As health insurance rates continue to rise and coverage gaps continue to increase, consumers are looking for affordable alternatives to traditional insurance. In addition, finding a plan that aligns with one’s values is also an increasing concern for many in the marketplace. A Health Share Ministry Plan can solve both of these problems. But what is a Health Share Ministry Plan? Let’s talk about that.
What is a Health Share Ministry
A Health Share Ministry is an organization that promotes sharing of healthcare costs between individual members who have common ethical or religious beliefs in the United States. It is not insurance, but members are exempt from the individual responsibility requirements of the Affordable Care Act (aka Obamacare) and do not have to pay a penalty. This exception to ACA was intended to exempt religious groups that felt non-participation in the Affordable Care Act was a matter of religious freedom.
There are some basic requirements of a Health Share Ministry:
- Must be a 501(c)(3)
- Members must share common religious or ethical beliefs
- Ministry cannot discriminate membership based on state of residence or employment
- Members cannot lose membership due to development of a medical condition
- Must be subject to annual audit by an independent CPA which must be publicly available
- Must have been in existence and practice continually since December 31, 1999. There are several Ministry Plans that were started after Affordable Care Act was passed and are not exempted from penalty. Most of these organizations set aside the penalty dollars to pay on behalf of members keeping them whole. An example of this is Medical Cost Sharing.
Health Share Ministry plans are not health insurance. They are considered a membership that has health benefits. Since they are insurance they are not regulated by any state department of insurance or a part of any state guaranty fund.
Health Share Ministry Plans also use different language than traditional insurance plans. For example, a member responsibility amount replaces the terms of deductible, copays, and out-of-pocket maximums. Contributions replace the word premium. Needs replaces the concept of a health insurance claim.
Differences between Insurance & Health Shares
There are some significant differences between a traditional insurance plan and a health share.
First, there is no open enrollment period. Because a health share ministry is not considered health insurance there is no need to follow the rules for open enrollment. Individuals can enroll at any time based on the rules of the health share.
Second, a person can be denied entrance into the plan or specific share pool. Because a Health Share Ministry is not insurance there is no guaranteed issue provision. Each person is individually medically underwritten and can be denied coverage based on medical conditions. In addition, rates can be different for people enrolling in a health share because of their medical conditions.
Third, the cost is different. Generally, unless a person qualifies for a subsidy in the Federally Facilitated Marketplace the cost of a health share is significantly less than that of a traditional insurance plan.
Finally, care is different in a share plan versus traditional insurance. There are limitations and lifetime maximums in a health share. Finding the right type of health share for your family is also important. Some health shares offer value added services for preventative care and wellness benefits while others do not.
Health Share Ministry Plans are not a fit for everyone. If you have chronic conditions you may be better suited in an ACA plan. However, they are gaining popularity because they are able to lower costs for many.
If you would like more information about our Health Share Ministry option, please click here or contact us to learn more.