Medical Cost Sharing insurance

[ProudGrandma]

Has anybody here used or is using a medical cost sharing type insurance? ( Medishare, Liberty Healthshare or Sedera....to name a couple).  I am looking for thoughts and opinions about these kinds of companies.   I need a family plan and we would like to have the option to seek alternative (more natural) doctors on occasion and have those be covered.  Is that an option with these companies?  I just don't really know how these work or how reliable they are to come through for you when you need them to.  How much extra work on our side it is.  And ANYTHING else you can share.  THANK YOU SO MUCH!!!!!

[ScoutTN]

We checked into one a while ago, but didn’t end up pursuing it. They generally do not take anyone with high risk or high expense previously existing conditions, which excludes me and Dh. They are essentially disaster insurance, like a very high deductible plan in that they don’t “cover” most routine medical expenses. You pay those OOP.  

[ProudGrandma]

Just now, ScoutTN said:

We checked into one a while ago, but didn’t end up pursuing it. They generally do not take anyone with high risk or high expense previously existing conditions, which excludes me and Dh. They are essentially disaster insurance, like a very high deductible plan in that they don’t “cover” most routine medical expenses. You pay those OOP.  

interesting.....I thought I saw that they do cover "regular" stuff...guess I better start reading between the lines to find out for sure. thanks. 

[KeriJ]

We have used Samaritan's for 8 years. They have different plans. The one we have now is a low monthly cost with a reasonable yearly deductible.  Because of the low monthly cost, we are able to create a savings account for basic medical expenses.  We haven't had major issues, but 2 ER visits were fully covered.  

[KeriJ]

When we go to the doctor,  we tell them we are cash pay and they usually give a reasonable flat rate. So we pay out of pocket for regular visits,  but because we have saved for it, it works out ok for now.

eta we have to be creative looking for labs or at least ask up front about the cost because we were burned by a large unexpected bill once.

Edited February 8 by KeriJ

[Katy]

I’ve known two families who regretted using them when their family experienced major illness (cancer) and they did not get sent the amount needed. I would absolutely not use it after their horror stories. 

[KeriJ]

My sister's family uses a different one. Her husband has had 2 major heart attacks with hospital stays and cancer surgery. They have been able to get bills paid and reduced by applying for programs the hospital offered. She has to do a lot of paperwork, but feels it is worth it.

eta he was accepted with pre-existing conditions with stipulations,  but still has had a decent experience 

Edited February 8 by KeriJ

[ScoutTN]

10 minutes ago, kfeusse said:

interesting.....I thought I saw that they do cover "regular" stuff...guess I better start reading between the lines to find out for sure. thanks. 

Maybe that was particular to the one we looked into? I know they wouldn’t pay for some of our regular, routine medical expenses and Rx. But we didn’t go too deep in researching when it became clear that brain surgery and diabetes would be deal breakers. 

[ProudGrandma]

2 hours ago, KeriJ said:

We have used Samaritan's for 8 years. They have different plans. The one we have now is a low monthly cost with a reasonable yearly deductible.  Because of the low monthly cost, we are able to create a savings account for basic medical expenses.  We haven't had major issues, but 2 ER visits were fully covered.  

they are on my list to call.  So, thanks for that.  

[cintinative]

When I have looked into it, the ones I looked at had a look back for medical issues of 3-5 years so that automatically disqualified us. 

[Brittany1116]

We looked into one. I have a thyroid issue they would cover but the high cost of the Rx made up for any potential savings vs traditional insurance. Also, they hounded us via calls and emails for MONTHS. 

[gardenmom5]

We've looked at them.  They are very exclusionary.  they discriminate against religions they don't like as well - health has nothing to do with it.

[prairiewindmomma]

Read the fine print. Generally you are on the hook for all expenses upfront and you may (but are not contractually obligated to receive) partial to full reimbursement. Washington State has fully banned medical sharing plans and some other states have regulated them but in over 30+ states they are unregulated.

Also: https://www.verywellhealth.com/health-care-sharing-ministries-4010207

[ProudGrandma]

4 minutes ago, gardenmom5 said:

We've looked at them.  They are very exclusionary.  they discriminate against religions they don't like as well - health has nothing to do with it.

can you tell me more about this?  do they ask you directly what religion you are?

[PeterPan]

Make sure you're factoring in the "free" annual doctor's visit and bloodwork a typical insurance policy will cover.

[Sharpie]

We are on one not listed, and so far they have covered what I submitted to them in full within a couple months.  There is a deductible that we had to meet first.  We used to have Liberty and moved from them prior to their restructuring and significant rate increase.  It took nearly a year to be reimbursed for medical expense with them but they may have things better now. 

We are self employed and the reality is we either have health sharing or nothing.  Thankfully we did not have pre-existing medical conditions. 

[Kuovonne]

Just to be clear, these types of medical cost sharing programs are NOT insurance.

If you have (or will soon have) young adult children (ages 18-26), whether or not they can be included in a “family” plan is different from insurance. For most insurance plans, these young adults can be on their parents’ family insurance plan. However, health care cost sharing plans are more likely to have requirements like the young adult attending college, living with parents, being single, etc.

[knitgrl]

We used Liberty maybe 8 years ago when dh was working as a contractor. We liked it, as it was less expensive than what we would have gotten through the state. It was like $500/mo vs. $1,300/mo plus $12,000 deductible. At that point, we had no prior conditions. They made all the calls to doctor billing offices, which was nice. However, they did not cover vaccinations for our young children. We learned those are pricey when you have to pay for them yourself -- about $400/shot.

[gardenmom5]

1 hour ago, kfeusse said:

can you tell me more about this?  do they ask you directly what religion you are?

yes

[knitgrl]

I think Liberty is Mennonite-based and we are Catholic. They didn't seem to have a problem with that. But, Dh signed us up, so I don't know what they asked.

[TechWife]

As someone said above, this is not insurance. It is a betting pool. You're paying an entry fee in the hopes that you can get reimbursed for expenses you've already incurred, but they aren't under any obligation to do so. Because they are not regulated, they can change their fee structure and their "eligible" bills at any time. I could go on about what they say is ineligible right, but instead of doing that I'll summarize it to say that if you or someone in your family has any pre-exisiting conditions, they won't be covered. Mental health care is rarely covered.

You have to pay for care up front or make payment arrangements. Providers are under no obligation to give you discounts or to agree to delayed payment or a payment plan. I've heard several stories from plans like this where they have gotten discounts from providers. I'll be honest with you - when you're in the ED with chest pain or another emergent situation, you are not in a position to negotiate anything.  Getting a discount for an annual physical, or an office visit for an established patient is nothing in comparison to the hospital contracted prices we've had these past fifteen months. I would be shocked if an individual could negotiate charges down as low as our insurance company does, even for routine office visits. We  pay a lot for insurance through my husband's employers. However, I can tell you that in the past 15 months we have gotten our  money's worth as a result of contracted arrangements. We can go to any physician we want to. Three major medical centers take the insurance. We've not had any problems getting the prescriptions we need.

A few of these plans have gone bankrupt in the past 5-7 years, so be very wary.

 

 

[TechWife]

5 hours ago, KeriJ said:

My sister's family uses a different one. Her husband has had 2 major heart attacks with hospital stays and cancer surgery. They have been able to get bills paid and reduced by applying for programs the hospital offered. She has to do a lot of paperwork, but feels it is worth it.

eta he was accepted with pre-existing conditions with stipulations,  but still has had a decent experience 

By programs the hospital offered, do you mean charity funds? Those programs are available for everyone who meets the need criteria, whether or not they have insurance, are in a cost share or cash pay. Insurance companies get lower negotiated rates than individuals do. Far lower (yes, we have experience, both professional and, more recently, personal).

I'm glad this is working well for your sister's family at this point in time, but it's not for everyone.

 

[TechWife]

41 minutes ago, knitgrl said:

We used Liberty maybe 8 years ago when dh was working as a contractor. We liked it, as it was less expensive than what we would have gotten through the state. It was like $500/mo vs. $1,300/mo plus $12,000 deductible. At that point, we had no prior conditions. They made all the calls to doctor billing offices, which was nice. However, they did not cover vaccinations for our young children. We learned those are pricey when you have to pay for them yourself -- about $400/shot.

Try your county health department the next time they need immunizations.

[TechWife]

1 hour ago, PeterPan said:

Make sure you're factoring in the "free" annual doctor's visit and bloodwork a typical insurance policy will cover.

Add pap smear, mammogram and colonoscopy.

[TechWife]

I'll also add in here that i know two families who are in these programs. Both families have delayed or declined care because of the out of pocket expense. Even though these programs tout the fact that you can "choose your own providers" - if you can't pay the providers, you can't access health care.

[prairiewindmomma]

Additionally, providers are not required to provide care (outside of Emtala/emergency care to stabilization). If you have no insurance on file (and remember, medical sharing is not insurance by definition), they may require full cash price for the appointment at checkin.

Edited February 8 by prairiewindmomma

[LauraClark]

I've had Samaritans for a few years but haven't ever had to use it. It's a low monthly cost but they don't cover anything until it exceeds $400 (I think). All of my Dr visits have been under that amount. My friend also has Samaritans and has had multiple things that have been covered no problem. I think these type of programs are fantastic for those who are generally healthy and don't need to go to a Dr often. I love the whole concept: that we are helping others pay for their needs and praying for them at the same time.

[historically accurate]

nm

 

Edited February 8 by historically accurate

[ProudGrandma]

3 hours ago, Sharpie said:

We are on one not listed, and so far they have covered what I submitted to them in full within a couple months.  There is a deductible that we had to meet first.  We used to have Liberty and moved from them prior to their restructuring and significant rate increase.  It took nearly a year to be reimbursed for medical expense with them but they may have things better now. 

We are self employed and the reality is we either have health sharing or nothing.  Thankfully we did not have pre-existing medical conditions. 

Might you be willing to share which one you use now?

[ProudGrandma]

Thank you for your help in this.  We greatly appreciate it. 

[Faith-manor]

I would caution against them. My parents used one back in the 80's when they were kind of first invented. Theirs was called "The Christian Brotherhood". It rarely ever paid anything, and when it did, it took FOREVER - often a year - for the money to arrive. The CEO/President of CB absconded with all the money, and Florida courts ruled that it was pretty much a " too bad, so sad" situation because legally, they really are not bound to pay. It isn't insurance. But they did seize his Florida home and some other assets in the states, sell it, and refund some money to the tens of thousands who subscribed to it. 

Many of these do a five year look back on every iota of your health, and that of every family member so being rejected for pre-existing conditions is pretty normal, and there is no law against it because again they are not insurance companies. 

[Carol in Cal.]

Personally I don’t trust them.

[Ting Tang]

We are self-employed, so our health insurance is over $3,000 per month.  Of course, I looked into one.  Since I do not have my rear end in a church pew every Sunday and do drink wine, I had to rule our family out of that, lol.

For me, it just seems very risky.  As someone else said, read the fine print. 

Our health insurance is about triple our escroed mortgage payment.  They keep saying they are willing to pay $20 per month per gym membership costs (big LOL), but I've been requesting my debit card for that since October without much luck.  

[freesia]

56 minutes ago, Ting Tang said:

We are self-employed, so our health insurance is over $3,000 per month.  Of course, I looked into one.  Since I do not have my rear end in a church pew every Sunday and do drink wine, I had to rule our family out of that, lol.

For me, it just seems very risky.  As someone else said, read the fine print. 

Our health insurance is about triple our escroed mortgage payment.  They keep saying they are willing to pay $20 per month per gym membership costs (big LOL), but I've been requesting my debit card for that since October without much luck.  

Can you get health insurance through the health exchanges?

[freesia]

My in-laws had one and liked it. It did cover FIL’s  cancer bills. I think individuals sent my Mil money directly. (FIL passed from his cancer.) I would never do it because of the risk that something wouldn’t come through. 

[GoVanGogh]

I have a friend who had one of these plans, though I can’t remember which one. Her 60 yr old husband suffered a major, life altering, stroke in 2022. They were left with $$$$$$ in medical bills not paid. As others have said, it is a gamble. It is not insurance. 

[Ting Tang]

22 hours ago, freesia said:

Can you get health insurance through the health exchanges?

That is the only way our health insurance will allow us to purchase it (we have two options for companies offering insurance).  Our income is unpredictable, so we typically have to reconcile and end up paying about this much.  Seeing how much everything costs, I understand why it is so high, but I never imagined it would be our biggest expense.  I wish self employed people could form groups.  We are required to be farm bureau members for our auto/farm insurance, so I wish we could form a group that way.  

[Halftime Hope]

1 hour ago, Ting Tang said:

That is the only way our health insurance will allow us to purchase it (we have two options for companies offering insurance).  Our income is unpredictable, so we typically have to reconcile and end up paying about this much.  Seeing how much everything costs, I understand why it is so high, but I never imagined it would be our biggest expense.  I wish self employed people could form groups.  We are required to be farm bureau members for our auto/farm insurance, so I wish we could form a group that way.  

I don't know if it still exists, but there used to be a group called NASE, National Association of the Self-Employed, and one could purchase group insurance through them. You might use those search terms and see if there is something similar now. ??

[Halftime Hope]

On 2/8/2024 at 7:25 AM, kfeusse said:

Has anybody here used or is using a medical cost sharing type insurance? ( Medishare, Liberty Healthshare or Sedera....to name a couple).  I am looking for thoughts and opinions about these kinds of companies.   I need a family plan and we would like to have the option to seek alternative (more natural) doctors on occasion and have those be covered.  Is that an option with these companies?  I just don't really know how these work or how reliable they are to come through for you when you need them to.  How much extra work on our side it is.  And ANYTHING else you can share.  THANK YOU SO MUCH!!!!!

I have heard some bad experiences with the first company on the list, and I used Samaritan Ministries. In the two years I was covered with them, I did not have to file any claims. I did have to pay for all minor medical costs out of pockets, because there was a $500 deductible for all claims related to a single condition or accident. For example, if I had broken an arm, I would have paid for $500 of the claims out of pocket, but any further claims related to the care for that injury would have already met the deductible. I did have healthcare providers who were willing to reduce the cost of office visits since they knew they would be paid, by me, without the insurance paperwork.  Finally, I had a doozy of a pre-existing condition, but I was six years out from the illness, a year off of treatment meds, and it was not called out as a pre-existing condition. I have a paper copy of my file (a report of sorts) with them, and it's on the intake form, but it did not was not listed in their account report under pre-existing conditions.

They have all kinds of services to help members access reduced price care such as databases of actual pricing for services, and recommendations to mail-order labs. I now have a high deductible full-featured health insurance plan through a new employer, but I'm still using some of their cost-cutting strategies. For example, I order needed labs from a lab company on my own and save $$$, then I submit that to the insurance company to have it denied as I haven't met the deductible, but it whittles down my remaining deductible, in case I have something catastrophic happen. And then I get it reimbursed from my HSA. 

Back to Samaritan: their requirement is that you be a church member in good standing. That doesn't mean that you have to "have your butt in the pew every week" 🙂 just that the people on staff know you, and you have a relationship as a member of the church. If you're not a church member type, this would not be for you.

 

 

 

 

[cintinative]

46 minutes ago, Halftime Hope said:

 I'm still using some of their cost-cutting strategies. For example, I order needed labs from a lab company on my own and save $$$, then I submit that to the insurance company to have it denied as I haven't met the deductible, but it whittles down my remaining deductible, in case I have something catastrophic happen. And then I get it reimbursed from my HSA. 

 

I am not sure I understand how this works--so instead of getting a lab order from the doctor you do this? Or you take the lab order from the doctor to a different lab?  Thanks for clarifying. We would be grateful for anything we can do to cut costs. 

[*LC]

1 hour ago, Halftime Hope said:

Back to Samaritan: their requirement is that you be a church member in good standing. That doesn't mean that you have to "have your butt in the pew every week" 🙂 just that the people on staff know you, and you have a relationship as a member of the church. If you're not a church member type, this would not be for you.

We have Samaritan, and I simply have my Bible study leader sign the form each year, and I've never been questioned. (I've never heard of our church having anything called good standing.)

[Halftime Hope]

47 minutes ago, cintinative said:

I am not sure I understand how this works--so instead of getting a lab order from the doctor you do this? Or you take the lab order from the doctor to a different lab?  Thanks for clarifying. We would be grateful for anything we can do to cut costs. 

Find out what the doctor wants ordered, go to the lab website, tell them where you are going to have your labs drawn, and then pay for the labs. Download the order, have the labs drawn, and forward the results to the doctor's office.  DirectLabs was one of the companies, but there is at least one more.

[Heartstrings]

46 minutes ago, cintinative said:

I am not sure I understand how this works--so instead of getting a lab order from the doctor you do this? Or you take the lab order from the doctor to a different lab?  Thanks for clarifying. We would be grateful for anything we can do to cut costs. 

It can really pay to shop around.  We went where the doctor recommended and paid $2000 for an MRI, the next time that we needed one we called an imaging place in town and it was $500.  We just had the doctor send the orders to the imaging place instead of the hospital.  
 

I know we can do it with labs too.  You do the leg work to find a cheaper place and just tell your doctor to send the orders there.  

[Halftime Hope]

3 minutes ago, Heartstrings said:

It can really pay to shop around.  We went where the doctor recommended and paid $2000 for an MRI, the next time that we needed one we called an imaging place in town and it was $500.  We just had the doctor send the orders to the imaging place instead of the hospital.  
 

I know we can do it with labs too.  You do the leg work to find a cheaper place and just tell your doctor to send the orders there.  

I didn't want to drive as far to the mammography place I had been using, so I switched to a branch office closer to me -- same company -- that happened to be in a professional building on a hospital campus. I was charged a $400 hospital use fee in addition to the cost of the mammogram. I was able to get insurance to disallow the fee after a lot of wrangling, but I shudder to think how much Medicare pays to have seniors get their mammogram at that location!

[Lucy the Valiant]

We were in one not named here, and they were generous and honest and accessible. I wish they were an option as an alternative to employer-required insurance, because it would save us a LOT of money.

[Halftime Hope]

18 minutes ago, *LC said:

We have Samaritan, and I simply have my Bible study leader sign the form each year, and I've never been questioned. (I've never heard of our church having anything called good standing.)

So this is what I said, in totality:  Back to Samaritan: their requirement is that you be a church member in good standing. That doesn't mean that you have to "have your butt in the pew every week" 🙂 just that the people on staff know you, and you have a relationship as a member of the church. If you're not a church member type, this would not be for you.

I can't remember if there is any wording about "in good standing" on their website, but that is a reasonable approximation of the intent.

[Halftime Hope]

This isn't quite on the OPs topic, but someone else raised it in the thread.  If you are self-employed or the owner of small business, and you want to be in a group plan:  https://www.nase.org/request-insurance-quote

I have no idea what the cost is.

[*LC]

3 hours ago, *LC said:

We have Samaritan, and I simply have my Bible study leader sign the form each year, and I've never been questioned. (I've never heard of our church having anything called good standing.)

I apologize, because my post was not clear. My Bible study leader is not on staff at our church; she is simply a member who agreed to lead a class when asked many years ago. Our annual Samaritan form has never been questioned even when I changed who signed my form from from my minister friend who moved to a different state to the leader of my Bible study. 

To the OP: I completely agree that health shares are not for everyone. However, if you are interested, please talk to people you know that are health share members just like one would speak to homeschoolers when deciding whether or not to homeschool. 

We have been self-pay for insurance for more than 25 years, and we have had many health episodes. Sometimes health insurance worked great and sometimes it failed miserably. There are plenty of people with traditional health insurance, who still end up in debt or bankrupt. 

We started with a health-share plan, when marketplace started and our traditional sources of self-pay insurance went away. None of the plans available at that time had a high-family deductible and affordable premiums like we had prior to marketplace.

We also had been burned by recent changes to our self-pay high-deductible plan around the same time. A bunch of my kids had vaccines, including flu and some other ones, at their well visit that year. (They weren't babies, so I scheduled all well checks at same time.) Our plan had changed and no longer covered vaccines. We ended up paying thousands of dollars for shots that had previously been covered.

That same year or the next, my oldest had some health issues that required a visit to a specialist and testing. She was referred to a hematologist associated with a local children's hospital for a consultation and testing. Our insurance plan at that time had $20 doctor visits. (I can't remember the details of what the testing, but it was a good plan and we had hit our high deductible.) Turns out this doctor had recently moved his office into hospital from the clinic across the street where my kids had seen a variety of doctors over the years with normal coverage. Unfortunately, the insurance treated the doctor visit as a hospital stay instead of 20-30 minutes doctors visit, and the visit was subject to our-high hospital deductible. It also meant all the testing was not covered. 

That is why we changed to a health share. Luckily, we are healthy and have not had to use it often. We just self pay for most things and a lot of doctors/hospitals give a generous self-pay discount. Samaritan does require you ask for a self-pay discount, which at first made me uncomfortable. I've found most places offer their self-pay price as soon as I say we don't have insurance.

Like I mentioned earlier, we had self-pay high deductible insurance for many years that covered tons of expensive procedures and hospital stays for us. I never thought I would be comfortable without insurance. However, things changed. I do know Samaritan will reach out to a member if their share wasn't received by the person with the need, because they reached out to us when someone didn't mark that they received our share.

They also assign/ publish special needs for people with health needs that aren't covered, such as dental expenses or care for pre-existing conditions. There are at different levels of coverage, and if someone with the lower level has medical needs exceeding the amount the lower level covers, maybe 250,000, Samaritan will assign/publish the extra as as a special need.

Before I sound too much like a commercial, I will say our share went up this year, and I looked on marketplace to see what plans were available and what they would cost. Unfortunately, due to weird tax stuff last year marketplace thinks we are eligible for government paid insurance and wouldn't show me any plans. Instead, they forwarded our information to our state for them to provide state insurance, but we haven't heard anything.

One last thing, kids can stay on Samaritan until 25/26. They send a letter when they turn 22, I think, but you just have to say they want to stay on and meet eligibility. They are covered under the signing the parent receives from their church. It doesn't matter if they don't live at home. One of my kids was injured playing baseball at an out-of-state college, and his bills were covered by Samaritan members.