Medical Cost Sharing Plans: What You Need to Know

Finding that traditional health insurance costs too much for you? Tired of paying for benefits that you don’t use or believe in? It may be time to consider a Medical Cost Sharing Plan instead.

Medical cost sharing plans, also known as health sharing plans, are a viable alternative to traditional health insurance. These plans allow individuals and families to share medical expenses among a community of like-minded individuals who have similar beliefs and values. These plans have gained popularity due to their affordability and flexibility.

In a healthcare cost sharing plan, members contribute a monthly “share” instead of paying a premium. These shares are then used to cover the medical expenses of the members within the community.

When a member incurs a medical expense, they submit a claim to the plan administrator. The administrator reviews the claim and verifies its eligibility based on the plan guidelines. Once approved, the eligible expense is shared among the members. Each member’s share is allocated to cover the expense, ensuring a fair distribution of costs. This sharing process reflects the principle of community support and solidarity within health cost sharing plans.

There are a number of key benefits to Medical Sharing Plans which is why more people are choosing them than ever before.

1. Affordability: Cost sharing plans often have lower monthly costs compared to traditional health insurance premiums, making them an attractive option for individuals and families on a budget. They also appeal to people with a higher income that don’t receive any tax breaks on traditional health insurance and find the premiums too high for the benefits they use.
2. Flexibility: Unlike traditional health insurance plans, health cost sharing plans are not bound by strict networks or provider restrictions. Members have the freedom to choose their healthcare providers and facilities.
3. Shared Responsibility: With medical cost sharing plans, the financial burden is shared among the members of the community. This promotes a sense of solidarity and community support.
4. Exemption from ACA Penalties: Members of recognized health cost sharing plans are exempt from penalties associated with the individual mandate of the Affordable Care Act (ACA).

Health cost sharing plans typically cover a wide range of healthcare services, aiming to provide comprehensive coverage to their members. While specific coverage may vary among different plans, they generally include essential medical expenses, preventive care, hospital stays, and certain specialist consultations.

• Essential Medical Expenses: Health cost sharing plans typically cover essential medical expenses, which may include doctor visits, emergency room care, surgeries, and diagnostic tests. Prescription medications, both generic and brand-name, are often included as well. However, coverage for pre-existing conditions may vary, and some plans may have limitations or waiting periods for such conditions.
• Preventive Care and Wellness: These plans recognize the importance of preventive care and wellness, and most include coverage for preventive services. These services may encompass routine check-ups, vaccinations, screenings, and preventive tests. By promoting preventative measures, these plans aim to maintain and improve the overall health of their members while reducing the need for more costly treatments in the future. Such coverage encourages a proactive approach to healthcare and emphasizes the importance of early detection and prevention.
• Hospital Stays and Surgical Procedures: Health cost sharing plans typically cover hospital stays, whether they are for emergencies or planned surgeries. Coverage may include room charges, operating room fees, nursing care, and anesthesia. However, it’s essential to review the plan’s guidelines regarding coverage limits, co-payments, and any specific requirements for prior authorization or notification.
• Specialist Consultations: Many health cost sharing plans provide coverage for specialist consultations, allowing members to seek expert care for specific medical conditions. This may include consultations with specialists such as cardiologists, dermatologists, neurologists, or orthopedic surgeons. However, similar to other services, coverage for specialist consultations may have certain limitations or requirements, so it’s important to consult the plan guidelines for specific details.

One of the benefits of health cost sharing plans is that everyone is eligible at any time. So you can switch to one of these plans at any time.

Medical sharing plans typically have specific membership requirements that individuals must meet to be eligible. While requirements may vary among different plans, some common criteria include adherence to certain lifestyle choices, such as abstaining from tobacco and illegal drug use. Most plans require members to share a common set of values or beliefs.

Some but not all plans are operated by religious organizations or health sharing ministries that require members to share a common religious affiliation or faith. These plans may have specific requirements related to religious beliefs or participation in religious activities.

While medical cost sharing plans offer many benefits, it’s important to understand their eligibility requirements and limitations. Typically, these plans require members to adhere to certain guidelines, such as abstaining from tobacco and illegal drug use. Additionally, some pre-existing conditions may have limited coverage or waiting periods. These are designed to make sure the community as a whole is supporting each other in the same way.