I am expecting to retire at the end of the year and have been doing some research about my options for insurance. A friend mentioned to me that they have a HealthShare plan through their ministry. My friend says the premium is very affordable and seems to be happy with the coverage, but I’ve never heard of this before. What is a HealthShare plan?
-Gerald (Lexington, KY)
HealthShare programs have been around for quite some time, however they became more recognized in recent years as an alternative to the Affordable Care Act. Although membership is not limited to a certain age group or location, these plans are usually offered by faith-based groups. These programs are not “insurance”, but they can help pay for healthcare services.
This is how it works: HealthShare plans have a fee-pooling system where all members pay a monthly membership fee and some sort of deductible up front. When one of the members has a claim, they submit it to the program for payment. Some plans will not cover your until you have made a predetermined number of payments.
HealthShare programs can decide not to cover pre-existing conditions, preventative care, reproductive care, or services for substance use disorders. They can also determine which health services they will choose to cover and may deny claims for services that do not align with their religious beliefs. There is also no legal protection for the consumer should the HealthShare program go bankrupt or fail to pay claims since they are offered by private groups.
HealthShare programs are not designed to replace your Original Medicare or drug coverage. If you fail to pick up Parts A, B, or D, then you could incur a penalty later. The HealthShare plan is not a supplement to Medicare either. If you have Medicare and a HealthShare plan, your provider will bill Medicare first. You can take the unpaid portion of your bill to the HealthShare plan, but there is no guarantee that they will pay towards it.
These are the risks associated with HealthShare programs, however it’s not to say that they can’t work for some. These plans may cover items that traditional insurance does not, like funeral expenses, adoption fees, etc. Also, there is a sense of community among members that is unique to this type of program. They promote that they are non-profit and therefore are more affordable because they don’t have a big overhead like major insurance companies. But again, you could run the risk of having significant out of pocket costs so it may not be that affordable in the long run.
If you would like to review specific plan options, our licensed agents here at AMAC are happy to assist you. They are licensed with top-rated insurers throughout the country.
Call 1-855-611-4856 to speak with one today!