For the last decade, politics has divided much of the debate over how Texans protect themselves financially from their medical expenses. Health Insurance as we traditionally knew was turned upside down with the Affordable Care Act. Insurance For Texans does not care about your particular point of view 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.
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?
Simply put, a health sharing plan is a collection of individual families to share the cost of medical bills between one another through a monthly contribution. The idea is that the families will pay cash out of pocket for items like primary care visits, and the sharing 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 a traditional health insurance plan. Let's look at why.
First things first, a Health Share Plan is not actually Health Insurance. It is not run or administered by insurance companies. This means that if you are headed to the hospital for a surgery, the hospital can ask you to pay for the medical cost of 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 if they do not have the cash flow to absorb that medical bill. 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 of the medical costs are completely up to the insured and the health systems and you likely lack the bargaining power in those negotiations that a big health insurance company does. These two items can be worked around, but you need to understand the risk going into using a healthcare sharing ministry.
Most Health Share Plans function on a system that you would recognize as a Deductible and reimbursement model for medical expenses. That means, when you head in for a major procedure, the 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 for the medical care gets paid is going to be a bit of a crap shoot. Some of the health sharing plans have networks that will look and function like a PPO network. If you use one of those, the healthcare system or provider will allow for medical expenses reimbursement to come from the Plan itself rather than your pocket. Many find this preferable. However, if your plan does not use the "network" model you need to be prepared that you could be asked to pay for that six figure plus bill and await 45 to 90 days for reimbursement of the health care cost. While preventive of financial ruin in the end, it can make things a bit tight at the moment if your medical condition requires a large cash payment up front.
You also need to understand that many of the sharing 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.
One main consideration for many is that the majority of the Health Share Plans have a faith based statement requirement. Because of this statement of faith, you will also want to fully understand the benefits provided by the sharing plan. Some treatment options like maternity coverage outside of a marriage situation may not be covered under the sharing plan. This can be incredibly problematic if something unexpected happens to you. If you're not in tune with the items that are and are not covered, the healthcare costs that arise with those plans will definitely not be for you. One side note is that there are some health sharing plan options that do not require the faith statement.
Some other considerations can actually be similar to ACA non-compliant health insurance plans. Many plans do have underwriting for pre-existing conditions. These provisions may limit the benefits available to you for any pre-existing conditions either entirely or graduated in over time. 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 recent horror stories of mismanagement of funds and people having reimbursement denied reimbursement 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.
The first step is to determine if a Share Plan is the right step for you and your family. If you live a healthy lifestyle and have a solid understanding of their underwriting and requirements for reimbursement, the monthly costs may fall in line with what you are seeking. While preventive care may not be covered on every health care sharing program, they make a great way to keep monthly payments in check and maintain what you deem as essential coverage.
We tend to recommend the very large organizations like Christian Healthcare Ministries and Medishare that have long track records of working with families in a great fashion. They have very sound processes and financials to make sure that you don't wind up in a worst case scenario.There are many other options and you need to research carefully.
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!