Do Not Buy List: Healthcare Sharing Ministry As Health Insurance Alternative

I am creating a “Do Not Buy” list as part of my estate planning to help my family avoid potentially dangerous financial products. These things are not illegal “scams”, but may have hidden risks where it is better to simply avoid them. In addition to equity-indexed universal life Insurance, I am also including health-care sharing ministries (HCSM). The bigger names in this group include Samaritan, Medi-Share, Christian Healthcare Ministries, Trinity/Aliera, and Liberty.

I’ve been reading about these off and on, and they are often mentioned as a cost-saving option for the self-employed and/or those in early retirement. Read this NY Times article It Looks Like Health Insurance, but It’s Not, this Seattle Times article Washington state orders ‘sham’ health-care sharing ministries to halt, and this Consumer Reports article to get some background.

I can definitely see the appeal of the lower monthly costs and the positive feelings from being part of a cooperative community. I can accept that many (but not all) require a strong religious affiliation. I might overlook the fact that they usually don’t cover and basic preventative care like screening exams (mammograms, colonoscopies), flu shots, and other vaccines. However, I cannot accept the following:

  • HCSMs are not health insurance. This also means they are not overseen by state insurance agencies. There no government oversight, nobody to appeal to and have them say “hey that’s not right, you can’t do that”.
  • HCSMs provide no guarantee of payment. Legally, they are just a charity. The ministry looks at each claim and has sole discretion as to whether they want to provide payment.
  • HCSMs do not have to accept or cover pre-existing conditions.
  • HCSMs do not have to cover prescriptions drugs. Read their rules very carefully.
  • HCSMs can cap lifetime payments at relatively low amounts like $250,000. Read their rules very carefully. ACA-compliant health insurance plans have no lifetime limits.

The problem is that by design, yes, MOST people will be satisfied by these programs. MOST people get their bills paid. MOST people can thus leave a positive review. MOST people won’t have an extreme event that requires $500,000 of medical care over time. However, that is not the point of insurance! Insurance is there to protect you from bankruptcy due to a catastrophic event out of your control. Insurance is based on strict contracts, and you should notice that all forms of real insurance (life, health, auto, homeowners, etc) are tightly regulated. What happens if they run into some sort of financial difficulty, perhaps in a recession or from a rogue employee or executive?

Think of the importance of only putting your cash in an FDIC-insured bank or NCUA-insured credit union. The vast, vast majority of the time, banks don’t fail. I’ve never had a bank fail on me. I don’t know anyone who has had money in a truly failed bank where the FDIC had to step in. But I still know that having the proper checks and backstops is important. Sometimes things are great for long time… until they aren’t.

Also, don’t forget that if a healthcare sharing ministry rejects a child’s claims and the family is bankrupt and desperate, they’ll likely end up falling back on taxpayer-funded Medicaid to cover their healthcare needs. Is this how we want the system to work?

My recommendation is to steer clear of all healthcare sharing ministries. I do not doubt that most have good intentions and happy customers, but things can happen that may even be out of their control. HCSMs are charities, not insurance. They can fail as much as any business. Yes, real insurance costs more, but at least you have a clear contract with defined rules and legal options as a backup. If you are my loved one and are reading this, please protect yourself fully and make sure you are buying true health insurance.

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