Just because it doesn’t have the word insurance doesn’t mean it’s not health care.

Even though healthshares aren’t mainstream yet, they have seen rapid growth due to the rising cost of healthcare. Over the past several decades, the cost of healthcare has drastically increased. For many families and the self-employed who do not obtain insurance through their employer, they go without healthcare or pay 3x the rates. Monthly premiums and deductibles have made obtaining affordable quality healthcare difficult.

When you are enrolling in a health plan, there can be a sticker shock; not everyone qualifies for subsidies and in some cases, the subsidies are tied to your earnings & keep you at the same income level for the year. If you earn more, you may need to pay back the length of time you qualified for the subsidy amount. That could be thousands of dollars!

Medical cost-sharing, or healthsharing, membership has increased among the self-employed and families seeking to lower their healthcare costs. But not all healthshares are created equal, and there have been some bad apples that have tainted this alternative to traditional insurance. If you aren’t familiar with this healthcare concept continue reading to learn more about healthshares and how to tell if one is legit.

What are healthshares and how do they work?

Instead of paying a premium and deductible with additional out-of-pocket costs throughout the year, a healthshare is made up of members who pay a monthly contribution to the community. The community shares the costs of a medical need after the member pays their “responsibility,” or set amount.

Health insurance and healthshares share the same basic principle: to make the cost of healthcare predictable – mainly when unexpected health problems arise. But, there’s a big difference too.

The most significant difference between health insurance and healthshares is that healthshares aren’t governed by the Affordable Care Act (ACA). 

Because of that, the terms a healthshare uses have to change so that healthshare companies aren’t presenting their product in a way that looks like insurance.

So, a “premium” becomes a “contribution” or “membership.”

A “deductible” becomes a “member responsibility” or “unshareable amount.”

A “covered” medical expense becomes a “shared expense” with the community.

And a “claim” becomes a “need.”

Where the difference really matters is in what “needs” can be “shared” with the community vs. what is “covered” by an insurance company. The ACA mandates health insurance companies to cover all kinds of things that not everyone needs. That means that you often wind up paying for things you never use. Healthshares are different. Because they aren’t insurance and aren’t regulated by the ACA, they are free to tailor their plans to meet members’ needs.

You are more than an ID card with a healthshare. You are a person needing care; not a number based on claim codes and networks. 

Instead of calling your provider or rushing to urgent care for a sprained ankle, you would use the healthshare app or a care team number. The team will help navigate the best course of care at the right cost. For example, the care team might provide an order form for you to go directly to an imaging center and get an x-ray of your ankle. Next, a provider would follow up with you to explain the injury and what the next step would be. You always have access 24/7 to speak with a medical team member, as well. Of course, if you are in extreme pain or have a life-threatening emergency, go directly to the ER or call 911.

Depending on the healthshare, this entire process might be included in the plan, so the cost to you is $0.

You will always know the fair medical price for any imaging, procedure, lab work, etc. This is transparency at its best. If it turns out your sprained ankle from the example above really is a fractured bone and requires surgery, then you would be responsible for a set specific amount; typically $1,000 or $2,500. This is the portion you would owe for the surgery. The remainder will be negotiated by the healthshare and paid from the community pool.

A brief history of healthshares

Healthshares were originally created by members that shared a religious or cultural background in order to pool resources for medical care. Sharing healthcare costs is thought to have begun with Amish & Mennonite communities in the early 1900s, where communities would often come together to lessen burdens on one another. As of 2014, over one million people are members of healthshares.

As they evolved over time, healthshares began to include more services than just covering medical costs, such as preventative care, concierge services, telehealth, and expanding outside of religious and cultural restrictions. Since healthshares are exempt from the Affordable Care Act, open enrollment is available year-round and many new members can enroll outside of the traditional open enrollment dates of December and January.

Healthshare ministries vs. healthshares

A healthshare without a religious affiliation does not require anyone to be of a certain faith or background, nor do they reject medical care due to what could be perceived as a violation of faith. 

There is a marked difference between healthshare ministries and healthshares without a religious affiliation. A healthshare ministry can reject a member’s application based on religious beliefs, lifestyle, or place of worship. They may also require a statement of faith to be signed before approving an application, or a letter of recommendation from a leader in the congregation. Treatments that are seen as a violation of faith, such as contraception or treatment for an addiction, may not be covered, as well. In addition, beliefs regarding marriage and cohabitation can affect who is accepted or covered in the healthshare plan.

For those that are not comfortable with having God part of the healthcare document, this type of healthshare is probably not a good fit for you. But there is good news! There are numerous healthshares to choose from, and not all of them have a statement of faith, but a statement of living a healthy lifestyle, refraining from illegal activities, and minimizing health risks.

Not all healthshares are the same

All healthshares function differently and have various requirements to become a member. Some check medical history for the last 12-24 months for pre-existing conditions and for the first year that condition may not be shareable. Each healthshare has its own definition of what pre-existing is. You may be surprised to find that a cancer-free patient of 5 years, not on medication or under a provider’s care, can become a member and not be labeled as having a pre-existing condition. Or a person with Type II Diabetes that’s been medically managed for several years may also join.

Healthshares are in place for the expenses you know are coming, but will also provide peace of mind for those unexpected moments that happen to us all. Each healthshare operates with its own processes and partnerships and may provide different benefits of care. The goal is the same: they leverage a concierge or care team to help guide you, ensuring you receive the best care at the right cost.

Red flags to look out for

Since healthshares have very little government interference and aren’t ruled by the ACA, it’s important to be alert.

Because healthshares are not regulated by the government, it is crucial you do research on the healthshare and have a deep understanding of the plans they offer. Check their standing with the Better Business Bureau, read reviews, use on-site chats, read the fine print, and inquire about “what if” scenarios like:

• Are you comfortable with a high out-of-pocket cost for a surgery, but a low monthly fee?
• Are you comfortable with paying a large hospital bill and waiting to receive a reimbursed check in the mail?
• Do you see limitations in what the healthshare will share ( another word for cover)?
• Are there lifetime or annual caps?
• Are the guidelines clear?

You can click here to see a presentation created by indipop founder & CEO Melissa Blatt regarding red flags and healthshares. 

Healthsharing has gained in popularity amongst the self-employed and families seeking to lower their healthcare costs. A typical saving for health-conscious individuals is around 40%. For families, it can be as high as 70%. Healthshares can be utilized by anyone, but are very popular with entrepreneurs, contractors, freelancers, and the self-employed to receive cost-effective medical coverage. Healthshares have been around for decades and millions of people have opted to choose a healthshare over a traditional medical insurance company.

If you are in the market for new healthcare or want to see if healthsharing could be right for you, do some comparison, explore your monthly and annual out-of-pocket costs, review the fine print, and research what is included and what the maximum healthcare spend would be for the year. Then, pull up a few healthshares to do a side-by-side comparison. Many of the red flags the FTC offers for health insurance also apply to healthshares, even though they’re not technically insurance.

Healthshares are required to alert people that they’re not traditional health insurance & that they shouldn’t replace an affordable insurance plan. The problem is, so many people can’t afford an “affordable insurance” plan, and many plans do not include a large network of providers or have high deductibles. Sadly, there are many problematic healthshares out there that have taken advantage of people, as a result, several healthshares have gotten a questionable reputation. The good news is that not all healthshares are alike and there are a few that stand out among the crowd. Click below to learn more.