Making healthcare decisions with a pre-existing condition is often complicated and challenging. With many people having medical histories that include what organizations consider a pre-existing condition, concerns may arise about HealthShares and their willingness to share costs related to these conditions—especially when needs are pressing.
For members considering a HealthShare and dealing with pre-existing conditions, there are five critical points to consider.
A HealthShare will:
- accept individuals with a pre-existing condition.
- establish a lookback period when defining a pre-existing condition.
- impose a waiting period before the condition is eligible for sharing.
- place limits on sharing for pre-existing conditions.
- outline exceptions to their main pre-existing condition guidelines.
1. Pre-existing condition acceptance
A HealthShare is unlikely to reject an individual due to a pre-existing condition. Most HealthShares will accept new members provided they adhere to the shared community standards. However, this acceptance should not be interpreted as readiness to immediately share expenses related to the pre-existing condition.
2. Pre-existing conditions lookback period
HealthShares generally define pre-existing conditions within their member guidelines. Definitions may vary across the many organizations, but all will specify a timeline for the condition. Typically, a pre-existing condition is defined as a health issue that has exhibited symptoms or required treatment within a certain period of time before membership begins, known as lookback period.
For example, a HealthShare may require a symptom-free period of two years before enrollment, implying a two-year lookback. If a member’s condition has been ongoing or required medication or treatment in the past two years, it will be considered pre-existing and not immediately shareable.
3. Pre-existing conditions waiting period
After membership is established, a waiting period is typically imposed before sharing begins for needs relating to any pre-existing condition. Depending on the HealthShare, this waiting period may extend up to five years.
Lookbacks can range from one to ten years. Waiting periods can range from twelve months to five years. For example, OneShare Health has a 24-month lookback and a 24-month waiting period; Altrua HealthShare has a ten-year lookback with a two-to-five-year waiting period; and MediShare has a 36-month lookback and a 36-month waiting period.
4. Pre-existing condition limitations
This key limitation exists industry-wide: no HealthShare will immediately share costs related to pre-existing conditions. Once the waiting period has been satisfied and a condition is deemed eligible for sharing according to their member guidelines, the amount shared may still be limited.
General limits may be in place, such as a cap on any cancer-related expenses at $50,000. Or, a HealthShare may limit the total shareable dollar amount for the first few years that a health issue is eligible. There may also be per-need or per-year limits for needs related to a pre-existing condition.
Another potentially significant limitation is the potential reset of the pre-existing condition timeline if membership lapses. Any health issue a member experiences during an active membership could be considered pre-existing if they allow their membership to lapse.
5. Pre-existing condition exceptions
HealthShares use the term pre-existing broadly. If treatment has been received, symptoms experienced, or medication taken for a condition, it will typically be considered pre-existing. However, there are exceptions.
Common chronic issues like high blood pressure, elevated cholesterol, or thyroid conditions may still be shareable if present before membership began. Conversely, some health issues, including hereditary diseases, may never be shared, irrespective of the waiting period.
For health issues that could improve with lifestyle changes, some HealthShares have introduced wellness plans. These programs can serve as stepping stones to full-fledged member status. Liberty HealthShare offers the HealthTrac membership, and Solidarity offers the Solidarity Well program. Indeed, evaluating overall health, including any pre-existing conditions, is one of the top factors to consider before joining any HealthShare.
Who will share pre-existing conditions?
An in-depth examination of the member guidelines of several major HealthShares, including Christian Healthcare Ministries*, Liberty HealthShare, Sedera, Solidarity, United Refuah, and Zion HealthShare, reveals a general willingness to share in expenses related to pre-existing conditions, even if they are ongoing.
However, a one-year waiting period is typically in place before these HealthShares will consider contributing to these costs. Each company introduces a gradual cost sharing for members’ pre-existing conditions. The longer an active membership is maintained, the greater potential for sharing eligibility, regardless of ongoing symptoms.
For example, after a year of continuous membership with a pre-existing condition, a member may be able to share up to $25,000 in bills related to that condition. After two years of membership, they may be able to share up to $50,000, and potentially more as the membership progresses. To understand how this could work in individual circumstances, members should contact their prospective HealthShare’s member guidelines.
*Christian Healthcare Ministries may share some pre-existing, maintained conditions after 90 days for Gold memberships.
Finding the right HealthShare
Though the process of selecting a HealthShare may be more complicated for those with pre-existing conditions, options are available. Members may find that what they save in monthly expenses and other healthcare costs makes up for what they initially spend on pre-existing conditions. Of course, this will vary depending on individual healthcare needs.
