Health Care Sharing Ministries
Over the years, I’ve had a few clients cancel their health insurance because they decided, over my objections, to join a health care sharing ministry. Health care sharing ministries are charities, usually religious-based, to whom people pay money each month to help cover each other’s medical expenses. This sounds like a classic risk retention group, a type of insurance entity, but health care sharing ministries are not considered insurance companies and the coverage they provide is not considered health insurance because they do not meet all the requirements of health insurance stipulated by the Affordable Care Act.
California exempts health care sharing ministry participants from the state penalty for not having health insurance, which has caused participation to jump significantly as people look for alternatives to their monthly health insurance premiums. This particularly applies to higher-income individuals who don’t receive large premium tax credits under the Affordable Care Act to lower their premiums. But California’s penalty exemption does not exempt health care sharing ministry participants from the inviolable rule that you get what you pay for. A 2023 KFF Health News article sums it up very well:
Sharing plans do not guarantee payment for health services and are not held to the same standards and consumer protections as health insurance plans. Sharing plans are not required to cover preexisting conditions or provide the minimum health benefits mandated by the Affordable Care Act. And unlike health insurance, sharing plans can place annual or lifetime caps on payments. A single catastrophic health event can easily exceed a sharing plan’s limits.
A 2020 New York Times article explains how sharing plans are largely unregulated, citing many examples of people whose health care bills were not reimbursed. And if you think that somehow doesn’t apply to us here in El Dorado County, you’re mistaken: In November, one of my clients who dropped their health insurance for a health care sharing ministry called me to switch back after the ministry didn’t cover their hospital stay, leaving them with a $50,000 bill to pay. That was a very expensive lesson for them.
Here is a comparison of the health care sharing ministry plan of one of my life insurance clients, versus what they could get through Covered California for their family of six without having to change their doctor:
Health Care Sharing Ministry | Covered California Bronze HDHP Plan | |
---|---|---|
Monthly Cost | $595 | $750 |
Deductible | $500 per visit | $7,050 per year |
Tax Deductible† | no | yes |
Free Preventative Care | no | yes |
Free Dental and Vision Care for Children | no | yes |
Lifetime Cap On Benefits | yes | no |
Can Fund HSA for Additional Tax Savings | no | yes |
This client and their family left Covered California in 2019, before Congress eliminated the subsidy cliff for high income households in 2021. Even with a nice six figure income, they would have been eligible for advanced premium tax credits that reduced their monthly premium cost to below what they were paying for their health care sharing ministry—plus their premium payments would now be tax-deductible because they were self-employed. Unfortunately, while the client’s spouse is self-employed, the client’s employer offered them coverage that is considered affordable under the Affordable Care Act (less than 8.39% of adjusted gross income for 2024), making them ineligible for advanced premium tax credits even though they opted out of their employer’s plan.
I was going to switch this family our of their health care sharing ministry, giving them superior coverage and saving them thousands of dollars on their taxes, because Covered California decided to extend open enrollment until . While it didn’t work out for them, if you haven’t signed up for health coverage yet and would rather not wait until next year to get it, you only have two more weeks before the Covered California extra time
window runs out. Call us now!