With health insurance costs on the rise, consumers are looking at other options for financially protecting themselves and their families. One popular alternative is health share plans, but at what cost?
It’s important to know health share plans are not the same as a typical health insurance plan. With our help, you can easily help your clients navigate these plans and make sure your clients aren’t being led astray.
What Is a Health Share Plan?
You may have heard health share plans referred to as health care sharing programs or health sharing ministries. These programs are typically faith-based and rely on their members to pay a portion of one another’s costs. When a member of the program is sick, they submit a request for their bills to be paid with money from an escrow account.
Since these cooperatives also prioritize faith, many require that their members embrace a Christian lifestyle and abstain from activities like drinking or smoking.
What Isn’t Covered Under Health Share Plans?
In many states, health share plans are exempt from health insurance laws. Without these regulations, a consumer with a preexisting condition may not get coverage. Since these programs have a religious foundation, they also may not cover services they deem “unbiblical,” which could include things like fertility/infertility care. Ultimately, it’s up to the individual program to decide what requests they will approve.
Without the same regulations that apply to health insurance, a consumer with preexisting condition may not get coverage from a health share.
Basically, if your client has a condition that requires frequent doctor visits, this isn’t the right program for them.
Differences Between Health Insurance and Health Share Plans
Under a traditional health insurance plan, members pay a premium and are guaranteed compensation for outlined losses, illness, damage, or death. There is no guarantee of coverage for health share plans. Each community decides their own process for money distribution after a member submits their claim. They may also limit the payout even if the plan would cover the service otherwise.
There is no guaranteed coverage for health share plans.
|Health Share Plans||Health Insurance|
|Subject to Health Insurance Laws|
|Payout Guarantee for Covered Services|
|Preventative Care Covered|
|Wellness Visits Covered|
|Negotiating Power for Discounts|
|Provider Network Restrictions|
|Open Enrollment Period Restrictions|
While health share plans aren’t like typical health insurance, they have similar details, which can be confusing for seniors or those eligible for Medicare. In a health share plan, members choose a deductible amount they’ll contribute as a household before receiving assistance from the community. Similar to a premium, a monthly share payment ensures your assistance eligibility.
Here are some health insurance terms and their health share plan equivalent:
- Deductible: Annual unshared amount
- Premium: Monthly share
- Explanation of Benefits: Explanation of Sharing
- Claim: Eligible event, illness, or incident
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It’s important to help your clients understand that health share plans are not equivalent to health insurance and are not required to guarantee coverage of pre-existing conditions or provide benefits absent of meeting lifestyle standards. We hope this breakdown helps you to educate your clients about the availability of options and the value of qualified health insurance.