Making healthcare decisions when you have pre-existing conditions is often complicated and frustrating. Unfortunately, many of us have something in our medical history that any organization might consider a pre-existing condition. If you are currently experiencing symptoms or receiving treatment for a pre-existing condition, you may be concerned that few HealthShares will share costs related to that condition—and none will share immediately.
If you have pre-existing conditions and are trying to select a HealthShare, here are five important things you should know.
A HealthShare will…
- accept you if you have a pre-existing condition.
- establish a lookback period when defining a pre-existing condition.
- require a waiting period before your condition is eligible for sharing.
- limit how they share your pre-existing conditions.
- outline exceptions to their main pre-existing condition guidelines.
1. Pre-existing condition acceptance
It is very unlikely that a HealthShare will reject you due to a pre-existing condition. Pretty much any HealthShare will accept you as a member as long as you adhere to the shared community standards. However, just because a HealthShare won’t reject you for having a pre-existing condition does not mean that they will readily share in expenses related to that condition.
2. Pre-existing conditions lookback period
Your HealthShare will define pre-existing conditions in the member guidelines. Definitions may vary between HealthShares, but all will include specifics about the timeline of your condition. That is, they will define a pre-existing condition as a health issue that has shown symptoms or required treatment for a certain amount of time prior to your becoming a member. Your HealthShare may call this a lookback period.
For example, a HealthShare may want you to be symptom-free for two years before you enroll. This would be a lookback of two years. If you have a condition that is ongoing, or has 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
Once you are a member, you will wait a while before you see sharing for needs relating to any pre-existing condition. Depending on the HealthShare, you may wait up to five years before a pre-existing condition will even be considered for sharing.
Some lookbacks are as short as a year but can go up to 10 years. Waiting periods can range from 12 months to 5 years. For example, OneShare Health has a 24-month lookback and a 24-month waiting period; Altrua HealthShare has a 10-year lookback with a 2 to 5-year waiting period; and MediShare has a 36-month lookback and a 36-month waiting period.
4. Pre-existing condition limitations
We already covered one major limitation: no HealthShare will immediately share in costs related to your pre-existing conditions. Once you satisfy the waiting period and a HealthShare deems your condition eligible for sharing according to their member guidelines, the HealthShare may still limit how much you can share.
There might be general limits (for example, any cancer sharing may have a cap of $50,000). Or your HealthShare may limit the total dollar amount you can share for the first few years that your health issue is eligible. Depending on the HealthShare, there may be per need or per year limits for needs related to a pre-existing condition.
Another potentially significant limitation to be aware of: if your membership lapses, your pre-existing condition clock may reset. It is possible that any health issue you have experienced during your current membership program will be considered pre-existing if you allow your membership to lapse.
5. Pre-existing condition exceptions
HealthShares use the term pre-existing broadly. Generally speaking, your HealthShare will consider your condition pre-existing if you have received treatment, experienced symptoms, or taken medication for a condition. Despite this general definition, your HealthShare will have some exceptions.
Common chronic issues like high blood pressure, elevated cholesterol, or thyroid conditions may still be shareable if you had them before becoming a member. On the other hand, some health issues (such as hereditary diseases) may never be shared no matter how long you wait.
If some lifestyle changes could improve your health issues, a couple of HealthShares have rolled out wellness plans to help. A hopeful member can use these programs as a stepping stone to full-fledged member status. Liberty HealthShare offers the HealthTrac membership, and Solidarity offers the Solidarity Well program. Indeed, evaluating your general health, including any pre-existing conditions, is one of the top factors you need to consider before joining any HealthShare.
Who will share your pre-existing conditions?
At HealthShare Guide, we have taken a close look at the member guidelines of several of the major HealthShares. We found that, though they may outline pre-existing conditions somewhat differently, Christian Healthcare Ministries, Liberty HealthShare, Sedera, Solidarity, United Refuah, and Zion Health are willing to share in expenses related to your pre-existing condition—even if it is ongoing.
Granted, you will wait for a year* before any of these HealthShares will chip in; however, each one has some type of gradual introduction of cost sharing for members’ pre-existing conditions. The longer you maintain an active membership, the more sharing you may be eligible for—whether or not you are still having symptoms.
For example, though you have a pre-existing health issue, after a year of continuous membership you may be able to share up to $25,000 in bills related to that issue. After two years of membership, you may be able to share up to $50,000.
If you are curious about how this might work for you, check your potential HealthShare’s member guidelines.
*Christian Healthcare Ministries may share some pre-existing, maintained conditions after 90 days if you are enrolled in the Gold program.
Finding the right fit
Though the process of selecting a HealthShare may be more complicated if you have a pre-existing condition, there is hope! You will find a HealthShare that accepts you regardless of your prior, or current, health issues. Many members find that what they save in monthly expenses and other healthcare costs makes up for what they spend on pre-existing conditions. Of course, this will vary depending on your healthcare needs.
Now you know you have options and what to look for when making your final decision. Shop for your HealthShare knowing that you can find the right fit for your healthcare needs.