One major drawback of traditional health insurance is the frequency with which policyholders are penalized for receiving care out of state. This can include limitations on visiting top specialists or having to pay out of pocket for emergency care while traveling. HealthShares, on the other hand, often have an advantage over health insurance in this regard, as they typically have fewer location restrictions.
Out of state care with health insurance
Out-of-state care with health insurance varies depending on the plan. Some people have access to extensive insurance plans with a large, national provider network, often provided by an employer. These comprehensive insurance plans typically do not have limitations on seeing providers out-of-state, but such broad-reaching plans are rare and more expensive. More commonly, people find themselves in smaller employer-provided plans, or even smaller individual plans. These smaller memberships are usually more affordable, but the affordability comes at the cost of less-extensive coverage or a smaller provider network. More affordable insurance plans may be run by companies only operating in one or two states, making out-of-state care challenging due to logistics and costs. As a result, requests to go out-of-network are frequently denied.
There are exceptions, of course. Insurers may approve out-of-network requests if no local providers are capable of treating a specific medical problem. In general, insurance policyholders are safest assuming that going out-of-state also means going out-of-network, which can result in insurance paying less, or nothing at all, for those costs.
How out of state care works with Health Shares
Out-of-state care with HealthShares varies depending on the organization. Most large HealthShares no longer use provider networks. The few that do often use PHCS/Multiplan, one of the largest networks in the United States. The usefulness of the PHCS network depends on the number of contracted providers in a given area, as some regions have significantly more providers than others.
For HealthShares without a provider network, the organization is simpler. These open-network HealthShares still have some requirements, but these are generally easy to meet:
- The provider/facility must be fully qualified and licensed.
- Treatments must be medically appropriate and FDA approved.*
*Occasionally, HealthShares may consider sharing costs for alternative or experimental treatments, but evidence of the treatment’s benefits is typically required.
This flexible structure makes HealthShare membership an attractive option for people who may benefit from out-of-state care. Although HealthShares limit which bills are eligible for sharing, particularly those related to pre-existing conditions, membership might still be advantageous. For example, many cost-sharing ministries begin sharing for pre-existing conditions after a waiting period. An individual with a long-term condition seeking specialists in another state could potentially do so after the waiting period.
Flexible provider requirements mean that members may extend their reach beyond out-of-state care—they can use their HealthShare anywhere in the world!
Traveling with HealthShares
If a member is traveling out of the country, determining if a provider in a foreign country is properly certified can be challenging, especially when unfamiliar with the local language. Nearly all HealthShares require members to submit itemized bills after an incident to decide if the cost is shareable. In a place that does not speak, or produce receipts in, English asking for and getting these could be a huge challenge.
The other thing to remember about HealthShare memberships is that not all medical costs are shareable. Generally, low-cost services (such as checkups or immunizations) can’t be shared. Costs related to high-risk activities, such as skydiving, are never shareable.
Ultimately, individual needs should dictate decision-making. If healthcare access away from home is crucial and immediate assistance with restricted costs is not a priority, HealthShares could be a viable option.