Should You Place Your Faith in Christian Health Insurance?
There’s no doubt that each year Americans are spending more of their household budgets on healthcare costs,1 and many Americans are struggling to pay for major medical insurance.2
The Affordable Care Act (ACA), passed in 2014, was intended to expand health insurance coverage for the more than 44 million Americans who had no insurance before the law took effect. But in 2017 – three years after the ACA took effect – more than 27 million non-elderly Americans were still uninsured. And more than 45% of them said it was because they could not afford coverage.3
Over the past five years, an increasing number of Americans have turned to healthcare sharing ministries (HCSMs) to help pay for their medical costs. While in 2014 only 160,000 Americans were enrolled in HCSMs,4 that number has risen to nearly one million participants in 2019.5
Some people join HCSMs for religious reasons. However, after the ACA took effect, some individuals enrolled in these plans in order to:
- Gain an exemption from the ACA’s individual mandate – and not have to pay the penalty for not enrolling in an ACA or “Obamacare” plan.6
- Save money – because monthly costs for health share plans can be lower than unsubsidized marketplace plan premiums due to fewer regulations and administrative costs.7
As of January 1, 2019, the Federal ACA penalty for going without minimum essential coverage has been eliminated, although some states have implemented state mandates and penalties. So, if you joined a qualified healthcare sharing ministry to avoid paying the ACA penalty or to save money, this may be a good time to consider other coverage options available to you.
Short term health insurance – a form of non-major medical insurance, may be able to offer you more coverage than your healthcare sharing ministry, at an affordable monthly premium.8 Since these types of policies are not compliant with the ACA, they are not guaranteed issue and don’t include coverage for the essential health benefits.
The easiest way to find out how much a short term health plan could cost you is to get a quote.
What are Healthcare Sharing Plans?
Faith-based health sharing ministries are formed when people who hold common religious or ethical beliefs band together to share in paying for each other’s medical expenses.9 Healthcare sharing ministries have existed for several decades in the U.S.10
As of 2019, there are 104 known and active Christian healthcare sharing ministries operating in America that are certified for exemption from the ACA. Most of these are affiliated with Mennonite churches.11 United Refuah HealthShare is the first and only (known) Jewish healthcare sharing ministry operating in the U.S.12
How do Healthcare Sharing Ministries Work?
Ministry members donate a monthly “share” amount which is used to help pay for members’ medical needs. Based on the ministry’s structure, members may send their share amounts to the ministry, which then pools and redistributes the funds, or directly to another member.
Typically, the ministry sends a monthly newsletter to members, listing the names of members who are receiving shares, along with encouragement for members to pray and send good wishes to the member who is experiencing a medical situation.
Are Health Share Plans a Type of Insurance?
No. Despite some people referring to them as “Christian health insurance plans,” or “faith-based health insurance,” healthcare sharing ministries are not insurance plans. In fact, 30 states have now enacted safe harbor laws specifically stating that ministries are not insurance and therefore are not subject to the same regulations which apply to insurance companies.13
While it’s legal for the healthcare sharing ministries to operate, the safe harbor laws mean that members do not receive the same consumer protections that enrollees in insurance plans receive in case of a dispute with their insurance company.
Please note, the materials available at this website are for informational purposes only and not for the purpose of providing legal or tax advice. You should contact your attorney or tax professional to obtain advice with respect to any particular issue or problem.
Let’s take a closer look at how some features of health sharing ministries resemble those of insurance plans, as well as how they differ.
Similarities between Health Share Ministries and Traditional Insurance
Benefits package – some health sharing ministries may outline the types of services that are typically covered, similar to an insurance company providing a list of covered services. However, a healthcare share plan is not contractually obligated to pay for your medical services, even if they are listed on your “schedule of benefits.”14
Membership card – when you enroll in a health insurance plan, you receive an identification card that you show each time you visit your doctor. Health share plans also give you a membership card to show your provider when you receive medical services. Some Christian medical sharing groups negotiate fees on your behalf and pay amounts eligible for cost sharing directly to your doctor.15
Payments you make to participate + before eligible costs may be shared – with most ministries you pay a “monthly share amount” based on the membership level you choose. Some ministries ask you to send your monthly share directly to another member16 while for other ministries you contribute your monthly share online and the ministry matches it to another member’s needs.17 This payment is comparable to an insurance monthly premium payment, except in this case, there’s no contract or policy being maintained.
Many healthcare sharing ministries also require members to pay “personal responsibility amounts”18 or “unshared amounts.”19 This is the amount of medical expenses eligible for sharing that you are responsible to pay on your own before eligible costs exceeding that amount may be shared. Some ministries set an annual amount,20 while others set an amount per incident.21 Again, if this were an insurance policy, this cost would be similar to out-of-pocket costs like deductible, coinsurance or copay.
Provider arrangements – similar to health insurance plans, a few health share ministries may participate in preferred provider organizations (PPOs), while most healthcare sharing ministries place no restrictions at all on which providers you visit – providing greater flexibility and choice.22 However, you have no guarantee that a provider will accept sharing ministry coverage.23
Differences between Health Share Plans and Health Insurance
Participation guidelines – healthcare sharing ministries are faith-based. As such, they typically ask applicants to attest to a declaration of faith. They may also require you to attend church regularly, receive an endorsement from a church leader, and provide you a set of guidelines outlining acceptable lifestyle and health behavioral choices for participation (such as limited or no alcohol consumption, or no smoking).24
And, if you do engage in prohibited behaviors that result in a medical incident, your costs may not be eligible for healthcare sharing payments.
Health insurance does not require you to attest to faith statements, attend church or engage only in biblically-approved lifestyles and behaviors.
Not guaranteed issue – the ACA requires all major medical plans to cover anyone, regardless of pre existing conditions. It also limits health insurance companies to five factors when setting premium amounts: age, location, tobacco use, individual or family enrollment, and plan category.25
A health share ministry may require you to complete a medical history as part of your application process, and charge you a different contribution rate based on your health status – or decline your application altogether.26
No essential health benefits – Unlike ACA-qualifying major medical plans, healthcare sharing ministries aren’t required to include coverage for essential health benefits like preventive care and mental health treatment. In fact, because of the faith-based guidelines, some of these healthcare services, like contraception, may even be explicitly excluded.27
Annual + Lifetime Benefits Caps – One of the consumer protections under the ACA is that you’re not subject to annual or lifetime limits on major medical insurance benefits.28 That’s not the case with HCSMs. They can and do impose annual and lifetime benefit caps for members.29
Contractual obligations – when you enroll in an insurance plan and pay your premiums, you enter into a contract with a health insurance company. The insurance company is obligated to pay your medical expenses as outlined in your policy (contract). You do not have a contract with a healthcare sharing ministry; even if your costs are included on the ministry’s covered schedule of benefits, there’s no guarantee your medical costs will be paid.30
Who Typically Joins a Health Share Ministry?
Individuals who apply for membership with a healthcare sharing ministry are those who are willing to affirm their belief in specific religious doctrine, as well as commit to engaging only in lifestyle and behavioral choices that comply with the ministry’s guidelines.
Members of a health share plan also should recognize that their membership is not the same as having health insurance. They are not covered by consumer protection laws to ensure payment of medical costs listed in their schedule of benefits.
Comparing HCSMs + Health Insurance Options
Now that the Federal ACA penalty has been eliminated, you may be considering going without coverage. (Remember, you may still be subject to a state mandate tax depending on where you live.)
Maybe you were previously part of a healthcare sharing ministry in order to avoid the mandate tax. Or maybe you just prefer to pay less in monthly premium for less comprehensive health insurance, paying for routine medical care on your own.
Whatever situation describes you, it’s a good idea to review your healthcare needs and assess if your health coverage meets them. Below we’ll outline two more affordable health insurance options, in addition to HCSMs:
- Subsidized ACA major medical health plans
- Non-ACA short term health insurance plans
Feature Comparison: HCSM, Major Medical and STM
|ACA-Qualifying Major Medical Insurance31||Healthcare Sharing Ministries32||Short Term Medical Insurance|
|Covers Essential Health Benefits||Yes||No||No|
|Covers Pre-existing Conditions||Yes||Not usually||Not usually|
|Enroll Year Round||No||Yes||Yes|
|Includes Annual + Lifetime Limits||No||Yes||Yes|
|Includes an Out-of-Pocket Maximum Limit||Yes||No||No|
|Fulfills ACA Individual Mandate||Yes||Yes – As an exemption||No|
|Denied Claims Can be Appealed||Yes||Sometimes33||Yes|
Subsidized ACA Health Insurance Plans
If you joined a healthcare sharing ministry to avoid paying the ACA penalty and keep your health care coverage costs as low as possible, there’s good news about major medical plan costs.
$0-premium bronze plan – Depending on your age, income and size of your family, you may be eligible to enroll in a bronze-level marketplace ACA plan, and pay $0 in premiums (after applying tax credits).34
If you’d like to avoid a bronze-level plan coverage because of its high deductible (in 2019, the average bronze-level plan deductible is $6,258 per year35), consider a silver-level plan.
Reduced-premium silver plan – Silver plans have lower deductibles, and you may still be eligible for tax credits to help reduce your premiums. Learn more about income limits to qualify for ACA subsidies, and find out more about ACA plan metal levels and how they work.
Two key things to remember about enrolling in subsidized ACA health plans are:
- You can only enroll in major medical plans during the annual open enrollment period (Nov-Dec) unless you qualify for a special enrollment period.
- To obtain a subsidized plan you must enroll from the federal marketplace or your state exchange. Private major medical health plans are not eligible for subsidies.
Even if you didn’t qualify in the past for subsidies, it’s still a good idea to check now because the income guidelines for subsidy eligibility change each year.
Find out if you could qualify for an ACA subsidy to enroll in major medical coverage.
Comparing HCSM Coverage Options
If you’re still considering joining a health share plan, start by doing your homework. Although there are more than 100 health sharing ministries currently in operation in the U.S.,36 there are four major players:
A recent comparison of these four healthcare sharing ministries highlights that the programs each have distinct features. Depending on your circumstances, one may be a better fit for you if you have a religious affiliation.
And to help lower the chances you’ll be surprised by a ministry’s decision when the time comes for you to ask for cost sharing, research what other members have to say about the programs you’re considering.
One health sharing ministry is now under investigation by a state attorney general after several members complained that their ministry took their money but never paid for any of their medical costs.37 For another couple, a different healthcare sharing ministry refused to pay costs associated with medical testing for their adopted child, explaining that any conditions a child had before adoption were considered pre-existing.38
Get Non-ACA Qualifying Short Term Medical Insurance
If neither major medical coverage nor a healthcare sharing ministry are the right fit for your needs or budget, consider temporary coverage with a non-ACA qualifying short term health insurance policy instead of going uninsured.
- Depending on your state’s regulations, you can keep your coverage anywhere from 30 to 364 days, providing you time to find a more permanent insurance solution.
- Short term health insurance does not provide coverage for the essential health benefits required of ACA-compliant plans (so it doesn’t offer preventive services and most do not cover pre-existing conditions).
- It does, however, usually pay benefits for important health care services such as hospital room and board, surgery, and emergency room treatment.
- Premiums are typically lower than those of major medical coverage because these plans cover less.
- Benefits are paid according to the terms outlined in the plan’s policy – and unlike HCSMs you are covered by consumer protection laws because you’re engaged in a contract with an insurance company.
The best way to find short term plan options near you and compare costs is to get an online quote.
Input a couple of pieces of information, like name and birthdate, and get your results immediately.
Summary + Next Steps
With the Federal ACA penalty for not having major medical insurance now eliminated, this may be a good time to check into other coverage solutions to help pay your healthcare costs.
Get a free, instant short term insurance quote to see what plan options are available in your state, along with premium and deductible information.
If you prefer to work with a health insurance agent who can provide you guidance and help review your options, call 888-855-6837 to speak with a licensed agent during business hours.
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