As HealthShare memberships grow as a popular alternative to health insurance, many people, often including those already enrolled, find themselves in a completely new space. Many members are not fully acquainted with the extent of the features and services included with their HealthShare membership. To better take advantage of the potential benefits of HealthShare membership in 2024, there are a few key actions members should take.
Understand a HealthShare membership’s features
Every HealthShare organization has unique features and restrictions. Even after joining, members should make it a priority to research and the specific details of their membership and understand what types of needs qualify, and which do not. The following are important questions that most new HealthShare members will benefit from answering:
- What types of medical needs are eligible for sharing? Members should ask if there are any restrictions on the types of medical services the organization will share in. For example, are mental health services or specialized treatments shareable?
- Are prescription benefits included? Members should determine if their membership shares in prescription medication expenses and, if so, which types. Some memberships may share for generic medications but not brand-name prescriptions, or they may have a list of approved medications. Also, members should be clear on how this type of sharing may change when a prescription is directly related to an eligible need.
- Does the membership include preventive care? Preventive care is important to many people and can be key to catching diseases early—but many HealthShare organizations do not share inany preventive needs. Members should find out if their HealthShare includes services like routine checkups, screenings, immunizations, or wellness programs. Companies like Zion HealthShare are notable for providing members with immediate access to certain preventive services upon joining, without waiting periods.
- What are the financial implications? Members should make sure they are familiar with their HealthShare membership’s cost structure, including any Personal Responsibility Amounts (PRA), sharing caps, or out-of-pocket expenses.
Budget for member responsibility
Understanding Personal Responsibility Amounts
The PRA is a fundamental component of HealthShare membership, a counterpart to the health insurance deductible. It represents the amount a member is responsible for paying for a medical need before the HealthShare organization contributes. Different plans can have varying PRAs, so a member needs to know theirs in order to properly budget for it. Here are a couple key questions consider:
- What type of PRA is it? Members should determine what their exact IUA is, and how it may apply to different types of medical incidents. Some HealthShares might have a single IUA for all medical needs, while others might vary the amount based on the type of treatment or service.
- How is the PRA applied? In some memberships, like Zion HealthShare, the member’s responsibility is capped at three per 12-month period, providing a predictable limit on out-of-pocket expenses.
Strategies for Budgeting for an IUA
- Create a dedicated savings account. One way that members can ensure that funds are readily available when a medical need arises is by setting up a savings account specifically for their IUA.
- Make regular contributions. Ideally, members would treat their IUA savings like a bill, making regular payments into this savings account. By incrementally building up a reserve fund like this, members will be prepared for their share of the medical expense.
- Assess health risks. If a member has known health issues or a history of frequent medical needs, they should budget toward the higher end of their IUA range. Because PRAs are often paid on a per-need basis, it would be wise to keep enough to cover multiple. With a program like Zion, where they cap the PRAs, a member could set a payment schedule that allows them to pay a PRA and replenish it within the same year.
- Use a Health Savings Account (HSA). Members should take advantage of an HSA if possible. HSAs offer a tax-advantaged way to save and pay for eligible medical expenses, including PRAs. This is starting to be a possibility for more and more people as benefits companies like Planstin Administration innovate new products that combine HSAs with HealthShare memberships.
Understand sharing needs
In HealthShare memberships, medical expenses are shared based on specific incidents or needs, not on each medical service or treatment. This means that once a particular need (like an injury or illness) is established and approved for sharing by the organization, all related expenses, including initial treatment, follow-ups, and prescriptions, are generally eligible for sharing because they arise out of that approved need.
HealthShare professionals often emphasize that a common misunderstanding among members is the scope of expenses eligible for sharing once a need is approved. Not only is the immediate medical intervention shareable, but the associated ongoing treatments are also eligible for sharing.
Recognizing Shareable Expenses
Members should make sure they know the types of expenses that are shareable. Typically, shareable expenses include doctor visits, hospital stays, surgeries, and certain medications. However, each HealthShare membership has its own guidelines, so members should get familiar with these to maximize their benefits.
Example: The Case of a Broken Leg
Consider a scenario where a member, John, breaks his leg:
- Initial treatment (ER visit & X-rays): John visits the ER, where his leg is X-rayed and casted. This initial visit and treatment are considered part of the need associated with his broken leg.
- Follow-up visits: Two weeks later, John visits an orthopedic specialist for a follow-up, and six weeks after that, he has another follow-up to assess the healing progress and discuss potential physical therapy. Because these follow-up visits are directly related to his initial need (the broken leg), John should submit them for sharing under the same need.
- Prescriptions: John is prescribed pain medication during his ER visit and later, a different medication for inflammation by his orthopedic doctor. As these medications are related to his broken leg, they also fall under the same need and are eligible for sharing.
In this example, all expenses from the ER visit to the follow-up treatments and medications are interconnected. They stem from a single incident of John breaking his leg, which was an approved need, and are therefore shareable.
Maintain accurate records
Members should make it a priority to keep record of medical expenses, as more organized and thorough records will only help the sharing process. But organizing records for HealthShare submissions may require different methods than regular record-keeping. Here are a few ideas for efficient HealthShare record-keeping:
- Group records by need: Organize documents based on each specific need or incident. Include all related medical bills, receipts, prescription records, and communication with healthcare providers as part of this grouping.
- Opt for digital records: Whenever possible, maintain digital copies of all health-related documents. Digital records are not only more accessible, but also easier to submit to the HealthShare organization when needed. Digital records can also easily be backed up and stored securely, either physically or in a cloud storage service.
- Maintain a treatment timeline: For each sharing need folder, keep a detailed timeline of treatments, consultations, and prescriptions. This will help show how the medical services are connected and relevant to the specific need, making the sharing process even smoother.
- Keep detailed notes of communications: Members should document every interaction with their HealthShare organization and healthcare providers, including the date, nature of the communication, and representative’s name. This can be important in case of discrepancies or disputes.
Use member support services
HealthShare organizations often provide support services to help their members understand and navigate their new and unfamiliar memberships. These services can be a valuable resource and are often not used as much as they should by members who may not know what they don’t know. By leveraging these support services, members can better understand how to use their benefits, the features of their plan, and the policies and guidelines of the organization. From guides and FAQs to dedicated phone support, most HealthShares provide channels for members to find answers, and members should feel encouraged to use them.
Plan for preventive care
Effective planning for preventive care is a key strategy for members to maximize their HealthShare benefits. When preventive care services like routine checkups, screenings, and vaccinations are included with a HealthShare membership, members should take full advantage of these offerings. These services are not just about maintaining health, they are a proactive approach to healthcare management. Membership is not free, and if members aren’t fully using all the features provided by that membership, they are leaving money on the table.
If members are unsure about the specifics of the preventive services included in their plan, they should not hesitate to reach out to their HealthShare’s customer support for answers.
Leveraging the features and services of a HealthShare membership in 2024 requires informed action and management. In short, members can maximize the value of their membership by:
- Understanding their membership specifics
- Understanding sharing needs
- Budgeting for responsibility amounts
- Maintaining good records
- Using available support services
- Planning for preventive care
As 2024 unfolds, these proactive steps are key to successfully navigate the HealthShare ecosystem.
