Health Care Sharing Ministries–Your alternative to ACA
I was talking to a client the other day. She’s in a situation where she is ready to retire, but her younger husband is not quite 65. She will be on Medicare once she enters retirement, but the husband has been on her group plan for work. He is on disability (and therefore on Medicare), but since he is under 65, he can not get a Medicare Supplement. This particular family is set against getting a Medicare Advantage (for their own reasons) and asked what else her husband can do to help offset the costs left over by Medicare. I did research on that and wanted to share what I found.
2015 ACA Exemptions
For those of us who want health insurance, the Affordable Care Act may or may not affect us directly. When I was given the challenge of finding other alternatives for this couple, I went straight to the website, though (healthcare.gov). While I don’t think most people over the age of 60 will like the premiums attached to an actual ACA healthcare plan, I wanted to explore what other options existed according to the government. There, you can see a list of exemptions. In the case of this family, they are not really looking for an exemption, since they are both still covered by Medicare. However, looking at this list allows me to think outside the box just a little.
The exemption groups are listed as such (a complete list is found here):
- Health Coverage-related
- Group Membership
- Other Exemptions (including jailed, living abroad, and various hardships)
My main attention was called to the third category. This is mainly due to the fact that most things in healthcare cost less for the subscriber when the word “group” is attached to it. Add that to the fact that health insurance costs increase as you get older, and you can see why group options are more favorable most of the time.
Group Membership Exemptions
There are three options listed under the heading of group membership exemptions. The first relates to being a member of a tribe or able to receive services from an Indian Health Services Provider. This would apply to a low population of the United States, but I’m glad this is here. The third option is being a member of a group that has religious objections to insurance. Tribal and religious freedom from having to be on certain plans is a good thing in my opinion.
The second option is what drew me in a bit–being a member of a recognized health care sharing ministry. These ministries recognized by the government have to have been in existence before January 1, 2000 (though there are two exceptions that alternatives that I will outline below). They must also have been sharing medical expenses continuously since then. They must be tax-exempt and share a set of ethical or religious beliefs. You can claim this exemption on your federal tax return or by filling out this form.
The ministries have to meet some additional requirements in order to keep you from tax penalties. For one, they cannot discriminate based on where you live or work. They cannot deny you coverage based on any medical condition that may develop. They also have to be subject to an annual audit–which is then made available to the public. If you are researching organizations like these, make sure that they meet all the requirements.
Some of the ones that I found out about are:
- MCS Medical Cost Sharing
- Medi-Share (Christian Care Ministry)
- Samaritan Ministries
- Altrua HealthShare
- Christian Healthcare Ministries
- Liberty HealthShare
I’ll give a brief summary of what I found about each. Although these ministries tend to use terminology that is different from healthcare terminology, I will use the words we are more used to in order to keep everything comparable.
MCS Medical Cost Sharing
Year Established: Exception–They were founded after 1999, so tax penalties apply, BUT they offer to pay the penalties.
Cost (Adult): $175/month – $285/month
|Premium||Deductible||Membership Limit||Lifetime Benefit|
|Plan A Gold||$285||$1,000||$1,000,000||Unlimited|
|Plan B Silver||$240||$2,500||$500,000||$1,000,000|
|Plan C Bronze||$175||$5,000||$500,000||$1,000,000|
There are also plans for younger people and family plans. A maximum of three family members will be charged. That makes this an affordable option for large families. See their website for further details on those. Some amazing features of this organization are things like Return of Contribution, Contribution Cap, and Vanishing Personal Responsibility. They also have a 12-month pre-existing clause, so if you’re in poor health, this may or may not be an option for you. However, on my phone call with Craig, he told me that there are some things they could work out, depending on how severe your condition is. Keep in mind that all these ministries have to be good stewards of what they take in. There is a critical balance that companies have to strike–they have to be able to pay the claims! MCS also doesn’t cover costs resulting from unethical behavior.
Medicare: The age limit is age 65, so this will not work as a supplement.
Medi-Share (Christian Care Ministry)
Year Established: 1993
Phone: 1-800-Psalm-23 (1-800-772-5623)
Cost (Adult): $70/month to $476/month
Plans: The plan costs depend on age, desired deductible, and health of the one applying. Medi-Share also offers a plan for those over 65 to be used with Medicare. There is a “share calculator” that will tell you what your premium would be. I’ll put an example below for someone age 40:
|Option 1||Option 4||Option 6|
|Standard Monthly Premium||$303||$184||$117|
|Healthy Monthly Premium||$259||$155||$94|
Medicare: There is also a program called “Senior Assist” that you can have if you’re on Medicare A and B AND age 65 and older. If you are on Medicare and under 65, you would have to subscribe to one of the normal programs. You can definitely do a family plan with Medi-Share as well. Beyond that, this organization really encourages being healthy. They also offer a disability program that will pay up to 80% of your lost wages for up to a year. There is a network of providers that readily accept members of this plan.
Year Established: 1994
Cost (Adult): $140/month-$180/month
Plans: There is really one plan. The amount of your premium is based on the size of the family joining. For individuals, the cost is $140/month for an individual that is age 25 or younger. If you’re older than 25, the cost is $180/month. There is a one-time fee of $200 when you join. There is another added feature of this company, though. If you wish to share more than your own risk, you can pay extra in order to help those whose medical needs exceed the $250,000 maximum.
The thing that is attractive about this ministry is the fact that there is no real high deductible. Any medical cost that is $300 or less is your responsibility. Anything between $300 and $250,000 is shared (or covered). Anything over $250,000 is covered by the optional extra premiums that you and/or other members pay.
Medicare: There is no special program for Medicare, so if you are any age, you can use this program. There is a special prayer request program where members can submit offerings to offset those needs that aren’t covered or that are ongoing preexisting needs. There is a book of needs that are covered and not covered provided for your reference.
Pre-existing: If you have pre-existing conditions, this may or may not be feasible for you. They are always looking for healing. So if you have a long-term condition (like a heart condition), the waiting period for full sharing based on that illness is 5 years. And that’s 5 years without symptoms, medication, or any other treatment.
The last I checked, in order to become a member here, you have to send in a statement of Christian faith. For those who have no problem with this, there is no issue. If you do have an issue with this, there are other more open ministries.
Year Established: March 2000–granted approval, so you are still exempt from penalties
Cost (Adult): $100/month – $315/month
Plans: There are three tiers: Bronze, Silver, and Gold. On the Silver and Gold levels, you can also add a package of 6 office visits a year for an additional fee.
|Monthly Premium (age 0-39,60-64)||Annual Deductible (in-network)||Annual Max||Lifetime Max|
There is prescription coverage through CVS/Caremark for all members and maternity for silver and gold members. Once members have met their initial deductible, there is a second deductible that is equal to a percentage of the next $10,000.
Altrua was started due to an uninsured family in a vehicle accident. The family had no way of paying the bills, but the word got out and people chipped in. By the time they family left the hospital, the bills had been paid. This, like all the others, is made with helping one another in mind.
As far as Medicare goes, I will update this once I get a call back from them. I was unable to get a live person on my first call.
Christian Healthcare Ministries (#1 recommendation)
Year Established: 1981
Cost (Adult): $45/month to $150/month
Plans: Like Altrua, Christian Healthcare Ministries has three plans, Bronze, Silver, and Gold. There is no age band, so the prices are pretty set.
|Premium||Per Incident Deductible||Coverage Per Illness|
As you notice, the “deductible” is per incident, not per year. But, this company is big on negotiating discounts. So, $5000 represents the amount of money paid OR $5000 worth of discounts negotiated on your medical bills. A lot of the discounts come from being a self-pay patient. This type of discount, for example, will count towards the deductible. The gold tier allows for physical therapy, home health care, and incident related doctor’s office visits and prescriptions. When you compare this to the other groups, this is a great value! Also, like Altrua, you can opt to pay more per year to up to an additional $100,000 per illness per year with their program called “Brother’s Keeper.”
This organization also allows you to use their plan alongside Medicare as long as you have Parts A and B and the costs are eligible. There are no networks associated with CHM.
Honestly, this is the one I personally subscribe to. It has been around the longest and seems the most affordable in my situation. You have to be affiliated with a church to participate. If you are interested in joining CHM, you can use my referral number. Email me at email@example.com for it.
Medicare: requirements are the same and costs are the same. At CHM, you do not have to be 65 to enjoy their cooperation with Medicare. Once you get your explanation of benefits from Medicare after a visit, you just send that to CHM and they take it from there (as long as it’s covered). You have to be enrolled in part A and B to have this pay out, though. For most of you, this isn’t a problem. Here’s the cool thing: whatever Medicare pays goes towards your “personal responsibility” (or what we kinda call “deductible”) with Christian Healthcare Ministries (if it is a covered cost)! If CHM covers the cost, but Medicare doesn’t, CHM will still pay their part.
Pre-Existing: If you have these conditions you can still be accepted by CHM. If they are controlled, then they can even be covered up to a certain amount! In the first year, they can be covered up to $15,000. After 2 years, they can be covered for up to $25,000. And finally after the third year, the condition will no longer be considered pre-existing.
Year Established: 1998
Phone: 855-58-LIBERTY (855-585-4237)
Cost (Adult): $107/Month – $199/month
Plans: There are three plans. There is a discount for those under age 30, but no further tiering:
|Premium/Under 30||Annual Deductible||Cost Sharing|
|Liberty Share||$157/$107||$500||70% up to $125,000 per incident|
|Liberty Plus||$181/$131||$500||100% up to $125,000 per incident|
|Liberty Complete||$199/$149||$500||$100 up to $1,000,000 per incident|
The main difference between the Liberty Share and Liberty Plus (besides the cost sharing percentage) is access to pharmacy, Chiropractic services, dental, hearing, and vision (discounts). There is also an annual membership fee of $125 for all three plans.
Liberty HeathShare was started as a response to an accident (like Altrua). Fellow Christians pooled finances together to pay the bills of the pastor who suffered injuries in the accident. Although Liberty is a church ministry, you qualify if you don’t use tobacco, don’t abuse alcohol or drugs, lead a healthy lifestyle, and agree with their shared beliefs. You can see these in more detail here.
Medicare: In order for this to work with Medicare, you have to have parts A, B, and D. Like CHM, whatever Medicare pays goes towards your personal responsibility. However, if you have ongoing medical issues, getting coverage here may be difficult because of their requirements.
There are a lot of options out there! I want to dive into other healthcare co-ops. What have you found that works? Let me know and I’ll add them to the list. Please comment below.