They’re called Christian cost-sharing plans (ministries) and are often considered an affordable biblical faith-based alternative to conventional health insurance plans. Typically, all applicants are accepted and premiums are often about the same or lower than coverage from a major insurer. There are no “Open Enrollments” and federal tax subsidies do not apply.
More than 250,000 Americans are enrolled in these types of plans, and the number of covered persons is expected to continue to increase each year. The main reason is that conventional plan rates, despite the ACA legislation, remain very expensive for consumers that don’t qualify for large amounts of financial assistance in the form of instant tax credits.
They’re an ideal solution for some folks and a potential financial nightmare for others. They also are not required to meet Affordable Care Act (Obamacare) mandates or participate in federal and state Exchanges. Our published guide explains how to enroll in the healthcare Marketplace and offers tips for consumers that do not participate in the ministries we are discussing in this article.
And although they have been in existence (officially) for about 40 years, the concept is still considered anything but mainstream. You are required to live a “biblical lifestyle” to qualify for a policy. Policy provisions are also much different than mainstream contracts and usually your premiums are not tax-deductible.
Submitted claims for alcohol abuse, drug abuse and abortion are rarely covered, along with several other similar and sometimes-costly situations. Also, as an ungoverned industry since this type of policy falls within the grey area of the law, Many standards don’t have to be met and there is rarely a legal contract to sign.
What Is It?
Actually, the concept is fairly simple, As an alternative to Obamacare, employer-sponsored and privately-purchased medical plans, members share other member costs of healthcare treatment by paying a monthly “premium.” The amount of the premium often determines how much coverage you receive and what your potential out-of-pocket cost is going to be. Companies that offer these programs are non-profit and administer the collection of dues and disbursement of funds to pay medical bills.
Although your coverage does not satisfy ACA (Affordable Care Act) Guidelines and mandates, you still may be exempt from the annual non-compliance tax if the “health cost sharing ministries qualifications” are met. It’s important to verify this information in advance, so you can avoid potentially expensive tax penalties.
The industry itself is not regulated on a state or federal level, so all consumers should understand all provisions of their contract. But since the typical Ministry is non-profit, a formal complaint can be submitted at the state-level. Also, audits are completed on a regular basis, and the results rarely show any improprieties.
How Are Pre-Existing Conditions Treated?
Marketplace Health Plans Cover Pre-Existing Conditions
Unlike Obamacare, it is possible that pre-existing conditions may not be initially covered. Each plan has different sets of criteria, and of course, your specific ailment will be carefully reviewed to determine if expenses will be paid. Usually, if you are being treated for an illness (as opposed to it being contained with maintenance drugs), it will not be covered. If it is a serious expensive illness, ACA Marketplace plans are far superior.
There is also benefit enhancements that many Christian plans include. For an existing condition, the longer you are a member of the program, the higher the benefits become for current treatment. The assumption is that as your disease or condition gets treated, the overall cost will be lower each year. There are exceptions, of course.
Typically, you must be Christian (also all family members) and tobacco use and illegal drug usage is strictly forbidden. Premarital sex is also not allowed. Alcohol consumption is a bit of a grey area, and of course, very hard to closely monitor. Regular attendance at churches or other specific types of worship are generally required. Children are also eligible, although they must be unmarried and listed as dependents on your federal tax return. Once they file their own return, they can request an individual application.
You submit bills directly to the organization and not to a health insurance company. Any discounts you receive or payments you make would be deducted from the amount due. Usually you must notify the cost-sharing billing department within 30-180 days of receiving treatment. There is no waiting period and you’re allowed to choose your own treatment, assuming they are licensed practitioners. Experimental drugs and unconventional treatment should be approved in advance.
What Providers Are Available?
You can choose your own doctor, specialist or hospital for treatment as long as they meet the Christian Cross Sharing plan guidelines. Since there are several levels of benefits available, coverage depends on the option you select. It is recommended that you inform the provider you are paying by cash or check, so the cost of treatment is less.
A direct-bill payment plan is also utilized, which may allow members to spread out payments over a 3-12 month period. Depending upon where you live, it is possible that certain local providers will offer special billing options that may involve a substantial reduction.
Often the “Healthcare Bluebook” is recommended (you can view it here). This guide informs consumers about the cost of services in their area and what they should expect to pay. It acts as an unbiased resource that is especially helpful when unconventional coverage is being utilized. Separate sections are available for doctors, hospitals, labs, dental, hearing aids, cosmetic medicine and X-ray imaging.
What Type Of Plans Are Available And How Much Do They Cost?
Often, there are several options available. The differences are cost, the benefits you receive, the amount of out-of-pocket expenses you are expected to pay, and whether maternity coverage will be included.
For example, the most basic tier of benefits may cost between $35 and $55 monthly per person. Thus, a family of four would be expected to pay about $200 per month. For this premium, maternity is generally not fully (and sometimes not partially) covered. Although inpatient and hospital bills are covered, often any condition or illness that is not hospital-related will be limited. This differs greatly with Federal and State Exchange policies (other than catastrophic).
There also are “Gold” or “Platinum” tiers (not to be confused with Exchange Marketplace tiers) that feature more comprehensive benefits. Premiums are naturally higher and can range in the $70 to $150 per month per person. For larger families, of course, this will result in large premiums. However, free healthcare plans are actually possible, depending on your income and state of residence. We discussed these options in the link at the beginning of this sentence.
Drugs Not Always Covered
Often, prescription coverage is only offered on the most expensive plans. Otherwise, you pay for any drugs that are prescribed. The risk is substantial if a serious chronic illness (or injury) requires using an expensive non-generic drug. If the condition is chronic, years of paying out of pocket for prescriptions could be financially debilitating.
Some of the most common ailments and conditions that you should not expect to be covered include abortion (previously mentioned), expenses resulting from attempted suicide, illegal activity that results in injury, HIV or AIDS (there are many exceptions), or any illicit drug-related illness.
Benefits are upgraded from the “basic” policies and include a much richer maternity benefit. Most often, prenatal, delivery, hospitalization, delivery, and complications (including C-Sections) are covered. And instead of only $2,000-$5,000 of benefits, often the limit exceeds $100,000. An extra rider is often offered that will increase the cap above $125,000. However, often you slowly build up the extra coverage by “renewing” the rider each year.
However, other coverage is also upgraded, including physical therapy, prescriptions, diagnostic testing, and treatment outside of a hospital. Although the term “deductible” is rarely used, the “responsibility” of each member is typically $500-$2,500 per year, instead of $5,000 or more.
Since the average PPO/HMO from a major insurance company costs about $350-$700 per month (catastrophic plans are much less), it would appear that Christian Health plans are a “good buy.” In many situations, they are. However, when taking into consideration missed federal tax credits and specialized critical care and therapy that may be lacking, it’s important to understand the importance of thoroughly researching personal plans.
Prayer Hotlines Are Typically Available 24 Hours Per Day
A monthly or quarterly publication offers free expert advice and information along with a “hotline” to live persons that can offer advice and recommendations. Prayer requests can be requested privately or through social media outlets such as Facebook or Google Plus. Prayer requests also, as you might expect, are obtained in a variety of ways, along with support from staff members and other plan participants.
A referral service is also fairly common to encourage new participation. As an inducement to refer more potential members, a credit is often given for the successful recommendation and subsequent enrollment of anyone that signs up. Typically, anywhere from 1-6 months of your own suggested premium can be waived. Thus, if you continuously refer new people, your cost could substantially reduce.
What Companies Offer Christian Health Insurance?
Actually, there aren’t many organizations that provide this type of coverage. Although verifying reliability and reputation are difficult, we listed the three largest companies below:
Medi-Share – In business since 1993, Medi-Share exemplifies the “Christians helping Christians” concept. Located in Melbourne, Florida, they require members to profess a “statement of faith” before joining. A $120 fee is also required before becoming a member, along with total abstention from alcohol and tobacco for one year before enrolling. Currently, more than 90,000 members are enrolled, and since their founding, more than $1 billion in medical bills has been discounted or paid.
The 2.5% tax penalty for not having compliant medical coverage is waived if you enroll in this type of plan. Your exemption can be documented when you file your federal tax return each year. However, if you were uncovered throughout a portion of the calendar year, you will have to pay a prorated penalty based on the number of months you were uninsured.
The Board of Directors makes all key decisions regarding major operations, although members are heavily involved in making and shaping rules. They can vote on what type of care is given and who receives it, along with recommending specific guideline changes. The America’s Christina Credit Union (ACCU) creates an account with every family to handle disbursement of funds.
An online “PrayerStream” can be utilized at any time along with a Chaplain for specific needs. Counseling and education are also readily available. Additional nursing, nutrition and physical therapy professionals also assist members on a regular basis. Two adoptions per household, are also allowed.
The monthly cost for a 50-year old for a $1,250 sharing plan is between $293 and $351, depending on health conditions. A $2,500 deductible would increase the rate to between $248 and $298. A 30-year old would pay between $141 and $163 for the $2,500 shared contribution.
And yes…prices can increase if the number of submitted claims rises faster than expected. However, there is also a potential 20% savings reduction if you meet specific criteria. Your BMI and weight will be evaluated along with results from an HbA1c home test. Exceptions can be made for athletes with higher body masses. Eligibility is still determined on various factors.
Also available through Medi-Share is a disability coverage referred to as “Manna.” Partial replacement of income from illness or injury is available for 12 months. Up to 80% of lost income can be replaced. Different levels are offered, although the $22 per month option is the least expensive. It will provide up to $2,200 of monthly income replacement for a year. Cosmetic surgery, mental illness, acts of war and fibromyalgia are several of the conditions not covered.
Note: The Kentucky State Legislature banned Medi-Share in 2012 from operating in the state. However, the ban was rescinded in 2013.
Samaritan Ministries – Fairly new, Samaritan was created in 1994 in Illinois. Today, more than 120,000 persons contribute more than $10 million per month, which makes it one of the larger Christian healthcare organizations. Each month, members send “shares” to other members that are “in need.”
Samaritan Christian Ministries Pays Most Hospital Bills
A central data system matches the members who will be sending money with those persons that will be receiving it. Usually, only about 1 in10 persons needs medical treatment in a specific month. Of course, the seriousness of the ailment and cost of medical expenses can greatly vary. About $9 million each month is available to pay bills. Occasionally, members will send other members that are being treated, more than the required share. Those extra funds are considered “gifts” and do not have to be returned.
While most conditions are covered, pre-existing conditions prior to joining generally will not be paid for. Also, routine checkups, preventive exams and annual physicals, although covered in full on conventional Marketplace plans, are not covered through Samaritan Ministries. However, similar to Marketplace policies, there is no maximum limit to the amount of benefits paid over a lifetime.
The Monthly Cost
$360 – Husband And Wife
$405 – Family
$250 – Single Parent And Child
If an applicant is 25 or older, a $40-$50 per person youth discount may apply. Members can increase premiums through a majority vote. Typically, increases occur every few years, and are less than 10%. Maternity benefits are limited if you become pregnant before joining.
“Save To Share” is a special program designed to pay for needs of members that have more than $250,000 of medical expenses. An extra annual payment of $133 (per person) is required and a $15 administration fee is added to the cost. When a special need arises, other “Save To Share” participants withdraw some of their extra deposited funds to help other needy persons. The $133 charge is capped at three persons per household.
A “referral credit” is provided to members that refer others that eventually become members themselves. There is no limit to the number of credits you can receive. So conceivably, a family could cover their membership fees by continuously referring other members to the organization.
Christian Healthcare Ministries (CHM) – Created in 1981, CHM was the first sharing ministry in the US. Since that time, they have paid more than $1 billion in medical expenses for its members and are classified as a 501 (c) (3) organization. Their Board of Directors consists of an impressive array of bank presidents and hospital CEOs. Currently, there are more than 80,000 active members, and the main directive of the company is still based on Galatians 6:2 and Acts 2 and 4.
The budget and financial statements are reviewed each year by the Board of Directors and an outside public accounting firm is responsible for the annual certified audit. In our research of CHM, we have noticed that fraud prevention and detection is heavily emphasized. Also, all medical expense payments are personally reviewed by the Chief Operating Officer or President.
Just like other sharing organizations, members must be Christian and adhere to the teachings of the bible. Alcohol and tobacco use are not allowed and there are no restrictions based on your BMI (Body Mass Index), age or where you reside. Pre-existing conditions will be covered only if you are receiving “Maintenance” treatment as opposed to treatment for the illness or disease itself.
However, there is still a three-year initial period after enrollment that limits the payment of expenses. There is a cap of $15,000 during the first year and a cumulative limit of $50,000 for the first three years. After the first 36 months, no limits or restrictions apply. Maternity is treated similar to other ministries.
The Monthly Cost
$150 – Gold Membership
$85 – Silver Membership
$45 – Bronze Membership
The Gold, Silver and Bronze plans have no relevance to the Affordable Care Act Metal plans, which are recognized by the same name. All three plans have a $125,000 per illness cap. Of course, this is substantially less than the unlimited lifetime maximums for Marketplace plans. It is also less than many “short-term” policies that include $250,000 (or more) of coverage for a single illness.
“Personal Responsibility,” which is synonyms with a “deductible,” is $500, $1,000 and $5,000 on these three plans. The “Brother’s Keeper” rider will add $100,000 of benefits to the Silver and Bronze plans, and unlimited benefits to the Gold plan. The Gold plan also provides up to 45 physical therapy visits while the other options exclude this benefit.
To summarize our findings, Christian health insurance plans don’t provide the comprehensive coverage, financial backing or extensive national networks that many large health insurers offer. Depending on your income, you may also actually pay more for these types of plans. However, in some instances, they are worth considering, and may provide the benefits you need at a price lower than Marketplace policies in your area.
November 2015 – MediShare now has almost 110,000 members, which is about double the amount they had four years ago. Most of the owners of these plans are in states that have big Christian followings, such as Texas. New York has also seen a significant rise in membership the last four years.
Currently, these types of medical plans still qualify for the ACA exemption, which waives the current 2.5% household income penalty tax. But, to get the waiver, you must file your request with the Internal Revenue Service or the federal Exchange.
December 2015 – CHM’s rates have not changed for 2016. The Gold, Silver, and Bronze options are still offered. Of course, these should not be confused with Marketplace “Metal” policies. Also, “Team Them Diligently,” one of the largest US homeschooling resources, will be working with CHM in 2016.
Four national conventions are schedules which will provide attendees the opportunity to learn about the available medical plans. “Worldwide Tentmakers” sponsors the conventions and feels the synergy between the two organizations will further traditional family beliefs.
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