Drawbacks to Health Share Plans & HCSM’s
Problems with Health Care Sharing Ministries
Despite the great pricing and benefits, Health Share Plans are not for everyone. People with pre-existing conditions and subsidy eligible individuals may benefit more by going with a traditional health insurance plan through the state exchange. There are certain drawbacks to Faith Based and Christian Health Share Plans:
- No Government Subsidies
- Exclusions/Wait Times for Pre-Existing Conditions
- $1 Million Life-Time Limit
- No Coverage for Mental Health, Addiction or Eating Disorders
- No Coverage for Autism or ADHD
- Require agreement to a statement of beliefs
No Government Subsidies
A pillar of Obamacare — and one its most attractive features — is the availability of financial assistance from the federal government that can result in significantly lower premiums for enrollees. The amount of the subsidy you can receive depends on your income level. There are no government discounts on Health Share Plans. If you qualify for a substantial Obamacare subsidy, it may be in your best interest to enroll in a standard health insurance plan through Covered California. You’ll need to perform a cost comparison to see which is the better option for you and your family.
Coverage Limitations/Exclusions for Pre-existing Conditions
Another valuable benefit offered under the Affordable Care Act is that your medical history is not a factor in determining your eligibility for a plan. An insurer cannot deny you coverage or limit your benefits even if you or a member of your family have a chronic medical condition such as cancer, diabetes or obesity. You can also renew your coverage without concerns about the insurance company dropping you, even if you develop a serious health condition after enrolling in an Obamacare plan.
If you have a pre-existing condition which requires expensive prescription drugs or will require hospitalization or surgery, most likely your best option would be a traditional health insurance plan. On Health Share Plans, coverage for pre-existing conditions often requires up to a 24 month waiting period or is excluded altogether. A Health Share Plan provider must take this step to minimize claim payments and keep coverage affordable for all of its members.
Health Share Plans typically limit the maximum amount they will pay out in medical benefits over a member’s lifetime to $1 million. For most people, the $1 million limit is not a significant deterrent. Most members will not approach the maximum unless they experience a catastrophic injury or develop a chronic illness that requires expensive treatment over several months or years.
However, in the rare case that you did hit that limit, you could just switch over to a regular health insurance plan at the end of the year during open enrollment so you would no longer have to worry about the $1 million limit. Remember — an Obamacare plan provider must accept you regardless of your health history. You’ll also be starting over with a new lifetime limit amount.
Conditions for Smokers
If you smoke or chew tobacco, a Health Share Plan might not work for you. Most of these plans either exclude tobacco users or charge them much higher rates. For example, with Aliera Health Care, smokers have to pay an additional fee of $60 per month. And, they have to quit smoking within one year to stay on the plan. While the Affordable Care Act does permit insurance companies to charge higher premiums to smokers, it does not allow them to deny coverage, even if they suffer from a smoking-related medical condition.
Adherence to Beliefs
There is a statement of beliefs that you have to agree to if you want to join a Health Share Plan. Depending on the organization, you might have to follow a particular religious faith or adhere to a strict moral or ethical code. These plans also typically require their members to commit to a healthy lifestyle to reduce their likelihood of getting sick. By doing so, they hope to keep medical costs under control by minimizing claim payouts.
Each plan has different requirements. With Aliera, for example, almost anyone could agree to their statement of beliefs. It is open to all religious views and sexual orientations. However, with other Health Care Share Ministries (HCSMs) like Medi-Share, Altrua, Christian Healthcare Ministries, Liberty HealthShare and Samaritan Ministries, they require strict adherence to a Christian ethical code along with a commitment to church attendance, limited drinking, heterosexuality, and sexual relations only within the context of marriage.
No Coverage for Mental Health or Substance Abuse Counseling/Treatment
Many traditional health insurance plans now provide coverage for mental health and substance abuse services. These coverages are mandatory for any Obamacare policy offered on the exchange. Thus, if you’ve had an issue with drugs or alcohol or have a family member with a chronic mental health disorder such as depression, anxiety, autism or schizophrenia, you can get the coverage you need under the Affordable Care Act.
However, the same cannot be said for Health Share Plans. Be aware that these plans do not include coverage for mental health or counseling services. They do not include addiction recovery or assistance with eating disorders. Also, there is no coverage for Autism or Attention Deficit Hyperactive Disorder (ADHD).
Learn More About All That Health Share Plans Have to Offer
While it’s true that Health Share Plans aren’t for everyone, they can provide an excellent alternative to Obamacare for many Americans. If these drawbacks are not a deterrent for you, you may be able to get great coverage at very affordable prices through a Health Share Plan like Aliera Health Care. Click here to find out why Health Share Plans are so attractive to some people.