Author Topic: Switch from medical insurance to healthcare sharing ministry?  (Read 9388 times)

AgentCooper

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Switch from medical insurance to healthcare sharing ministry?
« on: November 16, 2015, 08:55:58 AM »
Can anybody talk me out of this?

It’s Open Enrollment season and I’m seriously thinking of turning off my and my wife’s health insurance, and signing up for a healthcare sharing ministry instead.  Here’s why:

Our insurance is a high-deductible health plan with a shared $5,000 deductible (the plan does not cover any non-preventive expenses until you pay that deductible).

With traditional medical insurance:
$4320 – Amount spent on premiums in 2015
$750 – Amount of before-discount preventive care the doctors billed this year (only about $150 or $200 was actually paid by the insurer to the doctors; the rest was the amount the doctor had to forgive as a discount for having that insurance plan.  Presumably, if had had no insurance this year, I would have been billed $750 or more likely considerably less, because I would have negotiated for a cash discount)
$54,828 - Amount such premiums will cost me over a 10-year period, assuming a 5% annual increase in premium amounts (which was our increase every year for past 3 years).
$6700 – Out of pocket max per calendar year (includes deductible)

With Christian Healthcare Ministries:
$810 – Amount to be spent on monthly “share” amounts in 2016*
$0 – Amount they will cover up front.  I pay all costs and then request reimbursement. 
$750 – Amount I might have paid for preventive care in all of 2015, and that is before negotiating a cash discount.  (Note:  each ministry has different rules, but I've read in at least one of them that preventive care is not covered; members are expected to save for that and pay for it themselves).
$8,474 – Amount the monthly payments will cost over a 10-year period, assuming a 1% annual increase in share amounts
Unlimited – Out of pocket max per calendar year

Edit: 
*Actually $810 would cover us for 9 months of 2016.  You avoid the individual mandate penalty by not having a coverage gap of longer than 3 months.  So I'd sign up on 4/1/16, and have a gap for the first 3 months.  Or if a year's coverage is chosen, it would be $1080 for the first full year.  Subsequent years would add up to...
$11,142 over a 10-year period, assuming a 1% annual increase.

I see this move as very Mustachian.  It puts responsibility for our care, our savings, and our financial future in our hands, rather than making a fear-based decision (Safety is an Expensive Illusion).  It potentially moves a fat stack of cash out of Blue's pockets and into ours.

Several arguments against it:  The healthcare sharing ministries have no legal obligation to pay (counter:  I have faith that they will, when or if we ever truly need it).  They could go bankrupt (counter:  I’d tell my employer I “lost” coverage equivalent, and seek a Special Enrollment; or I'd enroll at our subsequent annual enrollment opportunity).  They don’t cover pre-existing conditions (counter:  We don’t think we have any).  If it was that easy, everyone would do it (counter:  Mustachianism in general is easier than working till death, but not everyone does it yet).

This is an offshoot from my case study thread at
http://forum.mrmoneymustache.com/ask-a-mustachian/reader-case-study-move-large-family-to-city-to-save-on-commuting/.

3 options (I'm learning towards the first one):
http://www.chministries.org/programs.aspx
https://mychristiancare.org/Medi-Share/Public_Content/How_Do_I_Join_.aspx
http://samaritanministries.org/costs/monthly/



« Last Edit: November 16, 2015, 01:17:31 PM by AgentCooper »

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AgentCooper

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #2 on: November 16, 2015, 09:07:31 AM »
I found in the case study that one person did make a very detailed response to this question (thank you!) and I'll add it here, since I have a new thread on the topic:
….As far as the Christian "insurance," I would strongly recommend that you don't get that with such a large family. I have read that it can be logistically impossible to get all your bills paid before collections. It can ruin your credit, and there are all these morality clauses that might make them not pay for things. Yeah, yeah. That won't happen to you, since you probably don't drink and drive or cheat on your spouse. But what if on your commute, say, you get hit by a drunk driver? Based on the morality clause in that type of "insurance", they could refuse to pay your medical bills. Basically they are not bound legally to pay anything when push comes to shove and you have no legal recourse. You are essentially relying on the kindness of religious strangers, and in many cases that may not be enough. And the pool of money you are talking about is possibly not enough to pay for the bills of your whole family if they are in a car accident. Or if one of your kids gets a rare illness or cancer. In essence, you could bankrupt the "insurance" and they would fold or refuse to pay your bills.
My earlier question (in the case study) was not as clear, but to address these concerns:  my kids would continue to have medical insurance.  This change would only affect my wife and I.  We have read and discussed the morality clauses and are not concerned about them.  It is definitely hard, perhaps impossible, to get reimbursed before the bills are due.  I'm experienced in negotiating monthly payments with our medical providers (e.g., 24 monthly payments at 0% interest) and I think I would have to rely on that while waiting for reimbursement.

It is a concern, however, when getting reimbursed depends on all the members following the instructions to mail you a check.  Each ministry is different, but on at least one of them, i read how if someone doesn’t pay up, you report them to the ministry.  The ministry makes a note about it on that person’s file, and then…I think that’s that.  I think you don’t get paid if the member decides not to mail you a payment.  If you have a $5,000 bill, you might have 33 people instructed to mail you a payment of $150.  Then some portion of that 33 might not pay.  I would see the risk of that as quite similar to the risk that when I think something will be covered by Blue Cross, and am told that it will be covered, they find a way to not pay when the time comes.  For example right now I'm holding a bill to pay for a portion of my own preventive care, since Blue incorrectly decided the deductible applied to it.  So I get to write a series of letters and deal with this garbage for multiple months, all to try to save $100.  One of the attractions to the ministry would be never having to deal with an insurance company.

AgentCooper

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #3 on: November 16, 2015, 09:21:15 AM »
Ah, I see - there are plenty of opinions posted at the above link (http://forum.mrmoneymustache.com/welcome-to-the-forum/health-insurance-alternative/).  That link also leads me to these past discussions someone helpfully provided:

http://forum.mrmoneymustache.com/ask-a-mustachian/how-to-avoid-paying-the-obamacare-penalty-for-not-having-health-insurance/10/?

http://forum.mrmoneymustache.com/welcome-to-the-forum/anyone-tried-a-health-share-plan/

http://forum.mrmoneymustache.com/continue-the-blog-conversation/our-new-$237month-health-insurance-plan/20/

If you have personal experience in using sharing, please message me or post your experience.  Thanks!

Proud Foot

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #4 on: November 16, 2015, 12:58:17 PM »
I did not see anywhere in your calculations what you might expect for your share of other members medical bills or is that the $810?  Is there a way to find out what each member typically pays annually for the shared bills? What makes me hesitate is not knowing the health of the other members and potentially having to pay more annually than enrolling in an insurance plan.

AgentCooper

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #5 on: November 16, 2015, 01:12:12 PM »
I did not see anywhere in your calculations what you might expect for your share of other members medical bills or is that the $810?  Is there a way to find out what each member typically pays annually for the shared bills? What makes me hesitate is not knowing the health of the other members and potentially having to pay more annually than enrolling in an insurance plan.

Yeah, that's the $810 per year.  Monthly cost varies from one healthcare sharing ministry to another, but say I choose one that is X amount per month, then every month I'll pay that X amount by mailing an after-tax, non-deductible contribution in X amount to wherever they direct me to mail it (sometimes to the headquarters, but usually directly to members in need who have documented their medical bills to the group).  Payment of the medical bills depends on any number of unknown members mailing their monthly payment directly to the member who had the bill.

MoonShadow

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #6 on: November 16, 2015, 01:22:16 PM »
These medical sharing organizations have their place, but what is really happening is that you are choosing to join a voluntary insurance pool with fuzzy rules & limited enforcement.  This would be a great thing if your local church were running the sharing pool, not so much as a semi-anonymous online thing.  Fraud is higher than you would think, under the assumption that new members are actually Christians, as opposed to identity thieves.

Is a high-deductible plan not available to you?

KayakMom

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #7 on: November 16, 2015, 03:03:01 PM »
we did it.
I've only had to make one "claim" for an Emergency Room visit for a broken finger for my daughter.
So far so good. Everything was paid as expected.
The monthly share amount is so much cheaper than anything we could find.
I'm glad we did it.

justajane

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #8 on: November 16, 2015, 03:11:18 PM »
I was going to comment on here but I see you've already quoted me. :) I spent a fair amount of time reading about them, because my neighbor is on one and I was curious. I have no dog in this fight really. I just saw some read flags in my reading.

That's all I have to say on the matter. I imagine many people have positive experiences on these plans. But the stakes are pretty high if you don't. They are not legally bound to pay for your bills.

Richie Poor

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #9 on: November 16, 2015, 06:37:23 PM »
I'm still a member of Samaritan Ministries and still very pleased with it. As noted in the linked thread I've had two occasions so far to submit bills for reimbursement. As you said you can set up small payment plans until they send the money. In our case it was within two months that we received checks. Since the total amount was pretty high (around 20k) we ended up receiving checks from almost 50 people. Every single one paid and only one was about 2 weeks late. I was just about to report it as unpaid before I got the check. I'm pretty sure they would have someone else send a check if it went unpaid but I would ask them yourself for clarification.

For the rates to go up the outgoing money has to be greater than the incoming money for 3 months in a row, and then it goes to a vote. It hasn't happened yet since I joined a year and a half ago but when it does I would expect it to be a reasonable amount.

Since open enrollment occurs every year I suppose you could always switch back to insurance if you don't like it. Personally I would begin in January instead of being uncovered for 3 months. The biggest downside for me is not being able to contribute to an HSA. Hopefully that gets changed soon.

Everyone's situation is different so do your due diligence and ask them lots of questions.

Tom Bri

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #10 on: November 16, 2015, 10:17:22 PM »
If you go this route, consider also buying a supplemental plan of some sort. I work for an insurance company in Customer Service, so I see the mistakes people make. Some people try to use supplemental/indemnity plans as their sole insurance. It seems like a bad idea to me. However, the biggest payout I have encountered in the last 5 years was through a supplemental accident plan. It was one of those where you pay $30 or $50/ month, and the insurance company pays you $X/day you are in-patient in a hospital. This guy got over $600,000! Obviously though, his total bills must have been a lot higher, so I hope he also had a major medical.
The indemnity plans are cheap, and you really have to study the fine print to not get screwed, but I have seen that they can be a helpful addition. When I was initially trained to give benefits/claims information, I was really negative about them, until I learned more about how they work.
Feel free to ask questions, I'll follow this thread for a while as I am interested in this topic.

AgentCooper

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #11 on: November 17, 2015, 08:51:38 AM »
If you go this route, consider also buying a supplemental plan of some sort....
I'm concerned about how that would impact my (contemplated) coverage under the sharing ministry.  When I go to a doctor, I'm supposed to say, "I don't have insurance."  Are supplemental plans not considered a form of health insurance?  Or is this more the AFLAC-type thing, where it does not pay any providers anything but covers my lost wages, or pays me in the event of an accident or lost toe etc.?

rulesofacquisition

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #12 on: November 17, 2015, 10:20:18 AM »
DH & I switched to Samaritan in May but haven't had to use it. We also did "Save to Share" to cover amounts over $250,000. It was less expensive than insurance thru work, which had a huge deductible. I'm glad to see others here are using it and it seems to work for them.

Tom Bri

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #13 on: November 17, 2015, 07:02:15 PM »
If you go this route, consider also buying a supplemental plan of some sort....
I'm concerned about how that would impact my (contemplated) coverage under the sharing ministry.  When I go to a doctor, I'm supposed to say, "I don't have insurance."  Are supplemental plans not considered a form of health insurance?  Or is this more the AFLAC-type thing, where it does not pay any providers anything but covers my lost wages, or pays me in the event of an accident or lost toe etc.?
You can submit the claims yourself, and the checks go to you. At least, the plans I am familiar with work this way. On the other hand, some people do have their providers submit the claims.
Here is a question for you: How does Samaritan treat other insurance? Do you tell them "My bills are such and such, but my insurance already paid $X." ? Or do they require/assume you have no OI?

Freedom2016

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #14 on: November 17, 2015, 08:38:38 PM »
Gosh, I would just never ever do this.

What's the annual/lifetime cap on reimbursements in a program like this? What if you're in a terrible accident? Or are diagnosed with cancer? Or an expensive chronic disease? Are you not worried about a black swan health event? If not, why not?

I was diagnosed with cancer at age 36. I was very healthy, active, and had no obvious risk factors (had just run the Boston Marathon for petes sake). Your health might be fine, right up to the day it's totally completely not fine. Is this a good scheme to be in if the black swan event happens?

AgentCooper

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #15 on: November 18, 2015, 10:08:26 AM »
Here is a question for you: How does Samaritan treat other insurance? Do you tell them "My bills are such and such, but my insurance already paid $X." ? Or do they require/assume you have no OI?

Each of the 3 ministry options has their own rules, but I believe it is that they are a payer of last resort, so it would be illogical to have both regular medical and Samaritan, since all regular medical payers also want to be payers of last resort.  If I get on a ministry, I would not get any regular/traditional medical.  But I may need to look into the supplemental/pay-directly-to-me policies offered at work for accident and long-term care.

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #16 on: November 18, 2015, 11:08:02 AM »
   So some months you would send your monthly $810 to the company, and some months you would send it to another person to pay their medical bills?  That sounds annoying.  But in any case, what does the company do with the money when you send it to them?  Do they pay some medical bills directly?  I would also be curious to hear how that all works with a major issue like cancer, where you might have several hundred thousand dollars of medical bills.  Are you going to have to keep up with 8,000 different people sending you a check for $300? 
   I have very good coverage through my employer so have no need for this.  But I admit, I have often wondered about the details on this type of thing, and if I ever needed to get my own insurance I would seriously look into it.

Tom Bri

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #17 on: November 18, 2015, 04:17:13 PM »
Quote from the Samaritan website FAQ:
...Once again, Samaritan Ministries does not offer insurance, so our procedures are different. At Samaritan, a medical need involving less than $300 is not shared among the members. When the need goes over $300, the amount from $300 to $250,000 is shared. (The amount of a need that exceeds $250,000 can be eligible for sharing if the member also joins Samaritan’s Save to Share™.) If a member household has more than three shareable needs in any 12-month period, the first $300 is also shared for the fourth, and any subsequent needs in that period....end quote.
http://samaritanministries.org/how-it-works/faq/

It also does not cover most preX conditions. The monthly cost is higher than I currently pay for a family of 4, but I also have a super-high deductible, and according the FAQ above, the equivalent of a DED is only $300 for Samaritan. On the other hand, wellness, shots and physicals, appear to NOT be covered.

For me, it would be a tossup. If I never get sick, my current plan is better. If I got kind of sick, Samaritan is better, up to $250000 in benefits. If I got really messed up, my current plan might be better.

AgentCooper

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #18 on: November 19, 2015, 11:07:02 AM »
Quote from the Samaritan website FAQ:....http://samaritanministries.org/how-it-works/faq/
....It also does not cover most preX conditions. The monthly cost is higher than I currently pay for a family of 4, but I also have a super-high deductible, and according the FAQ above, the equivalent of a DED is only $300 for Samaritan. On the other hand, wellness, shots and physicals, appear to NOT be covered. For me, it would be a tossup. If I never get sick, my current plan is better. If I got kind of sick, Samaritan is better, up to $250000 in benefits. If I got really messed up, my current plan might be better.
Yep, I'm kind of seeing it as a toss up as well.  I have to consider whether the "If I got really messed up" fear is a valid reason to buy gobs and gobs of protective insurance.  Safety is an expensive illusion, as MMM pointed out on the blog.  What's more likely to happen, for fairly young, active, healthy people -- staying well (with only the periodic minor things that require minor treatment) or the black swan/staring-down-the-barrel-of-chemo event? 

And those are good points from the FAQs.  Since the Affordable Care Act did not force the healthcare sharing minstries to update their practices to match modern insurance policies, a healthcare sharing ministry today works a lot like healthcare policies worked about 4 or 5 years ago:  1) very SMALL deductibles (e.g., $300), 2) no coverage for pre-existing conditions, 3) dollar limits (e.g., $250,000) on treatment, 4) no required coverage of preventive care (all that "preventive care is free" for all health plans stuff is a result of ACA).  I haven't been to a doctor since I don't know when, and I don't fancy paying some health insurer $4000 or $5000 a year so I can go have a $700 visit (office visit and annual blood work). 

Another factor is I'm not truly considering this as a long-term solution as we age; just to get us through the healthy years, then we jump in to the employer plan in maybe a few years from now.

Freedom2016

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #19 on: November 19, 2015, 01:08:44 PM »
I don't mean to be a scaremonger here, but "getting through the healthy years" builds in some pretty big assumptions that nothing catastrophic is going to happen to you during that time.

I'm all for self-insuring where you can, and not getting suckered into unnecessary coverage, but man. I really wouldn't play the odds when it comes to health. If you get cancer, and reach the $250k lifetime limit, what's your plan for paying for the rest of your million dollar (or more) treatment?

I'll reiterate: I was a very healthy, active 36-year old who rarely needed to see a doctor when I was diagnosed with cancer. I was in my "healthy years." And I could have been seriously fucked if I was in a Samaritan program.

At the least, build a realistic strategy for what you will do if said black swan event happens to you. Gofundme campaign? Bankruptcy? Forego treatment?

Richie Poor

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #20 on: November 19, 2015, 02:53:59 PM »
I'll reiterate: I was a very healthy, active 36-year old who rarely needed to see a doctor when I was diagnosed with cancer. I was in my "healthy years." And I could have been seriously fucked if I was in a Samaritan program.

At the least, build a realistic strategy for what you will do if said black swan event happens to you. Gofundme campaign? Bankruptcy? Forego treatment?

It is definitely worth being cautious when joining this type of plan but there are two things in the OP's favor. One is that a black swan event has a low probability (We know it's possible) and they second is that Samaritan will probably pay for that black swan event (it's just missing that 100% guarantee that we crave). If you belong to the "save-to-share" program you are covered for more than 250k. Samaritan has been around awhile and has about 40,000 families I think. I'm pretty sure they have paid people with cancer. We know the risk with Samaritan is if a ton of black swan events happened to a bunch of members and it brought the system down. So the Samaritan system falling apart just when you happen to have your unlikely black swan event seems improbable to me but I guess improbable coincidences do happen from time to time.

Also, I'm not sure how cancer treatment expenses go but if you did get cancer or some other ailment you would really just need treatment covered until you could enroll in an ACA plan. That might help.

Again, I would only join if you've done the research and determine if it is a good fit for your situation.

HarbingerofBunnies

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #21 on: November 19, 2015, 02:55:38 PM »
Since preexisting conditions can't be considered, couldn't one switch insurances during the next open enrollment if health had slid that badly?

Why are we treating this debate as a binary decision that's made for Life?

Conventional insurance has OOP max, but they also have lifetime payout limits at the top end IIRC.
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MoonShadow

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #22 on: November 19, 2015, 04:25:45 PM »
I'll reiterate: I was a very healthy, active 36-year old who rarely needed to see a doctor when I was diagnosed with cancer. I was in my "healthy years." And I could have been seriously fucked if I was in a Samaritan program.

At the least, build a realistic strategy for what you will do if said black swan event happens to you. Gofundme campaign? Bankruptcy? Forego treatment?

It is definitely worth being cautious when joining this type of plan but there are two things in the OP's favor. One is that a black swan event has a low probability (We know it's possible) and they second is that Samaritan will probably pay for that black swan event (it's just missing that 100% guarantee that we crave). If you belong to the "save-to-share" program you are covered for more than 250k. Samaritan has been around awhile and has about 40,000 families I think. I'm pretty sure they have paid people with cancer. We know the risk with Samaritan is if a ton of black swan events happened to a bunch of members and it brought the system down. So the Samaritan system falling apart just when you happen to have your unlikely black swan event seems improbable to me but I guess improbable coincidences do happen from time to time.

Well, even Katrina didn't break them, so the only widespread black swan event that I can think of that would do it is a war on US soil within our lifetimes.  Not only is that astronomically remote, as in approximately as likely than a ELE comet strike, I'd think; it's also a condition that would interrupt pretty much any other health insurance program or contract you could get anyway.  I can't even think of any health insurance plan I've ever seen that covered an act of war, except for the VA itself.

Tom Bri

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #23 on: November 19, 2015, 04:29:46 PM »
Since preexisting conditions can't be considered, couldn't one switch insurances during the next open enrollment if health had slid that badly?

Why are we treating this debate as a binary decision that's made for Life?

Exactly.

Freedom2016

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #24 on: November 19, 2015, 07:42:27 PM »
Since preexisting conditions can't be considered, couldn't one switch insurances during the next open enrollment if health had slid that badly?

Why are we treating this debate as a binary decision that's made for Life?

Conventional insurance has OOP max, but they also have lifetime payout limits at the top end IIRC.

Lifetime payout limits were abolished under ACA (see http://www.hhs.gov/healthcare/about-the-law/benefit-limits/index.html):

Quote
Thanks to the Affordable Care Act, lifetime limits on most benefits are prohibited in any health plan or insurance policy. Previously, many plans set a lifetime limit — a dollar limit on what they would spend for your covered benefits during the entire time you were enrolled in that plan. You were required to pay the cost of all care exceeding those limits.

Yes, one could change insurance during open enrollment if health had "slid badly" but I sure wouldn't want to risk having a serious health event in February that couldn't be fully treated until the following January.

Obviously those considering these plans have different risk profiles than I do, so YMMV. But I am a walking case study of the reality that your health can take a turn at any time, and most people (even MMM types) do not have the resources on hand to handle a black swan health event. So I guess as long as you're prepared to handle that possibility, without any complainypants whining once it happens, more power to you.

TheDudeReturns

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #25 on: November 20, 2015, 02:05:05 AM »
If you are only on one of these "heathsharing" plans, aren't you always considered "without insurance" for the purposes of ACA signup and can then apply outside of the open season? I mean, you just tick a damn box on the website, it's not like a human eyeball is looking at this crap really...

Astatine

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #26 on: November 20, 2015, 02:19:12 AM »
I had 2 black swan events in less than 4 years plus I guess what you'd call a grey swan event (not life threatening but severe illness lasting 6 weeks with 2 hospital admissions and weekly specialist appts) plus hmm I've lost count of the number of visits to emergency in the past 4 years plus an autoimmune condition. I'm in my early 40s.

I personally think that it's crazy to gamble on not getting seriously sick. I have health insurance in my country for the unlikely but major consequences situation for the same reason I insure for the unlikely situation of my house being destroyed.

Richie Poor

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #27 on: November 20, 2015, 09:30:24 AM »
If you are only on one of these "heathsharing" plans, aren't you always considered "without insurance" for the purposes of ACA signup and can then apply outside of the open season? I mean, you just tick a damn box on the website, it's not like a human eyeball is looking at this crap really...

I am pretty sure you can't get an individual ACA plan outside of the enrollment period unless you have a "life event" (Marraige, Baby) that qualifies. Whether that is checked carefully I can't say but it might be by the insurance company if you signed up and immediately had high costs.

AgentCooper

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #28 on: November 24, 2015, 09:04:36 AM »
OP here:  Has anyone read Dr. Paul Ruggieri's “The Cost of Cutting,” a surgeon’s book about surgery?  I’m only about halfway through it and it has already caused me to be way more concerned about dropping health coverage. 

Being uninsured, or even having low-paying insurance (e.g., Medicare or Medicaid which don’t reimburse surgeons or hospitals as well as other insurance), can supposedly affect the surgeon’s decision on whether or not to operate, at least in non-emergency situations.  It theoretically shouldn’t, but the author claims that it often does.  Surgeons know how much they get reimbursed for each surgical procedure by each major insurer, and if it is a $5,000 surgery and they know they will only be paid $300 for it by Medicaid, then some surgeons may end up saying “I don’t take your insurance.”  They may send you on to some other surgeon, who also may or may not take the case.  It’s even worse for uninsured people. 

He cites several national studies showing that uninsured and Medicaid-only patients tend to have worse surgical outcomes and a higher risk of death following several kinds of surgeries. 

So I was picturing going uninsured as a simple matter of dealing with paying the bills myself with no guarantee of reimbursement, negotiating with doctors for cash discounts, and otherwise having the same medical experience as someone with insurance.  But according to this book, being uninsured might make it much harder to even get seen, harder to get a referral to a surgeon, and harder to get a surgeon to agree to do a necessary surgery.  ‘Merica!

Pigeon

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #29 on: November 24, 2015, 11:06:54 AM »
As a person who married into a family that's rotten with doctors, I seriously doubt surgeons are the only specialists whose behavior is strongly affected by the insurance status of the patient.

I'm another person who was perfectly healthy in their early 40s with a sudden February cancer diagnosis.  No way in hell would I ever purposely go without decent medical coverage.

snowball

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #30 on: November 25, 2015, 09:35:58 PM »
It's hard, as a healthy 30something who's never had any serious health issues, and has no evidence of lurking genetic time bombs in their family history, to really believe your health can turn on a dime.  Not just that it can happen to other people, but that it can happen to you.  I didn't have a real sense of my own mortality until my late twenties.  Then I didn't have a sense of my own vulnerability to serious illness until I got cancer in my thirties.  (I had allowed for illness later in life, of course.  But it wasn't supposed to happen yet!  That was not in the plan!)

Sure, cancer at that age is pretty unlikely.  But it happens, as do other things.  And the whole point of insurance is to cover you in low-probability-but-highly-expensive situations.

The healthcare sharing ministry thing seems a bit sketchy to me, but I don't know much about it, so I won't argue for or against.  But if you don't realllllly believe any major medical events can happen to you at your age, it might skew your decisions in a way you may regret.  Kind of like the people who don't save for retirement because they don't really believe in their older self.  :)

MoonShadow

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #31 on: November 28, 2015, 11:55:47 AM »
It's hard, as a healthy 30something who's never had any serious health issues, and has no evidence of lurking genetic time bombs in their family history, to really believe your health can turn on a dime.  Not just that it can happen to other people, but that it can happen to you.

You don't have any sense of your own mortality before your mid 20's, because it's statistically unlikely that your health would turn on a dime; unless you lead a particularly risky lifestyle.  And this is coming from a man in his 40's that was diagnosed with a slow, degenerative; but ultimately fatal; genetic disorder at age 24.  Almost no one needs health insurance before they are married with children, and those that do already know why.  I can't say if a health cost sharing group is right for any particular person, but I can say that they are not a scam.  At least, not the one's I'm aware of.

bacchi

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #32 on: November 28, 2015, 12:12:24 PM »
CHM had a previous name, Christian Brotherhood, and some of the funds went to the founder's lifestyle. Millions in claims went unpaid because it was used instead for cars, boats, blow, and strippers.

I'd say that was a scam.

Of course, they changed their name, that group went to jail, the claims were eventually paid down, and now you can trust them again. Honest.

MoonShadow

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #33 on: November 28, 2015, 12:16:43 PM »
CHM had a previous name, Christian Brotherhood, and some of the funds went to the founder's lifestyle. Millions in claims went unpaid because it was used instead for cars, boats, blow, and strippers.

I'd say that was a scam.

Of course, they changed their name, that group went to jail, the claims were eventually paid down, and now you can trust them again. Honest.

References please?

hops

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #34 on: November 28, 2015, 12:26:45 PM »
CHM had a previous name, Christian Brotherhood, and some of the funds went to the founder's lifestyle. Millions in claims went unpaid because it was used instead for cars, boats, blow, and strippers.

I'd say that was a scam.

Of course, they changed their name, that group went to jail, the claims were eventually paid down, and now you can trust them again. Honest.

References please?

Via Google:

http://www.christianitytoday.com/ct/2006/january/6.19.html

From that article:

Quote
It almost collapsed in the late 1990s when founder Bruce Hawthorn and subordinates diverted $25 million into their own pockets, leaving the ministry with $24 million in unpaid claims.

Editing to add this for anyone questioning Bacchi's reference to where the money went:

http://www.washingtonpost.com/wp-dyn/content/article/2005/10/22/AR2005102200046.html

Quote
Last year a jury in Akron ruled that its founder, Rev. Bruce Hawthorn, and other former officials defrauded the ministry and ordered them to repay nearly $15 million they spent on luxury houses, motorcycles, expensive cars and high salaries, including one for a stripper whom Hawthorn said in an interview he was "trying to help."
« Last Edit: November 28, 2015, 12:30:59 PM by hops »

MoonShadow

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #35 on: November 28, 2015, 12:37:38 PM »
Well, I suppose it was bound to happen eventually.  I just wasn't aware of it.

Cassie

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #36 on: November 28, 2015, 12:58:56 PM »
Since medical bills can send you into a lifetime of debt I think it is too big of a gamble.

acroy

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #37 on: November 28, 2015, 02:37:12 PM »
Several families I know use it and like it.
I did not jump ship this year; stuck with employer provided High deductible HSA plan. But it was close....

A lot of the previous posters are fear mongers: 'what if', 'lifetime debt', etc etc. This just plays into the human condition of fearing the unknown. Don't let it sway you. Insurance of any kind is a bet against yourself. It would not be such a profitable racket if it was anything else.
SWAMI (Satisfied Working Advanced Mustachian Individual) 1 stash, 1 DW, 7 Mini MM's...
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MoonShadow

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #38 on: November 28, 2015, 05:23:09 PM »
Since medical bills can send you into a lifetime of debt I think it is too big of a gamble.

It's a gamble that everyone makes anyway.  It's part of life.  The real question is, how much money are you willing to part with, in order to limit your near term risks?  If the risk of catastrophic financial failure, as a direct result of a major illness, causes you to lose sleep at night; stick with the HMO.  If you have a family history of cancer, heart disease, or other major illness; make sure that you maintain the appropriate coverage.  If you have kids that depend upon your income to eat regularly, maintain the appropriate coverage on yourself & your kids.  If you have no known issues, no known family history, don't have dangerous hobbies, and are younger than 35; do what you will.

frugalstudio

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #39 on: December 10, 2015, 08:43:36 PM »
I don't mean to be a scaremonger here, but "getting through the healthy years" builds in some pretty big assumptions that nothing catastrophic is going to happen to you during that time.

I'm all for self-insuring where you can, and not getting suckered into unnecessary coverage, but man. I really wouldn't play the odds when it comes to health. If you get cancer, and reach the $250k lifetime limit, what's your plan for paying for the rest of your million dollar (or more) treatment?

I'll reiterate: I was a very healthy, active 36-year old who rarely needed to see a doctor when I was diagnosed with cancer. I was in my "healthy years." And I could have been seriously fucked if I was in a Samaritan program.

At the least, build a realistic strategy for what you will do if said black swan event happens to you. Gofundme campaign? Bankruptcy? Forego treatment?

Liberty Healthshare is interesting https://www.libertyhealthshare.org
They have a plan that allows 1 million catastrophic coverage over the 125K base per incident, with an unlimited lifetime amount.
I too had early cancer and about $200K in radiation and another $50K in surgery and hospitalization. At that point I had great coverage and I think my out of pocket was around $1500!
The current healthcare problem is focused mostly on those who are working hard to FIRE. They are young middle class people without access to subsidies, facing 30% or greater annual increases in costs.
I see people in their 20s and 30s that say they pay $1500 per month for a family?!? How can you save when that is the situation? So I think these health sharing ministries certainly have a place...and deserve serious study.
There is one vague area that gave me pause--they can deny coverage for injuries from "high risk hobbies" and the language reads "includes but not limited to..."  followed by a short list including bungee jumping and sky diving. So as a bicyclist and motorcyclist and hiker, I wrote to them and have not received a satisfactory answer on that point.
« Last Edit: December 10, 2015, 08:52:12 PM by frugalstudio »

jackiechiles2

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #40 on: December 11, 2015, 08:43:16 AM »
Gosh, I would just never ever do this.

What's the annual/lifetime cap on reimbursements in a program like this? What if you're in a terrible accident? Or are diagnosed with cancer? Or an expensive chronic disease? Are you not worried about a black swan health event? If not, why not?

I was diagnosed with cancer at age 36. I was very healthy, active, and had no obvious risk factors (had just run the Boston Marathon for petes sake). Your health might be fine, right up to the day it's totally completely not fine. Is this a good scheme to be in if the black swan event happens?

If the black swan event happens and you use up your lifetime benefits, you can just switch to a normal health insurance plan since pre-existing are covered now.  I'm not sure I understand your concern.

retiringearly

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Re: Switch from medical insurance to healthcare sharing ministry?
« Reply #41 on: June 13, 2017, 07:23:39 PM »
In

Dr Kidstache

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Just a data point. Denied for Liberty Healthshare for a pre-existing condition (history of traumatic brain injury). Not really surprised - I knew they deny enrollment for many pre-existing conditions. Back to the ACA for me!

WonderfulLife43

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PTF.   I'm very interested in these healthcare sharing organizations, such as Christian Care Ministry.   I'm currently on a HDHP w/HSA plan with my employer, and maxing out the HSA every year.   However,  when I leave my employer, I'll be looking for something to bridge the several year gap until Medicare eligible.   The extremely expensive ACA insurance doesn't appeal to me.

NoraLenderbee

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Gosh, I would just never ever do this.

What's the annual/lifetime cap on reimbursements in a program like this? What if you're in a terrible accident? Or are diagnosed with cancer? Or an expensive chronic disease? Are you not worried about a black swan health event? If not, why not?

I was diagnosed with cancer at age 36. I was very healthy, active, and had no obvious risk factors (had just run the Boston Marathon for petes sake). Your health might be fine, right up to the day it's totally completely not fine. Is this a good scheme to be in if the black swan event happens?

If the black swan event happens and you use up your lifetime benefits, you can just switch to a normal health insurance plan since pre-existing are covered now.  I'm not sure I understand your concern.

Getting sick, being injured, developing a disorder are not black swan events.