Caveat emptor. It’s a Latin phrase that basically means “Buyer Beware.” If something appears too good to be true, most the time it is.
In recent years since the passing of the Affordable Care Act (“ACA”), there has been significant growth in non-profit health cost sharing ministries. These plans were excluded from ACA regulations and allowed individuals to escape ACA penalties. Some are even sold as group health plans, and are sold as having much lower cost than traditional insurance. And they have some GREAT marketing.
The above article is one good reason why we strongly recommend against such plans. While this particular group allegedly was doing bad things with their members’ hard-earned dollars, even those ministries that are acting in good faith have fundamental flaws (in our opinion), and could lead to potential major problems for you. Here’s why we don’t sell or represent these plans, despite numerous opportunities to do so:
· These plans are essentially unregulated. Even if you don’t like excessive regulations as a rule, insurance company regulation should be an exception because it ensures that in insurance company has enough money to pay claims. Health sharing ministries have no solvency regulation, and therefore don’t need to keep any money in reserves, and may or may not have enough money to pay your claim.
· Since they are exempt from regulation, there is no regulatory agency to appeal to if your claim isn’t paid. With insurance, you can appeal to the state insurance department. If the health sharing ministry denies your claim, and denies your appeal, who can you appeal to from there? I’m no fan of health insurance companies sometimes, but at least you can appeal to the insurance department if they make a blatantly bad decision.
· Depending on the plan, you might have to try to negotiate with the providers yourself. I can tell you from professional experience, good luck with that. If you are not in a standard PPO network, many providers will not do much negotiating after the fact. The plan might only reimburse a small amount of the claim, if any, and you might be stuck with the rest.
You normally get what you pay for. While none of us are happy about the cost of health insurance and are always looking for ways to lower those costs, we strongly recommend against putting your trust in unregulated health sharing ministries.
Give us a call and we can help you navigate the complicated world of health plans! 913-722-2111 in the greater KC metro, and 573-817-3455 in Central Missouri, or firstname.lastname@example.org.