Martin Estacio was shelling out $800 per month for a health plan that didn鈥檛 fit his two-state lifestyle.
The retired San Bernardino firefighter lives between Oklahoma and California. But his health insurance policy, purchased in Oklahoma, didn鈥檛 cover non-emergency care outside the state.
So Estacio dropped his plan this month and took a leap of faith. He joined (CHM), an alternative to health insurance that offers a religious approach to covering medical bills.
Health care ministries such as CHM are essentially cost-sharing programs. Members鈥 monthly fees are applied directly to other members鈥 medical bills, no matter where they live in the U.S. Members also pray for each other, and often send notes of support and encouragement.
鈥淲hat led me to look into it was financial,鈥 says Estacio, 58. 鈥淲hen I started to realize it鈥檚 based on biblical principles where you help your brother out, that鈥檚 what really clinched me.鈥
A health care sharing ministry is primarily a 鈥渃ommunity of faith,鈥 says Michael Gardner, spokesman for Christian Care Ministry, which operates the program. Medi-Share has roughly 300,000 members as of June, he says.
But let鈥檚 be clear: Christian health care ministries are not insurance. You must attend church regularly. You must agree to abstain from certain behaviors, such as 鈥溾 and drug abuse. Preventive care, routine prescriptions and mental health care may not be reimbursed. Forget about abortion. Coverage for your preexisting conditions will likely be limited 鈥 at least initially.
Estacio pays $150 per month for his membership, plus quarterly payments of about $30 that offer him a higher level of reimbursement.
He鈥檚 responsible for the first $500 on each medical incident before the ministry鈥檚 sharing kicks in, but only for allowed services. CHM鈥檚 list of non-covered services includes 鈥,鈥 medical supplies and equipment, immunizations, maintenance prescriptions and bills related to drug abuse.
鈥淵ou have to try to live a good lifestyle,鈥 Estacio says. 鈥淵ou can鈥檛 be drinking and smoking. It鈥檚 on you.鈥
Membership in health care sharing ministries has ballooned since passage of Obamacare, in part because the health law provides for members. If you belong to a qualified health care sharing ministry, you don鈥檛 have to pay the Obamacare tax penalty for not having insurance.
About 1 million Americans participate nationwide, according to the . Texas has the most members; California places second.
There are more than 100 ministries across the U.S., though the vast majority are small Mennonite churches, says alliance President , a doctor and former Florida congressman. The three largest ministries are CHM, Medi-Share and , he says.
All the ministries are Christian at this point, though Weldon says there鈥檚 an attempt to start a Jewish sharing ministry.
鈥淚t鈥檚 our Christian practice of how we bear one another鈥檚 burdens,鈥 says James Lansberry, executive vice president of Samaritan Ministries, which has about 227,000 members nationwide.
Samaritan members, who share about $23 million a month, mail their monthly fees directly to other members facing medical bills, along with notes of support, Lansberry says.
Each ministry works differently, but you can generally expect to pay a monthly membership fee. You may be responsible for all of your own routine and preventive medical costs in addition to paying a set amount before reimbursements kick in.
鈥淚n effect, they become sort of like catastrophic programs,鈥 Weldon says. 鈥淏ut that鈥檚 true for a lot of plans on the Obamacare exchanges as well.鈥
Unlike catastrophic insurance plans, there鈥檚 no contract with health care sharing ministries, he says. That means there鈥檚 no guarantee that your bills will be covered.
鈥淗owever, most of them have always paid their members when they have medical bills,鈥 Weldon says.
Because there鈥檚 no guarantee, and because the ministries limit coverage, Sabrina Corlette has two words for you: 鈥淏uyer beware.鈥
鈥淩ead the fine print,鈥 says Corlette, research professor at Georgetown University鈥檚 . 鈥淢ake sure you truly understand what you鈥檙e getting with these plans.鈥
Coverage Caps And Covered Services
Some of these ministries put dollar limits on coverage, a practice that Obamacare ended for .
鈥淚f you鈥檙e fairly young and fairly healthy, you may never face that,鈥 says , associate professor of health policy at University of California-San Francisco. But 鈥渟ome people have catastrophic illnesses that may cost millions of dollars.鈥
Most health care sharing ministries don鈥檛 cover preventive care such as mammograms, colonoscopies and birth control, and some don鈥檛 cover mental health care, addiction treatment and other services, Coffman says.
Since monthly fees are generally less than health insurance premiums, members can save money on those costs, says Medi-Share鈥檚 Gardner.
鈥淏ecause it鈥檚 so much less expensive, I can be a good steward of my finances and set some money aside,鈥 he says.
Preexisting Conditions
Health care sharing ministries aren鈥檛 required to cover preexisting conditions.
As a result, 鈥渁 lot of these plans have waiting periods or limitations鈥 on聽them, says Coffman.
You may have to wait one to three years 鈥 or longer 鈥 to be reimbursed for preexisting conditions. And you may face a limit on reimbursement.
Providers 鈥榃illing To Take Cash鈥
Medi-Share has a network of providers with which it has negotiated rates, though members are not limited to it, Gardner says.
Samaritan does not have such a network.
鈥淧atients are treated by providers as cash pay,鈥 Lansberry says. 鈥淢embers make their own choice.鈥
In these cases, if you have a doctor you want to keep, would she be willing to see you as a cash customer?
鈥淲e鈥檝e never had trouble with members losing their doctors,鈥 Lansberry says. 鈥淒octors are almost always willing to take cash.鈥
But remember: You may have to cover the entire cost of the bill and wait for reimbursement.
鈥淪hould you have to be hospitalized, could you afford it upfront?鈥 Corlette asks.
The ministries encourage you to negotiate for lower prices with providers, though they usually go to the bargaining table for you when the bills are large.
Right To Appeal
Health care sharing ministries are not regulated by聽government agencies that oversee commercial health insurance.
If you don鈥檛 agree with how much you鈥檙e being reimbursed 鈥 or whether you鈥檙e being reimbursed at all 鈥 your only recourse will likely be an internal appeals process.
State regulatory agencies wouldn鈥檛 have any power to help you, says Janice Rocco, deputy insurance commissioner at the .
We 鈥渆ncourage people to obtain commercial health insurance, which they know they can count on if they have a serious health crisis in the future,鈥 she says.
Estacio hasn鈥檛 had to request reimbursement from his health care ministry yet, and he has money set aside for health care expenses that wouldn鈥檛 be eligible for reimbursement.
But he鈥檚 not worried.
鈥淚鈥檓 confident,鈥 he says. 鈥淚 have faith in it.鈥
This story was produced by , which publishes , an editorially independent service of the .