Healthcare Ministries vs. Marketplace Insurance

If you’re looking into health insurance options, you need to understand the difference between a health sharing ministry and actual health insurance.Call us at iHealthBrokers today at 888-410-0344. Our services are 100% Free!

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Healthcare ministries are NOT health insurance. As a result, you may not have any type of legal recourse should you experience difficulties with your plan.

Insurance requires you to pay a monthly premium in return for set copays or coinsurance as dictated by the terms of the plan. You may have to meet an out of pocket deductible but after that your plan should detail the costs of services. These costs, of course, depend upon your plan and carrier and whether your doctor or hospital is in or out of network. All plans must have an out of pocket maximum which should protect you in case you incur large medical bills.

Healthcare ministries are NOT insurance. Basically, you and a group of people contribute a small amount of money on a monthly basis. This money is pooled together and held for when a member is in need. Depending on the terms of your “plan” you may be able to be reimbursed for a portion of certain medical expenses after you have paid.

The first drawback of healthcare ministries is eligibility. Under the ACA, you cannot be denied or charged more for any preexisting conditions. This is not the case with healthcare ministries. For example someone with diabetes could be charged more on a monthly basis. A child with cancer could be denied outright.
Additionally, eligibility can be affected by your personal religious beliefs. If you don’t share or practice the same religion as dictated by your healthcare ministry, you may be denied.

Under the ACA, there are certain essential benefits which must be covered by an insurance plan. This is not the case with healthcare ministries. For example, very often treatment for substance addiction will not be covered because it violates the plan’s “morality clause”. Unfortunately it can go even further than that.

A ministry can refuse to reimburse you because they feel that the medical needs violate their morality clause. In all honesty, perhaps you agree with these terms. However, because these terms are not clearly defined in any type of contract, you may find yourself denied for reimbursement. Ambiguity in finances and healthcare is far from ideal.

Another major issue is how payments are issued. Basically first, you negotiate a cash payment with the doctor or hospital. Then you submit your receipts or bills to your plan and await reimbursement. This can be problematic.

1. Your reimbursement could be denied based on what we’ve discussed already
2. If you pay upfront, that could be a financial hardship.
3. If you wait, your bill may end up going to collections while you wait for your plan to reimburse you which can be extremely unpleasant.

Finally, there is much less regulation than insurance. ACA plans have the 80/20 rule. So at least 80% of your monthly premiums must go towards paying healthcare costs. No such rules exist with healthcare ministries so most of your money could be going towards marketing or administration which could explain the difficulty in getting reimbursed.

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[hartfischer]

If you are not Protestant Christian ( enough like me), or you are of a different faith or agnostic, look into Crowd Health. I am extremely happy with Crowd Health, cutting my monthly contributions to half or less, when compared to traditional Obama Care Bronze plans. Instead of the $8500 Bronze deductible per year, I only pay $500 deductible per incident ( health event, no matter how long it takes ). I can pick any doctor as long as I coordinate with the plan advisors. So much better.

[micheles.]

So helpful and very nice people at this company. Thank you!

[erinaustin]

Good info and video. We all need to be aware of the issues. Can you talk about how you are compensated and your fiduciary obligations to the insured? Do commissions provide incentives that might be in conflict with the interests of the insured? Do you have access to all plans, in particular the ACA plans?

[hartfischer]

The 80-20 rule means, that Obama Care insurance companies are incentivized to massively increase medical costs so that the 20% profit margin increases along with it. Health Ministries and Crowd Health have the opposite incentive. Great video, thanks for highlighting many important aspects that one has to be aware of before joining Health Ministries / Crowd Health. For me, it is a clear choice.