Q. My husband and I are self-employed, with a two-year old son. We are considering joining the Samaritan Ministries health-care sharing ministry, which is a faith-based non-profit in which members help each other pay medical bills. Is that a good idea?
A. Samaritan Ministries is one of three major health-care sharing ministries in the U.S. (the others are Christian Care Ministry’s Medi-Share and Christian Healthcare Ministries). The first thing you need to understand is that they do not provide the same degree of legal and financial protection as real insurance.
“Health insurance is an actuarial contract,” says James Lansberry, Samaritan’s executive vice president and also president of the Alliance of Health Care Sharing Ministries, a trade organization. “People buy policies and health insurance promises to pay out claims and makes contracts with doctors and hospitals. They are regulated by the department of insurance in whatever state they’re in.”
By contrast, Lansberry says, “health-care sharing ministries make no promises or guarantees. We are faith-based ministries that deal with what has happened rather than what might happen. Members share in each other’s bills after they have already occurred.”
The ministries collect monthly “shares” from members that are considerably cheaper than regular health insurance premiums: Samaritan shares are $320 for a family and $135 for an individual.
After incurring a medical expense deemed eligible under the sharing organization’s guidelines, members submit these bills or “needs” to the ministry, which manages the redistribution of members’ monthly payments to the appropriate households. Samaritan simply instructs members to send their monthly share checks directly to other members in need, whereas the other two programs collect and redistribute monthly contributions.
Members are in turn responsible for paying their medical bills directly. “Hospitals and doctors treat them as self-pay patients,” Lansberry says. “We encourage them to negotiate discounts on their bills.”
“We talk about the way that members take care of one another, and that does happen,” Lansberry says. “But all of that hinges upon our binding relationship in Christ.”
Indeed, to be eligible for the programs, one has to profess an evangelical Christian faith, attend church, and abstain from proscribed behaviors like sex outside traditional marriage and alcohol or drug abuse.
The regulatory status of these plans has been controversial. Some insurance regulators argue that in substantive ways these programs look and act like insurance—but with none of the legally prescribed safeguards against rip-offs and nasty surprises when medical bills reach catastrophic proportions. The ministry programs incorporate key elements of health insurance, including deductibles, annual or per-incident dollar limits on coverage, and major exclusions for things like mental health care, prescriptions, and pre-existing conditions. “There are promises made. It doesn’t matter that they say it’s not insurance,” says Mila Kofman, former superintendent of insurance in Maine.
Insurance or not, the programs function outside the laws that constrain licensed insurers, with 17 states explicitly exempting them from that regulation, according to Lansberry. That, says Kofman, means there’s very little recourse if payments don’t come, and no one to make sure there’s enough money on reserve to cover claims the way there is for real health insurance.
Come 2014, when key provisions of the Affordable Care Act kick in, those considering a cost-sharing ministry will have a somewhat different insurance landscape to survey. Membership in a health-care sharing ministry in operation since 1999 (i.e. any of the big three mentioned above) will exempt individuals from the law’s controversial mandate to purchase health insurance. On the other hand, insurers—unlike the ministries—will no longer be able to cap lifetime expenditures or limit coverage because of a pre-existing condition. And most low-income people will be eligible for new subsidies to help them buy real insurance.
Read more of our coverage of health insurance.
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