes dental and vision. To keep this plan for 18 more months through COBRA will cost nearly $800 a month -- more than a 550% jump. The cheapest ACA Bronze plan for me is over $500 a month with a $7,000 deductible. This is why I am shopping around.

[Oddball]

A major piece of your puzzle is how much in healthcare services you consume each year. Are you insuring for known costs or are you insuring against catastrophic things you can’t predict, possibly catastrophic? That’s a rhetorical question you don’t have to answer, it’s just what strikes me when I read your post.
So far I have been very low use, so I am looking to insure against catastrophic things I can't predict. I live a super clean lifestyle and have no issues with the health share networks' requirements since I live that way anyway.

[Oddball]

Do these plans qualify as having health insurance coverage under the law?
Some do, some don't. The religious ones do as long as they formed before 1998. The newer ones that are not religious do not qualify. For now, the ACA mandate is repealed (since the 2017 tax law), but of course it could return. At that point, I would have to look at ACA plans for sure, or pay the fine.

[Tradd]

I was permanently laid off in late March. Cobra was about $600/month. I called a friend who has always been self employed and asked what she did for insurance. Got the number of her independent agent. Ended up with a short term plan that can go for no more than 6 months. $5K deductible. Not regulated by ACA. Pretty similar to one of the old catastrophic plans before the ACA. I’m saving about $200/month.

I would look into this option until the end of the year.

[Oddball]

So I went for a bike ride this afternoon and got to thinking about Steve's post above re deductible resets.

If I switch to a high-deductible ACA plan for the last few months of the year and something big happens -- like if I get hit by a car while biking -- I'm out at least the $7,000 deductible.

If I bite the bullet and go with COBRA for six months, I could drop the vision portion, get the health portion only, trimming the total to $700 a month, and that would be $4,200.

If I subtract the $120 a month that I would have spent anyway, had I not been laid off, the difference is $3,480.

So for $3,480 in unexpected premiums, I could keep most of my coverage (all but the vision portion, which I exhausted in January) while insuring against a possible $7,000+ loss, not to mention the hassle of changing doctors, since the ACA plan would not include my current docs in its network.

Then in January, maybe sooner, I'd either have a new job with new coverage, or a very affordable ACA plan, since I'd have little income still and therefore qualify for a large subsidy. Or if I have zero to very low income, I would qualify for my state's relatively good expanded Medicaid.

Just thinking out loud here, but maybe COBRA isn't the wild rip-off I was grumbling about after all?

Tradd, sorry about your layoff. Hang in there.

[SteveinMN]

Just thinking out loud here, but maybe COBRA isn't the wild rip-off I was grumbling about after all?
That was kind of our conclusion -- and our COBRA is significantly more expensive than yours. It helps that DW's unused PTO was thrown into a reimbursement account we can use for insurance premiums, so it's sorta-free money. We'll go for an ACA plan (or whatever's out there; the healthcare situation in the U.S. is nuts) when we can do so without resetting deductibles and costing us some money that way. It's insurance. It's always a gamble.

[Tybee]

Yeah, we experienced the restarting deductible, although in our case, it was with Cobra. Maybe that has changed. If you go to Cobra, will your deductible restart? Ours did, but that was 10 years ago.

[iris lilies]

Oddball, that analysis seems fine for your situation.


We have always self-insured for vision and dental. And DH wore glasses until his cataract surgery that cost around $1000. But that’s just what we budgeted for. We kept COBRA not because it was a cost analysis deal but because DH was not rational about an ACA policy and I just didn’t want to fight it. Besides it was just easier since we had the money to continue insurance coverage from work.