For the last decade, politics has divided much of the debate over how Texans protect themselves financially for the way that they receive health care. Health Insurance as we traditionally knew was turned upside down with the Affordable Care Act. Insurance For Texans does not care about your particular view point on the politics. And we mean that with all sincerity. Our job, and interest, is to help you use the regulations of the current landscape to make sure that you can obtain healthcare in the most effective fashion for your family's situation.
As we look at the options available to Texas families, they generally break down into five ways.
- Group Plan Coverage through your work.
- Affordable Care Act Exchange via Healthcare.gov.
- Short Term Medical Plans
- Catastrophic Health Insurance Coverage
- Health Share Plans
The first option means you or a family member are employed with a company that provides coverage. If that's available, it's a great option. But many Texans are caught in a trap where that may not be reality. The ACA Exchange can be frustrating depending upon the county you live in because the plans available change. Short Term Medical Plans and Catastrophic Health Insurance Coverage are both great for the right person. But they can leave those with pre-existing conditions with little hope or options. As a result, the question becomes what is a Health Share Plan anyway?
What Is A Health Share Plan?
Simply, a health share plan is a collection of individual families to share the cost of medical care between one another. The idea is that the families will pay cash out of pocket for items like primary care visits, and the plan will help absorb the cost of big ticket items like hospital stays. In that way, it functions quite a bit like Catastrophic Health Insurance. But it is not. Let's look at why.
First things first, a Health Share Plan is not actually Health Insurance. This means that if you are headed to the hospital for a surgery, the hospital can ask you to pay for the surgery and related treatment up front in cash rather than doing what is known as balance billing against health insurance coverage. That can put the recipient of that surgery in a precarious position financially. The other place that can create problems is that the health system is free to charge you whatever they would like since there is no set amount for a procedure. The negotiations are completely up to the insured. These two items can be worked around, but you need to understand the risk going in to it.
How Does It Work?
Most Health Share Plans function on a system that you would recognize as a Deductible and reimbursement model. That means, when you head in for a major procedure, they first dollars toward the bill come from your pocket and are considered your responsibility. Since the plan isn't actually insurance it will not be referred to as a deductible, but rather an "unshared amount". Functionally for you, they are interchangeable.
At that point, how the bill gets paid is going to be a bit of crap shoot. Some of the health share plans have networks that will look like a PPO network. If you use one of those, they will allow for reimbursement to come from the Plan itself rather than your pocket. Many find this preferable. However, be prepared that you could be asked to pay for that six figure plus bill and await 45 to 90 days for reimbursement. While preventive of financial ruin in the end, it can make things a bit tight at the moment.
Many plans will have a lifetime maximum benefit amount, just like underwritten health plans. That maximum amount may vary between contribution levels to the Sharing Plan. Some are as low as $100,000 and as high as $1,000,000. You have to dig into the details of the Sharing Plan.
What Else To Consider?
One main consideration for many is that the majority of the Health Share Plans have a faith based statement requirement. In this same manner of thought, you will also want to fully understand if more treatment options like maternity coverage outside of a marriage situation is covered under the plan. If you're not in tune with some of those aspects, those plans will definitely not be for you. However, there are still some options that do not require the faith statement and will be open to more options of care.
Beyond that, considerations can actually be similar to non-compliant health insurance plans. Many plans will have underwriting for pre-existing conditions, and may limit the benefits available to you for those conditions in the first one to four years. You need to understand the mechanics of how reimbursement is made to you and if there are network requirements.
Finally, you need to evaluate the solvency of the sharing plan. There have been some recent horror stories of mismanagement of funds and people having reimbursement denied for treatment that is supposed to be covered according to the guidelines of care. While a worst case scenario, we would be remiss for not bringing it up.
Which One Should I Choose?
The first step is to determine if a Share Plan is the right step for you and your family. Understand their underwriting and requirements for reimbursement. If they suit your way of thinking about health care, it then becomes a process of finding the right fit. There are very large organizations like Christian Healthcare Ministries that have long track records of working with families in a great fashion. We also have experience with Liberty Health Share, Samaritan Ministries, Medishare, and OneShare Health. While they all have similarities, there are distinct differences as well.
If you are a Texan and would like help in navigating that maze of options, schedule a time to speak with us today! Just click the blue button to find out what your options are and how we can help!
