It’s important to recognize that there are both pros and cons to being a HealthShare member. Current and prospective HealthShare members must understand what those are, and how they may affect their HealthShare experience. Finding a healthcare plan that meets your needs but does not break the bank is not easy, and HealthShares can be an affordable, quality alternative. But it may take research to find a membership that provides the right balance of support and affordability.
Pros
- Peace of mind
- Freedom and flexibility
Peace of mind
HealthShare members don’t have to face the perils of modern healthcare alone, because being a HealthShare member means being part of a medical cost sharing community. Members of HealthShare communities share one another’s medical expenses through monthly contributions to their HealthShare, which are shared based on members’ medical needs.
Depending on the details of a membership, the community may share the bulk, or even the entirety, of eligible medical expenses. Members don’t have to worry about insolvency due to injury or illness. They can have peace of mind knowing the community is there to help in times of dire need.
For the most part, members also don’t have to worry about co-payments or having to pay large portions of major medical expenses on their own. While some HealthShares feature a co-share structure, wherein members are required to pay a percentage of any eligible medical expense for it to be shared, most don’t require additional payment from the member on the same need after their personal responsibility amount has been met.
Freedom and flexibility
As opposed to traditional health insurance plans, which are subject to open enrollment and require annual commitments, HealthShare memberships are month-to-month, and there is no need to wait until the tail end of the year to sign up for a membership.
Members have the freedom to join and leave at their leisure: they can change from one HealthShare to another without significant delay because there is no open enrollment period for HealthShares. They are free to try out a membership, and if it’s not for them, move on. There are plenty of options in the HealthShare market and making the wrong choice doesn’t mean a member will be locked into an agreement they don’t want to be in.
Noticeably, many HealthShares are moving away from provider networks. This shift is more in-line with what HealthShares are about: freedom. HealthShares provide flexibility for their members and a wealth of options when it comes to seeking care and providers. It is important that members research their membership choices carefully, so that whether it be a primary care doctor or other provider choice, they are always able to make best choice for their healthcare needs.
Depending on the particular HealthShare membership, this freedom of choice when it comes to providers may extend outside state boundaries, or even the boundaries of the United States. Members planning an international trip should see if their HealthShare offers international sharing, and may be willing to share medical expenses incurred abroad.
Cons
- Limitations
- Ambiguity
Limitations
Depending on the details of the membership, and the membership guidelines laid out by the HealthShare, sharing for some, or all, medical needs may be limited, either per need, per year, or for the lifetime of a membership. This means that if a member incurs expenses exceeding the annual limit, for example, they are no longer eligible to share medical expenses until the next calendar year (or, in some cases, until the end of a 12-month rolling period). This potential pitfall can be avoided by carefully researching which HealthShares meet your sharing needs, and choosing accordingly.
However, limitations cannot be avoided altogether, especially when it comes to preventive sharing, pre-existing conditions, and occasionally maternity care. Typically, any medical needs for which a member has received treatment or had symptoms in the two years before starting their membership count as pre-existing conditions. Pre-existing conditions are either not initially shareable or limited in the amount that may be shared for them. These limitations or exemptions can last years, and it’s important to know to what extent a HealthShare limits the amount that may be shared toward pre-existing conditions before signing up.
Stopping and starting a membership (usually with a break of 60 or more days between the date a member leaves and rejoins) will result in their membership being considered new. This means the waiting period for sharing pre-existing conditions for that membership will reset, and any conditions that developed during their previous time as a member will now be considered pre-existing conditions, and will be subject to any associated limitations and waiting periods.
Ambiguity
HealthShares are a relatively young, but rapidly growing industry (though some companies may argue that the HealthShare model dates back to the first century). As a result, there is not a strict set of standard industry guidelines or terminology all HealthShares must follow; many terms, membership details, and sharing limits vary from company to company. This makes it more difficult to try and pin down what is being discussed, how it relates to an individual member’s situation, and how best to go about researching memberships generally.
Although the member guidelines can be a great resource for learning about a HealthShare’s rules regarding sharing, those guidelines are also subject to quarterly or yearly updates, which means members may have to reread guidelines in order to assess changes that may impact their memberships.
As mentioned above, many HealthShares are moving away from provider networks, which is a generally positive development. However, there are still a few major HealthShares that use networks like PHCS/Multiplan, which may make it harder for members in rural areas to find providers in their network. Information on whether a HealthShare does or does not use a provider network can be found in their member guidelines.
Conclusion
HealthShare Guide realizes that navigating the pros and cons of HealthShare membership is not easy. That is why this site has content and features designed to help members make the right choice for their situation, and uses a standardized set core of terminology to reference different concepts. Because of this, HealthShare Guide is the leading resource for researching HealthShare memberships.
