We got a flier in the mail yesterday from Medi-Share. The front of it says “According to the new law, guess who’s not required to buy health insurance? You.” Inside the brochure, it goes on to explain that “Healthcare sharing ministries like Medi-Share are the only organizations exempted from the costs and regulations of the new law (HR3590).”
It’s true that programs like Medi-Share are exempt from the regulations established under HR3590, because they’re technically not health insurance companies. Of course that has it’s downsides too… they are not regulated by state insurance commissioners, and they are very clear in stating that the program is not health insurance and that payments are not guaranteed.
Although regular health insurance companies do impose various limitations and restrictions on various aspects of coverage, Medi-Share does so to a greater extent. Pregnancies to unwed mothers are not covered unless the woman can prove that she was raped. In the event that a member has fertility treatment that results in multiple births, the program will pay up to $25,000 for complications to the mother and/or children, including the cost of the delivery. If you’ve ever known someone who gave birth to multiples with complications, you know that $25,000 won’t go far. I guess this is an incentive for Medi-Share members to steer clear of fertility treatments that might result in multiples (the infertility treatment itself is also not covered, but that is true of most individual health insurance policies too). Most individual health insurance carriers in Colorado don’t offer basic maternity coverage at all right now (although that will soon be changing), but they are all required by law to cover complications of pregnancy just like any other illness. Since medical sharing programs aren’t actually health insurance, they don’t have to abide by the rules that mandate coverage for pregnancy complications.
Pre-existing conditions aren’t covered with Medi-Share.
The mental health parity law that was passed in 2008 has no impact on programs like Medi-Share, and mental health issues are not eligible to be shared by other members. Neither are any conditions that stem from acts that would be considered un-Christian, such as sex outside of marriage. HIV/AIDS treatment is only covered if the disease was contracted via transfusion, rape that was reported to law enforcement, or by a health care worker in the line of duty. Members are not allowed to smoke, use drugs, or abuse alcohol, and conditions resulting from any of those things are not eligible to be shared with other members.
Medi-Share also does not cover routine preventive care. In Colorado, well-child visits, mammograms and PSA testing are required by law to be covered by health insurance carriers, but since Medi-Share is not a health insurance policy, it’s exempt from the mandates. Personally, I believe that health insurance should be more about providing a safety net to cover huge medical bills rather than focusing on small, routine, expected expenses. But it’s something that people should be aware of if they are considering a medical sharing program… actual out of pocket medical expenses might be quite a bit higher than the “annual household portion” simply because of the things that aren’t eligible to be shared with other members.
Out of curiosity, I got quotes on the Medi-Share website for my own family. We have no interest in joining a medical sharing program, but I was interested in seeing what the difference in price would be. We currently have a $5000 deductible HSA qualified policy. For a policy with a $5000 annual household portion, we’d pay about $240/month (including the discount we’d receive for being healthy). We currently pay $336/month for our health insurance policy. To me, the extra money we pay to have a policy that comes with written guarantees, a contract, and oversight from the division of insurance is worth it. Medi-Share’s website states that “Health insurance comes with a contractual guarantee to pay your medical bills. For over 17 years our participants have been faithfully sharing medical bills on a non-guaranteed basis…” For some people, that bit about no guarantee of payment might not be a concern. But the reason I have health insurance is to protect our family in the event of a catastrophic illness or injury. If that were to happen, I want to know that I have a real health insurance company paying my bills, and legal recourse in the event of a dispute. I like knowing that my health insurance policy is regulated by Colorado’s Division of Insurance, and I like the fact that it doesn’t say “this is not health insurance” anywhere on my policy information. For that peace of mind, I’ll pay an extra $96/month for my family’s coverage, which does come with preventive care coverage.