Understanding Health Care Sharing Programs: A Comprehensive Guide

With the rising cost of living, finding ways to save money on essential services like health care is more critical than ever. If you’re exploring options to manage your health care expenses, Health Care Sharing Programs might be a solution worth considering.

Health care sharing programs are faith-based, nonprofit organizations where members share medical costs. These programs are gaining popularity as individuals and families seek alternatives to traditional health insurance, often due to the potential for significant cost savings. These programs also appeal to those seeking healthcare options aligned with their faith and values.

Let’s delve into the details of health care sharing programs to understand how they work and if they could be the right choice for you.

What Are Health Care Sharing Programs?

A health care sharing program offers a different approach to managing health care costs compared to conventional health insurance. These programs are built on a model that allows members to:

Potentially reduce costs by avoiding coverage for services they may not need or use, which are often included in comprehensive and more expensive traditional health insurance plans.
Benefit from lower monthly contributions (similar to premiums) by focusing on a defined set of shared medical needs, rather than the broader coverage typically offered by insurance.

This model can be particularly appealing for those who prefer not to pay for medical services that may conflict with their religious or ethical beliefs. Health care sharing programs often exclude coverage for services that are against their members’ shared religious beliefs, which can also contribute to lower overall costs.

While health care sharing programs have existed for many years, their growth accelerated after the Affordable Care Act (ACA) was implemented in 2010. The ACA led to increases in health insurance premiums, making traditional insurance less affordable for many. As health insurance costs rose, health care sharing programs emerged as a viable and more budget-friendly option.

It’s important to note that health care sharing programs are not technically insurance. This distinction primarily means they don’t fall under the same regulatory requirements as insurance companies. However, this different regulatory framework is also a key reason why these programs can often offer more affordable options. Despite not being insurance, they function in a similar way by pooling member contributions to assist with medical expenses.

Understanding Health Share Plans

How Health Care Sharing Programs Resemble Health Insurance

If you are familiar with health insurance, you’ll find some notable similarities with health care sharing programs. Understanding these common aspects can make it easier to grasp how these programs operate.

Like health insurance, health care sharing programs require members to make regular monthly payments, often termed “contributions” rather than “premiums.” These contributions are the financial commitment members make to participate in the program. Additionally, similar to deductibles in insurance plans, most health care sharing programs have an annual unshared amount (AUA) or initial unshared amount (IUA). This is a set dollar amount members must pay out-of-pocket each year before the program begins to share eligible medical expenses.

Health care sharing programs also often utilize preferred provider networks. Just as with health insurance, using healthcare providers within the program’s network can lead to lower costs for services. Conversely, seeking care outside of the network may result in higher out-of-pocket expenses, or potentially non-covered services, depending on the program’s rules.

The level of your monthly contributions in a health care sharing program, much like health insurance premiums, can depend on the level of participation you choose and the number of family members included in your sharing program. Higher monthly contributions might provide access to more comprehensive sharing options or lower annual unshared amounts.

A fundamental similarity lies in the pooling of funds. In both health insurance and health care sharing programs, the monthly payments or contributions from all members are pooled together. This pooled money is then used to cover the medical needs of members who have eligible expenses.

In a health care sharing program, member contributions are typically managed by the program’s administration. When a member incurs medical expenses, they submit a request to the program for assistance. After the request is reviewed and approved according to the program’s guidelines, the eligible medical bills are paid using the pooled funds from other members’ contributions. This process covers a range of medical needs, from prescription medications to maternity care, depending on the program’s specific guidelines.

With these similarities in mind, it’s crucial to understand the distinctions that set health care sharing programs apart from traditional health insurance.

Key Differences Between Health Care Sharing Programs and Health Insurance

While there are similarities, significant differences exist between health care sharing programs and traditional health insurance. These distinctions are important to consider when deciding which option best suits your needs. Some key differences include:

Restrictions on Pre-existing Conditions: Health care sharing programs often have limitations or waiting periods regarding pre-existing medical conditions. Unlike ACA-compliant health insurance plans, which are prohibited from denying coverage or charging more due to pre-existing conditions, health care sharing programs have more flexibility in this area. They may exclude coverage for conditions that existed prior to membership or impose waiting periods before those conditions are eligible for sharing.
Statement of Faith Requirement: Given their foundation as faith-based organizations, most health care sharing programs require members to adhere to a statement of faith or lifestyle commitment. This is a core aspect of their community-based model and is not a requirement for traditional health insurance.
Regulatory Differences: Health care sharing programs are not subject to the same regulations as ACA-compliant insurance plans. This means they have greater autonomy in determining which services they cover. They are not mandated to include the same essential health benefits that ACA plans must offer, allowing them to tailor their coverage according to their members’ needs and values.
Coverage Scope and Philosophy: Traditional health insurance aims to cover a broad spectrum of health care needs, while health care sharing programs are often designed to focus on basic and catastrophic care for generally healthy individuals. However, the comprehensiveness of coverage can vary significantly among different health care sharing programs. It’s important to compare programs to find one that aligns with your specific health needs and risk tolerance.
Member Responsibility Periods: Some health care sharing programs may require a waiting period for new members before they become eligible to have their medical costs shared by the community. This initial period, where members contribute but cannot yet receive sharing for their own expenses, is not typically found in health insurance.
Payment and Reimbursement Processes: Traditional insurance typically pays its portion of a claim directly to the healthcare provider, and then bills the patient for any remaining balance. In contrast, health care sharing programs often operate on a reimbursement basis. Members may need to pay for their medical services upfront and then submit receipts to the program for reimbursement of eligible expenses. However, paying in cash can sometimes allow for negotiating discounts on medical services, potentially offsetting this upfront payment requirement.
Affordability: A significant difference, and a major draw for many, is that health care sharing programs are generally more affordable than traditional health insurance. Lower monthly contributions and different cost-sharing structures can lead to substantial savings, especially for healthy individuals and families.

Pros and Cons of Health Care Sharing Programs

Like any financial or healthcare decision, it’s important to weigh the advantages and disadvantages of health care sharing programs to determine if they are the right fit for your circumstances.

Pros

Cost Savings: Health care sharing programs typically offer more budget-friendly monthly contributions compared to health insurance premiums. This can result in significant savings for individuals and families, making healthcare more accessible and affordable.
Accessibility Regardless of Employment: Enrollment in health care sharing programs is generally not tied to employment status. This makes them an excellent option for self-employed individuals, stay-at-home parents, and those in transitional employment situations who may find it challenging to obtain or afford traditional employer-sponsored health insurance.
Year-Round Enrollment: Unlike health insurance, which often has limited open enrollment periods, health care sharing programs usually allow enrollment throughout the year. This flexibility is beneficial for those who experience qualifying life events or decide to switch to a sharing program outside of the traditional insurance enrollment windows.
No Coverage Cancellation Due to Health Conditions: Once you are accepted into a health care sharing program, you generally cannot be disenrolled or denied continued participation if you develop a medical condition. This provides long-term security and peace of mind.
Alignment with Faith-Based Values: For individuals and families who prioritize faith in their healthcare decisions, health care sharing programs offer an option that aligns with Christian values and principles. They often provide assurance that member contributions will not be used for services that conflict with their religious beliefs.
Community and Support: Many health care sharing programs foster a sense of community. Members often provide emotional and spiritual support to one another, such as sending letters of encouragement and prayers during times of illness and recovery.
No Annual or Lifetime Limits: Most health care sharing programs do not impose annual or lifetime limits on the amount of medical expenses that can be shared, providing substantial protection against high medical costs.
Additional Benefits: Some health care sharing programs extend their benefits beyond medical cost sharing to include discounts on dental and vision care. Some may also offer disability sharing programs to support members who are unable to work due to illness or injury, and telehealth services for convenient access to healthcare. In some cases, certain programs may even include sharing for adoption or funeral expenses, depending on the program’s guidelines.

Cons

Potential for Claim Denials and Lack of Regulatory Backing: While most valid claims are typically processed and shared promptly, there is always a possibility of claim denial. Furthermore, health care sharing programs are not backed by the same regulatory framework as insurance companies. This means that if a program were to become financially unstable or deny a valid claim unfairly, there may be fewer legal protections or guarantees of reimbursement compared to insurance.
Not Considered Minimum Essential Coverage: Health care sharing programs do not qualify as minimum essential coverage under the ACA. This is primarily relevant in the context of employer mandates under the ACA, and does not directly impact individual members’ access to care within the program.
Limitations on Pre-existing Conditions: As mentioned earlier, health care sharing programs typically have restrictions or waiting periods for pre-existing conditions. This can be a significant drawback for individuals with ongoing health issues or a history of medical conditions.
Potential Additional Costs for Pre-existing Conditions: Some programs may offer to share costs related to pre-existing conditions, but may require members to pay an additional fee or higher monthly contribution to access this coverage.

Despite these potential drawbacks, for many individuals and families, the advantages of health care sharing programs, particularly the cost savings and alignment with faith-based values, can outweigh the disadvantages.

Recommended Health Care Sharing Program

If you are considering a health care sharing program that combines effective healthcare cost management with a community-focused approach, Christian Healthcare Ministries (CHM) is a highly recommended option.

Christian Healthcare Ministries is a well-established and reputable health care sharing program that serves thousands of members across all 50 states. As a RamseyTrusted partner, CHM has demonstrated a commitment to financial responsibility and member service, ensuring that eligible medical bills are handled reliably and with integrity.

If you are ready to explore health care coverage that prioritizes both your health needs and your values, connecting with Christian Healthcare Ministries is a worthwhile step.

Connect with CHM today