When you think of health insurance, you probably think about one of the big-name companies that offers coverage through employers or the marketplace. Or, you think about government programs such as Medicare. Both are good options depending on someone's needs, but there are other options outside of those two main avenues for healthcare coverage. Healthcare sharing is one of those ways, but many people have never heard of it or have misconceptions about it. To make informed healthcare decisions, it’s important to understand the options available, including healthcare sharing communities.
Let’s get right down to what health care sharing (also commonly referred to as medical cost sharing or just “health sharing”) is not. Technically, it’s not insurance. Members in a healthcare sharing community contribute a monthly fee, and then when one member has a medical need, they submit their need (similar to a “claim” in insurance terminology) to the community. A needs processor reviews the need according to the community guidelines to determine if it is qualified for sharing. If it is qualified, the community pays the amount of the bill that exceeds the members “initial unshareable amount” (similar to a deductible.) Each member’s monthly share is voluntary but also a requirement in order to remain an active member in the community. Members are usually responsible for smaller medical bills such as a yearly physical, and the community covers the larger bills.
One of the perks of healthcare sharing communities is that members never have to worry about out-of-network costs because they can see whoever they want. With healthcare sharing, they are technically a cash pay patient. Even this has benefits, because often times cash pay patients are actually charged less than insured patients. Healthcare sharing communities also typically have providers, labs, or services they recommend because they’re more cost-effective, but members are not required to go there.
Originally, healthcare sharing communities were created for Christians (think the Mennonites covering each other’s costs.) That’s because one of the benefits to these communities is that members are with like-minded individuals, which means that most requested medical bills will be paid because it most likely will not conflict with any beliefs. However, more recently healthcare sharing communities that have no religious affiliation, such as Sedera, have begun to arise. Some communities do have other requirements, such as no tobacco use or a requirement of living a healthy lifestyle. This is because the goal of the community is to keep costs low, and theoretically, the healthier a lifestyle the less likely members will need medical care. This of course becomes a tricky topic when you get into chronic or hereditary conditions.
A huge perk to these communities is that if it’s approved, members can have bills covered for many different types of care that traditional insurance may not cover. In some cases, healthcare sharing communities will even help cover things like funeral costs or adoption fees. It all depends on the healthcare sharing community’s member guidelines. It’s important to know the guidelines and beliefs of a healthcare sharing community before joining to make sure beliefs and lifestyles are aligned. In addition to covering a wide variety of bills, many communities also offer other services to help save members money. Some of these services may include telemedicine, bill negotiation, counseling, and more.
When it comes to monthly payments, healthcare sharing communities can be significantly cheaper than traditional insurance plans. These communities can also offer discounts to medications, primary care or direct primary care doctors, and labs. Just like insurance, healthcare sharing communities generally offer tiered plans that allow members to find a monthly membership fee they can afford.
There are other rules and stipulations to each healthcare sharing community, so it’s important to read each community’s specific guidelines. For generally healthy individuals, healthcare sharing communities can be a cost-effective alternative to traditional health insurance coverage.
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