Q: My husband is considering buying a health insurance plan called Solidarity HealthShare as a supplement to our Medicare coverage. What does Consumer Reports know about this type of plan?—L. Ferguson
A: Solidarity HealthShare is a Christian healthcare sharing ministry (HCSM), one of more than 100 religiously affiliated nonprofit organizations where members, who must follow the practices of their faith community, pool their money to pay each other’s medical costs. They’ve been around for decades.
The important thing to know is that HCSMs are not health insurance and don’t come with the same protections or comprehensive coverage as insurance offered on the individual market, employer-based insurance, or Medicare Advantage plans, which typically cover a broader array of services than traditional Medicare.
Unlike health insurance that must meet standards set by the Affordable Care Act, a ministry plan could reject you or limit coverage for having a pre-existing health issue. There can also be lifetime limits on how much you’ll be reimbursed for your medical costs. Preventive care typically isn’t covered.
And unlike the kind of coverage you can get with Medicare Advantage plans, which cost an average of $30 a month, HCSM programs typically exclude a long list of medical services, including prescription drugs for chronic conditions, most dental care, and vision care—the kind of coverage older people might consider important.
Healthcare sharing ministries can be attractive because they generally cost less than traditional health insurance. But these HCSMs are not a good way to supplement your Medicare coverage because of their coverage limits, says Bonnie Burns, a policy specialist at California Health Advocates, a nonprofit focused on Medicare advocacy and education.
“People are much more likely to have health issues as they get older, and it’s often very expensive. They’re at risk for high out-of-pocket costs,” says Burns. “It’s critical to understand how they work.”
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 healthcare provider directly. But there’s no guarantee that any or all of your costs will be covered.
In its materials, Solidarity, like other HCSMs, makes it clear that it is not an insurance company and makes no promise that your medical bills will be paid or that you will be reimbursed for their cost.
Membership in HCSMs has surged in the last few years, and today almost 1 million people have chosen them over traditional health insurance, according to the Alliance of Health Care Sharing Ministries.
Membership in the three largest HCSMs—Samaritan Ministries, Medi-Share, and Christian Healthcare Ministries, which together account for 85 percent of all people participating in healthcare sharing ministries—has more than doubled to 872,000 this year, up from 350,000 in 2014 and 175,000 in 2012.
One reason for the rapid growth is that the ACA, passed into law in 2010, requires insurers to provide a comprehensive set of benefits, including coverage such as contraception, which some Christians object to, says David Weldon, M.D., president of the Alliance of Health Care Sharing Ministries.
Ministries also try to cultivate a sense of community. “If you have a serious illness, members will pray for you and communicate with you regularly,” he says.
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The rise in health insurance costs, particularly for insurance on the exchanges created by the ACA, also has fueled the growth. Healthcare sharing ministries “are competitive on price,” Weldon says.
Along with lower monthly costs, annual deductibles also are typically lower than traditional private health insurance, says Kev Coleman, head of research and data at HealthPocket.com, a health insurance research and comparison website.
Members in Solidarity, for example, who are ages 30 to 65 pay $157 a monthfor a plan that will cover 70 percent of medical bills deemed eligible, up to $125,000 per incident. A person over 65 would pay $182 a month. The deductible, known as a “personal responsibility” amount, for all age groups is $500 for an individual.
By contrast, the average premium for an ACA Silver plan, which covers about 70 percent of medical bills (with no upper limit), is $743 for 2018, up from $554 in 2017, according to Avalere Health. The average Silver plan deductible is $4,033 in 2018, up from $3,572 in 2017.
Consumer Reports is working with WNYC-New York Public Radio to educate consumers about their options during open enrollment. Find out more at We’ve Got You Covered.
Another financial difference with traditional health insurance: If you are a member of a healthcare sharing ministry that’s been in existence since 1999, you are exempt from the requirement that most people buy health coverage that meets ACA standards or pay a penalty. For 2018, the penalty is $695 for an adult and $347.50 for a child without insurance.
Though Solidarity was founded in 2015, it is affiliated with another, older ministry and is grandfathered into the ACA exemption.
But, because you have Medicare, which is ACA-qualified coverage, you and your husband aren’t subject to the penalty anyway.
Still, Burns from California Health Advocates says she has concerns about what would happen if a ministry ran into financial problems. If an insurance company becomes insolvent, each state has a guaranty association that takes over the obligations of that insurer. There is no such safety net for HCSMs, Burns says.
Weldon, who along with running the healthcare ministry sharing alliance is a practicing physician and former Florida congressman, says ministries are subject to annual independent financial audits of their operations and have a good track record of paying claims.
But Weldon agrees that it’s critical to understand how a ministry works. “People need to read the fine print about what benefits are covered and what are not,” he says.
Burns suggests contacting your State Health Insurance Assistance Program, which provides free one-on-one counseling in every state for seniors on Medicare, to review your options.