The medical expenses of Health share groups can be divided into two broad categories: eligible and ineligible segments. Eligible medical expenses are shared with members of the community, and ineligible expenses are the responsibility of the members themselves. Now, which medical expenses are considered ineligible can differ for each health-sharing plan. Expenses are considered ineligible depending on the associated conditions, services, and treatments, the amount of money already shared, how long a member has been with the community, and whether they are subject to co-sharing. Some costs that healthcare members should pay are discussed in this post.
Monthly Contributions
These are the fees that health sharing plan members have to pay to be a part of the community. These are monthly contributions that are used to share the medical expenses of the community and pay for the administrative costs of the health share organization. In case a member fails to pay their monthly contribution in a timely manner, their medical expenses will become ineligible for sharing.
Personal Responsibility
This is the amount a member should pay toward an eligible medical need before it becomes eligible for sharing. Personal responsibility is known as the unshareable amount or IUA, or member responsibility amount, depending on the health share. The more expensive the membership, the lower the personal responsibility amount will be. The needs will also be shareable with the community sooner.
Though health share memberships with high personal responsibility amounts appear affordable initially, a high personal responsibility amount could be more of a burden than paying a higher monthly contribution for a lower personal responsibility amount. These amounts may also be higher than that officially advertised. The amount is often associated with a membership for certain medical needs. For instance, maternity care has different personal responsibility amounts that should be met before the maternity need in order to be eligible for sharing.
You should also know that some health share plans limit how many personal responsibilities a member should pay in a year. If many members are participating in the same membership, it may not be practical to pay associated personal responsibility amounts for various medical needs. Some health share organizations limit their initial unshareable amounts to a certain limit, while some others require the members to continue to pay personal responsibility amounts.
Hence, it is suggested that members weigh the monthly cost of a membership with the associated personal responsibility amount and the policy towards personal responsibility amount limits. This will help them see what fits their budget and also fulfill their healthcare needs.
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Co-Share
Some health sharing plans offer members options with co-sharing. It is the percentage of eligible medical expenses members pay even after their personal responsibility amount has been met. Memberships with co-sharing usually have cheaper monthly contributions. Although co-share memberships may seem affordable, they may not be a good deal, and this depends on the medical circumstances of the member.
Costs Beyond Sharing Limits
Remember that not all sharing is unlimited. Hence, even after meeting the personal responsibility amount, some health share organizations put sharing limits on the shareable amount. These limits can come in different forms, such as annual, per incident, and lifetime. These limits are often placed on medical expenses related to certain conditions, forms of treatment, or medical services.
The most common per-incident limits are related to preventative and maternity care and pre existing conditions. The per-incident sharing limit may increase depending on the medical need in question and for how long a member has been with the health share, especially when it comes to preexisting conditions.
Annual limits apply to all sharing for any membership throughout the year. Medical expenses that exceed the annual limit are not eligible for sharing, which means that the member will once again be able to share the eligible expenses. Annual limits differ between various membership options offered by the same Healthshare organization. Some health sharing plans do not have any annual limits on sharing.
Lifetime limits do not reset at the end of the year. Once the sharing has exceeded their lifetime limit, they will no longer be able to share their eligible medical expenses with the health-sharing community.
Ineligible Medical Expenses
There are certain medical expenses related to specific medical conditions, services and treatments that are not eligible for sharing. These may include procedures like birth control, fertility treatments, cosmetic surgery, and medical expenses related to preexisting conditions during the first year of membership.
What each health share organization considers ineligible for sharing depends on the type of organization. These ineligible expenses exist due to ethical or religious reasons for the community and also to prevent the members from having to raise monthly contribution amounts in order to be shareable.
Bottom Line
Health sharing plans are affordable and are an effective part of healthcare expenses. But members should know about what their health share plans provide and what they don’t. Sharing limits, waiting periods, and personal responsibility amounts should be considered when choosing a health share plan.
Disclaimer: MPB.Health memberships are a non-insurance solution designed to provide access to healthcare services. To determine if this aligns with your specific needs, we recommend consulting a certified expert advisor.
