Health share plans and healthcare sharing ministries (HCSMs) are often marketed as “cost-effective alternatives to traditional health insurance.” However, as some Utahns are finding out, these plans have substantial limitations on coverage and lack the protections that ACA-approved health insurance plans provide.
If you’ve ever researched healthcare plans for yourself or your family, you know firsthand that searching for and comparing plans can be confusing—really confusing. There are so many different plans, pricing tiers, subsidies, and sign-up windows—the whole experience can be overwhelming. If you don’t know how to apply for subsidies made available through the Affordable Care Act (ACA), the cost of coverage can also seem impossible.
During your search for coverage, you may have encountered programs called health share plans or healthcare sharing ministries (HCSMs). These plans appeal to the human desire to be part of a community of people with similar beliefs and values. Members of HCSMs “share a common set of ethical or religious beliefs and share medical expenses among members in accordance with those beliefs.”
A report from the Colorado Division of Insurance found that more than 1.7 million Americans rely on sharing plans and that many of the plans require members to ask for charity care before submitting their bills.
-First Annual Report on Health Care Sharing Plans and Arrangements from Colorado Division of Insurance, May, 12, 2023
Both health share plans and healthcare sharing ministries plans are touted as affordable alternatives to traditional health insurance—and it’s true that monthly premiums are sometimes lower than health insurance plans. However, the reason the premiums are lower is alarming: Health share plans and healthcare sharing ministries plans are not insurance plans. They don’t provide essential coverage and benefits and don’t have to meet the minimum health benefits mandated by the Affordable Care Act.
Unlike regulated insurance companies, health share plans and healthcare sharing ministries are not required by law to pay their members’ claims for medical expenses.
Choosing a health share plan over an ACA-compliant health insurance plan can have profound, negative implications on your access to healthcare. No one plans for a severe illness, injury, or medical emergency, but if you choose a health share plan instead of insurance, there’s a good chance it won’t be covered. If you have a serious illness, it’s also very possible that the cost of your care exceeds the annual limit (the cap on the amount the health share will pay in a single year). There are thousands of documented cases of Americans with health share plans who ended up with a severe illness or injury, only to find themselves up a creek without a paddle.
Let’s dive in and cover a bit more about why you should avoid these plans, and how a health insurance plan through the Health Insurance Marketplace is the better alternative.
How Do Health Share Plans Work?
Health share plans and healthcare sharing ministries operate on the premise that members of the plan pool their money to cover each other’s medical expenses. Members typically pay a monthly “share” or contribution, and those contributions are used to pay the medical costs of other members who file claims.
Don’t Be Fooled. Health Share Plans Are Not Health Insurance
Some health share options offer free co-pays or coverage for specialty appointments, but when it comes to your health (which is affected by your insurance coverage) it’s important to look farther down the pipeline. Here are some crucial differences between health share plans and health insurance.
Health share plans aren’t regulated: Traditional health insurance plans are regulated by state insurance departments, while health share plans aren’t. Health share plan providers aren’t subject to the same oversight, consumer protections, or legal requirements as health insurance companies. As a result, health shares have fewer guarantees regarding coverage, claims processing, and dispute resolution. Often, these limitations are buried in the fine print. According to the Utah Insurance Department’s own website, when it comes to these plans “Don’t expect coverage for pre-existing conditions, mental health, or other needs.”
Limited coverage: Health share plans impose restrictions on coverage. Pre-existing conditions, preventative care, and medical treatments (like cancer treatment) aren’t fully covered. Coverage varies based on the plan you’re on, and the preferences of the health share’s members.
“Morality” as a litmus test for coverage: Many healthcare sharing ministries have a morality clause that requires members to adhere to specific religious or lifestyle guidelines to qualify for a plan. This often leads to a denial of coverage for conditions that are connected to activity or behaviors the administrators of the plan deem as “immoral.” This often includes treatment of STDs, treatment of alcohol or drug abuse, cirrhosis of the liver, or maternity benefits for anyone who is unmarried and pregnant.
No guarantees: Health share plans operate voluntarily and rely on the willingness of members to contribute to the shared pool of money. There are no guarantees there will be funds to cover all the members’ medical expenses, especially when there is a large-scale healthcare crisis (like COVID-19) or an unexpected financial hardship among members (such as a recession).
No provider network and lack of negotiated pricing: If you do find yourself paying out of pocket for your medical expenses that weren’t covered by a health share plan, there’s another unwelcome surprise waiting for you. Since health share plans don’t have provider networks, you’ll likely be charged full price by the doctors and hospitals, instead of the lower, negotiated rates available to people covered by health insurance. To add insult to injury, some plans require the patient to try to negotiate a lower price for services directly with the doctor or hospital before submitting a claim. Some even have you pay the bill and then request reimbursement.
Real-Life Consequences: A Short Case Study
In 2019, Salt Lake City’s Jennifer Wunderlich received some terrible news. Her daughter was diagnosed with a rare form of cancer and needed to start life-saving treatment immediately. Unfortunately, Jennifer’s family was enrolled in a health share plan, which she believed was the only option her family could afford, based on the perceived cost of health insurance. Jennifer contacted her health share plan, and they informed her they would only cover up to $100,000 of her daughter’s cancer treatment. Since her daughter was going to need almost 18 months of care and Jennifer would not be able to work during that time, it was looking like the Wunderlich family was also headed for financial ruin. Even worse, the health share plan would likely only cover the first few weeks of her daughter’s cancer treatment. The doctors recommended that Jennifer transfer ownership of their family’s home to one of her younger children through a trust. While it’s devastating to hear your child has cancer, learning that your “insurance” won’t cover the cost of treatment is an additional, unfathomable blow to anyone.
Luckily, Jennifer was friends with Rebecca Yates, CEO and Founder of Ark Insurance Solutions, a Salt Lake City-based health insurance brokerage. Based on Jennifer’s family income, Yates was able to sign her up for an affordable health insurance plan through the Health Insurance Marketplace. With subsidies, the health insurance plan was only $16 a month, substantially more affordable than the $450 per month Wunderlich was paying on her health share plan. The new coverage (which was actual health insurance) covered the cancer treatment, and her daughter received the life-saving healthcare she needed. Here’s what Jennifer had to say about the experience:
“Rebecca was able to find a plan that gave us the coverage we needed because we knew this would cost upwards of one million dollars. She was able to lay it out for us, and let us know what would be the best option. It changed everything. We had to go to have proton beam radiation done, which isn’t offered in Utah. So we were able to go to MD Anderson Cancer Center in Houston, and we spent the summer there while [my daughter] had her treatments and underwent other surgeries. We wouldn’t have been able to afford that had we not had insurance coverage. So it literally saved her life.”
Prioritize Your Health With Real Insurance
The significant risks and limitations of health share plans can negatively impact your access to health care. Having good health insurance coverage is critical to getting the best care. The good news is that quality health insurance can actually be affordable when sourced through the Health Insurance Marketplace, which offers subsidies and pricing tiers based on your income.
Since health insurance brokers’ fees are paid by the insurance carriers, you can get the help of a health insurance broker or agent at no additional cost. This empowers you with a professional who can advocate for you, evaluate your coverage needs, and help you find the plan that best suits your family’s budget.
Want to learn more about what type of quality health insurance coverage you can qualify for? Ark Insurance Solutions can help. Let’s talk! Navigating the complex world of health insurance can be daunting. The Ark Insurance Solutions team has the skill and experience to guide you. We’ll help you compare health plans to make the best decision based on your unique circumstances and budget. Give us a call at 801-901-7800 or click here to schedule an appointment with us.
https://www.ark-ins.com/wp-content/uploads/2024/05/HealthShareBlog_updated_0528.png6271200The Ark Insurance Teamhttps://www.ark-ins.com/wp-content/uploads/2019/10/ark-logo@2x.pngThe Ark Insurance Team2024-05-27 17:06:072024-06-06 23:08:46Not Insurance: Health Share Plans Could Leave You Unprotected
Select Health has announced that due to a breakdown in negotiations over “establishing fair and reasonable rates that ensure affordable insurance premiums” Holy Cross Hospital – Davis will not participate in the Select Health Value Network after December 31, 2023.
Additionally, Holy Cross Hospital-Davis will no longer participate in the Select Health Med, Select Health Care, and Select Health FEHB networks unless an agreement is reached by the end of the year.
According to Select Health, what this means for customers with affected plans is that after January 1, 2024, “Holy Cross Hospital-Davis will be considered out-of-network, and any services received at this facility may be denied or covered at a lesser benefit.”
If you’re an individual, family, or employer with Select Health, the company is encouraging you to find a new in-network facility to replace Holy Cross Hospital-Davis before January 1, 2024.
Select Health has offered the following guidance:
Visit the Select Health online provider directory at selecthealth.org/facilities. Search by facility type and geography.
For all other questions, please contact Member Services at 800-538-5038 weekdays, from 7:00 a.m. to 8:00 p.m., and Saturdays from 9:00 a.m. to 2:00 p.m. TTY users call 711. Member Services can help find an in-network hospital, such as:
Intermountain McKay-Dee Hospital in Ogden, UT
Intermountain Layton Hospital in Layton, UT
Intermountain LDS Hospital in Salt Lake City, UT
Navigating the complex world of health insurance can be daunting. The Ark Insurance Solutions team has the skill and experience to guide you. We’ll help you compare health plans to make the best decision based on your unique circumstances and budget. Give us a call at 801-901-7800 or click here to schedule an appointment with us.
https://www.ark-ins.com/wp-content/uploads/2023/09/SelectHealth-HolyCross.png6301200Doug Burtonhttps://www.ark-ins.com/wp-content/uploads/2019/10/ark-logo@2x.pngDoug Burton2023-10-01 00:08:552023-10-01 23:46:59Select Health announces a major change to covered hospitals in 2024: Holy Cross Hospital-Davis will not be a part of the Select Health Value Network
In some situations, people on specialty medications could end up paying an additional $9,450 (individual) to $18,900 (family) out of pocket in 2024
If you’re a Select Health customer through a small employer or individual plan, there are important changes to Select Health’s RxCore five-tier formulary that you should be aware of. Beginning January 1, 2024, when Select Health members fill specialty medications at in-network specialty pharmacies, payments made using manufacturer copay assistance programs will no longer count towards their accumulators. This is set to affect Select Health customers in all states.
What this means is that if you use a drug manufacturer’s copay assistance card to help cover the cost of your medication, and you usually reach your out-of-pocket maximum early in the year, that will likely change. You will also likely end up paying more out of your own pocket for your medications. That’s because like several other health insurance companies that do not count manufacturer copay assistance towards your deductible and out-of-pocket maximum for prescriptions, Select Health is now following suit.
Here’s a short (not comprehensive) list of medications that may be affected:
Even if you don’t see your medication on the list above, if you use are using a copay assistance card to help cover a portion of the cost of the your medication, we recommend contacting the provider of your copay assistance program to determine how changes to the Select Health RxCore five-tier formulary (the list of a plan’s covered drugs) will affect you.
Select Health says this change is being implemented to help manage the high cost of health care. In a recent agent alert, Select Health noted:
As we manage health care costs for all our members, we sometimes have to make difficult decisions about the drugs we cover and how we cover them. These changes are guided by evidence-based assessments and receive approval from our Pharmacy & Therapeutics Committee.
”This could have a major impact on the affordability and access to certain medications” according to Rebecca Yates, CEO and Founder of Ark Insurance Solutions. “Even if your copay assistance program card has covered the majority of the expense for your specialty medicines in the past, this will likely change in 2024. Worst case scenario, it could mean paying an additional $9,450 (individual) to $18,900 (family) out of pocket in 2024.”
Since the amount of out-of-pocket expense could increase by thousands of dollars in 2024, Select Health customers should be proactive in reaching out to the drug company’s copay assistance program to determine the amount of the annual assistance maximum. During the past 4 years, all other Utah health insurance carriers have implemented a copay accumulator or copay maximizer program.
Helpful Resources:
Your drug manufacturer copay assistance program:
Contact the program (the phone number is often listed on your copay assistance card) for specifics on how this change will affect you. Specifically, you’ll need to ask what your annual assistance maximum (or cap) is.
Navigating the complex world of health insurance can be daunting. The Ark Insurance Solutions team has the skill and experience to guide you. We’ll help you compare health plans to make the best decision based on your unique circumstances and budget. Give us a call at 801-901-7800 or click here to schedule an appointment with us.
https://www.ark-ins.com/wp-content/uploads/2023/09/prescription-costs.jpg6301200Doug Burtonhttps://www.ark-ins.com/wp-content/uploads/2019/10/ark-logo@2x.pngDoug Burton2023-09-29 01:57:182023-09-29 02:25:38Select Health’s announced change to their prescription drug coverage may dramatically affect your copayments and out-of-pocket maximum starting in 2024
Not Insurance: Health Share Plans Could Leave You Unprotected
/by The Ark Insurance TeamHealth share plans and healthcare sharing ministries (HCSMs) are often marketed as “cost-effective alternatives to traditional health insurance.” However, as some Utahns are finding out, these plans have substantial limitations on coverage and lack the protections that ACA-approved health insurance plans provide.
If you’ve ever researched healthcare plans for yourself or your family, you know firsthand that searching for and comparing plans can be confusing—really confusing. There are so many different plans, pricing tiers, subsidies, and sign-up windows—the whole experience can be overwhelming. If you don’t know how to apply for subsidies made available through the Affordable Care Act (ACA), the cost of coverage can also seem impossible.
During your search for coverage, you may have encountered programs called health share plans or healthcare sharing ministries (HCSMs). These plans appeal to the human desire to be part of a community of people with similar beliefs and values. Members of HCSMs “share a common set of ethical or religious beliefs and share medical expenses among members in accordance with those beliefs.”
A report from the Colorado Division of Insurance found that more than 1.7 million Americans rely on sharing plans and that many of the plans require members to ask for charity care before submitting their bills.
-First Annual Report on Health Care Sharing Plans and Arrangements from Colorado Division of Insurance, May, 12, 2023
Choosing a health share plan over an ACA-compliant health insurance plan can have profound, negative implications on your access to healthcare. No one plans for a severe illness, injury, or medical emergency, but if you choose a health share plan instead of insurance, there’s a good chance it won’t be covered. If you have a serious illness, it’s also very possible that the cost of your care exceeds the annual limit (the cap on the amount the health share will pay in a single year). There are thousands of documented cases of Americans with health share plans who ended up with a severe illness or injury, only to find themselves up a creek without a paddle.
Let’s dive in and cover a bit more about why you should avoid these plans, and how a health insurance plan through the Health Insurance Marketplace is the better alternative.
How Do Health Share Plans Work?
Health share plans and healthcare sharing ministries operate on the premise that members of the plan pool their money to cover each other’s medical expenses. Members typically pay a monthly “share” or contribution, and those contributions are used to pay the medical costs of other members who file claims.
Don’t Be Fooled. Health Share Plans Are Not Health Insurance
Some health share options offer free co-pays or coverage for specialty appointments, but when it comes to your health (which is affected by your insurance coverage) it’s important to look farther down the pipeline. Here are some crucial differences between health share plans and health insurance.
Real-Life Consequences: A Short Case Study
In 2019, Salt Lake City’s Jennifer Wunderlich received some terrible news. Her daughter was diagnosed with a rare form of cancer and needed to start life-saving treatment immediately. Unfortunately, Jennifer’s family was enrolled in a health share plan, which she believed was the only option her family could afford, based on the perceived cost of health insurance. Jennifer contacted her health share plan, and they informed her they would only cover up to $100,000 of her daughter’s cancer treatment. Since her daughter was going to need almost 18 months of care and Jennifer would not be able to work during that time, it was looking like the Wunderlich family was also headed for financial ruin. Even worse, the health share plan would likely only cover the first few weeks of her daughter’s cancer treatment. The doctors recommended that Jennifer transfer ownership of their family’s home to one of her younger children through a trust. While it’s devastating to hear your child has cancer, learning that your “insurance” won’t cover the cost of treatment is an additional, unfathomable blow to anyone.
Luckily, Jennifer was friends with Rebecca Yates, CEO and Founder of Ark Insurance Solutions, a Salt Lake City-based health insurance brokerage. Based on Jennifer’s family income, Yates was able to sign her up for an affordable health insurance plan through the Health Insurance Marketplace. With subsidies, the health insurance plan was only $16 a month, substantially more affordable than the $450 per month Wunderlich was paying on her health share plan. The new coverage (which was actual health insurance) covered the cancer treatment, and her daughter received the life-saving healthcare she needed. Here’s what Jennifer had to say about the experience:
Prioritize Your Health With Real Insurance
The significant risks and limitations of health share plans can negatively impact your access to health care. Having good health insurance coverage is critical to getting the best care. The good news is that quality health insurance can actually be affordable when sourced through the Health Insurance Marketplace, which offers subsidies and pricing tiers based on your income.
Since health insurance brokers’ fees are paid by the insurance carriers, you can get the help of a health insurance broker or agent at no additional cost. This empowers you with a professional who can advocate for you, evaluate your coverage needs, and help you find the plan that best suits your family’s budget.
Want to learn more about what type of quality health insurance coverage you can qualify for? Ark Insurance Solutions can help. Let’s talk!
Navigating the complex world of health insurance can be daunting. The Ark Insurance Solutions team has the skill and experience to guide you. We’ll help you compare health plans to make the best decision based on your unique circumstances and budget. Give us a call at 801-901-7800 or click here to schedule an appointment with us.
Select Health announces a major change to covered hospitals in 2024: Holy Cross Hospital-Davis will not be a part of the Select Health Value Network
/by Doug BurtonAdditionally, Holy Cross Hospital-Davis will no longer participate in the Select Health Med, Select Health Care, and Select Health FEHB networks unless an agreement is reached by the end of the year.
According to Select Health, what this means for customers with affected plans is that after January 1, 2024, “Holy Cross Hospital-Davis will be considered out-of-network, and any services received at this facility may be denied or covered at a lesser benefit.”
If you’re an individual, family, or employer with Select Health, the company is encouraging you to find a new in-network facility to replace Holy Cross Hospital-Davis before January 1, 2024.
Select Health has offered the following guidance:
Select Health’s announced change to their prescription drug coverage may dramatically affect your copayments and out-of-pocket maximum starting in 2024
/by Doug BurtonIn some situations, people on specialty medications could end up paying an additional $9,450 (individual) to $18,900 (family) out of pocket in 2024
If you’re a Select Health customer through a small employer or individual plan, there are important changes to Select Health’s RxCore five-tier formulary that you should be aware of. Beginning January 1, 2024, when Select Health members fill specialty medications at in-network specialty pharmacies, payments made using manufacturer copay assistance programs will no longer count towards their accumulators. This is set to affect Select Health customers in all states.
What this means is that if you use a drug manufacturer’s copay assistance card to help cover the cost of your medication, and you usually reach your out-of-pocket maximum early in the year, that will likely change. You will also likely end up paying more out of your own pocket for your medications. That’s because like several other health insurance companies that do not count manufacturer copay assistance towards your deductible and out-of-pocket maximum for prescriptions, Select Health is now following suit.
Here’s a short (not comprehensive) list of medications that may be affected:
Breo Ellipta
Dulera
Enbrel
Eliquis
Humalog
Humira
Januvia
Lantus
Levitra
Lyrica
Premarin
Proair
Restasis
Spiriva
Symbicort
Truvada
Xarelto
List from: GoodRX
Even if you don’t see your medication on the list above, if you use are using a copay assistance card to help cover a portion of the cost of the your medication, we recommend contacting the provider of your copay assistance program to determine how changes to the Select Health RxCore five-tier formulary (the list of a plan’s covered drugs) will affect you.
Select Health says this change is being implemented to help manage the high cost of health care. In a recent agent alert, Select Health noted:
As we manage health care costs for all our members, we sometimes have to make difficult decisions about the drugs we cover and how we cover them. These changes are guided by evidence-based assessments and receive approval from our Pharmacy & Therapeutics Committee.
”This could have a major impact on the affordability and access to certain medications” according to Rebecca Yates, CEO and Founder of Ark Insurance Solutions. “Even if your copay assistance program card has covered the majority of the expense for your specialty medicines in the past, this will likely change in 2024. Worst case scenario, it could mean paying an additional $9,450 (individual) to $18,900 (family) out of pocket in 2024.”
Since the amount of out-of-pocket expense could increase by thousands of dollars in 2024, Select Health customers should be proactive in reaching out to the drug company’s copay assistance program to determine the amount of the annual assistance maximum. During the past 4 years, all other Utah health insurance carriers have implemented a copay accumulator or copay maximizer program.
Helpful Resources:
Your drug manufacturer copay assistance program:
Contact the program (the phone number is often listed on your copay assistance card) for specifics on how this change will affect you. Specifically, you’ll need to ask what your annual assistance maximum (or cap) is.
Select Health:
For additional information, please visit selecthealth.org/rxfaq. To review the 2024 RxCore five-tier drug list for each state, visit selecthealth.org/pharmacy/pharmacy-coverage-2024