Understanding Costs Part 1: HealthShare Member Responsibility

What is member responsibility?

If you are shopping for a HealthShare, your biggest question probably lives in the neighborhood of, “How much?” Or, more specifically, “How much money will be coming out of my own pocket?”

Prospective HealthShare members tend to focus on monthly contributions—or what they will pay as a monthly due for their membership in the sharing community. This is understandable, since many soon-to-be members are shopping for a HealthShare in an effort to reduce their monthly expenditures. However, member responsibility is a critical number to look at before signing up, perhaps more critical than your monthly payment amount.

You are responsible for your healthcare costs

Member responsibility, which may range anywhere from $500–$15,000, can show up under different labels, but all they all mean essentially the same thing: you will be responsible for some part of your medical expenses, paid upfront, before the sharing community will begin to pitch in. No matter what your future, or current, HealthShare calls it, you will have to dig a little deeper to find out exactly what your responsibility will entail.

So just what labels or terms should you be on the lookout for? Some of the names that “member responsibility” goes by are: Annual Unshared Amount (AUA), Annual Household Portion (AHP), Initial Unshareable Amount (IUA), Member Responsibility Shared Amount (MRSA), Personal Responsibility Amount Yearly (PRAY), or more straightforward terms like Personal Responsibility (PR) and Unshared Amount (UA).

The terms by themselves are bound to create some questions as you try and determine what you will be accountable for when confronted with healthcare costs. However, don’t let the variety of terms mentioned above worry you, they all relate to personal responsibility and there are clues in each term to help you understand what you will be responsible for.

Per year or per need responsibility

If the word “annual” is a part of the term your HealthShare uses to describe your personal responsibility amount, then it will be an amount that you are responsible for each year—whether that be a calendar year or a membership year. Other terms may simply indicate an “unshared” or “unshareable” amount without specifying “annual.” In these cases, the personal responsibility may still be for a 12-month period. On the other hand, if “annual” is not in the term, it may suggest a per need or per incident amount. If the available personal responsibility options are on the lower end of the spectrum—say $500—it is very likely that this is a per need or per incident responsibility amount.

Co-shares and maximum unshareable amounts

Two other terms you may come across, are coshare and maximum unshareable amount. This is where things can get a little tricky. A coshare may be offered as a part of a membership that will not share in 100% of your expenses after you fulfill your member responsibility, but instead will share in only a portion of your expenses. In this case, you will have something like an annual unshared amount, say $2000 for example, and after that you will pay for 20% of your medical expenses—the sharing community thus shares the remaining 80%. Currently, this type of structure is less prevalent among HealthShares, but if you are looking into a HealthShare that is set up this way, you will find that there is some kind of maximum amount that you will be responsible for in the year. Going with the example above, your annual maximum personal responsibility might be around $5000.

Reduced sharing and maximum member responsibility

Meeting your member responsibility amount does not necessarily mean that you will no longer be responsible for your costs. Depending on your HealthShare, some of your expenses may be shared at 100% after your initial responsibility amount, while other expenses may only be shared at 60%. Each HealthShare is set up differently and not all are as straightforward as the homepage of their website may make it seem.

So, what do you do? A good thing to look for is a HealthShare that has some kind of limit on what you as a member will be responsible for. This may come in the form of an annual out of pocket maximum, or a maximum number of per need member responsibility amounts you will have to pay. For example, Zion Health will only hold you responsible for three Initial Unshareable Amounts (IUA) in a 12-month period, and Samaritan Ministries sets a maximum unshared amount of $2,500–$10,000 for their members on the Samaritan Given program.

You may pay more than your member responsibility amount

No matter what your monthly contribution and member responsibility are, these alone will not tell you how much you will end up paying out of your own pocket for your healthcare. Depending on your situation, you may still pay for medical expenses that will not be shared at all by your HealthShare community. These expenses generally do not count toward your member responsibility amount. When reading through member guidelines and program descriptions, look for sharing outlines that are best suited to your particular needs.

A determining factor

Whatever you do, when shopping for a HealthShare do not merely focus on your monthly contribution, or your monthly dues. Your member responsibility, max unshareable amount, coshare, and other responsibility amounts play a huge role in your overall costs. Ultimately, member responsibility may be the determining factor in your HealthShare selection. Pay close attention when you are doing your research, and make sure you choose a program that will share what is most critical to you and your budget.

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