Crowd-funding health care: Cost and conscience drive health care sharing ministries

More than nine years after the enactment of the Affordable Care Act (ACA), state and federal legislators are still kicking around the political football more commonly known as Obamacare. 

Meanwhile, regular folks remain on the sidelines trying to figure out how — or even if — they can afford health insurance.

For some Christians traditional insurance isn’t the answer. Even if they can afford the premiums and deductibles, they may object to their health insurance carrier covering services such as birth control, elective abortions or transgender operations. 

Whether for reasons of finance or conscience — or both — some people are turning to Christian health care sharing ministries (HCSMs), organizations in which people with shared religious or ethical beliefs help pay each other’s medical costs. 

Similiar beliefs

Think of it as a sort of crowd-funding for health care. But to join one of those crowds you’ll need to share similar beliefs, avoid unhealthy and immoral behavior, and for the most part possess no pre-existing conditions. For instance Samaritan Ministries, one of the top three HCSMs, requires participants to, among other things:

  • Be a professing Christian and sign a statement of faith
  • Attend a Christian church at least three out of four weeks per month as health or weather permits
  • Not abuse any legal or prescribed substance, abstain totally from illegal drugs and recreational use of marijuana, and abstain from tobacco use — alcohol is allowed but only moderately
  • Abstain from any sexual activity outside of traditional biblical marriage as designed by God between one man and one woman
  • Agree not to sue Samaritan or each other.

Samaritan applicants must have a pastor, elder or accountability partner sign a statement attesting they meet the requirements. Participants must submit statements each year reaffirming they continue to live accordingly.

HCSMs can save some people a significant amount of money. A monthly “share” in an HCSM typically costs hundreds less and the annual deductible thousands less than a comparable ACA-compliant insurance plan. But it’s important to learn exactly what is and isn’t covered before signing up for one. 

HCSMs usually don’t pay for chronic or pre-existing conditions like diabetes or high blood pressure, as required by the ACA. That makes HCSMs a lot less attractive to older adults, who typically suffer more of these conditions as they age. Moreover, Medicare-eligible people can usually buy additional insurance coverage — which helps pay the 20 percent of costs Medicare doesn’t cover.  

HCSMs usually don’t pay for preventive health care, dental or eye care either.

Nearly a million Americans now belong to HCSMs in 29 states including Alabama. But the concept is far from mainstream. 

The national Alliance for Health Care Sharing Ministries notes the great majority — 97 out of 104 certified HCSMs — are operated by Mennonite/OGB (Old German Baptist) churches and associations with closed membership.

In 2016 the Alabama Legislature codified an HCSM as a faith-based, tax-exempt nonprofit organization that, among other things:

  • Limits its participants to those who are of a similar faith
  • Provides for the financial or medical needs of a participant through contributions from one participant to another
  • Assumes no risk or promise to pay
  • Provides a written monthly statement listing the total dollar amount of qualified needs submitted to the HCSM, as well as the participant contributions
  • Provides a written statement that it is not an insurance company and that each participant is “personally responsible for the payment of your own medical bills,” even if the HCSM folds.

HCSMs range from small groups organized in individual churches to large national organizations. A December 2017 article in “Consumer Reports” reported that the three largest HCSMs — Samaritan Ministries, Medi-Share and Christian Healthcare Ministries — account for 85 percent of all people involved in health care cost sharing.

“Each ministry operates slightly differently, but in general members contribute a set amount — their ‘share’ — every month. If you have a medical issue you get it treated and afterward submit your bills to the ministry. 

The ministry reimburses you or will pay the health care provider directly. But there’s no guarantee that any or all of your costs will be covered,” according to Consumer Reports.

Some HCSMs direct members to send a check directly to the individual needing to pay for medical services, while other HCSMs negotiate costs for services with the providers and pay them directly, earning substantial discounts for prompt payment.

Good track record

While most HCSMs maintain a good track record for making payments, it’s important to underscore the fact that since they are not insurance companies they are unregulated and not backed up financially by a state guaranty association. If the health care ministry runs into financial problems the participant is still responsible for paying his or her own medical bills.

Participating in a health care sharing ministry is always a matter of faith.