More than 1.7 million Americans rely on Share plans, many of which require members to seek charity care before filing a bill, according to a report from the Colorado Department of Health. There was found.
The total number of members may be even higher. State officials collected data from 16 shared plans across the country, but he identified five other plans that didn’t report data.
“These plans are covering more people than we ever knew,” said Joan Volk, co-director of the Center for Health Insurance Reform at Georgetown University.
In this agreement, members who share some religious beliefs usually agree to send monthly money to cover the medical expenses of other members. At least 11 of the shared plans that reported data were operational or advertised plans in all 50 states in 2021.
Sharing plans do not guarantee payment for medical services and are not subject to the same standards and consumer protections as health insurance plans. A shared plan need not cover existing conditions or provide the minimum health benefits required by the Affordable Care Act. And unlike health insurance, a share plan allows you to cap your annual or lifetime payments. A single catastrophic health event can easily exceed your shared plan limits.
Colorado will have at least 67,000 Sharing Plan members in 2021, which translates to about one in four Colorados buying their own health insurance. Kate Harris, chief deputy director of the Colorado Department of Insurance, said she was concerned about the rate and said the agency regularly receives complaints from sharing plan participants.
“What we are hearing from consumers is that despite the disclaimers on many of these organizations’ websites, when they purchase these they are almost always guaranteed some kind of indemnification. I’m thinking about it,” Harris said.
Health-sharing arrangements may require members to seek philanthropic care and assistance from health care providers, governments and consumer advocacy groups before submitting a sharing request, according to a Colorado report. many. Those costs are then transferred to other public or private health insurance plans.
Katie Talent, executive director of the Coalition of Healthcare Sharing Ministries, which represents five of the country’s largest and longest-running sharing plans, said Sharing Ministries will offer its members a He said he encouraged them to act in the same way. Such a requirement for charitable care reflects the desire of members to manage their money properly, Talent said.
“Think of it like a soup kitchen,” she says.
Fourteen shared plans reported that Colorado members filed a cumulative $362 million in medical claims in 2021, of which nearly $132 million were approved. Sharing Plan executives told the department that the rest reflected duplicate bills, ineligible charges, negotiated discounts and members’ agreed portions of medical bills.
“Not all billing items on a healthcare sharing request are eligible for sharing,” Talent said. “They have to submit the bill in its entirety.
However, consumer complaints against consumer assistance programs such as the Department of Health and the Colorado Consumer Health Initiative indicate that members do not always understand the scope of shared plans.
“We’ve seen first-hand the risks people face when they sign up for these agreements without realizing the magnitude of their health care costs,” said Isabel Cruz, the initiative’s policy director. said.
Talent disputed the notion that the members were ignorant of the parameters of the shared plan.
“It just suggests that our members are stupid,” she said. “Is it possible, somehow, that people in our country could jump blindly into something on their own?”
Teresa Brilli, a small business owner in Longmont, Colorado, said she and her partner signed up in 2017 for a direct primary care plan that covers primary care visits for $179 a month. A direct primary care plan is a payment arrangement between a patient and a provider for medical services without making a claim. In an arrangement with Canton, Ohio-based Liberty HealthShare, which has more than 131,000 members nationwide, the plan offers additional services such as preventive testing, emergency room care and hospitalization for $349 per month. It was covered by dollars (deductible amount of 1,000 dollars). In 2020, Brilli said the fee was raised to $499 a month ($1,750 deductible).
But Mr. Brilli said getting paid was a huge hassle.
“It took about four to eight months to get my refund,” she said. “For every bill, it was a battle.”
When she heard that the ACA Marketplace plan would be more subsidized in 2022, she decided the hassle was no longer worth it and switched to the $397/month Kaiser Permanente plan.
“I will never go back to Liberty Health or a shared health plan,” she said. “I couldn’t agree with the whole mission. They made me sign that I believed in God, but it was like, ‘Oh my gosh, that’s what you have to do to get health insurance.’ was.”
Laura Murray, 49, of Aurora, Colorado, said she signed up in 2017 for the Liberty HealthShare plan, a more affordable alternative to her husband’s employer-based plan.
“We felt like we were kind of cutting out middlemen. It was a deal that helped our neighbors,” she said.
However, due to an unexpected pregnancy, she struggled to pay for her medical bills. Initially, Ms. Liberty paid only part of the tab and her bill was sent to a collection agency. It was through multiple phone calls that I learned that I needed to send the bill to a third party negotiating with the provider.
“It took years to resolve the issue,” she said.
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Timothy Bryan, Liberty’s vice president of marketing and communications, disputed many of Brilli’s account details, and attributed some of the payment delays to her “failure to provide the required supporting documentation.” claimed to have He said Murray was more than 10 months late in payments because he failed to give the required advance notice.
Denver resident Mike Quinlan, 42, had about $24,000 in premiums for the same year, plus $17,000 out-of-pocket for the birth of his first child under his employer-sponsored health plan. In 2014, after spending more than a dollar, he turned to medical sharing charity. plan. He said the birth of his three youngest children was fully covered by Samaritan Ministries International, a sharing program of 359,000 members based in Peoria, Illinois, to which he contributes $600 a month. Told. He says he gets a lot of $600 checks from other members when he has a large medical bill.
Every year, Quinlan identifies himself as a Christian and reveals the church he attends.
“This is a group of like-minded people who have voluntarily declared that they will trust each other to cover each other’s medical bills,” he said.
The rules are different for each plan. Some sharing plans require members to pledge to adhere to Christian principles, while others exclude payments for births out of wedlock or health problems caused by drug use. Contraception, mental health services and abortion are excluded from many shared plans, and rape and maternal safety are often no exceptions.
Regulators in Colorado and other states have also expressed concern that health-sharing plans pay brokers much higher fees for membership registration than health insurance plans. That could create an economic incentive to promote shared plans over health insurance without properly educating consumers about the differences.
In 2019, Golden State’s ACA market, Covered California, provided authorized distributors that sell both sharing plans and health insurance to provide consumers with a disclosure list about sharing plans and traditional health insurance. It was obliged to indicate the subsidy received when purchasing. coverage.
“It is very important that consumers understand what these arrangements are and what they are not,” said Jessica Altman, executive director of Covered California.
Harris said the Colorado Department of Health is investigating multiple health-sharing agreements based on consumer complaints, but declined to name them.
Colorado officials are also concerned that health-sharing arrangements may appeal primarily to people who don’t plan to use many health services. This could increase the share of sicker and more expensive patients among those enrolled in traditional health insurance plans, leading to higher premiums.
Harris said many consumers have access to health insurance for less than the cost of sharing plans, especially with increased federal and state subsidies introduced in recent years. State officials are also trying to educate consumers about the financial risks associated with the recently bankrupt health care sharing system.
“If you look at it month by month, it might look cheap,” Harris said. “But there is a real risk that if costs are actually required, they may not be covered.”
2023 KFF Health News.
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