With its lower rates, concierge care and fair medical pricing, healthsharing is a great alternative to traditional insurance, especially if you are self employed. Although memberships to healthshares are on the rise, not all healthshares are created equal and there are a few things to consider when doing your research.
Just like conventional health insurance, reading the guidelines and the fine print are essential to understanding your plan. Knowing what your plan includes and doesn’t include prior to a medical need arising will ease some of the stress when going through a health incident. Surprise health bills are not something to look forward to receiving in the mail. Healthshares work a little differently than regular health insurance and it is important to understand what to look out for before you enter into an agreement.
Instead of deductibles and premiums, healthshares have a “membership” or “contribution” amount that you pay monthly. Then when a medical need arises, let’s say a broken ankle, the member has a specific patient responsibility amount, sometimes called an IUA, Initial Unshareable Amount or an MRA, Member Responsibility Amount. This is the part of the bill that you owe, similar to a deductible. In many cases they range from $500-$5000 and that amount can be up to 3-5 times in a calendar year depending on if you are single or have a family.
No one plans for unexpected medical emergencies, but they do happen and can turn your life upside down. First, check the annual and lifetime limits, is there a cap, if so you may not want to pursue this type of plan. Next, if presented with options to choose your IUA or MRA and $5,000 is one of the selections, consider that broken ankle, you would owe $5,000 for this medical need. If in 3 months you need an emergency appendectomy that could mean another $5,000. Whereas if you had a $1000 IUA/MRA you would owe this amount for the broken ankle and another $1000 for the appendectomy surgery, typically capped at 3x per year. Which means the most out of pocket for major medical would be $3,000 compared to $15,000. Each healthshare functions differently and it is important to understand the amount you are responsible for if a medical need occurs.
Now that you chose your patient responsibility amount, let’s take a look at networks. We know how important it is to be able to see the provider of your choosing. A majority of healthshares use a network called PHCS, this is a very large network and you can even nominate your provider to be part of it.
There are healthshares that do have an open network to visit any provider, specialist or hospital. And in some plans the annual wellness or preventive care is the only stipulation where your provider must be in the network for the visit, labs etc. to be $0. For other health needs you may see providers outside the network. Again this is something that should be clear when enrolling.
There are healthshares that require you to pay the medical bill and then you wait for a reimbursement. This can be very frustrating and stressful if you are waiting for a $10,000 check to arrive. There are healthshares that allow for you to pay a specific amount that you know ahead of time like an IUA or MRA and the healthshare will negotiate the remainder of the bill on your behalf. There are times when you may pay for a physician’s visit, labs or imaging, but they may be eligible for reimbursement. Check with the healthshare on the timelines and eligibility for these types of services to be reimbursed.
Healthsharing has many benefits and with the attractive lower out of pockets costs it can be a perfect solution for managing your health needs. They do function differently than regular health insurance and we suggest before enrolling, have a checklist of what is important to you and if the healthshare you are researching can check all the boxes. There are many options available and these are three areas to consider when switching from conventional insurance to a healthshare.