If you have direct knowledge of Health Sharing plans, settle this debate

[Ginevra]

I’m talking about health sharing plans as opposed to traditional health insurance plans. Medi-share is one, Samaritan is another. Last year, DH and I were on the fence, considering quitting national health insurance and going the health sharing route because we are small business owners and our BCBS plan premiums increased so dramatically. We ultimately did not go this route, mainly because I was concerned about my kids old enough to have a health incident related to a “sin” or a really bad decision. But one thing they told me that also didn’t sit well with me is that the cost of diagnostic health care was “not sharable”; i.e., same as saying “not covered” by insurance. DH was a little bit bitter and in disagreement with going traditional insurance. He wanted to save money on the premiums.

We had a dispute today when I said something like, “I’m very glad right now that we did not go with the health sharing because the large majority of my care so far has been diagnostic, which they said is not covered.” He strongly disagrees with my interpretation. He says, “Really? You think they just say, ‘sorry, can’t help’?” Well - I am not sure what they say/do, but I’m glad I’m not finding out the hard way! 

Who is right? Would most health sharing groups share (same as “cover”) these procedures:

mammogram

breast ultrasound

needle biopsy

breast MRI

genetic testing

Would they cover the Oncolgic DX when the tumor is removed? Would they cover sentinel lymph node biopsy? What about in the future, since I will have diagnostic tests, probably at least yearly for years to come or the rest of my life? 

It’s somewhat moot because in my mind, I shall never consider health sharing in the future because diagnostics may save/have saved already my life. But I am curious if I am incorrect and they do share costs for diagnostics, perhaps if there is already a suspected disease? But that would still have left me paying for the initial mammo, ultrasound and biopsy, I am guessing. When the agent we spoke to told us about this guideline, he used colonoscopy as an example, so to me, that sounds the same as at least routine mammograms. 

[KrissiK]

No, they would not cover any of that. However, you need to think of it in this way, instead of the traditional health insurance way.....

We do Medi-share and this is what it looks like.....

The monthly premium for my husband’s employer insurance was $1100/month plus deductible plus co-pay. We could not afford that.

Our monthly share for Medi-share is $367/month. But, we pay for everything out of pocket up to $10,000.

Let’s say I go to my dermatologist and she takes a mole off, sends it to biopsy and then does an incision. Which is what happened a couple years ago. I payed for that all cash. But, it was still cheaper than the $1100/month premium I would have paid to the insurance company for that month and even then, that whole process wouldn’t have been covered 100%. And some months we don’t even go to the doctor. If we were on insurance, we would have paid our $1100/month premium and still not gone to the doctor. With Medi-share, we just bank the money. I do budget $ for medical bills, but it’s certainly not as much $ as we would have spent on an insurance premium.

Sure, it hurts to write out that check, because when things are deducted from a paycheck you don’t think about it. But for us, it works. It’s certainly not perfect, but it does make you a better consumer of health care. We don’t just automatically send our prescriptions to CVS anymore, we go to either Costco or Walmart. 

[Liz CA]

Krissik, I have to check out MediShare. I have recently cancelled another health share because they did not process anything or so it seemed (8 months and nothing done). You pay $376 for the entire family? I hope it would be less for me as it would be just me; dh has other coverage.

Quill, what I like about the sharing concept is that the consumer is in charge but there are other issues - or were with the one I had. My bills did not even total $1000 and they hemmed and hawed. My "deductible" (what they call annual unshared amount) was supposed to be $500 which I was well aware of but any amount over $500 was supposed to be shared. 

All this to say, I am glad you have whatever insurance you do have as it sounds like you like your doc and have a good team to accompany you through this health crisis. 

Edited October 20, 2018 by Liz CA

[Guest]

11 minutes ago, KrissiK said:

No, they would not cover any of that. However, you need to think of it in this way, instead of the traditional health insurance way.....

We do Medi-share and this is what it looks like.....

The monthly premium for my husband’s employer insurance was $1100/month plus deductible plus co-pay. We could not afford that.

Our monthly share for Medi-share is $367/month. But, we pay for everything out of pocket up to $10,000.

Let’s say I go to my dermatologist and she takes a mole off, sends it to biopsy and then does an incision. Which is what happened a couple years ago. I payed for that all cash. But, it was still cheaper than the $1100/month premium I would have paid to the insurance company for that month and even then, that whole process wouldn’t have been covered 100%. And some months we don’t even go to the doctor. If we were on insurance, we would have paid our $1100/month premium and still not gone to the doctor. With Medi-share, we just bank the money. I do budget $ for medical bills, but it’s certainly not as much $ as we would have spent on an insurance premium.

Sure, it hurts to write out that check, because when things are deducted from a paycheck you don’t think about it. But for us, it works. It’s certainly not perfect, but it does make you a better consumer of health care. We don’t just automatically send our prescriptions to CVS anymore, we go to either Costco or Walmart. 

Well, for us, the cost is not deducted from a paycheck; we already write that check and yes, that is painful. So I guess in a way, we choose where we want the pain to be. 

I did wonder if there was a legal way to put company funds into a medical cost savings account and use that for our Medi-share funding and costs, but then it would still be money we had to reserve out of the company the same as we do now to pay health insurance premiums. 

One thing I have noticed about choosing location of prescriptions is that Walmart, while often less expensive, is (purely my experience with my Walmart) much poorer quality service. One time I got liquid antibiotics for my child there and it was not fully integrated. They begin with a powder and it was not fully mixed; it was damp powder at the bottom. There were numerous other times they did not have the prescription I needed in stock so I had to either wait a few days or transfer it to another pharmacy. I have stopped using them because they seem so unreliable. 

[Guest]

22 minutes ago, Liz CA said:

Krissik, I have to check out MediShare. I have recently cancelled another health share because they did not process anything or so it seemed (8 months and nothing done). You pay $376 for the entire family? I hope it would be less for me as it would be just me; dh has other coverage.

Quill, what I like about the sharing concept is that the consumer is in charge but there are other issues - or were with the one I had. My bills did not even total $1000 and they hemmed and hawed. My "deductible" (what they call annual unshared amount) was supposed to be $500 which I was well aware of but any amount over $500 was supposed to be shared. 

All this to say, I am glad you have whatever insurance you do have as it sounds like you like your doc and have a good team to accompany you through this health crisis. 

Can you tell me what “they hemmed and hawed” looked like? This was a big part of my fear when we were considering going with a health share. I was afraid something could happen and time goes by, no reimbursement; I call, try to find out what’s happening, they’re debating about the incident - let’s say because it was an accident with my young adult child and they didn’t know if my child contributed to the accident with bad decisions/behavior...and so on. I was afraid of a scenario like that. 

In the end I chose what seemed like a safer route with a stronger guarantee. 

[Sharpie]

We have Liberty Share and I have had my mammograms covered in full.  I can't speak for the other procedures.  I can tell you that once we met our deductible for our family, everything so far has been covered this year.  My dh colonoscopy was covered in full and that was a routine exam before we met our deductible, not one that had to be done.  We had to pay for it up front because the doctor we used required it of those without traditional insurance.  Liberty Share reimbursed us but it did take several months.  We had to wait long enough after the procedure to get a copy of the bill that included all the codes.  That took almost 3 weeks and then we had to submit it.  It took about 3 months after LS received it before we had a check in the mail.

We too are self employed and reached the point where we literally could not afford the premiums for BCBS.  It was a sharing plan or nothing. 

[Liz CA]

15 minutes ago, Quill said:

Can you tell me what “they hemmed and hawed” looked like? This was a big part of my fear when we were considering going with a health share. I was afraid something could happen and time goes by, no reimbursement; I call, try to find out what’s happening, they’re debating about the incident - let’s say because it was an accident with my young adult child and they didn’t know if my child contributed to the accident with bad decisions/behavior...and so on. I was afraid of a scenario like that. 

In the end I chose what seemed like a safer route with a stronger guarantee. 

 

It was pretty much like you described (bolded). And my bills were so minor. Perhaps hemming and hawing is not the right expression. I talked to several people who always promised me that it was in processing and I should receive a check "shortly." The check amount was to be in the $300 range - so hardly a huge expense in regards to medical bills. This has gone on since February / March of this year and I became disenchanted and decided not to pay my monthly contribution anymore as I was evidently just paying and getting nothing at all but was being strung along. I was also concerned that it would be an absolute nightmare should something major happen and it seemed better to stop now and look for an alternative.

I am NOT saying this happens with all sharing organizations across the board. Creekland was always very happy with hers and she had some ongoing issues with a benign growth if I remember correctly. I will check into what Krissi mentioned above and see if I can remember Creekland's organization. 

Edited October 20, 2018 by Liz CA

[Guest]

1 hour ago, Liz CA said:

 

It was pretty much like you described (bolded). And my bills were so minor. Perhaps hemming and hawing is not the right expression. I talked to several people who always promised me that it was in processing and I should receive a check "shortly." The check amount was to be in the $300 range - so hardly a huge expense in regards to medical bills. This has gone on since February / March of this year and I became disenchanted and decided not to pay my monthly contribution anymore as I was evidently just paying and getting nothing at all but was being strung along. I was also concerned that it would be an absolute nightmare should something major happen and it seemed better to stop now and look for an alternative.

I am NOT saying this happens with all sharing organizations across the board. Creekland was always very happy with hers and she had some ongoing issues with a benign growth if I remember correctly. I will check into what Krissi mentioned above and see if I can remember Creekland's organization. 

I think Creekland was Samaritan. She is one person I though of asking because I know she has had some on-going medical issues. 

[KrissiK]

 Thing with Medi-share that we like is that people don’t send you checks. The company does. Also, regarding things that are not “covered”.... it can still get paid for. They have an “extra blessings” plan, so if you want to pay over and above your monthly share (even $5-$10 extra) that goes into a pot for people who don’t qualify for regular sharing. And from what I understand that works well.

[Crimson Wife]

Just now, Quill said:

   I did wonder if there was a legal way to put company funds into a medical cost savings account and use that for our Medi-share funding and costs, but then it would still be money we had to reserve out of the company the same as we do now to pay health insurance premiums.

No, you cannot use a Health Savings Account with a health-sharing ministry because only certain types of insurance plans qualify for HSA's. https://www.peoplekeep.com/blog/bid/297952/hras-and-health-care-ministry-sharing-programs

[Guest]

1 hour ago, Crimson Wife said:

No, you cannot use a Health Savings Account with a health-sharing ministry because only certain types of insurance plans qualify for HSA's. https://www.peoplekeep.com/blog/bid/297952/hras-and-health-care-ministry-sharing-programs

Worth knowing. Thanks! 

[TechWife]

1 hour ago, Crimson Wife said:

No, you cannot use a Health Savings Account with a health-sharing ministry because only certain types of insurance plans qualify for HSA's. https://www.peoplekeep.com/blog/bid/297952/hras-and-health-care-ministry-sharing-programs

You can, however, use an FSA. 

[OhioMomof3]

My family is enrolled in a health sharing plan. About a year ago, I had two biopsies and an ultrasound done that were covered because they were done as part of the diagnosis and follow-up for a medical condition. My understanding of our coverage is that normal preventative care would not be covered, but a mammogram, needle biopsy, , breast MRI, or ultrasound as part of a diagnosis or treatment protocol would be covered. I don't know if the genetic testing would be covered. 

[milovany]

Hmmmm, I wonder how this plays out with a procedure that is initially "preventative" but (with traditional insurance) no longer is because something was found.  I told this story here once before, but I had my first preventative colonoscopy because my naturopath wanted me to and because it was supposedly free.  Well, they removed two very small polyps during the procedure, and in the ensuing months, I learned that my insurance would not in fact cover everything because finding those two polyps made my colonoscopy "diagnostic" instead of  preventive.  I didn't get it then, and I don't get it now (to me, finding and removing the polyps prevented future cancer -- the purpose behind preventive care [the colonoscopy] in the first place), but so be it. 

So with a Medi-share type program, would this work in my favor?  Since the procedure found something, is it now diagnostic and not preventive, and therefore shareable? 

Edited October 21, 2018 by milovany

[LarlaB]

8 hours ago, OhioMomof3 said:

My family is enrolled in a health sharing plan. About a year ago, I had two biopsies and an ultrasound done that were covered because they were done as part of the diagnosis and follow-up for a medical condition. My understanding of our coverage is that normal preventative care would not be covered, but a mammogram, needle biopsy, , breast MRI, or ultrasound as part of a diagnosis or treatment protocol would be covered. I don't know if the genetic testing would be covered. 

 

Thats my understanding as well.  Normal preventative care is not covered but testing as part of a treatment or diagnostic process is covered.   You pay up front and are reimbursesd.

We have had Medishare for a few years and thankfully never needed to for major issues.

 I have been hugely encouraged to observe 3 families close to me who have needed to and used it for expenses related to childbirth with complications, toddler hospitalization, broken femur requiring surgery, kidney failure and subsequent surgery, spinal surgery and more.  Every single one has been major expenses and have all been covered. It’s my understanding that it can take a while simply based on getting an itemized bill but the MediShare reimbursement has been very fast.   

We are self employed and pay $336 a month with an $8k deductible for a family of 4. That’s an out of pocket savings savings of $700 a month for a traditional insurance plan that would have a $12k deductible.  Annually, that’s an $8400 savings, plus another $4k deductible savings.  A lot of healthcare can be covered for that amount of money.

[*LC]

I have Samaritan, but have not needed to use it.

I don't know the answer. From the guidelines:

Tests and Checkups—Tests are shareable only when prescribed by a licensed provider because of symptoms that are evident for a condition that was not evident prior to becoming a member. Follow-up tests or checkups more than one year after an illness or injury is stabilized after treatment, is in remission, or is cured are not shareable

Cancer—Shareable, but there may be a limitation if it is related to cancer of a type you had prior to becoming a member (see Section VII.A). During the first five years of membership, the statement described in Section VII.D may be required. 

 

Colonoscopy—A colonoscopy will be shareable when prescribed due to symptoms for a condition not evident prior to your membership, or when it results in the discovery of a shareable condition. Regular tests and checkups (Section VIII.B.36) are not shareable. 

Complications Following Non-Shareable Medical Procedures—If complications arise from a medical procedure that is not shareable (e.g. a routine colonoscopy and most cosmetic surgery—see Section VIII.B), expenses for treating the complications are shareable

 

Not Covered: Routine Medical Care—Such as routine physicals, checkups, vaccinations, flu shots, long-term maintenance prescriptions, and other routine medical expenses are not shareable.

 

 

[Sharpie]

9 hours ago, milovany said:

Hmmmm, I wonder how this plays out with a procedure that is initially "preventative" but (with traditional insurance) no longer is because something was found.  I told this story here once before, but I had my first preventative colonoscopy because my naturopath wanted me to and because it was supposedly free.  Well, they removed two very small polyps during the procedure, and in the ensuing months, I learned that my insurance would not in fact cover everything because finding those two polyps made my colonoscopy "diagnostic" instead of  preventive.  I didn't get it then, and I don't get it now (to me, finding and removing the polyps prevented future cancer -- the purpose behind preventive care [the colonoscopy] in the first place), but so be it. 

So with a Medi-share type program, would this work in my favor?  Since the procedure found something, is it now diagnostic and not preventive, and therefore shareable? 

In my dh case it was covered in full despite finding issues. The polyps found were sent out for further testing and that was also covered in full.  . 

[TravelingChris]

Just asking, but don't all exclude Mental Health in any form?  

[LucyStoner]

52 minutes ago, TravelingChris said:

Just asking, but don't all exclude Mental Health in any form?  

 

As I understand it, yes.  

[Crimson Wife]

16 hours ago, TechWife said:

You can, however, use an FSA. 

Not sure, but one big disadvantage to a FSA vs. a HSA is that FSA money has to be spent by the end of the plan year while HSA money can grow tax-free until such time as the owner needs it. If someone is healthy and has minimal expenses, a HSA is much better than the FSA.

[LarlaB]

10 hours ago, TravelingChris said:

Just asking, but don't all exclude Mental Health in any form?  

 

Yes, and I’m hoping that is something they change. It’s incredibly disheartening.

[creekland]

Quill, a little bird from the forum directed me to this thread...  Of the things you mentioned, the only one I'm not sure about coverage for would be genetic testing with Samaritan Ministries.  The rest all would have been covered at 100%.  FWIW genetic testing isn't covered by all insurances either based upon those I know with insurance.

Normal mammograms are not covered and they easily come out of monthly savings.  However, if something is found then even that original was covered.

With my brain tumor I first went to an eye doctor because my vision was off.  Normally vision isn't covered, but because the tests that office did discovered the medical problem, even the eye doctor visit was covered at 100%.  That surprised me, but in a great way.  The other surprise is the type of radiation that was recommended for me would not have been covered by most insurances (as per what I was told at JH). A different, more damaging one, would have had to have been used. Samaritans covered it without blinking an eyelash.  Considering the problems I have now four years later are supposedly caused by radiation I'm super thankful I could have the one with the best outcome rather than the one insurance would have paid for - esp since for us insurance would have come with a 20% co-pay until we had paid in excess of 12K.

For those with health share (at least Samaritans - I can't speak for any of the others), it's wise to save the monthly savings to use for all the basic care from mammograms to flu shots to whatever.  We have at least 6K per year in that "fund" and so far it's paid for everything routine we've needed.  We haven't even come close to breaking even with it.

Lately I've had cardiac stuff checked out - all based upon what appears to be more radiation brain damage, but it might not have been because the symptoms.  If it had been cardiac related it would have been playing with fire.  All of this (cath, stress test, blood tests, lung tests, specialists) has been covered at 100% even though it just proved my heart is perfectly fine (super good news as far as that is concerned - though it means I have more to live with due to the brain tumor, so a mixed bag overall).

We'd have been out a ton financially if we hadn't been with health share.  The cost comparison amazes me.

BUT... we don't need regular expensive prescriptions or a lot of routine testing post problems so everyone has to consider their own costs.   (Cancer prescriptions are covered with no limit.)  We also didn't have preexisting conditions before we joined over a decade ago.  Most of those still aren't covered, though some are.  Health share is definitely not a good option for you folks now, but if anyone else is reading and was curious... well, that's why the little forum bird asked me... so I'm posting our experience for all to read.