Do you feel that you cost of healthcare of too much? Does it seem that the amount that you pay for your healthcare seems to increase each year. Perhaps your premiums even with your employer seem to increase but yet you may not be happy with your benefits.

If you are an individual/family your options can be limited. If you are looking at plans on the exchange (ACA plans) then you will find that plans only seem to be reasonable if you manage to qualify for a subsidy. You can only qualify for a subsidy if your income meets a certain threshold – go beyond that threshold and you pay full price. If you are within the threshold you will revived a subsidy to off set the real cost. How much you receive depends on what amount of income you will file on your return that year.

Now within the past year or so (as this original post is written May 2022) there were increased subsidies within the exchange. This basically means that those you may have not been able to qualify for subsidies in the past now may be able to. Translation, you may now find that you can qualify for a ACA plan that looks affordable. We do not know how long that will last, but its currently what is in effect.

However, depending on your situation you may still find that the plans are too expensive, you may not like the access or quality of care – there are a lot of different factors here. To make a long story short sometime the exchange plans may not be the right fit. Here you may ask yourself, “Do I have any other options?”

There are some options actually. Its true the changes in healthcare over the years has limited it, but there are a few things that can be worth consideration. As a licensed insurance broker I do have some clients that I have assisted with ACA plans, its not my main focus but its true that some have found them helpful. Yet some of you are the ones asking the question looking for other options.

One option that can be of consideration is becoming a member of a healthsharing ministry and/or Medical Cost Sharing Group.

What Is A Healthsharing Ministry or Medical Cost Sharing Group

Not sure what they are? Here is the simple answer. It is a group of members that essentially band together to help assist one another on medical expenses. It is not insurance, an insurance company of any sort. Members join and have a set of standards and guidelines outlining the types of medical expenses in which they share in.

Depending on the structure of the organization you as an individual member/family will have to fulfill a certain amount of initial medical expenses and after you exceed that threshold then costs are shared with other members.

These originally came out of religious groups in which organized to share each others Burdon. Although a concept from a few decades ago it has become much more widely adopted and using 21rst century technology.

You pay a set amount each month (depending on the level of membership you selected) your funds help to assist another in the same way that theirs helps to assist you. Ultimately its a meaningful cooperative and collaborative environment in which members are able to assist other members with the unexpected and unaffordable medical costs that can cause financial hardship. Better yet membership can often be much less than what the cost it would be with a standard insurance plan.

It Costs Less, So What Is The Catch?

There really isn’t a catch – its just not a standard brick and mortar insurance plan that most people have become accustomed to. Additionally, its not for everyone. As an insurance broker, not every insurance plan is right for everyone, true. Its no different with joining an Medical Cost Sharing organization. For some its a really great option and for others it may not. To give you a little guidance here are some highlights of some Pros and Cons (in no particular order).

Pros of Joining a Heathsharing Ministry and/or Medical Cost Sharing Organization

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Cost Of Membership Can Be Much Less Than Traditional Insurance

Membership can often be a fraction of what you may get with a brick and mortar insurance plan. Since these are non-profit organizations, they do not have the overhead or regulations are the brick and mortar groups, it keep costs down. Additionally, since as a member you agree to the membership principles or guidelines you (along with other members) have an incentive to control your costs and be wise consumers in the market place (limited waste and abuse) its your money, your neighbors money etc.

Also, the structure is not set up to help pay for every single medical expense. Each household has to fulfill a certain amount before they are shared with the community (and there are some restrictions). This helps keep use of the organizations funds for the real purpose, to help avoid financial hardships for large unexpected medical expenses.

The member agreements may also have where each household agree to also adhere to certain healthy principles such as avoid abuse or drugs or alcohol, or as cliché as it sounds, make smart healthy lifetime choices and focus on wellness. There’s no doubt that those who choose to focus on wellness and health generally have better health outcomes and less expenses. Expand this to a large membership and the costs carries over.

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Flexibility Of Choices – You Have More Control

You can have more choices as a patient without some of the contractual restrictions (network) from insurance or employer plans. If you can choose any doctor of your choice (as those that operate within a self-pay approach) it puts the patient in the drivers seat to be in charge of their own medical decisions and choice of physicians.

Much as you have the control to select what business, shops and vendors you may use as a consumer to purchase groceries, repair your HVAC system or repair your car. You make those choices based upon of number of difference factors which could include, price, quality, service etc. Here you get the same power as a consumer of healthcare without the restrictive confines of networks.

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Increased Doctor & Patient Relationship And Better Outcomes

Since you will have greater flexibility and freedom to choose you can be able to work closer with you doctors. Many times doctors can be mandated on how to treat patients, what they can or can not do based upon the carrier or government. Sometimes these restrictions may not be in the best interest of what you have your physician of choice have discussed. Some physicians may completely move out of the system all together and only deal with patients on a direct basis. This means that they will have clear and transparent costs on the services they provide. You, the patient and consumer are in charge of your healthcare. You can then be able to submit the bills and paperwork to the appropriate entity.

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Cons Of Joining A Healthsharing Ministry And/Or Medical Cost Sharing Ministry

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Its Different And Outside Of What Many People Have Come To Associate With Healthcare

The structure of the healthsharing ministry and/or Medical Cost Sharing Group is outside what you may be accustomed to. Most people are used to paying for their insurance premium and having their deductibles and co-pay and going where they plan says they can go, stepping out of that realm can be unnerving. I’ve coached many individuals and families on how to empower themselves with knowledge to navigate along the healthcare market and I’m very familiar with this concept and structure, however not every person may not feel as if its the right fit.

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There Are Restrictions

 The guidelines will detail what types of expenses are accepted and there can also be pre-existing condition waiting periods or restrictions. Read your specific guidelines for details. If you have an existing treatment plan for an existing condition you may find it best to stay where you are and not make any changes, or to at least re-evaluate at a later period. Some chronic conditions may not be a fit at all.

This can include treatment medications for chronic conditions. While it is true that many common medications can often be very affordable using some of the discount and coupon programs available – there may be specialty medications or ones that may not have any other equivalent in the market in which the sharing programs simply will not be a correct fit.

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Some Groups Or Ministries May Have A Religious Component

It is true that the concept did in fact grow out of religious groups a few decades ago. Now they have become much more popular. There are some groups that may have a closer affiliation to a established faith – but there may be others not so much. It just depends.

I currently partner with a group that does not have a specific faith requirement. So in the event you aren’t quite sure if you will qualify on the faith based front (regardless if you are someone who considers themselves, religious, spiritual, or just someone who happens to strong morals and ethics etc.) it doesn’t matter, its an option worth considering.

Final Thoughts

These are just a few of the highlighted pros and cons based upon my personal experience as someone with a number of years in the healthcare industry. I am familiar with the healthsharing/medical cost sharing concept, and I am also an insurance broker. I understand both concepts. I can help assist you with them as well. Remember when a healthsharing/medical cost sharing membership is being discussed you will find that there is different language. That is because it is not insurance and you will never see any insurance terminology used.

Its important that you just understand what the terms mean as they may differ slightly from one organization to the next.

Interested to learn more about medical cost sharing?

Would you like to see how much it may cost you for a monthly membership?

Do you have a business and want to explore cost sharing as a healthcare concept for your employees?

I currently partner with the Medical Cost Sharing Group Sedera. Its a great concept, is it right for you? Contact me to receive some information and even and a consult if you wish (doesn’t cost a dime) – empower yourself with the information to find what is best for you.