HELTHCARE SHARING / MEDICAL COST SHARING PLAN

Medical Cost Sharing Plans are provided by organizations whose members “share” medical costs.

Plan Participants are responsible for paying a share amount each month (like a premium) as well as an “annual un-shared amount” (like a deductible) that must be met before the plan shares in paying your expenses. If the Plan is employer sponsored, the employer can contribute whatever they wish to the monthly share amount.

The un-shared (like a maximum annual out of pocket expense or deductible) yearly amount runs from $500 to $5000 for individuals and families.  Monthly costs range anywhere from $150-$900 depending on the plan and factors such as age of participant, number of dependents and coverage scope.

Health care sharing can be ideal for people who:

  • Are under 65
  • Are generally in good health
  • Do not have pre-existing conditions
  • Only carry catastrophic insurance coverage
  • Can’t afford current health insurance premiums
  • Prefer to go to one participating primary care provider
  • Only anticipate a limited scope of healthcare needs in a year

Healthcare Sharing Plan vs. Health Insurance

There are pros and cons of health care sharing over insurance include:

Lower cost. Monthly costs of health sharing are usually much lower than insurance premiums, although the rules are different for what procedures and conditions are covered.

Subscriber choice of provider. There are no network requirements. Participant provide their health sharing card as coverage but typically a Primary Care Provider is associated with the health care sharing plan.

Pre-existing conditions not covered.  Cancer, diabetes, asthma, heart disease, kidney problems are usually not covered. 

A Healthcare Sharing Plan cannot be used in conjunction with an HSA or HRA.  It cannot be used as an Health Savings Accounts (HSAs) or reimburse healthcare plans, such as the qualified small employer HRA (QSEHRA).

Little Industry Regulation. Many states do not consider Healthcare Sharing Plans  insurance, so consumers have little or no legal protection if a claim is not paid, coverage is denied, or the plan goes bankrupt.

There are only two Health Care Sharing Plans we know of currently –  that do not have a religious affiliation or requirement to become a member.

If you are interested to learn more about Healthcare Sharing Plans
as an alternative to offering traditional Health Insurance, contact us.