The dangers of health sharing ministries

[FireLane]

Since many FIRE folk are considering "health sharing" ministries as an alternative to expensive traditional insurance, this NPR story is a valuable warning.

The reason why health sharing ministries are cheaper is that they still have an option which ACA-compliant insurers no longer have: they can choose not to pay if your medical bills are too expensive. And yes, that's literally true, their paperwork says they have no legal obligation to pay any claim. For instance, they can use the good old "preexisting condition" excuse, as this poor guy found out for himself:

One New Hampshire customer who signed up for Trinity's health care sharing ministry is Keith Meehan, 49, an international rice salesman whose company doesn't provide health insurance.

After his doctor recommended back surgery for a disk issue, Aliera and Trinity HealthShare assured Meehan the procedure didn't require preapproval. But after the surgery, it declined to pay approximately $200,000 in medical bills, contending his back pain was a preexisting condition.

"I feel like I was sold a bad bill of goods," Meehan says. "I had no idea."

Health care sharing ministries don't have to follow the same rules as insurers, and they face no requirements to pay claims. To industry watchers, their marketing materials don't lay out these risks clearly enough.

As long as you're 100% sure you'll never get sick, never be in an accident and never age, this is a great deal for you. But if you ever have a big medical bill, you might find your "insurer" has abandoned you right when you need it the most.

[Omy]

I read a similar article about somebody who bought inexpensive insurance that wasn't ACA compliant. If it's too good to be true...

[freya]

It's always possible that in this case, the health sharing ministry was correct.   The quoted passage doesn't say when the "disk issue" started relative to the health sharing policy.  Actually I found another article reporting that the back pain did in fact start before the plan start date, which presumably was documented in the MD note.

Furthermore, for every one of those stories, it would be pretty easy to dig up a story of someone with conventional insurance who got hit with a huge medical bill.  There's a reason why medical bills are the #1 cause of personal bankruptcies.  And conventional insurance has all kinds of gotchas, like denying coverage for expensive medications or nailing you for out of network or balance-billing costs even when using an in-network hospital, ER, or surgeon.

The real question is, what are the risks of getting tagged with an unmanageably large bill with a health sharing ministry vs. an Obamacare or other private insurance plan?  They will be nonzero in both instances, but it would useful to put a number on it.  Also, to list causes.  Getting caught with pre-existing conditions with health sharing plans is something that's within your power to prevent (e.g. overlap conventional insurance with health sharing for 1 year), but the out of network and denied coverage traps with conventional insurance aren't quite so easy.

One indicator is the number of instances that are reported of such unfortunate situations.  One million people are currently covered by health sharing plans, compared to ~10 million in ACA plans.  That suggests that if the risks are equal, we should see about 10 times as many cases of large medical bills among those covered by ACA plans vs. health sharing ministries.   It would be great to dig up this information to get a fair comparison.  Just based on news reports, I see a report ratio that is much higher than 10:1 for conventional insurance vs. health sharing ministry failures.  Of course this might be biased because the conventional insurance population is more likely to be sick though.

[Fishindude]

I know several people that insure through one of those outfits and it was suggested that we do the same when I retired.   I checked it out and one of the very first things you have to do is agree to their basic religious beliefs and practices.   Upon reading that stuff, I would have immediately been lying and dishonest in order to get cheaper insurance, so I declined and went with traditional ACA insurance at considerably more expense.   I'm betting many of their users are dishonest in order to get the cheaper coverage.

[LifeHappens]

I've seen threads here passionately recommend Health Sharing Ministries for FIRE'd or self employed people. What anyone looking at these needs to understand above all things is, Health Sharing Ministries are NOT insurance. They are a cooperative ostensibly organized to help pay large medical bills. This model may work well in tight knit communities like the Amish, but they've now become commercialized and have the same profit motive insurance companies have, without all the legal protections afforded to health insurance customers.

[wheatstate]

Thanks for sharing the article.  I have the same concerns.  I have been a healthshare member for 4 years.  Here is my experience

Anyone using Liberty Healthshare?
Are you also a member of a Direct Primary Care (DPC) group?  This is the "gym membership" to a primary care physician that doesn't do insurance.
Are you getting your partial DPC reimbursements?
For my situation; Individual, Liberty is $249/month.  DPC is $59/month. Reimbursement for my type of DPC is $40.

I have been a Liberty Healthshare member for 4 years.  First year, they paid the dpc membership directly to the provider.  Next year, liberty switched to a reimbursement model.   This worked OK.  This year,  I have been submitting and not getting reimbursed.  Liberty is behind.  I am waiting on my April reimbursement and every month following (9 months total for $360).

I have had 4 low health insurance years with medical expenses that never went above the unshared/deductible level.  I don't know how sharing a 5 digit medical expense would work.

Additional Question:
Where is the best place to shop for a High Deductible Health Plan (HDHP)?  20k deductible.  The subsidized, bronze plans with $7k deductible are more expensive than I value.

[iris lily]

Thanks for sharing the article.  I have the same concerns.  I have been a healthshare member for 4 years.  Here is my experience

Anyone using Liberty Healthshare?
Are you also a member of a Direct Primary Care (DPC) group?  This is the "gym membership" to a primary care physician that doesn't do insurance.
Are you getting your partial DPC reimbursements?
For my situation; Individual, Liberty is $249/month.  DPC is $59/month. Reimbursement for my type of DPC is $40.

I have been a Liberty Healthshare member for 4 years.  First year, they paid the dpc membership directly to the provider.  Next year, liberty switched to a reimbursement model.   This worked OK.  This year,  I have been submitting and not getting reimbursed.  Liberty is behind.  I am waiting on my April reimbursement and every month following (9 months total for $360).

I have had 4 low health insurance years with medical expenses that never went above the unshared/deductible level.  I don't know how sharing a 5 digit medical expense would work.

Additional Question:
Where is the best place to shop for a High Deductible Health Plan (HDHP)?  20k deductible.  The subsidized, bronze plans with $7k deductible are more expensive than I value.

Good luck in finding high deductible ($20,000) policies. The ACA made those extinct.
I know! That’s what reasonable people want. Too bad we can’t get it.

[maczika]

I've been paying into Liberty Healthshare for 3 years, and never needed to cash in until I had a surfing accident that required stitches by a plastic surgeon. To be clear, when I signed up, I asked them about coverage for accidents when surfing or snowboarding, and they assured me that I would be covered as long as it was done recreationally and not for money, like in a contest. The plastic surgeon charged $600, which I was happy to pay. The hospital charged 7K for the rent of one of their beds for one hour. That one, I was not happy about. I submitted it to Liberty, and they misplaced it and sent it for repeated reprocessing and politely assured me over the phone for 14 months that they would take care of it, when I received a final notice in the mail. I was forced to pay it myself to save my credit, and I don't think I'll ever get a check from them. Now that there is no longer a fine for not having insurance, I canceled the plan. I read all the fine print when I signed up. They keep repeating that they are not insurance like it's some get out of jail free card, but there is a clear agreement about what will and will not be covered. They ignore and mishandle eligible costs. Their business model is to keep people paying in until they get exasperated enough to cancel, and then they have no recourse. I filed a complaint with the BBB and the DA. Someone needs to crack down on these people. ACA plans in my area (nyc) are $600/month and literally pay for nothing. I'll be stashing the money I used to pay in premiums, and if another accident happens, I'd rather find a vet to do it for cash under the table or take a medical vacation than deal with this ridiculous system. Maybe there are some DIY YouTube videos about conducting surgery on yourself.

[FireLane]

Necroposting my own thread to bring you this:

https://www.christianitytoday.com/news/2022/april/health-care-sharing-ministries-bankrupt-sharity-trinity-unp.html

Around 10,000 families whose faith led them to “share in one another’s medical expense burdens and so fulfill the law of Christ” have instead ended up with unpaid bills totaling over $50 million after their health care sharing ministry shut down.

Sharity Ministries, formerly known as Trinity HealthShare, filed for bankruptcy and then started the liquidation process last year. There are so many outstanding claims that it’s unlikely that members will receive the reimbursements they’re owed.

The organization had faced challenges, class-action lawsuits, and cease and desist orders in several states, where regulators said it had been operating as an unauthorized insurance provider. A 2022 lawsuit from the state of California alleges Sharity denied the majority of claims and spent as little as 16 cents on premiums.

If a real insurance company goes bankrupt, state guaranty associations will cover their outstanding claims. Since health sharing ministries aren't technically insurance, I don't think Sharity's members are going to be so lucky.

[Sibley]

There was a user semi-recently who seemed to think these things were awesome. They're not. They're feel good, until something happens and then its a nightmare.

[Mrs. Burning Bush]

Hi Sibley.  I am not sure if you are talking about my posts about Sedera or not, but yes, our experiences with Sedera (a secular organization) have been very good.   When the opportunity presented, we were covered exactly as stated.  We can upload our bills with our phones, the Sedera representatives are responsive and helpful, and we benefit from a low monthly "premium."   We did not find any of these things when we were covered by BC/BS.  In fact, a few times we had to battle with BC/BS to have the coverage we contracted to receive.   If you run across bad news on Sedera, by all means, please post it here.  In the mean time, we are extremely happy with Sedera.   YMMV.

[terran]

Thanks for posting, and for bringing the thread back to life. Health sharing ministries are exactly the opposite of what you want with insurance: They pay for little stuff, but can leave you on the hook for something that can actually bankrupt you. Especially for a mustachian, having insurance with a high deductible that costs a lot for the little stuff is probably fine as long as it starts paying if you suddenly wrack up 10's or 100's of thousands in medical bill without the option to deny coverage.

[rantk81]

Yeah, I want insurance for the "all-in cap on what I could possibly need to spend" to protect me.  Everything in-between (deductibles, co-pays, co-insurance, etc) is just noise...

[remizidae]

Not only are these groups religious, they actually deny coverage if your illness results from behavior they don’t approve of. I looked into one that actually said they would deny coverage for STDs unless you could prove thet your STD did not result from reckless behavior. (Paraphrasing). Something tells me all non-married sex would count as reckless to those people…it sure seemed like an attempt to deny gay people coverage.

[Viking Thor]

These health sharing ministries have tons of loopholes that save them money and make you suffer when you need insurance most.

Long story short - most insurance claims are modest (10k or less in a year). They will pay most of these. But that's meaningless because you could self-insure for this.

You could wind up with .medical bills in the 100k plus range or even that much per year for specialty medication. They will not pay that. This enables them to charge low fees. Because real insurance pays those big claims and charges everyone a little to spread the risk.

So its essentially garbage to make people think they are getting protection. But you need insurance for the rare catastrophic bills, in which case the health sharing ministry will not cover.

[Scandium]

So all the nasty exploitation of for-profit health insurance, coupled with the scam and self-enriching of bigoted religious organizations?? Where do I sign up!

[Laura33]

To me, the popularity of these ministries stems from the same concept that drives the popularity of crypto:  the concept that any sort of government regulation is bad and does nothing more than add costs and let the government interfere in your life, and that unrestricted private industry can do better for less.  Until you get screwed and realize that government regulation does, in fact, provide something of a backstop to protect people.

A health-sharing ministry is basically a voluntary agreement to pay for some health care costs (just like crypto is a voluntary agreement to pay money*).  I would absolutely expect expect any health-sharing ministry to be much cheaper than health insurance, because:

-- The ministry can choose not to pay, whereas an insurer cannot
-- The ministry can ignore legal requirements like coverage for pre-existing conditions, whereas an insurer cannot
-- The ministry can shut down or cut off claims if it doesn't have sufficient funds, whereas insurers are required by state insurance boards to maintain sufficient funds to maintain their right to do business in the state, including often paying into state funds to cover citizens left hanging if an insurer goes bankrupt.
-- If a health insurer violates these various requirements, it's subject to criminal prosecution by the state attorney general.  If a ministry doesn't live up to its promises, you get to personally sue them for breach of contract, at your own expense, and hope they have some assets left if you win. 

Yes, the US healthcare system sucks.  Yes, health insurance companies are often bloated and evil.  But healthcare ministries don't solve these problems; they just strip away the (already insufficient) protections you get from federal law and state regulation and oversight.  A better approach would be to try to strip the profit motive out of healthcare.  To me, medical care is a fundamental human right, and so companies that choose to work in that field should not be prioritizing profits over service.  And the religious organizations that now dominate hospital care in many areas should not be able to impose their private religious beliefs on the general public that is relying on them for service.  But that's another post. . . .


*The "full faith and credit" of the US government still does actually mean something -- there's a reason the US Dollar has been the preferred currency of many struggling countries for a very long time. 

[BeanCounter]

Necroposting my own thread to bring you this:

https://www.christianitytoday.com/news/2022/april/health-care-sharing-ministries-bankrupt-sharity-trinity-unp.html

Around 10,000 families whose faith led them to “share in one another’s medical expense burdens and so fulfill the law of Christ” have instead ended up with unpaid bills totaling over $50 million after their health care sharing ministry shut down.

Sharity Ministries, formerly known as Trinity HealthShare, filed for bankruptcy and then started the liquidation process last year. There are so many outstanding claims that it’s unlikely that members will receive the reimbursements they’re owed.

The organization had faced challenges, class-action lawsuits, and cease and desist orders in several states, where regulators said it had been operating as an unauthorized insurance provider. A 2022 lawsuit from the state of California alleges Sharity denied the majority of claims and spent as little as 16 cents on premiums.

If a real insurance company goes bankrupt, state guaranty associations will cover their outstanding claims. Since health sharing ministries aren't technically insurance, I don't think Sharity's members are going to be so lucky.

I have been warning about this very thing on this forum every time health shares came up. I was in finance for two major health insurers for years and the state requirements for reserves and paying into the state are very strict for a reason.

[Just Joe]

If a real insurance company goes bankrupt, state guaranty associations will cover their outstanding claims. Since health sharing ministries aren't technically insurance, I don't think Sharity's members are going to be so lucky.

Mismanagement or fraud or flawed business model?

[bmjohnson35]

I remember getting excited about these around 5 years ago.  I read several online articles about them and thought I had found the answer to our early retirement healthcare insurance problem.  There is a very successful early retirement website where the author speaks fondly of his experience with one.  Once I researched them, I quickly realized there was no way I could trust them. 

[Tempname23]

Additional Question:
Where is the best place to shop for a High Deductible Health Plan (HDHP)?  20k deductible.  The subsidized, bronze plans with $7k deductible are more expensive than I value.

Good luck in finding high deductible ($20,000) policies. The ACA made those extinct.
I know! That’s what reasonable people want. Too bad we can’t get it.

I had a (BCBS) HDHP with a $10k deductible and same $10k OOP for my family of 4. In 2010 the cost was $4,512 two years later, 2012 it was up to $5256, up $774. 2012 is when ACA regulations went into effect, two years after that my premium was $7,752 up $2,496.
 I have since moved on to Medicare, My son got his own insurance, so my wife and daughter have the same grandfathered policy at a cost of $8,040 per year. 63yrs old  and 30yrs old.

 btw, when I was paying $5,256 for a $10,000 deductible/OPP, our cost for the ACA   Bronze plan was $13,700 and had a $12,500 deductible. People told me I was crazy when I got a $10,000 deductible health insurance plan. Two years later the same people were whining that the ACA was no good because they can't afford the ACA deductible.

[FireLane]

A new report from ProPublica contains damning evidence about Liberty HealthShare:

https://www.propublica.org/article/liberty-healthshare-healthcare-sharing-ministries-obamacare

It's run by a family with a long history of fraud, and its owners have been skimming millions off the top through a web of self-dealing shell companies. They've used Liberty members' dues to buy themselves real estate and businesses like an airline, a wedding venue, a horse stable and a marijuana farm.

To make the scam less obvious, the company maintained two sets of books:

Liberty recorded its finances in two ways. One was the company’s bank account, which showed actual transactions — member fees received, medical providers paid. Only a small number of executives and staff could see those transactions, including Drudy Abel, according to interviews with former Liberty employees.

The second way was designed for Liberty members’ eyes. The company developed in-house software that purported to show members’ individual accounts and track their personal medical bills and monthly payments, according to Fabris. He called these “hypothetical accounts.” In other words, this software created a facade; it tracked accounts that didn’t exist and reflected transactions that may or may not have been completed.

Meanwhile, Liberty's actual members couldn't get their medical bills paid and ended up on the hook:

In its first two years, Liberty gained a reputation for paying most bills promptly, bringing in new members and hundreds of millions of dollars in fees. Then, beginning in late 2016, that reputation began to fall apart. Liberty started rejecting claims and lowballing doctors, leading some to return checks, which Liberty staff stuffed in boxes and stacked in a storage room, according to several former employees directly involved. Internal data and records obtained by ProPublica show that at least 50 hospitals refused to work with Liberty’s bill negotiators to settle unpaid charges. A memo from June 2017 shows Utah’s Intermountain Healthcare system, one of the largest in the western United States, refused to negotiate with the ministry and its billing contractor, leaving many members to fend for themselves.

At the same time, Liberty stopped reimbursing members for charges they paid out of pocket. This led to a massive backlog in bills, with both members and health care providers waiting months and years to be paid, if they were paid at all.

...ProPublica contacted nearly 300 current and former Liberty members and spoke with more than 70 who described extended periods of stress, harassment by bill collectors and financial ruin.

[curious_george]

Somehow that doesn't surprise me at all...

[JupiterGreen]

A new report from ProPublica contains damning evidence about Liberty HealthShare:

https://www.propublica.org/article/liberty-healthshare-healthcare-sharing-ministries-obamacare

It's run by a family with a long history of fraud, and its owners have been skimming millions off the top through a web of self-dealing shell companies. They've used Liberty members' dues to buy themselves real estate and businesses like an airline, a wedding venue, a horse stable and a marijuana farm.

To make the scam less obvious, the company maintained two sets of books:

Liberty recorded its finances in two ways. One was the company’s bank account, which showed actual transactions — member fees received, medical providers paid. Only a small number of executives and staff could see those transactions, including Drudy Abel, according to interviews with former Liberty employees.

The second way was designed for Liberty members’ eyes. The company developed in-house software that purported to show members’ individual accounts and track their personal medical bills and monthly payments, according to Fabris. He called these “hypothetical accounts.” In other words, this software created a facade; it tracked accounts that didn’t exist and reflected transactions that may or may not have been completed.

Meanwhile, Liberty's actual members couldn't get their medical bills paid and ended up on the hook:

In its first two years, Liberty gained a reputation for paying most bills promptly, bringing in new members and hundreds of millions of dollars in fees. Then, beginning in late 2016, that reputation began to fall apart. Liberty started rejecting claims and lowballing doctors, leading some to return checks, which Liberty staff stuffed in boxes and stacked in a storage room, according to several former employees directly involved. Internal data and records obtained by ProPublica show that at least 50 hospitals refused to work with Liberty’s bill negotiators to settle unpaid charges. A memo from June 2017 shows Utah’s Intermountain Healthcare system, one of the largest in the western United States, refused to negotiate with the ministry and its billing contractor, leaving many members to fend for themselves.

At the same time, Liberty stopped reimbursing members for charges they paid out of pocket. This led to a massive backlog in bills, with both members and health care providers waiting months and years to be paid, if they were paid at all.

...ProPublica contacted nearly 300 current and former Liberty members and spoke with more than 70 who described extended periods of stress, harassment by bill collectors and financial ruin.

Not surprised at all. Religion is a slimy business, especially in the US where they are tax exempt and egregiously political.

[Sibley]

Its not insurance, its not guaranteed, and there are very good reasons why I can think of several threads where people have been told very clearly not to use the health sharing.

[FINate]

FWIW, I've had a wonderful experience with my health sharing ministry.

We have Samaritan Ministries and pay about $400/month for a family of four, and this includes the "save-to-share" add-on that means we have no maximum.

Last year I was diagnosed with a rare cancer. It took quite a bit of time and not a few tests to figure out what was going on before I was eventually transferred from Boise to Salt Lake City for a higher level of care. I had major surgery in SLC followed by 6 months of chemo, which should finish soon.

Between multiple MRIs, CT scans, 3 surgeries, and spending almost 6 weeks in hospitals I racked up $350k in medical bills.

Samaritan Ministries has covered all of it beyond the initial $1800 unshareable amount (similar to a deductible). One of the surprising things I've really enjoyed about the process is the large number of personal notes and even get-well cards from total strangers. This is because money ("shares" as they call them) does't go through Samaritan Ministries directly*, and instead they direct members to give directly to those in need. So this meant I got gifts (and many prayers and notes of encouragement) from ~500 people across the US.

As an added benefit, there were no insurance pre-approvals or concerns about being in/out of network. Simply get the medical care then submit the itemized statements.

I had to transfer to SLC or I would very likely be dead by now. Yet this would have been out of network per our previous Bronze ACA plan (which was also around 3x the cost). By my calculation, under our previous ACA plan we would have been out of pocket nearly $150k, after paying considerably more in premiums.

So health sharing ministries aren't all bad , though YMMV. And there are downsides. They aren't regulated. Nor is there a contractual obligation for the ministry to pay. And for sure there are some scummy ones out there. So you have to choose carefully. We went with Samaritan Ministries because it's one of the oldest health sharing ministries with a good track record and I like how shares are sent directly between members (less chance for funny business).

We've since added a Gold ACA plan to supplement our health sharing ministry. My quarterly PET-CT/MRI scans will more than offset the premiums, we can easily afford it, and it just seemed like the prudent thing given my situation. But we will absolutely stay with Samaritan Ministries because I like sending money directly to those in need and it's such a low cost relative to the benefit. 

*Samaritan Ministries is funded by members, who one month of the year send their "share" to HQ for G&A, whereas the other 11 months shares go directly to other members. This means overhead is 1/12 of your overall yearly shares, which is rather reasonable.

[ATtiny85]

Not surprised at all. Religion is a slimy business, especially in the US where they are tax exempt and egregiously political.

And for reasons I’ll never understand no one ever tries to start a movement to fix it. It surely would be political suicide to try of course.

[Money Saver 1]

I wouldnt trust any program with "sharing" in its name.