Emergency room visits can be expensive, but health sharing plans provide an alternative to traditional insurance for handling these unexpected costs.
Health sharing plans are an extremely cost-efficient way for many families to protect against the need for an expensive emergency room or urgent care center – especially when it results in a medically necessary hospital admission.
However, every health sharing plan is different. The exact provisions vary by plan, and sometimes by the membership tier you select in your chosen health sharing plan.
This article will provide specifics on how many of the top health sharing plans share costs for ER and trauma center visits. So you can compare each of these health sharing options and make an informed decision.
What Is Health Sharing?
Health sharing plans, also known as health care sharing ministries, provide a community-based alternative to traditional health insurance.
- Members contribute to a shared pool that pays for each other’s medical costs.
- Often a more affordable option than traditional insurance.
- Have unique rules for emergency room visits, urgent care, and hospital stays.
Each organization’s approach varies, so it’s important to understand their specific policies to be prepared for unexpected medical needs. Let’s examine how major health sharing plans handle these scenarios.
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How Leading Health Sharing Plans Handle Emergency Room Visits
Altrua HealthShare
Altrua HealthShare is a faith-based health sharing ministry where members commit to a clean, healthy lifestyle and shared ethical beliefs. It offers tiered membership levels with tailored guidelines and sharing limits.
Emergency Room Visits
- The ER should only be used for serious, emergent medical issues.
- Definition of an Emergency: Treatment must be immediately necessary to alleviate a sudden, unforeseen illness or injury that, if untreated, could lead to disability or death.
- Eligibility for Sharing: Altrua HealthShare reviews medical records to assess eligibility based on presenting symptoms rather than the final diagnosis.
- Sharing Guidelines:
- $500 Service Fee per ER Visit, applied to the Member Responsibility Amount (MRA); fee may be waived if admitted.
- Urgent Care Visits: $50 service fee per visit, applied to the MRA.
- Member Responsibility Amount (MRA): Functions like a deductible—members pay out-of-pocket before cost sharing begins.
- Advance Opinion for Eligibility: Members can request an Advance Opinion for Eligibility to determine if an ER visit will qualify for sharing.
- Medical Need Advocacy: Available for members with significant medical needs, including negotiations for cost reduction.
Urgent Care Visits
- Diamond & Emerald Memberships: Members submit a $35 per visit co-share to the provider. After that, the Membership shares up to $300 per eligible visit.
Each household is allowed six combined office, specialist, or urgent care visits per family member each calendar year.
- Sapphire Membership: You pay the full or discounted price for an urgent care visit. However, you can apply up to up to $300 per visit against your 1st, then 2nd MRA.
- Ruby Membership: You pay the full or discounted price for an urgent care visit. After that, you can apply up to $300 against your 1st, then 2nd MRA..
- Note that the urgent care benefits are much more generous for the Diamond and Emerald memberships than the Sapphire and Ruby memberships.
Key Takeaways
- Altrua HealthShare provides structured sharing for ER visits, with a $500 service fee (waived if admitted) and cost-sharing after MRAs are met.
- Urgent care visits require a $50 service fee, with cost-sharing applicable based on membership level.
- Routine medical needs should be handled via telemedicine, primary care, or urgent care, as non-emergency ER visits are not eligible for sharing.
- Members can request an Advance Opinion for Eligibility to clarify whether a medical need will be shared.
- Medical Need Advocacy services are available to assist members in negotiating lower costs.
JHS Community Health Share
JHS Community Health Share is a faith-based, nonprofit 501(c)(3) Health Care Sharing Ministry offering a cost-effective alternative to traditional health insurance.
It provides tiered membership plans tailored to diverse healthcare needs and lifestyles, promoting a healthy and low-risk lifestyle among its members.
Emergency Room Visits
- $400 service fee per visit, applicable per member
- Service fee applied to the Member Responsibility Amount (MRA)
- If admitted to hospital, MRA and AMRA apply before sharing begins
Sharing Limits for Emergency Room Visits – By Membership Tier
- DISTINCT: Up to $4,000 per ER visit
- DIVERSE: Up to $8,000 per ER visit
- DYNAMIC: Up to $12,000 per ER visit
Urgent Care Visits
JHS Community encourages the use of urgent care facilities for non-emergency situations to reduce cost.
Additional Benefits
- Wellness visits and physician consultations (varying caps based on plan)
- Hospitalization and surgery fully shareable after meeting MRA and AMRAs
- Access to a broad network of healthcare providers through the MultiPlan PHCS Care Network
Medi-Share
Medi-Share is a faith-based health sharing ministry offering flexible tiers to meet diverse healthcare and financial needs. Members contribute monthly shares to help pay for each other’s eligible medical expenses.
Emergency and Urgent Care
- Emergency Room Visits: $200 provider fee per visit, not applied to the Annual Household Portion (AHP); fee waived if admitted
- Urgent Care Visits: $35 provider fee per visit, excluded from the AHP
- Remaining costs shareable after meeting the AHP
netWell
netWell HealthShare offers flexible programs tailored to diverse healthcare needs through three membership tiers:
- Essential Sharing: Provides basic medical sharing for routine and major care with lower monthly contributions and higher Initial Unshareable Amounts (IUAs).
- Enhanced Sharing: Balances affordability and benefits with broader sharing options, including ER and urgent care visits.
- Elite Sharing: Offers the most comprehensive benefits, with lower IUAs, higher sharing limits, and perks like wellness benefits and expanded care access.
- Emergency Room Visits: $500 service fee per visit, applied to the IUA; shareable amounts may vary based on admission.
- Urgent Care Visits: $50 service fee per visit, also applied to the IUA.
OneShare Health
One Share Health is a faith-based health care sharing ministry offering tiered membership plans tailored to diverse healthcare needs through three main program options: Classic, Catastrophic, and Complete.
OneShare Classic
The Classic Program balances preventive care and major medical sharing, offering three tiers: Basic, Enhanced, and Crown.
- Virtual Urgent Care (Telemedicine): $0 Visit Fee, 100% Shared
- Preventive Services and 1 Wellness Visit: 100% Shared up to $1,000 Per Program Year (after 180-day waiting period)
- Primary Care Physician visits: 1 (Basic), 3 (Enhanced), 5 (Crown) per Program Year, $40 Visit Fee
- Urgent Care Facility: $75 Visit Fee, 1 visit per Program Year (Basic and Enhanced), 2 visits (Crown)
- Emergency Room: $500 Visit Fee (Basic and Enhanced), $300 Visit Fee (Crown)
OneShare Catastrophic
The Catastrophic Program focuses on low-cost membership and major medical needs, starting at $115 per month.
- Emergency Room: $500 Visit Fee
- Urgent Care Facility: Not Eligible
- Virtual Urgent Care (Telemedicine): $0 Visit Fee, 100% Shared
- Specialist: $75 Visit Fee
OneShare Complete
The Complete Program offers broader sharing benefits and lower Initial Unshareable Amounts (IUAs).
However, specific details about this program are not provided in the search results.
Additional Benefits for All Programs:
- Prescription, health, wellness, and entertainment discounts
- Mental Health Support: 24/7 Intuitive Mental Health Chatbot from Clever Health
For all programs, Emergency Room expenses under $10,000 are subject to the Visit Fee, while expenses $10,000 or over are subject to the Individual Sharing Amount (ISA).
Sedera Health
Sedera Health focuses on community-based cost sharing and offers multiple membership programs.
Membership contributions for Sedera vary based on the Initial Unshareable Amount (IUA) and household size. Both urgent care and emergency room visits are generally shareable, subject to pre-existing condition limitations, and the member’s chosen initial unshareable amount.
You can choose an initial unshareable amount of $500, $1.000, $1,500, $2,500, or $5,000. You are responsible for this amount for each plan year. Sedera will share costs in excess of that amount.
Prosper
Prosper is a health share plan offered by Universal Healthshare.
It’s designed to simplify healthcare sharing for members, adhering to the principles of Unitarian Universalism. This non-denominational program provides multiple tiers, giving individuals and families flexibility in choosing a plan that suits their medical and financial needs.
At present, Prosper is among our most popular health share plans for new health sharing customers.
Emergency Room Visits
- Generally shareable after the member’s chosen IUA has been met. However:
- Members pay a $500 service fee per visit, which is applied to their Initial Unshareable Amount (IUA).
- If admitted to the hospital, additional costs are shareable according to the program’s guidelines after the IUA is met.
Urgent Care Visits
- Members typically pay a $50 service fee per Urgent Care visit, which counts toward their IUA.
- This makes urgent care a more affordable option for minor medical issues.
Hospital Admissions
- For hospital admissions, members are responsible for their chosen IUA per incident.
- After meeting the IUA, any additional costs incurred during the hospital stay may be eligible for sharing according to the program’s guidelines.
Additional Benefits
- Preventive Care Sharing: The program includes sharing for routine preventive services to promote long-term health.
- Prescription Discounts: Access to reduced costs on medications through participating networks.
- Telemedicine Services: Unlimited virtual consultations are included, enabling convenient access to healthcare professionals.
Other HealthShare Membership Options
We offer other programs that use Zion HealthShare: DCP Direct, HSA Secure, and Care+.
1. DCP Direct (For Direct Primary Care Members)
- Emergency & Urgent Care: Members pay their chosen Initial Unshareable Amount (IUA) per incident; after that, costs are shareable.
- Extras: $5/month for unlimited $0 telemedicine; optional Rx Share prescription discount.
2. HSA Secure (HSA-Compatible Plan)
- Emergency & Urgent Care: Members pay their chosen Initial Unshareable Amount (IUA) per incident; after that, costs are shareable.
- Pre-Existing Conditions:
- 12 months: Up to $25,000 shareable.
- 36 months: Increases to $50,000.
- 48 months: Up to $125,000.
- Eligibility: Available to self-employed, independent contractors, and small business owners. If you don’t meet these criteria, Consider Care+ as an affordable alternative.
- Extras: Unlimited telehealth, virtual behavioral health, concierge services, and life care assistance.
3. Care+ (Comprehensive Health Sharing)
- Emergency & Urgent Care: Members pay an IUA of $1,000, $2,500, or $5,000 per medical need before sharing begins. After that, ER and urgent care costs are shareable for the rest of the plan year.
- Pre-Existing Conditions: Subject to a two-year waiting period.
Bridging the Gap With Accident Insurance
Health sharing plans are cost-effective, but have coverage gaps.
Not everyone has $1,000 to $15,000 in ready cash available at any given time to cover their initial unshareable amount and visit fees for an ER visit.
That’s where an accident insurance or hospital insurance indemnity policy can be a great help.
These are very affordable and easy-to-qualify-for insurance policies that provide an immediate lump sum cash benefit as soon as you have a qualifying accident or hospital admission.
You can use this money for any purpose, including:
- To pay for your health share plan’s initial unshareable amount or member responsibility amount.
- To pay any per-visit fees
- Compensate for lost income if you have to take time off from work
- Pay for a caregiver or homemaker assistance while you recover
- Pay your insurance deductible or to repair or replace a car damaged or destroyed in an accident.
Accident and hospital indemnity insurance policies combine very well with health sharing plans/ They can effectively fill in gaps in your protection against unexpected medical bills – at an affordable price.
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Finding Coverage & Next Steps
Accident insurance is widely available and can be bundled with travel or supplementary plans.
For tailored coverage, consult a Personal Benefits Manager, who can help navigate providers and find the best fit.
Conclusion
Health sharing plans manage healthcare costs but may have gaps in ER and urgent care coverage.
Accident insurance fills these gaps, ensuring financial protection against unexpected expenses. A Personal Benefits Manager can guide you through options at no cost, helping you make informed decisions.
For Further Reading:
Hi! I’m Mike Montes, and I’m one of your Personal Benefits Managers. I like working with HSA for America because we’re creating solutions to healthcare problems. Our focus on money-saving alternatives like HSA plans and health sharing programs, and the variety of health share programs we offer, are what set us apart. Read more about me on my Bio page.
