Health Share: An Affordable Alternative to the Insurance Industry

by Timothy Hirsch on Tuesday, April 24, 2018

Today's article comes from Timothy Hirsch, a benefits advisor at Planstin.
Anyone who has ever been to a networking event knows at least five people who sell some kind of insurance. The reason Tim is my go-to guy when I have a question or need to refer someone is that he is a regular guy. He's like the neighbor down the street. He plays catch with the kids, cleans the gutters, and is always happy to answer questions.  And when it comes to getting help with a confusing topic like insurance, you can't get any better than Tim Hirsch.

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Is the high cost of healthcare coverage forcing you into a high-deductible plan you can't afford to use? 

All too often I find articles that boast about solutions to the rising costs of healthcare yet offer little or no help. Sometimes these articles will offer some remedial resolutions, such as purchasing a cheaper plan with a larger deductible. To me, that is more of a common-sense approach versus professional advice or an actual fix, especially if there is a $7,000 out-of-pocket deductible.

This approach only saves money if coverage is not needed in the first place. This is not practical nor is it a solution. This article is not to discuss the well-known problem many face, but instead to explore an actual healthcare solution unknowingly available to many people across the country.

My disclaimer before we get deeper into this topic is that this approach we are going to talk about is not for everyone. It is not for those who are eligible for significant financial assistance (subsidy) or for those who are unhealthy. Fortunately for these people, there is ObamaCare (ObamaCare = Affordable Care Act) and the plans available through Healthcare.gov or the state exchanges. While there is so much criticism surrounding ObamaCare, it is extremely important for these segments of the population. People who have lower incomes can get affordable health insurance coverage. People who do not get employer-sponsored coverage through a job and have health issues can get coverage for their pre-existing conditions. The fact of the matter is that most people that qualify for financial assistance now know this and have enrolled in their coverage.

Who Can Benefit?

My goal in this article is to help the self-employed, individuals, and families who are not eligible for financial assistance, and who consider themselves healthy, or not in need of specific coverage for pre-existing conditions. Often, they will describe the coverage for which they are searching by saying, “I am healthy, and I need something just in case”. Or they will use the term “catastrophic” to describe the coverage that they want. These people are a forgotten part of the population who the Affordable Care Act does not help, but rather as many argue, hurts in many ways. The good news is that there are more affordable healthcare solutions available for these struggling people and they are widely available.

In fact, the plans available are not only lower in cost monthly, they also offer larger networks of doctors and lower out-of-pocket costs when members actually utilize the plans. I am curious how so many politicians talk about how we need plans that can work across state lines when they already exist! I am not writing to argue politics, or about why this is not more widely talked about, but it does make me curious.

What is a Health Share?

The solution that many are seeking is a HealthShare. A HealthShare is known by several different names such as Christian Ministry, Medical Cost Sharing, Christian Healthcare Plans and any combination of these terms. Simply put, they are a community-based way in which members share the cost of each other's medical bills. Does this sound a lot like insurance without profits going to an insurance company? Members of a HealthShare can benefit from any savings or unused money that has not been paid for medical needs to lower future costs. This is a big reason why HealthShare plans rarely take rate increases for coverage and why the coverage is so much more affordable in the first place.

Let’s keep in mind one other very important factor, that a HealthShare is NOT insurance coverage nor is it offered by insurance companies. This solution is an alternative to health insurance and in many instances, coverage is offered through non-profit organizations similar an association. All too often we hear about a lack of trust in insurance companies and, even further, a strong dislike of insurance companies and yet it is shocking that people are still deterred by the fact that these plans are not federally regulated by state insurance departments or offered by insurance companies. It is refreshing that this approach is more about like-minded people pooling their money together to share in each other’s health-related expenses. What more can anyone ask for regarding affordable health coverage?

What many will find with any HealthShare, regardless of the company, is that the logistics of paying claims or paying members’ monthly payments can be different. It is not necessarily harder or less convenient, just different and will take some getting used to, just like anything that is new. All HealthShares use different terminology than what is used for insurance plans. Familiar terms that we know and love such as, “deductible”, “coinsurance”, or “monthly premium” are not used. Instead verbiage such as, “member responsibility” or “contribution amount” will be used in its place. This can vary by HealthShare but is easily found in each company’s “Member Guidelines”.

There are a few reasons why coverage through a HealthShare is more affordable (other than the exclusions of pre-existing conditions). One is that as self-pay patients, members do not pay the inflated prices that doctors and hospitals typically bill to insurance companies. The HealthShare will often negotiate lower rates for larger hospital bills on a member’s behalf. After all, how often is it that we see the costs of a procedure, or what a hospital charges with our traditional health insurance plans?

Now, there are several different ways to go about choosing a plan and many companies from which to choose when it comes to HealthShare options. Let’s keep in mind the most important features of any HealthShare, and those are: lower monthly cost, no (or limited) pre-existing conditions coverage, lower out-of-pocket costs, no financial assistance or proof of income required, large PPO networks (often times the ability to see ANY doctor), availability in 50 states with no state lines, no government open enrollment deadlines (convenience of signing up anytime during the year) and compliance with the government mandate while still in effect for 2018.

Small Business Group HealthShare

One type of HealthShare is specifically for business owners. To be eligible, one must be self-employed or own a business. This takes a layered approach of blending three plans together to create a comprehensive health plan designed for the self-employed. This plan is the same rate for business owners aged 30-64 (a little less for younger members). Members can see any doctor anywhere in the country; it provides cash reimbursements for accidents directly to the member, and $1,000 is the “member responsibility amount” per incident on the plan. The member is only responsible for the first $1,000 in claims and the rest is paid in full by the HealthShare. Members will pay a flat, affordable co-pay for most services with no deductible. These services include doctor visits, specialists, lab work, urgent care, prescriptions, x-rays, MRIs and CT scans. Some may assume the cost of such a plan would be outrageous, but $343 for an individual, $563 for a couple and $894 for a family, regardless of family size, is reasonable compared to many health insurance options families see today. This can be a savings of roughly 40-60% lower than traditional health coverage, and an even less out-of-pocket cost depending on how much the plan is utilized. Sound too good to be true? Well, it’s not, and while there are some differences between traditional insurance coverage, this should sound compelling to most. Visit www.Planstin.com to learn more about coverage.

Individual Health Share Options

There is another HealthShare option for business owners and individuals looking for an alternative to health insurance. There are currently five of these HealthShare options available across the country. Members are going to find that with any of these HealthShare options there will be considerably lower costs for the plans on a monthly basis. For the most part, they will also have lower out-of-pocket exposure when members use the plan often limiting member exposure to $500 or $1000 per claim. This is a fraction of what especially traditional health insurance claims would total. It is not always the case because some plans have extremely low monthly cost, where members are responsible for the first $5,000-$10,000 of a claim before the HealthShare’s coverage will apply. Each HealthShare can design its own plans and coverage based on what the HealthShare and its members feel is best. There are several HealthShares that were grandfathered in through the Affordable Care Act which can offer these plans and members are still considered compliant with the government mandate for having credible coverage (no tax penalties for members). In 2019 individual mandates seem to be disappearing and it is likely that more HealthShare companies and plans will become available.

Choosing the Right HealthShare

A HealthShare will come in many shapes and sizes and there are factors to consider when it comes to choosing the “right one”. One misnomer is that these HealthShare plans are only available to Christians. That is true for some of these companies, but not all of them. Each HealthShare will have either a “statement of faith” or a “statement of standards” and this should be read thoroughly by prospective members. These “statements” will often contain the necessary information to dictate which HealthShare is right for the member. It is important to read through the “Member Guidelines” to find out about any limitations or exclusions that may affect the coverage. Each HealthShare has developed their own “Member Guidelines” and it’s a great insight into how the coverage will work. It is also a great way to learn the terminology of HealthShares and how they differ from traditional insurance coverage.

Altrua Health Share

Altrua is a great HealthShare example to use because of its popularity. I find it is as close to health insurance that people are used to. It pays claims and works much like traditional health coverage. Altrua members do not have to pay claims directly and yet they have large national PPO network of providers that they can access. Their “Silver Advantage” plan offers six doctor or urgent care visits annually to each member with a $35 copay per visit. When faced with hospitalization or surgery, members pay the first $3,500 and Altrua shares in 100% of the cost thereafter, up to one million dollars. Members under the age of 40 will pay $202 monthly for a single person, and a full family with up to three children will pay $420 monthly. This is significantly less cost on a monthly basis and about half the exposure from a catastrophic event as it compares to most traditional health insurance plans. Now even with Altrua, there will be some exclusions or limitations and a supplemental plan in conjunction with Altrua is recommended. The combined monthly cost is still about a 30-60% savings for members versus traditional health insurance options.

How many people across the country have no idea that these alternatives exist? It is common to hear about what few options are available for health coverage. With millions of members enrolled in this coverage, it’s amazing how they are still a secret to many. My belief is that as people learn more about HealthShare options it will bring hope and perspective to those who have lost faith in the health insurance industry. The world of getting health insurance is changing and is evolving it’s about time people knew about it.

You can find more information about Health  Share plans at planstin.com.  To contact Tim Hirsch you can find him on Facebook, or give him a call 603-560-3851

NOTE: I have no affiliation with Tim Hirsch or Planstin and do not make any money for promoting their products and services. The goal of Queen City Buzz is to promote and support local businesses and that includes sharing information about business resources, promotions, and events of interest to local small business owners. If you have an event, product or service you'd like to share drop me a line. I can be reached at buzz@queencity.buzz