The Affordable Care Act – more informally known as Obamacare – has been a colossal failure.
Yes, more people have health insurance now than they did prior to the passage of the Affordable Care Act. But the increase in the number of covered individuals came at a frightful cost.
Hundreds of billions of dollars that could simply have been allocated to expanding Medicaid to cover many of the same people more efficiently. The destruction of the individual children’s insurance market. Increased costs.
The destruction of the freedom to choose one’s own doctor or hospital for millions of Americans. (Remember “if you like your doctor you can keep your doctor? They knew it was a lie at the time)
The destruction of hundreds of thousands of jobs thanks to the employer mandate – a burden that fell almost entirely on poor, low-income Americans.
A litany of broken promises. Remember when we were told the Affordable Care Act would save us an average of $2,500 per year on our health insurance? Instead, health insurance costs skyrocketed after the ACA’s passage, as did insurance deductibles.
Meanwhile, Americans who rely on Affordable Care Act-style health insurance plans got screwed. Care networks got narrower, and premiums rose thanks to insane mandates like first-dollar abortion coverage and mandatory coverage for drug and alcohol addictions for people who don’t drink or do drugs at all.
In a free market, Americans would be able to opt out of coverage they won’t need and never will need, because they are simply not at risk. They get no value for the premiums paid.
But with traditional health insurance plans under the Affordable Care Act, we are no longer allowed to make those decisions for ourselves. At least as long as we want a traditional health insurance plan and receive a subsidy to help us pay the premiums, anyway.
Fortunately, for millions of Americans, there’s a better alternative to bloated, overpriced Obamacare health insurance policies: Medical cost sharing programs – or more simply, – healthsharing.
What Is Healthsharing?
Health sharing plans have been helping Americans reduce their monthly health care spending for years.
In their modern form, these plans date back to the early 1980s. But they trace their heritage back to the faith-based mutual aid societies of the early part of the 20th century.
Today, these healthsharing organizations exist as a great, affordable alternative to Obamacare. Especially for those of us who are making too much to qualify for the premium subsidy.
In some circles, these money-saving alternatives to traditional health insurance approaches are well-known. They are immensely popular in many faith communities, some of whom have created their own versions of health sharing plans to help their members pay the high cost of unexpected health care costs.
But more work needs to be done to introduce these plans to average Americans.
It seems like every day we are meeting folks that still don’t know what health sharing plans are, how they work, or whether they might be a good option for them.
In this blog, I’ll answer these questions and more, and discuss the advantages and disadvantages of healthsharing vis-a-vis traditional Obamacare-style health insurance policies.
Q: What is a Health Sharing Plan?
To put it simply, health sharing plans are voluntary associations of like-minded people who agree to share medical expenses with plan members in need who share their basic value systems.
In contrast with traditional for-profit health insurance carriers, These associations, called “health care sharing ministries,” or HCSMs, are tax-exempt, not-for-profit organizations,. which provide important cost-structure advantages for healthsharing plans compared to major medical insurance companies.
They should not be confused with insurance products. While both healthsharing and health insurance serve a similar function, healthsharing plans function very differently from insurance products, and are not regulated like insurance products
Healthsharing Cost Savings
For those millions of us who earn too much money to qualify for a big Obamacare subsidy, healthsharing plans can be a financial Godsend.
Because healthsharing plans don’t have to take smokers, the morbidly obese, or others with significant pre-existing health conditions, and because they only take members who commit to living healthy lifestyles, medical cost sharing programs tend to have a much healthier risk pool compared to most traditional health insurance plans.
Healthsharing plans also don’t have to lard up their benefits with expensive but unneeded or unwanted coverages like health insurance plans do.
As a result, the typical monthly cost of a healthsharing plan is around 40 or 50% less than the unsubsidized premiums of a typical Obamacare plan available over the state health insurance exchanges.
This makes healthsharing plans an ideal choice for Americans who are in good general health, do not have pre-existing conditions, and who do not receive a subsidy under the Affordable Care Act – or who only receive a small one – due to their income.
Because the average monthly cost of an unsubsidized ACA-qualified health plan for a family of four is now more than $1,200, on average, switching out of a traditional health insurance policy and into a comparable healthsharing plan potentially saves hundreds of dollars per month, and thousands of dollars per year.
Is Healthsharing Exempt from the Obamacare Mandate?
In the past, the Affordable Care Act required most individuals and families to obtain a qualified health insurance plan that includes ten “minimum essential coverages” defined under federal law, or pay a tax penalty, unless they met certain exemption criteria.
Under current law, that federal tax penalty has been reduced to zero. So it’s no longer an issue under federal law. And members of healthsharing ministry organizations were exempt from the penalty, in any case.
The State of California still imposes a penalty on the uninsured, in most cases. But members of healthsharing plans are exempt from California’s penalty, as well.
Does Healthsharing Accept People WIth Preexisting Conditions
While traditional health insurance plans must accept all comers regardless of their medical history – as long as they apply during an open enrollment period or a special enrollment period triggered by qualifying life event – healthsharing plans can be more selective.
Depending on your healthsharing plan and your medical history, the plan may impose a waiting period on your pre-existing condition. That means that it will be some time before your medical bills for treating that specific condition or complication of that specific condition become shareable.
The plan will share other medical bills, such as bills arising from injuries and accidents and other unrelated illnesses.
Some healthsharing plans impose a shorter waiting period before they will cover cancer treatment, surgeries, other those needed as a result of an accidental injury that could not have been anticipated at the time of the application.
So if you have pre-existing conditions, healthsharing is much better than nothing. But it may not be the best solution for those with pre-existing conditions that may need ongoing medical treatment.
Is Healthsharing Right For You?
Every individual and family is different.
Healthsharing is most effective for individuals and families who are in good health with no major pre-existing conditions that will require ongoing care over the next few years.
Healthsharing also works great for those who don’t qualify for a subsidy under the Affordable Care Act, and therefore must pay the full price for their medical insurance, or close to it.
The best way to decide which approach is best for you – healthsharing or traditional health insurance, is to contact one of HSA for America’s highly-trained Personal Benefits Managers, and schedule a free, no-obligation analysis and recommendation.
Just click here, select your state from the drop down menu, and follow the prompts.
HSA for America is the nation’s leading independent brokerage when it comes to healthsharing plans. And for those who are better served by a traditional health insurance approach, we represent a full line of health insurance carriers across the United States.
HSA for America, therefore, is one of the only a handful of health insurance brokers who are willing and able to discuss all the options available to you.
For more information on healthshare plans in general, click here.
The PROS & CONS of Medical Sharing Plans
PROS |
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Health Sharing is about HALF the monthly cost of an ACA plan. |
Because Health Sharing Plans tend to attract more health conscious members, and because offer a more “stripped down” form of coverage, they are significantly less expensive than most unsubsidized insurance plans on the market. |
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Health Sharing Plans both Encourage & Reward a Healthy Lifestyle |
The various restrictions associated with health sharing plans make them particularly well-suited for people who are generally healthy. As plan members start to realize how much they are saving on monthly health care costs, their incentive to lead a clean and healthy lifestyle goes exponentially up. |
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No “Open Enrollment Period.” You can enroll any time. |
You can sign up for a health sharing plan anytime of the year, unlike insurance plans that restrict enrollment to specific, narrow windows. |
CONS |
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Health Sharing is more restrictive than health insurance |
Not only are many pre-existing conditions not covered by medical sharing plans, but even certain conditions that arise during your first few years of coverage might also not be covered. Depending on the plan you choose, preventative care is sometimes not covered, and mental health is often not covered under sharing programs. Healthsharing plans also typically do not provide prescription drug insurance. However, members typically have access to excellent discount plans for drugs and medical supplies. Benefits are strongest for generic drugs, as opposed to “name brand” drugs.
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Health Sharing Plans are not subject to the same legal protections as insurance |
Because of the faith-based nature of cost sharing organizations, certain federal protections that you would expect under a traditional insurance plan are not present in a sharing plan. For example, there is no legal mechanism to guarantee that your claims under a sharing program will be paid. |
Compare Pricing on the Best HealthShare Plans Available
The Most Popular Healthshare Plans in 2023
While there are dozens of different sharing organizations to choose from, a few specific plans have stood out from the pack in terms of both price and coverage options.
Details vary with each healthsharing plan. And some healthsharing plans will accept members with certain conditions that are managed with medication and lifestyle, such as Type II diabetes and high blood pressure.
Contact a Personal Benefits Manager for information on waiting periods for your specific condition, and which health sharing plan may be the best solution for your individual situation.
Popular health share plans plans include:
- HSA SECURE. This innovative plan allows self-employed and business owners to harness the power of pretax health savings account (HSA) contributions. It combines the best features of a traditional health insurance policy with the ten minimum essential coverages with the best features of a health savings account – provided you make the contributions.
- CARE+. This is one of our most cost-effective healthsharing plans. It’s similar to the HSA SECURE plan, except that it’s open to people who are not self-employed, business owners, or independent contractors. CARE+ also does not cover colonoscopies or mammograms, and does not maintain members’ eligibility to make pre-tax HSA contributions. But otherwise benefits are very similar to HSA SECURE.
- DPC DIRECT. This healthshare plan is specifically designed for people who are also members of a direct primary care (DPC) plan. It’s also one of our most affordable healthshare plans. However, you must also maintain membership in a DPC plan.
- netWell. An extremely popular, well-rounded plan with a great set of benefits. One of our best-sellers.
- OneShare Health. A great option if you want maximum flexibility when it comes to choosing your own doctors or providers.
- Medi-Share. One of the largest and most established healthshare plans in the country, with a terrific set of benefits.
Some healthshare plans have religious requirements for membership, though many are completely secular. Most healthshare plans also have lifestyle restrictions designed to keep plan costs slow for members.
You can self-enroll with HSA for America with any of these plans in minutes at each of the links above. Just scroll down the page to get your quote, and follow the instructions from there. You’ll be guided through the process step by step.
And, of course, you can get more personalized assistance from one of our Personal Benefits Managers licensed in your state by clicking here and making an appointment.
Consultations are always free. Whether you want help comparing the different plans out there or you get stuck on your application, we’re happy to help.
Get Help with Health Sharing
The truth is, the cost sharing plan for you is going to depend on both your current health and the specific things that you need covered. Navigating the plan details is something best done with the help of someone who knows what they’re talking about, and fortune has it that we have just the experts for the job.
Call us today if you are interested in learning more about whether switching to a health sharing program is the right decision for you, or which plans you might qualify for.
Here are some additional articles on healthsharing programs: Healthsharing Plans for Small Businesses – What Business Owners Need to Know | Medical Cost Sharing – A Viable Alternative to Traditional Health Insurance
And here are some additional pages related to this article: Health Insurance Plans: Which Is Best for Me? | Best Healthshare Plans Comparison Guide (2023 Update)
Frequently Asked Questions About Heathsharing
What are health sharing plans?
Health sharing plans, also known as health care sharing ministries (HCSMs), are cooperative groups, where members share each other’s health care costs. These are not insurance policies. Instead, they are faith-based cooperatives where members follow specific lifestyle and faith guidelines and contribute a set amount each month.
How do health sharing plans differ from traditional insurance?
Traditional insurance involves pooling risk and making payments for health care services. On the other hand, health sharing plans involve a group of individuals agreeing to help cover each other’s medical expenses as they arise. Health sharing plans are exempt from ACA regulations, which means they don’t have to cover pre-existing conditions or provide minimum essential coverage.
Are health sharing plans cheaper than traditional insurance plans?
Health sharing plans often have lower monthly costs (also known as “shares”) compared to traditional insurance premiums. However, these costs can vary significantly based on the health sharing organization, the number of people in your family, and other factors.
Are pre-existing conditions covered in health sharing plans?
Most health sharing plans do not cover pre-existing conditions, especially within the first year of membership. Some plans might cover them after a waiting period, and others may never cover them. This varies greatly among organizations, so it’s crucial to read the guidelines before joining.
Is prescription medication covered in these plans?
Many health sharing plans do not cover prescription drugs, or they might cover them only under specific conditions, such as during hospitalization or for a short period after a surgery or an illness.
What are the membership requirements for health sharing plans?
Health sharing plans often require members to agree to a statement of beliefs, which usually involves living a healthy lifestyle (e.g., no smoking, moderate drinking, etc.) and following specific faith-based principles. Some require regular church attendance. The requirements vary by organization.
What if I need medical treatment that’s against my health sharing plan’s guidelines?
If a treatment conflicts with the guidelines of your health sharing plan, it’s likely that the cost will not be shared. This is often the case for services like abortion, contraception, and sometimes mental health care.
Is preventive care covered under health sharing plans?
Preventive care, such as regular check-ups, vaccines, and screenings, is often not covered under health sharing plans. This varies by organization, so it’s important to check the specific guidelines of any plan you’re considering.
Are health sharing plans compliant with the Affordable Care Act (ACA)?
Health sharing plans are not insurance and do not meet the requirements for health insurance under the ACA. However, members of health sharing ministries are exempt from the requirement to have ACA-compliant insurance.
Can I use health sharing plans with other insurance plans?
Yes, you can use health sharing plans in conjunction with a high-deductible insurance plan. This can help cover major medical expenses that exceed the limits of the health sharing plan.
Are there maximum limits to how much these plans will pay out?
Yes, many health sharing plans have limits on how much they will pay for a single incident or for a year. These limits can vary significantly from one plan to another, and it’s crucial to be aware of these limits when considering a plan.
Are all medical procedures eligible for cost-sharing?
No, not all medical procedures are eligible. Typically, health sharing plans do not cover procedures that they consider to be against their guiding principles. This often includes things like abortion, cosmetic surgery, and sometimes mental health treatment.
Are health sharing plans available nationwide?
Yes, most health sharing plans are available nationwide. However, the rules and regulations, along with the sharing limits and member responsibilities, can vary from one plan to another.
Hi! I’m Misty Berryman, 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.