Navigating the healthcare landscape can be challenging, particularly when considering alternatives to traditional insurance like HealthShares. Medical cost sharing programs offer unique benefits and challenges, requiring careful consideration before committing to one. In approaching this decision, there are four major factors prospective members should consider:
1. Personal finances
HealthShares appeal to many because they come with lower month-to-month costs than traditional insurance not subsidized by an employer, but a HealthShare does not guarantee all bills will be paid. Determining bill eligibility and the corresponding shareable amount within a HealthShare takes time.
In some cases, HealthShare members who waited for the organization to pay their bills, rather than paying their own and requesting reimbursement, have faced collections due to the prolonged process. Some companies will be able to process such needs faster than others, but reliance on timely reimbursement could potentially put a member’s credit score at risk.
Most HealthShares prefer to reimburse members. However, some companies have their own process for handling payment of shareable expenses. Prospective members should contact companies or read the member guidelines carefully for more information.
2. Health and age
As HealthShares are not insurance, they are not obligated to accept members with pre-existing conditions, regardless of severity. Most HealthShares either exclude members over 65, as they are then eligible for Medicare, or charge a higher membership fee. Age-based membership dues are common among HealthShares, so prospective members should be careful to check plan and pricing information before committing.
Many HealthShares provide limited assistance for costs associated with any pre-existing conditions. Accepting members with pre-existing health issues usually includes one or more of the following conditions:
- Conditions that might be improved by lifestyle changes, such as obesity, require the member to pay an extra fee for their membership and join a health coaching program. These programs track members’ progress, and if the member does not meet their targeted goals in the time allowed, they might lose their membership eligibility.
- Waiting periods, typically 1-2 years, preceding the sharing of any bills related to the pre-existing condition.
- Caps on the shareable amount of a bill related to a pre-existing condition.
Many HealthShares exclude mental health or pharmaceutical bills, and some also exclude routine care costs. Although most HealthShares offer discount programs for prescriptions, these discounts may not be sufficient for all members’ needs. For example, even with a discount program, costs for a generic-brand steroid inhaler or specialized medications like insulin can still be substantial.
3. Values alignment
HealthShares are nonprofit entities often associated with specific faith groups, and they typically require their members to agree to certain lifestyle standards. Common stipulations include no tobacco use and no alcohol or drug abuse.
Certain HealthShare organizations also require membership in a specified faith, while others maintain a broader requirement that members try to be healthy, kind people. Membership requirements can be stringent, and the values of the associated religion may influence the shareability of bills. For example, many HealthShares do not share maternity costs for a babies born to single mothers.
4. Provider network
As HealthShares operate differently from traditional insurance, they don’t typically contract with providers in the same way. Some HealthShares allow members to visit any provider, with no effect on shareable bills. Nonetheless, some HealthShares do recommend seeing caregivers in a provider network, which has a few benefits:
- If a provider is contracted with an insurance network, it means they are legally licensed and have approval to practice.
- Providers contracted with insurance are familiar with medical billing. This might make submitting a sharing request easier.
However, some people might prefer not having a provider network or may live in an area where they do not have access to one. For those to whom provider networks are not important or accessible, there are many options. Further reading on this subject can be found here.
