It was either $1,600 and slated to rise to $2,300, or it already was $2,300 for themselves and their three daughters.

Either way, $2,300 was the breaking point for the couple, who live in Duluth’s Lakeside neighborhood.

“That’s when I said, ‘This is enough,'” Dorothy Sayers said during a recent interview.

So they switched, and since then haven’t paid anything for health insurance. They’ve done so without running afoul of the Affordable Care Act’s health insurance requirement and without being flattened by medical bills, including eye surgery and stomach surgery for Joe Sayers.

They switched to Christian Healthcare Ministries, one of several “health sharing ministries” whose members pool their resources to pay for one another’s health care expenses.

It’s not health insurance, said Dr. Dave Weldon, a former member of Congress who represents three of the organizations as president of the Alliance of Health Care Sharing Ministries.

But the Affordable Care Act exempted members of health care sharing organizations from the penalty for not having health insurance, said Michael Gardner, a spokesman for Christian Care Ministry, which operates a plan called Medi-Share.

“We’re not a health insurance company, but it does meet the requirements to have some sort of health care solution,” Gardner said.

What the sharing plans offer is lower payments up front. With Medi-Share, the average household pays about $350 in what the organization calls a “monthly share amount,” Gardner said. He pays a little less than $300 monthly to cover his own family of four.

With Christian Healthcare Ministries, the Sayerses started out at $450 per month. Six years later, they still pay $450. Only the youngest of their three daughters is now in the plan with them, but that didn’t affect the rate, Joe Sayers said. Then, as now, the rate is $150 for each of them and another $150 covering any number of children.

In its January 2018 newsletter, Christian Healthcare Ministries boasted of having had no rate increase in 10 years.

No smoking

Members of the health-sharing organizations are expected to abide by a code of conduct. At Austin, Texas-based Altrua, it’s called a “statement of standards,” said Ron Bruno, executive vice president of Crown HealthShare Administrators, which offers the plan.

The stipulations vary from one organization to another, but most prohibit smoking, Weldon said. Most permit drinking alcoholic beverages in moderation.

“We … ask our members to abstain, certainly, from using illegal drugs, but also from abusing prescription drugs and alcohol as well,” Medi-Share’s Gardner said.

To be part of Christian Healthcare Ministries, you have to be a member or regular attender of a congregation, Dorothy Sayers said.

“And they will call,” Joe Sayers added. “They want to know who your pastor is. They will call your pastor.”

Altrua is a Christian ministry but doesn’t require that its members be Christians, Bruno said.

“We believe that multiple walks of faith should have the opportunity to share in one another’s medical needs as long as they adhere to those six statements of standards,” he said.

None of the plans covers abortion, and some plans don’t cover contraception.

Growing movement

The idea of sharing costs in lieu of insurance is nothing new, Weldon said, particularly among certain religious groups.

“The Mennonites (have) been doing medical sharing forever,” he said. “They don’t believe in insurance. There’s about 150,000 Mennonites who do medical sharing.”

But the movement has been growing over the past 25 years, now encompassing about a million people nationally, Weldon said. Passage of the Affordable Care Act only accelerated the movement.

“There’s been no professional research to explain that,” said Weldon, who served in Congress out of Melbourne, Fla., from 1995-2008. “Two obvious explanations that people have proposed are, No. 1, the controversies in the ACA regarding contraception and things of that nature.

“As well as price. There’s been significant price inflation in the individual market, and a lot of the people who do sharing are farmers, small businessmen, and … those who are Christians have turned to medical sharing as a viable option.”

Jim Schowalter understands the search for cheaper options.

“As care gets more expensive, people are doing whatever they can to find the best possible option for them and their family,” said Schowalter, president and CEO of the Minnesota Council of Health Plans, which represents the insurance industry.

Not surprisingly, though, Schowalter advises caution when considering options other than traditional health insurance plans.

“The first thing is check the fine print,” he said. “Health insurance, if a company makes a decision you don’t like, there are things that can be done. With these noninsurance plans, there’s not an insurance commissioner who you can appeal to. … Checking the fine print to see what’s covered is really, really important.”

One doesn’t have to go back far to find examples of such plans not working out in the long run, Schowalter said.

The Sayerses said they’re aware that things once worked out badly for the plan they’re apart of. Then known as Christian Brotherhood Newsletter, the precursor to Christian Healthcare Ministries was sued by Ohio’s attorney general in 2001, the New York Times reported. Its leaders were forced to repay $15 million they had drawn from the organization’s fund to spend on themselves.

The state of Minnesota has received no consumer complaints regarding health care sharing ministries, said Ross Corson, a spokesman for the state Department of Commerce. The state doesn’t regulate the plans, he added, because they’re covered by the Affordable Care Act exemption.

The Sayerses have had no serious difficulties with Christian Healthcare Ministries, they said, although it can be a long wait for a reimbursement after they make the up-front payment to their provider.

Most of his care comes from St. Luke’s, Sayers said, which, after some initial confusion has “really embraced this. … They’ve been very, very good about this.”

In contrast, Altrua doesn’t want its members to pay up front or negotiate prices, Bruno said. Instead, the provider submits the claim to Altrua, which pays the provider directly.

“It kind of freaks everybody out because … (they say) there is no guarantee to pay,” Bruno said. “I like to tell people all the time, ‘Read the fine print on your insurance policy. It says the exact same thing.’ ”

Not for everyone

Depending on the organization, terms of coverage might be markedly different from what’s provided by commercial insurance plans. With Medi-Share, for example, preventive care — such as a yearly physical — isn’t covered, Gardner said. It has limits on coverage for pre-existing conditions. Prescription medications are covered, but only for the first six months after a new condition is announced.

The Gardners’ minimal monthly payment comes at a price: They’re entirely responsible for the first $10,000 of their medical spending in a given year. It has worked out well for his family, Gardner said. But he acknowledged that it might not be the right choice for everyone, even among those who are Christians.

“It’s an option, and it’s going to make sense for a lot of people, and for some folks, they may find that there are other, better solutions for them,” he said.

Their plan has made sense for them, Joe and Dorothy Sayers said. They’re responsible for the first $500 of any medical “occurrence,” and then the plan takes over. They contribute to a fund called “Brother’s Keeper,” which is intended to help members with pre-existing conditions who might otherwise not be covered. In turn, the lifetime cap on their benefits is increased.

“It’s about a million dollars, or something like that,” Joe Sayers said. “To be honest, I don’t ever intend to get near it.”

They also can pray for other Christian Healthcare Ministries members, and be prayed for by them.

That’s probably one of the most notable differences with faith-based health care sharing, Weldon said.

“If you visit one of these ministries, they have all these people on the phone dealing with people who have medical issues, and they regularly are praying with these people,” he said. “It’s not a business. They’re 501(c)(3)s (nonprofits). There’s no stockholders. There’s no CEOs making seven-figure salaries.”

Read more at Sharing health costs with faith.