As health insurance costs grow and provider networks shrink, more Americans are turning to a cost-effective alternative to traditional third-party insurers, despite the Affordable Care Act’s mandate that those who can afford to purchase health insurance do so.
Unlike other federal mandate dodgers in U.S. history, a growing number of insurance dodgers are dodging in full compliance with the law. These are budget-savvy, self-pay patients who have found the best way around the ACA is straight through it.
Carved into the ACA’s individual mandate is an exception for members of health care sharing ministries. Membership in an HCSM costs less than health insurance, accommodates members’ conscientious objections to the ACA, and reduces health care price inflation by placing patients directly in charge of their health care costs.
HCSMs operate similarly to insurers, with important distinctions. Instead of premiums, members pay monthly fees commonly referred to as “shares” a key word in HCSMs’ faith based paradigm. Sharing for religious reasons is the basis for HCSMs’ exemption. Groups such as Medi-Share, Samaritan Ministries, and Liberty HealthShare maintain Christians have been cost-sharing to meet each other’s needs since the days of the early church, almost two thousand years ago.
Monthly shares range from approximately $200 per individual to $500 dollars per family. Most organizations collect and redistribute these shares to other members with medical needs, although Samaritan members send shares directly to needy members via personal check.
The receiving members pay a portion of their own medical expenses, similar to a deductible. A family within the Samaritan’s framework would pay the first $300 for each of their first three non-preventive medical “needs” in a year. Every dollar above this limit is “publishable,” meaning members receive “gifts” for the remainder of all medical costs up to $250,000 per need until the need is met. After a family’s third publishable need in a year, all subsequent needs costing at least $300 are publishable.
This means a typical Samaritan family pays a quasi-premium of $405 per month, for a quasi-deductible as low as $900 per year plus smaller-dollar non-publishable expenses.
Contrast these costs to those of health insurance. In 2015, the average family coverage premium was $17,545 per year, with employees contributing $4,955, according to the Kaiser Family Foundation’s 2015 Employer Health Benefits Survey. Employees with high deductible health plans were then liable to pay a family coverage deductible of $4,345 on average, with 19 percent having an aggregate family deductible of at least $6,000, states the same report. The legal limit on out-of-pocket maximums for family coverage was $13,200.
Date: May 16, 2016