Health care costs in the United States continue to rise, prompting many individuals and families to seek alternatives to traditional health insurance. One option that has gained popularity in recent years is health care sharing plans, also known as health care sharing ministries. These plans offer a unique way to manage medical expenses through a community-based model. If you're considering a health care sharing plan, here’s what you need to know.

What Are Health Care Sharing Plans?

Health care sharing plans are organizations in which members share each other’s medical costs. Unlike traditional health insurance, these plans are usually faith-based and operate as nonprofit entities. Members contribute a set amount of money each month (often called a “share”), which is then pooled and used to cover eligible medical expenses for other members.

These programs emphasize the concept of community support, where members help each other by sharing medical bills. It’s important to note that these plans are not insurance, and they are not regulated by state insurance departments.

How Do Health Care Sharing Plans Work?

When you join a health care sharing plan, you agree to share the medical expenses of other members in the program. Each month, you contribute a set amount (typically determined by your age, family size, and the plan you choose). When you have a medical need, you submit your bills to the plan. If your expenses are eligible under the plan’s guidelines, other members will contribute to cover your costs.

Key features of health care sharing plans include:

Monthly sharing contributions: Instead of paying a premium to an insurance company, you contribute a monthly share to the community.

Sharing eligibility: Each plan has specific guidelines on what types of medical expenses are eligible for sharing. For example, many plans exclude expenses related to pre-existing conditions, mental health, or preventive care.

Out-of-pocket expenses: Like insurance, health care sharing plans often have an initial out-of-pocket amount, similar to a deductible. You must cover these costs before the plan starts sharing your expenses.

Benefits of Health Care Sharing Plans

Lower Monthly Costs: Many people find that health care sharing plans have lower monthly costs than traditional health insurance. This can be particularly appealing to individuals and families looking for affordable health care options.

Flexibility: Health care sharing plans often provide more flexibility in choosing health care providers. Unlike some traditional insurance plans, you may not be limited to a network of providers.

Community Support: Members of health care sharing ministries often appreciate the sense of community and support that comes with sharing health care costs with like-minded individuals.

Exemption from ACA Requirements: Health care sharing ministries are exempt from the individual mandate penalty under the Affordable Care Act (ACA). This can be an attractive option for those looking for an alternative to ACA-compliant health insurance.

Potential Drawbacks of Health Care Sharing Plans

While health care sharing plans offer a number of benefits, they also have potential drawbacks. It’s important to weigh these factors before making a decision.

Not Regulated as Insurance: Health care sharing plans are not regulated as traditional insurance. This means there is no legal requirement for the plan to pay your medical expenses, and there may be fewer consumer protections in place.

Limited Coverage: Many health care sharing plans do not cover pre-existing conditions, preventive care, or mental health services. Some also exclude coverage for maternity care or require members to adhere to certain lifestyle choices, such as abstaining from smoking or excessive alcohol consumption.

No Guarantee of Payment: Because health care sharing plans are based on voluntary contributions from members, there is no legal obligation for the plan to pay your medical bills. This is a key difference from traditional insurance, which is legally required to cover certain expenses.

Potential for High Out-of-Pocket Costs: Depending on the plan, members may have to pay a significant portion of their medical expenses out-of-pocket before their costs are shared with the community.

Is a Health Care Sharing Plan Right for You?

Health care sharing plans can be a viable option for those looking for a more affordable alternative to traditional health insurance. However, it’s essential to thoroughly research the plan you’re considering and understand the potential limitations.

Before joining a health care sharing ministry, ask yourself the following questions:

Are you comfortable with the faith-based nature of the plan? Many health care sharing plans are rooted in religious values and require members to follow specific lifestyle guidelines.

Are you prepared for potential out-of-pocket costs? Be sure to review the plan’s guidelines carefully to understand what medical expenses are covered and what you’ll be responsible for.

Do you understand the risks? Since these plans are not insurance, there is no guarantee that your medical bills will be paid.

Conclusion

Health care sharing plans provide an alternative to traditional health insurance by offering a community-based approach to sharing medical costs. While these plans may offer lower monthly costs and greater flexibility, they also come with potential limitations and risks. As with any health care decision, it’s crucial to do your research and carefully weigh the pros and cons before deciding if a health care sharing plan is the right fit for you.

By understanding how health care sharing plans work and what they offer, you can make an informed decision about whether this type of coverage aligns with your health care needs and financial goals.