Health Share Ministries: A Different Way to Handle Healthcare Costs
Health Share Ministries: A Different Way to Handle Healthcare Costs
Health share ministries have become a much bigger part of the conversation for people buying their own health coverage.
They are especially popular with self-employed individuals, ranchers, small business owners, independent contractors, early retirees, and families looking for an alternative to traditional health insurance.
But the first thing people need to understand is simple:
A health share is not health insurance.
That does not automatically make it good or bad. It just means it works differently, and you need to understand those differences before joining.
How Does a Health Share Work?
Instead of paying an insurance premium, members make a monthly contribution to a healthcare sharing community.
When a member has an eligible medical need, the community helps share those expenses according to the organization’s membership guidelines.
Some health share programs use what is called an Initial Unshareable Amount, or IUA.
Think of the IUA somewhat like a deductible, although it is not technically an insurance deductible.
A member may choose from several IUA levels. Once the member pays the applicable IUA for an eligible medical need, additional eligible expenses related to that need can generally be submitted for sharing according to the program’s guidelines.
Some programs also limit how many IUAs a household can be responsible for during a rolling 12-month period.
That structure can be attractive for people who want protection against larger medical expenses without paying the premium associated with traditional major medical coverage.
One Medical Need Can Work Differently Than an Annual Deductible
This is an important distinction.
With traditional insurance, you generally have an annual deductible and maximum out-of-pocket amount.
With this type of health share, the IUA is generally connected to a medical need rather than simply accumulating all healthcare spending throughout the year.
For example, if you had an accident requiring surgery and follow-up treatment, those related bills may be treated as one medical need.
Once the applicable IUA is met, additional eligible expenses related to that need may be shareable according to the membership guidelines.
That can work very well in some situations, but it is different enough from traditional insurance that people need to understand it before joining.
The Good
One reason people look at health shares is cost.
Monthly contributions can sometimes be considerably lower than traditional health insurance, particularly for households that receive little or no ACA premium assistance.
There can also be more flexibility in how you receive care.
Depending on the program, members may not be tied to the same type of traditional insurance network. Some programs allow members to use a broad range of providers and then work through the sharing process afterward.
For a healthy family primarily concerned about protecting themselves from larger medical events, that structure can be worth considering.
Another feature some people like is the ability to choose an IUA level that fits their comfort level and monthly budget.
The Bad
Health shares do not have the same guarantees that come with ACA-compliant health insurance.
An eligible expense is generally shared according to the organization’s membership guidelines rather than paid under an insurance contract.
That distinction matters.
You need to understand what is eligible for sharing and what is not.
Some expenses that people may automatically expect a traditional health plan to cover may have restrictions, waiting periods, limits, or may not be shareable at all.
This can include things like preventive care, prescriptions, maternity, dental, vision, medical equipment, and certain ongoing treatments.
That means reading the membership guidelines is not optional.
Pre-Existing Conditions Are One of the Biggest Differences
This is probably the area I would spend the most time explaining to someone considering a health share.
You may be allowed to join even if you have existing medical conditions, but that does not necessarily mean expenses related to those conditions will immediately be eligible for sharing.
Many health share programs have specific rules for pre-membership medical conditions.
Those rules can include waiting periods, phased-in sharing, or other limitations.
That is very different from ACA Marketplace coverage.
An ACA plan cannot exclude your pre-existing conditions.
So if someone has significant ongoing health problems, expensive treatments, or a major procedure already on the horizon, I would look very carefully at whether a health share makes sense.
What About Preventive Care?
Some people assume health shares do not offer any preventive benefits.
That is not always true.
Certain programs may share specific preventive services or offer preventive benefits through certain membership options.
But those benefits may have limits, waiting periods, or specific eligibility requirements.
Again, that is different from ACA coverage, where many qualifying preventive services are generally covered without cost sharing when applicable requirements are met.
What About Maternity?
Maternity is another area where you need to read the details before joining.
Some health shares do provide maternity sharing, including certain prenatal, delivery, and postnatal expenses.
But maternity may have its own IUA, timing requirements, and eligibility rules.
If you are planning to have a baby, I would never assume maternity works the same way as traditional insurance.
Ask the questions before you need the benefit.
Prescriptions Can Work Differently Too
Prescription coverage is another area where health shares can be very different from insurance.
Some programs offer prescription discount services, while certain prescription expenses connected to an eligible medical need may also qualify for sharing.
But that is not the same thing as having a traditional insurance formulary with defined copays and tiers.
If you take expensive maintenance medications every month, this deserves a close look before switching away from traditional insurance.
The Ugly
The biggest problem I see with health shares is not necessarily the product itself.
It is misunderstanding the product.
If someone joins believing they purchased traditional comprehensive health insurance, they can be disappointed later when an expense does not qualify for sharing.
Health shares operate under membership guidelines.
Certain expenses may be excluded.
Pre-membership conditions may be limited.
Some routine dental and vision expenses may not be eligible.
Prescription benefits can work differently.
And because this is not insurance, members do not have all of the same contractual protections that come with an insurance policy.
That is why transparency is extremely important.
Who Might Want to Consider a Health Share?
I think a health share may be worth comparing for someone who:
Is relatively healthy
Is self-employed
Is paying a very high unsubsidized health insurance premium
Wants protection primarily against larger medical expenses
Is comfortable understanding and following membership guidelines
Wants an alternative to traditional health insurance
Does not have significant ongoing medical or prescription needs
That still does not mean it is automatically the right choice.
It means it deserves a comparison.
Who Should Be More Cautious?
I would be much more cautious if someone has:
Significant pre-existing conditions
Expensive ongoing prescription medications
Major procedures already planned
Complex chronic healthcare needs
Upcoming maternity needs without understanding the eligibility rules
A substantial ACA premium tax credit
A strong preference for the guarantees and protections of traditional insurance
In those situations, an ACA Marketplace plan may offer protections that are very difficult for a health share to duplicate.
Health Share vs. ACA Coverage
I do not think this needs to be an either-or argument.
ACA coverage offers comprehensive insurance protections, guaranteed acceptance regardless of medical history, and potentially substantial premium tax credits.
A health share can sometimes offer a much lower monthly cost and a different approach to larger medical expenses.
But the tradeoff is that it is not insurance, and sharing is governed by membership guidelines.
For the right person, that tradeoff may make sense.
For someone else, it may not.
Questions I Would Ask Before Joining
Before joining any health share, I would want answers to questions like:
What is my monthly contribution?
What is my IUA?
How many IUAs could my household be responsible for in a year?
How are pre-existing conditions handled?
What preventive care is eligible?
How does maternity work?
How are prescriptions handled?
Are there limits on specific procedures or services?
What expenses are not eligible for sharing?
What happens if I have a $100,000 or $500,000 medical event?
How are provider bills handled?
What happens if a medical expense is determined not to be eligible for sharing?
If those answers make sense to you, then you can make an informed decision.
My View on Health Shares
I think health shares deserve a place in the individual health coverage conversation.
For the right household, they can provide a way to protect against significant healthcare expenses while keeping monthly costs more manageable.
But I do not think they should ever be presented as simply “cheaper health insurance.”
They are different.
That difference can be a strength when the program fits the person.
It can also become a major problem when someone does not understand what they joined.
Through WyoHealthPlans.com, The Bullock Agency and Simplified Benefits help individuals and families compare ACA Marketplace plans, private health plans, and health share options.
Sometimes the right answer is an ACA Marketplace plan.
Sometimes it is a private health plan.
And for some families, a health share may make sense.
The important thing is understanding the differences before you make the decision.
Visit WyoHealthPlans.com to learn more or connect with a licensed agent from Simplified Benefits.
WyoHealthPlans.com is an informational website provided by The Bullock Agency and Simplified Benefits, independent insurance agencies. Health care sharing programs are not health insurance. Membership, eligibility, sharing of medical expenses, pre-membership medical condition limitations, waiting periods, and other terms are governed by the applicable membership guidelines and may change. Sharing of medical expenses is not guaranteed in the same manner as payment under an insurance policy. Review all applicable program documents carefully before joining.
