Insight, analysis & opinion from Joe Paduda

< Back to Home

Jul
6

Healthcare Sharing Ministries – the latest

Healthcare costs are about to jump again, driven by exploding staffing expenses, continued healthcare provider consolidation, and the brilliant profiteering by some of the largest (mostly for-profit) healthcare systems.

So, what’s a family to do?

A few have turned to Healthcare Sharing Ministries, a thing that looks like health insurance but isn’t. HCSMs purport to “share” health care costs among members in what might best be described as a risk-pooling framework. Almost all claim to be “Christian”, they are largely unregulated (except as charities), don’t comply with insurance regulations or laws in most states, and most have requirements that members:

  • are in good health,
  • make a statement of Christian belief, attend church regularly, don’t use tobacco or have sex outside of marriage and
  • commit to taking care of their own health.

note there are ministries focused on other religious denominations.

So…sounds good right? cheaper healthcare is better…well, HCSMs also:

  • are not legally required to pay your medical bills,
  • require enrollees to do much of the groundwork to get bills paid (negotiate upfront with the provider, get all the paperwork and documentation, pay upfront then seek reimbursement)
  • medically underwrite – meaning they require disclosures of pre-existing conditions and can reject applicants for medical reasons,
  • can refuse coverage to anyone for any reason,
  • have limits on what they’ll pay for healthcare,
  • can’t guarantee healthcare providers will accept sharing ministry coverage, and
  • have appeals processes that aren’t subject to regulatory oversight.

Enrollment is a bit hard to nail down; the Alliance of Health Care Sharing Ministries claims 1.5 million enrollees although it doesn’t specify the year. Other reports indicate AHCSM reported membership was “over 1 million” in February of 2019. Other sources report membership closer to that 1 million figure.

HCSMs tend to be significantly cheaper than health insurance plans, making them increasingly attractive. However, most families that buy health insurance through the exchanges get major subsidies that significantly reduce their premiums.

There have been multiple reports of individuals and families stuck with huge bills after their “Ministry” refused to pay for care. Aliera Healthcare Inc. and Trinity Healthshares, Inc are the most visible example of what can happen without tight regulation. Regulators in multiple states issued cease and desist orders after concluding the companies violated laws; Aliera was found guilty of fraud and filed for bankruptcy late last year.

Tops among concerns is this – HCSMs are NOT required to have enough cash on hand to pay medical bills. Even more concerning, they don’t have to report their finances, cash reserves, expense ratios or other data.

There’s an effort underway to “accredit” HCSMs; the process/requirements don’t appear to address this critical issue and the accreditation board doesn’t include individuals with actuarial or financial credentials.

I’ve asked the lobbying outfit that purports to represent HCSMs for details on the financial portion of that accreditation process. So far they’ve been less than forthcoming.

What does this mean for you?

be very careful.

 


6 thoughts on “Healthcare Sharing Ministries – the latest”

  1. I remember hearing ads for these programs on the radio after the ACA was signed into law and thinking there’s no way these cooperatives can work as advertised. Not surprisingly, it sounds like they don’t. Thanks for shedding some light on these rather dubious operating practices, Joe.

    1. Thanks for the observation Jeff.

      Much as we’d all like a simple, effective, and low-cost solution to healthcare, we can only have one of those three.

      My sense is many/most of the people behind HCSMs are well-intentioned, believe strongly in what they are doing, and are committed to their missions. However, they don’t know nearly enough about healthcare and the delivery and reimbursement thereof. As a result folks who sign up for HCSMs likely aren’t getting all the information, background, and details they need – not because this is being willfully withheld, but because HCSMs are a wildly over-simplistic approach to an incredibly knotty problem.

      be well Joe

  2. Thanks for putting some attention on this issue, I hadn’t heard of these ministries before this article. I’m surprised the regulators are letting these groups play in the healthcare space without being subject to regulations. I’ve dealt with a few vendors who used that same logic “I’m not a healthcare company, so these rules don’t apply to me;” ultimately, the regulators caught up with them. The ability to deny care at any time for any reason would scare me, especially if you get cancer or need to be hospitalized, as you could be stuck footing the bill while the ministry happily counts the money from the premiums you’ve been paying with the understanding that they would cover you. As often as I bash the health insurance companies, there are at least guardrails in place and regulators to appeal to when they abrogate their responsibilities.

    1. Thanks for weighing in Andrew.

      While some members do benefit from these entities, others have had far less luck. At the end of the day, if a member doesn’t like what they receive from the HCSM, they have no recourse and are on their own.

      be well Joe

  3. One of my sisters and her husband (extremely religious members of a non-denominational fundamental Christian church ) are members of one of these. Three years ago, he contracted the worst possible version of West Nile Virus –which left him quadriplegic and on a ventilator for quite a while. He moved to a rehab facility for a long while after that, and eventually back home. He has made a remarkable but incomplete recovery of his muscular strength, but has been able to return to work part-time. My sister DID negotiate “self-pay” rates from all of the healthcare facilities — and then received literally hundreds of checks for $500 each from individual members of the group who had committed to pitch in if asked. It worked out very well for them.

    1. Thanks for the note Jennifer. Which HCSM did your sister and husband use? How much of the ultimate cost did the checks cover?

      be well Joe

Comments are closed.

Joe Paduda is the principal of Health Strategy Associates

SUBSCRIBE BY EMAIL

SEARCH THIS SITE

A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.

 

DISCLAIMER

© Joe Paduda 2022. We encourage links to any material on this page. Fair use excerpts of material written by Joe Paduda may be used with attribution to Joe Paduda, Managed Care Matters.

Note: Some material on this page may be excerpted from other sources. In such cases, copyright is retained by the respective authors of those sources.

ARCHIVES

Archives