In part two of this series, we compared the pre-existing condition guidelines for Zion HealthShare, Christian Healthcare Ministries, and United Refuah HealthShare were put to the challenge to see who had the best sharing policies for pre-existing conditions. All three had their own advantages and disadvantages, but unlike in part one, no clear frontrunner emerged. For example, while United Refuah fully shares in pre-existing conditions after three years of membership, their policy of requiring certain members to sign permanent waivers for sharing certain pre-existing conditions left something to be desired.
In the third and final part of the Best HealthShare for Pre-Existing Conditions series, we will compare the final four HealthShares featured on our site: Samaritan Ministries, Medi-Share, OneShare Health, and Solidarity HealthShare.
Finally, we will select an overall winner from all of the HealthShares featured in this pre-existing condition series.
HealthShares and pre-existing conditions
When joining a HealthShare, it’s important to understand that HealthShares are not insurance, and there are differences between what insurances can be expected to cover and HealthShares can be expected to share. Since HealthShares share the medical expenses of their medical cost sharing community via members’ monthly contributions, and because being a part of the community is a monthly rather than annual commitment, they place some restrictions on what is shared in order to keep costs lower for members.
Typically, pre-existing conditions are any condition for which a member has shown signs or symptoms, received treatment, or taken medication within the two years before the start of their membership (this timeframe is known as the lookback period).
Unlike with traditional health insurance, which cannot refuse coverage to members based on whether they have pre-existing conditions, HealthShares are not obligated to share expenses related to pre-existing conditions, and in rare cases may decline membership to those who have them.
In fact, all HealthShares place limitations on, and have waiting periods for, sharing medical expenses related to pre-existing conditions. These limitations on sharing, and allowances made to members with pre-existing conditions, vary between HealthShares.
Samaritan Ministries
Samaritan Ministries has been sharing members’ medical expenses for over twenty-five years, making them one of the longest-tenured healthcare sharing ministries in the industry.
According to their guidelines, Samaritan separates pre-existing conditions into two categories: cured conditions and stabilized conditions, each with separate lookback periods.
Cured conditions have a one year lookback period
- Appears to be cured
- At least one year without symptoms of, or treatment/medication for, the condition
- May require doctor’s verification
Stabilized conditions have a five year lookback period
- Not cured
- At least five years without treatment nor plans or prescriptions for future treatment
- At least five years without harmful symptoms or further deterioration
- Recommend seeing a doctor for evaluation of stabilized condition before starting membership
For some conditions, Samaritan requires a statement signed by both the doctor and the member verifying the above to be true for the duration of the lookback period. If members meet the criteria laid out above, then the conditions are generally shareable. If not, they are not eligible for sharing with the community.
While the lookback period for cured conditions is reasonable, members should know that if any of their cured or stabilized conditions do not fall within the lookback period for Samaritan, they will be unable to share them for the lifetime of their membership.
Expenses related to pre-membership conditions that do not fall within the lookback periods are fully shareable, however.
Medi-Share
Founded in 1993, Medi-Share has over a quarter million members and has shared over $6,000,000,000 of members’ medical expenses.
According to their guidelines, Medi-Share has a 36 month lookback period (any condition for which a member has had “signs/symptoms, testing, diagnosis, treatment, or medication for” within the 36 months before membership is considered a pre-existing medical condition).
Pre-existing medical conditions (as well as any congenital conditions) are eligible for sharing up to:
- $100k per member, per year after 36 months of consecutive membership
- $500k per member, per year after 60 months of consecutive membership
Prescription medications related to pre-existing conditions are ineligible for sharing.
Medi-Share’s waiting period for sharing pre-existing conditions is longer than most, and imposes limits on sharing for pre-existing conditions for the lifetime of a membership, rather than allowing them to be shared fully after a set time period.
OneShare Health
OneShare Health, an Anabaptist-based HealthShare out of Texas, has a fairly simple pre-existing conditions policy.
OneShare has a 24-month lookback period and a 24-month waiting period for sharing pre-existing conditions. After the waiting period, pre-existing conditions become shareable with the community. However, many treatments, including those for pre-existing conditions, require prenotification with OneShare in order to be eligible for sharing, so members should plan accordingly in order to share related medical expenses. Sharing is still subject to the sharing limit associated with a member’s chosen membership option.
Solidarity HealthShare
Solidarity HealthShare is a Catholic-based HealthShare headquartered in Tempe, Arizona.
According to their guidelines, pre-existing conditions are shareable as follows:
- $25k per member, per year after the first year of membership
- An additional $25k per member, per year after two years of membership
- After three years of membership, the condition is no longer considered a pre-existing condition and is fully shareable
However, some members will be asked to agree to a permanent waiver in order to obtain membership, making certain pre-existing conditions ineligible for sharing for the lifetime of the membership.
The best HealthShare is…
The four HealthShares featured in part three vary greatly in how they handle pre-existing conditions. OneShare Health stood out for being simple and straightforward—a 24-month lookback period followed by a 24-month waiting period for sharing—which, when compared to the others in this installment, is a definite positive. While Samaritan Ministries may not have a waiting period for sharing certain pre-existing conditions, their two lookback periods and permanent ineligibility for sharing for conditions incurred during those periods make them a less forgiving option than others compared during this challenge.
After reviewing all of the available information, the frontrunner for part one, Sedera, ended up being the overall best HealthShare for pre-existing conditions. Sedera stood out for their inclusivity and their lifting limitations on pre-existing conditions after a member meets certain longevity requirements. To learn more about Sedera’s pre-existing conditions guidelines, read part one of this series.
