Posted: February 17, 2022
Health sharing plans are a way for people with similar faiths and beliefs to pool their money, helping members cover their medical expenses. These plans differ from insurance in many ways, and membership in these nonprofit groups comes with both advantages and disadvantages.
Learn the basics of health sharing plans, including the types you may encounter, their advantages and disadvantages and when a health share plan may be the right choice for you.
What Are Health Sharing Plans?
Traditional insurance plans, provided by companies or government programs, offer guaranteed payments under predefined conditions. Health share plans, on the other hand, are healthcare funding co-ops. These programs are typically faith-based, with members who share a common set of practices and beliefs.
Also known as medishare plans or health sharing ministries, health share plans are nonprofits that serve as alternatives or additions to traditional insurance. Members’ monthly contributions create a pool the group can draw from to help cover out-of-pocket medical expenses.
Health share plans aren’t classified as insurance, which allows them todiffer from traditional insurancein several ways, including:
- No network requirements:While insurance plans pay for health care through in-network providers only, health share plans allow members to visit any doctor they want.
- Direct money-sharing:Some health share plans may allow members to give each other money for medical bills directly.
- Limited coverage:To comply with the Affordable Care Act (ACA), insurance plans must providerequired essential health services. Health sharing plans, however, can make their own rules about what they’ll cover. Since most of these plans are faith-based, they often limit their coverage to services that align with their religious beliefs.
- Variable coverage:While insurance plans have defined lists of services they guarantee to cover, health sharing plans can decide to pay on a case-by-case basis. They may also limit how much they’ll pay — some health share plans will cover expenses only until they meet a set dollar amount.
- Membership requirements:Membership in health sharing ministries often requires a commitment to certain standards of behavior. While these requirements are frequently religious, they also almost always include promises of healthy behaviors. Membership in most health share plans is dependent on a promise to forego smoking, drugs and illegal activity.
Types of Health Sharing Plans
Health sharing plans are usually faith-based — most often Christian — organizations. Within that religious framework, however, there’s a wide range for how strictly they expect their members to follow those beliefs.
Groups like Zion Health represent the low end of this range. While it is an organization founded and run on religious principles, they’re open to anyone who wants to join. Their membership requirements are free of any mention of religious commitment.
On the other end of the range, health share plans like Medi-Share, Christian Healthshare Ministries and Samaritan Ministries have strict requirements for their members to demonstrate commitment to their Christian beliefs. Medi-Share sometimes interviews their applicants’ church leaders, and Christian Healthcare Ministries must swear to live by biblical principles. Samaritan Ministries requires annual verification from a church leader that their applicants and members regularly attend services.
Though rare, religiously unaffiliated health care plans do exist. For example, the only faith that the Austin, Texas, medishare plan Sedera asks its members to share is in their shared community.
Pros and Cons of Health Share Plans
Like insurance, health share plans offer both advantages and disadvantages. This section will take you through the pros and cons of choosing this option.
Advantages of Health Sharing Plans
Whether you’re uncovered or looking at options to supplement your current insurance plan, you may be wondering about medishare plan benefits. While federal rules and regulations dictate how traditional insurance plans must work, health sharing plans have more freedom in how they operate. Some of those differences offer advantages over insurance plans:
- Lower costs:Health share plans allow you to choose the program that fits your needs and budget, giving you more control over how much you contribute than most employer-provided insurance offers. Monthly contributions are usually less than the cost of an insurance plan, making these programs a money-saving option for those who don’t qualify for an ACA subsidy. Depending on the group, you may even be able to hold your monthly contribution and remain enrolled.
- Community-minded membership:While insurance is often tied to employment status, withpremiums influenced by where you live, health sharing plans bypass those variables. A medishare plan’s primary consideration is for its members to share the same values and priorities. Members are sometimes able to contact each other directly, fostering a greater sense of community.
- Tax penalty exemption: In 2023, California instituted a state tax penalty of at least $850 for each adult and $425 for each dependent child without qualifying health insurance. However, membership in a health share plan provides a qualified exemption, allowing those without insurance to avoid that penalty.
Disadvantages of Health Sharing Plans
Health share plansqualify as 501(c)(3) charitable organizationsrather than insurance. They are subject to regulation at the state and federal level, undergoing annual reviews by the state attorneys general and the IRS. However, they are not regulated by the Federal Insurance Office, the Centers for Medicare & Medicaid Services or the California Department of Insurance.
While the freedom that health sharing ministries offer has its advantages, it alsocomes with disadvantages:
- No protection for pre-existing conditions:Although ACA regulations require insurance plans toprovide coverage for pre-existing conditions, those regulations don’t apply to health sharing ministries. Some plans impose restrictions on treatment for pre-existing conditions, either denying coverage or requiring membership for a set amount of time before coverage is available. In other cases, pre-existing conditions like diabetes may require a member to pay an additional monthly fee on top of their regular membership contribution.
- Coverage isn’t guaranteed:Unlike insurance plans, health sharing ministries have no legal obligation to provide the minimum essential healthcare services or any others. Since their coverage is unregulated, they have complete control over what they pay for. Most will not pay for birth control, while some also decline coverage for any OB-GYN services. Substance abuse treatment is rarely covered.
- Strict membership rules:Membership in health sharing ministries requires dedication to their codes of conduct, which vary widely between organizations. Most include an agreement to avoid tobacco and drug use, usually as part of living a healthy lifestyle. Stricter groups often also include a statement of faith and a pledge to attend church services regularly. Those found in violation of their agreements typically find their membership terminated.
Why and When to Choose Health Share Plans
Health sharing plans can be a valuable option in certain circ*mstances.
While those with chronic or pre-existing conditions should opt for insurance whenever possible, medishare plans may cover everything you need at a lower cost if you’re in good health overall. A health sharing plan can also be a viable alternative if you aren’t eligible for an ACA subsidy. Even if a health sharing ministry only covers a portion of your medical costs, any coverage is better than none.
You can also use health share plans to supplement your existing insurance. If a plan will cover enough to offset your membership contribution, you may be able to reduce how much you spend on copays or out-of-pocket costs.
Learn Your Options With Health for California
Ensuring you and your family have adequate health insurance is vital, and choosing the right one can feel challenging with so many options available. Let Health for California help you find the best fit for your budget and needs.
Whether you’re currently uninsured or thinking of switching plans, our fast, easy and accurate online application process gives you the information you need to make an informed decision. Investigate your options with afree health insurance quoteor contact us tospeak to one of our agentswith any questions today.
