How Do Medical Share Programs Work?
Everyone needs medical attention from time to time, but these services are expensive. Rather than depending on a traditional health insurance plan to cover the costs of these services, members of a medical cost-sharing program can rely on other members to share the cost of eligible medical expenses when the need arises.
At the same time, members contribute to the program so that others who incur eligible medical expenses can access member-to-member sharing to share the cost.
Health share programs serve as a financial connecting point between plan members and the medical professionals and services they require. All funds are voluntarily contributed to these programs by each member, and the contributions are pooled and managed to pay for members’ eligible medical expenses, which would typically include routine doctor visits and a variety of diagnostics and procedures.
Because medical costs are shared with other like-minded individuals, members who participate in these unique programs are able to keep their monthly contribution amounts and expenses lower, compared to the rising prices of health insurance premiums.
To participate in a medical share program, members must meet certain requirements, such as maintaining a healthy lifestyle, avoiding risky behaviors, and understanding that they will be joining others who share the same beliefs, particularly when it comes to faith-based health share programs.
Once accepted, members will select a specific program and voluntarily contribute a set monthly amount based on the program level chosen. These funds will be accessible to other members who meet the necessary criteria to be a part of the medical sharing program when the need to submit an eligible medical expense arises. There are various programs from which to choose within a medical sharing program.
“It is more blessed to give than to receive.” (Acts 20:35)
What Is Faith-Based Medical Sharing?
Faith-based medical sharing is an alternative to traditional health care. Medical sharing ministries provide faith-based medical bill sharing programs to members who share similar religious beliefs. These ministries are designed to help families share the cost of medical services with others that share the same faith.
Medical Sharing Vs. Health Insurance
While both medical health sharing programs and traditional insurance plans may be designed to provide financial coverage of medical service, they are not the same.
Medical sharing programs are non-profit organizations that are designed to help members share the cost of medical services by using contributed funds from other members. Further, medical sharing programs are not mandated by the Affordable Care Act (ACA), unlike insurance plans. Because medical share programs can be selective about membership eligibility, these programs can often keep health costs low for the entire membership in a way that is simply not possible with traditional health insurance.
The following table outlines some of the differences between medical sharing programs and ACA-mandated insurance plans:
Health Insurance Plans | Medical Health Sharing Programs |
For-profit | Non-profit |
ACA policies mandate that all individuals with pre-existing medical conditions must be accepted. | ACA policies do not mandate medical health sharing programs. Eligibility for program acceptance is based on the specific medical sharing programs standards. |
ACA policies mandate that all individuals with all lifestyle choices must be accepted. | Members must share the common belief system of the organization and maintain certain lifestyle choices that comply with those beliefs. |
Insurance companies guarantee coverage of specific medical services and procedures, amounts paid out, and what policyholders pay according to their specific plan. | Medical sharing programs make no guarantees regarding sharing of specific medical services and procedures. Payment eligibility is dependent on the specific medical sharing program’s guidelines. |
Signed contract provisions dictate how claims are processed. | Providers submit billing to UHSM on behalf of members and eligible medical expenses are submitted to members for sharing. Members do not have to submit requests or reimbursement requests. |
Explanation of Benefits (EOB) is provided to policyholders when claims are processed. | Explanation of Share (EOS) is provided to members when Share Requests are processed. |
Who Uses Medical Share Programs?
UHSM is a selective program, and not everyone will be accepted. Those who wish to become a member must meet certain requirements. To qualify to become a part of a Christian healthcare program, members must:
Individuals with no chronic pre-existing health conditions. Most medical sharing programs require that members do not have any pre-existing medical conditions. Those who are in good overall health are better suited for medical sharing programs.
Individuals who maintain a healthy lifestyle. Those who avoid potentially hazardous practices, such as tobacco use, smoking or excessive consumption of alcohol, may be eligible for participation in a medical sharing program.
Individuals who share the same faith and beliefs as other members of the medical sharing organization. Medical sharing programs are designed to serve those who share the same religious beliefs, providing members with the opportunity to be part of a group of other like-minded individuals.
Individuals looking for a more affordable alternative to traditional insurance plans. ACA-mandated insurance plans tend to be quite expensive, leaving many Americans unable to afford these policies. Medical sharing programs offer a much more cost-effective option to health care coverage, allowing members to save as much as half – or more – of what a typical insurance policy would cost.
Individuals looking to help their fellow members. The Bible teaches the importance of helping others. Medical sharing programs offer the chance to be a part of an environment where each member does their part to help others financially. As is stated in Proverbs 19:17: “If you help the poor, you are lending to the Lord and he will repay you.”
Individuals approaching or preparing for retirement who will be ineligible for their employers’ health care benefits. Those who are between the ages of 50 and 64 years of age and are nearing retirement before becoming eligible for Medicare may find medical sharing programs useful in bridging the gap between the coverage received through employment and Medicare.
Self-employed individuals, freelancers, and contractors. Those who do not have insurable employment will not be able to take advantage of employer insurance plans. These individuals may choose medical sharing programs as an affordable option.
Small business owners who need to provide healthcare coverage to staff. Businesses with a handful of employees may offer a medical sharing program to employees as an alternative to a health insurance plan.
Individuals who are ineligible for subsidies with ACA-backed plans. Those with incomes that exceed the federal poverty level will not be eligible for subsidies, even though they may not be able to afford traditional health insurance plans. In these situations, a medical sharing program may be a more accessible and affordable option.
Why Use Medical Share Programs?
An increasing number of Americans are turning to medical sharing programs as an alternative way to secure healthcare benefits, and there are several reasons why:
Save money
Medical sharing programs are much more affordable and attainable for Americans who are unable to afford the exorbitant prices of traditional health insurance policies. Members can save as much as 50 percent or more compared to health insurance plans.
Budget-friendly
Members of medical sharing programs can choose the plan that fits their budget.
Discounts for cash payments
Members are able to benefit from major discounts on medical services from health care providers who consider medical sharing plan members as “cash-pay” patients.
Medical sharing programs can be customized
There are several different program levels available to medical sharing program members that can meet their needs.
Flexibility in choosing medical professionals
Members of medical sharing programs have the freedom to select the specific type of physician or specialist that they want to see.
Chance to help out other believers
Bible-following members are given the opportunity to be a part of something that helps others who share the same faith, just as the Bible commands.
Medical Cost Sharing Program Overviews
UHSM offers members various program levels to best fit their budgets and suit their particular needs. The following is a brief rundown of some of the more popular programs offered by UHSM.
Service | Gold | Vital | Fundamental |
Annual Member Care Share (AMCS) | $5,000 | $10,000 | $10,000 |
Annual Member Care Share Maximum | $7,500 | $12,500 | $10,000 |
Annual Wellness & Preventive Care | $0 Consult Fee | $0 Consult Fee | $0 Consult Fee 60-day waiting period from effective membership date |
Primary Care Physician Visits | $35 Consult Fee | $20 Consult Fee | Not available |
Specialist Visits | $60 Consult Fee | $40 Consult Fee | Not available |
Telemedicine | $0 Consult Fee | $0 Consult Fee | $0 Consult Fee |
Urgent Care Visits | $60 Fee | $40 Fee | $100 Fee |
Maternity Care - Physician Visits | $60 Consult Fee | $40 Consult Fee | Not available |
Maternity Care - Delivery Services | 100% after AMCS | 100% after AMCS | Not available |
Inpatient Facility Services | 100% after AMCS | 100% after AMCS | 100% after AMCS |
Outpatient Facility Services: Ambulatory Surgery Outpatient Hospital Department: Surgery | 100% after AMCS | 100% after AMCS | 100% after AMCS |
Pharmacy Services | Additional Annual Care Share of $250 | Not available | Not available |
X-Rays, Imagine, Laboratory and Pathology Services | 100% after AMCS | 100% after AMCS | 100% after AMCS |
Physical, Occupational, and Speech Therapy | 100% after AMCS 10 visit Share Maximum for all therapies combined | 100% after AMCS 10 visit Share Maximum for all therapies combined | 100% after AMCS 10 visit Share Maximum for all therapies combined |
Durable Medical Equipment | 100% after AMCS | 100% after AMCS | Not available |
ER Visits | 100% after AMCS | 100% after AMCS | 100% after AMCS |
Ambulance Services | 100% after ACMS | 100% after ACMS | 100% after ACMS |
UHSM Is Here for You
Health care doesn’t have to be financially out of reach or overly complex. If you are looking for a more affordable and flexible choice to health insurance designed specifically for people of faith, we encourage you to get in touch with UHSM to discuss your particular health care needs and requirements.
