Health share programs might be a new concept to you, but they have been helping people manage their health care costs since the 1980s. Today, too many Americans are struggling with the increasing cost of health care and insurance premiums just to cover necessary medical expenses. For those looking for a cost-effective and flexible alternative, health share programs may be just what the doctor ordered.
Health share programs are a low-cost alternative to health insurance. A Health share is a group of people who have agreed to help with each other’s medical costs.
Unlike health insurance plans, the majority of health share programs are nonprofit organizations, dedicated to helping members with their medical expenses.
Basics of How Health Share Programs Work
When people first hear about it, the number one question asked is, ‘How does health care sharing actually work?’ It’s a simple concept, but the idea of directly sharing health care costs from household to household can be foreign to many. To start with, the non-profit manages funds contributed monthly by individuals, families, and small businesses. This is done using modern technology so that it doesn’t add big cost burdens that come from insurance companies that have huge staffs overseeing every member’s medical business. Following clear and easy-to-understand guidelines, the health share program reviews, approves, and distributes funds directly to families with eligible medical needs (often directly to the medical provider).
When members receive medical services, they request member-to-member sharing, and eligibility is determined. The health share program coordinates voluntary monthly financial contributions from its members to support the medical needs of all sharing members.
As part of a health care sharing plan, you are responsible for paying in a certain share amount each month (like a premium) as well as an annual unshared amount for your own expenses (like a deductible) that your medical expenses must exceed before the plan shares your expenses. A few of the top reasons people find health sharing to be financially beneficial are:
- For people who are generally in good health.
- Find the cost of current health insurance premiums to be prohibitively expensive.
- Lack of access to insurance through an employer or government program.
- Aren’t able to get coverage after missing an open enrollment period.
- Only want/need catastrophic coverage.
- Are not eligible for a tax credit based on income.
Many health share programs ask that you agree to live a moral and healthy lifestyle — like not using tobacco or abusing drugs and alcohol.
Health Share Programs Are Different From Health Insurance
Health sharing is not the same as traditional health insurance. However, most programs do count as insurance under the Affordable Care Act (ACA). By directly connecting individuals, families, and small businesses and using technology, the health share alternative is lower cost than health insurance. Bottom line — lower cost. Monthly costs of health share programs are usually much lower than insurance premiums, although the rules may be different for what’s covered.
Also financially important is that the annual ‘unshared amount’ is much, much lower than deductibles on lower-premium or catastrophic insurance plans. Even with the lower costs, you still choose your own medical provider. There are no network requirements.
Something similar with health insurance is that you receive a health sharing card with all the information needed for the doctor’s office to directly bill the health share program. Because health share plans are not as widely used as health insurance, it’s possible that your preferred provider might not yet accept these types of payment solutions. In that case, the health share program will reimburse your expenses for covered treatment.
There is an important caveat to health share programs. Not all of them cover pre-existing conditions such as cancer, diabetes, or lifestyle-related conditions like smoking. There are different ways this is handled. Some health share programs decline membership and others impose a waiting period of a year or more before coverage for pre-existing conditions begins. You’ll want to understand what is and is not covered before selecting a health share program. For instance, some but not all cover wellness exams and/or mental health counseling.
Choosing a health share organization to join is a more personal decision than choosing a health insurance company.
Who Can Join a Health Share Program?
The short answer to the question of who is eligible to join a health share is ‘it depends.’ Each health share program has its own requirements, offers different benefits, and the level of lifestyle strictness can vary significantly.
Health sharing is not necessarily for everyone, but there are specific groups of people that are better suited to participating in health share programs. Some common traits include:
- Engage in a healthy lifestyle, avoiding tobacco use and excessive alcohol consumption.
- Being in overall good health helps keep costs down for the entire membership.
- Looking for a more affordable option than what traditional health insurance provides.
- Own a small business or operate a non-profit organization with staff that requires health care coverage. Also, self-employed, freelancers, consultants, contractors, etc.
- Want to help others while helping themselves.
- Earn too much money to be eligible for subsidies with conventional ACA plans.
For many individuals, families, and independent business owners these programs are reliable alternatives to traditional health insurance because they help alleviate the cost and expense of medical bills while providing quality healthcare.
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