Is a Medical Sharing Plan a good option for you?

Guest Author: Sean Turner

A topic that has been growing considerable traction amongst the Christian community has been Medishare. Most notably, what has been driving the conversation, has been the extreme rise in health insurance premiums. Questions you may be asking yourself are, how do I protect my budget from rising healthcare costs? And can I get reasonably priced medical coverage without breaking the bank?

The cost of insurance is just the starting point, there are several factors to assess before deciding which medical coverage route you ought to take.

Before we dive into the comparisons between traditional medical insurance and Medishare, it is important to point out the fact that Medishare is not actually insurance. Medishare is known as a faith-based member program that coordinates the sharing of medical services amongst its members. While it’s not insurance, it is still regarded as Affordable Care Act approved coverage.

In fact, the Texas Department of Insurance goes as far as to not allow Medishare to even use the same terminology that is often familiar when discussing medical insurance. Such as premium, deductible, or coinsurance.

Instead, Medishare uses phrases such as Annual household portion and Monthly share amount to describe their program.

So why compare Medishare to my insurance? Well, simply put, it could be a cost-effective alternative to the traditional insurance plans we’ve all seen become extremely costly.

Comparing the Cost

Inevitably, as my wife and I shop for something at the store, she will see something on the shelf and say “Sean, isn’t this great?”, and every time the first thing I do is glance at the price tag and say, “sure if you don’t mind paying $XXXX for it”. My wife would say that she has ‘good taste’, I would more closely describe it as ‘expensive taste’.

My point is, just as you would shop for any other item, people always want to know the price upfront, so they can place that item into perspective.

In the table below are several comparisons between a traditional medical insurance plan with Blue Cross Blue Shield and Medishare. None of their plans are identical, so we are comparing a middle of the road plan for each.

Blue Cross Blue Shield plan with $5600 deductible vs. Medishare $5,500 annual household portion.

*These Blue Cross Blue Shield prices assume there is no government subsidy being used.

**Medishare does offer a 20% discount for folks to qualify for their healthy monthly share program. Share amounts listed above are the standard rate.

If you’d like to research the cost of traditional insurance verses Medishare for you or your family, you can do so by using the individual insurance pricing tool and the Medishare pricing tool.

Network of Doctors 

It is safe to assume that if something is costs less, it is because it has fewer features, or in this case fewer doctors…but you would be wrong.

The above compared Blue Cross Blue Shield plans are all HMO plans, which means that you’d need to see an in-network doctor and if you went outside of their network, you would essentially have no coverage. Whereas, if you decided on Medishare, they utilize the largest PPO network in the nation, PHCS.

A PPO is also known as a Preferred Provider Organization, which means that the insurance company, or in this case the member-sharing organization, prefers that you use the providers in-network, but you will still have coverage if you go outside that preferred network of healthcare professionals.

Qualifications for Membership

Not everyone can join. There are specific requirements an applicant must meet to join Medishare. They’re fairly strict qualifications, so make sure you understand them before you sign up.

Several qualifications for membership in Medishare are:

•    Must not have used tobacco products in the past 12 months. 

•    Not actively using illegal drugs.

•    Commit to not having sexual relations outside of marriage.

•    Must be actively engaged in a church.

In addition to meeting the above requirements, upon applying for coverage you will have to sign a commitment to follow the above-mentioned points (and Medishare reserves a right to interview leaders of your church to verify involvement).

Pre-Existing Conditions

A major part of the Affordable Care Act’s impact on medical insurance was that pre-existing conditions were eliminated from plans. Essentially, if a woman is nine months pregnant and enrolls in a qualified health insurance plan, she could have the baby and drop coverage the following week. With Medishare, pre-existing conditions are covered for limited amounts depending on if there have been recent signs, symptoms, or treatment.

Conclusion

Is Medishare a good fit for everyone? No, of course not. However, if you're paying expensive insurance premiums and are looking for ways to cinch down your monthly expenses, Medishare could be right for you. Traditional insurance has strict enrollment guidelines for annual and special election periods, while Medishare has no election periods, so you can join anytime. 

Before committing one way or another, it is always beneficial to seek advice from a licensed health insurance agent before making the switch.

Sean Turner is a licensed health and life insurance agent for Buffer Benefits. Upon graduating from University of Texas at Arlington, he assumed the role of Chief Operating Officer at a Texas healthcare provider. It was during this time that he began developing a fund of knowledge about health insurance. Currently, he serves as an instructor for newly licensed agents at Buffer. He is an expert in areas such as employer benefits, individual medical, Medicare and life insurance. He has a passion for learning and sharing biblical principles in the areas of stewardship and business.

You can find more about Sean and his services at Buffer Benefits.