This could be a really short post because really the answer is: because Samaritan Ministries health care sharing works so much better for our family and we save so much money (especially because we use natural remedies and don’t run to the doctor for minor stuff). For our family, the combination of healthshare and concierge medicine has made a huge difference for our finances and the quality of care we receive.
I mentioned this in a recent podcast episode and was bombarded with questions, so I’m sharing our experience here.
If you’re reading this, I’m guessing you may be trying to decide if a healthshare program like Samaritan could be a good fit for you or your family, and you may have a few more specific questions. I’ll try to answer all of the questions I had when researching health care sharing in the rest of this post. If I miss something, let me know in the comments below so I can add it!
If you do decide to try out Samaritan Ministries, please let them know that Katie Wells/Wellness Mama sent you!
What Is Health Care Sharing or Healthshare?
A healthshare or health care sharing program is a system that allows members to help each other directly when there is a medical need. Instead of paying premiums to an insurance company each month, members send money to each other. There are several well-established health care sharing ministry options and all are permissible under the Affordable Care Act.
In this post, I’ll be specifically talking about Samaritan Ministries, because that is the program our family uses and I do not have any direct experience with others. We chose Samaritan for the simple pricing structure, ability to choose our own providers, and inclusion of natural and alternative treatments when approved.
To be clear: health care sharing ministries are NOT insurance and don’t work the same way. In my opinion, they are better, but they are different and it is important to understand the ins and outs before deciding to switch.
I did months and months of research before making a decision. These were the factors that I weighed in my decision:
Benefits of Health Care Sharing
Having now been a member of Samaritan Ministries for over 5 years, it is easy to see all of the benefits we’ve received from being members.
Lower Cost Than Private Insurance
My husband and I are both self-employed. This means we get to work 80 hours a week for the toughest bosses in the world (us) instead of commuting to a job…
All jokes aside, we’re so grateful to be entrepreneurs and to do fulfilling work that we love and that we feel makes a positive difference in the world.
But the insurance system isn’t really designed for “weird” cases like us (even though many families are pursuing entrepreneurial options these days). When we first started our business, we used the most affordable private insurance option we could find. It still cost well over $1,000/month for our family and had a super high deductible ($5,000 individual/10,000 family).
On top of that, we still had to pay 20% after we met the deductible. Plus, we were stuck in networks and often couldn’t work with providers we liked.
Not a lot of pluses there.
I’ll explain more on the specifics below, but now with Samaritan Ministries we pay under $500/mo for our whole family and when we have (rarely) needed it. When we have, our medical events have been completely covered.
We Choose Providers
The “network” aspect of many traditional insurance programs was always frustrating for me. When my first child was born, I couldn’t work with any of the doctors or midwives I really liked because they weren’t in our approved network. We had to go to certain doctors and hospitals and it was often really confusing to figure out which one.
In contrast, with healthshare like Samaritan Ministries, we get to choose the providers and the places we go when we have a medical need. (There are some differences with other healthshare ministries so make sure to read the fine print carefully for any program you are considering!).
Since I know many amazing doctors and practitioners that are out of state, we also have the freedom to work with specialists who can truly address a problem rather than be stuck in a network.
Alternative Methods When Approved
Our family chooses to be very proactive in preventative care and natural remedies. This means that we don’t run to the doctor for every illness, bump, or bruise (though we certainly do for anything big or life-threatening, of course!)
We don’t visit a doctor or hospital often, and many times choose to work with doctors who use alternative methods. With traditional insurance, these options would almost never be covered and we’d be coming out of pocket for all of the cost.
With Samaritan, as long as the treatments are suggested by a doctor and receive approval, we are able to use them.
Homebirth and Midwives Are Covered
My first four babies were born in hospitals. My last two were born at home and while I would not trade any of my birth experiences, there is no comparison between the ease of my labors, my recovery, and how happy my babies were when I gave birth at home. It isn’t the right option for every mom, but it was for me.
Traditional insurance rarely covers midwives or home births. For this reason, this option wasn’t on the table financially for us with our first few children. Surprisingly, the cost of births has been drastically different (and better) with health care sharing vs insurance. Here’s what I mean:
- First and second births: Born in hospital. Paid $825/mo for insurance with maternity rider through work at the time. Also paid $3,000 deductible and 20% of remaining cost. Total cost was just over $6,000, not including the cost of the monthly premiums. The second birth was about $500 less than my first, but only because I didn’t show up to the hospital until almost pushing so there was less to bill for, no IV fluids, etc.
- Third birth: Total cost was about $15,000 because of an emergency c-section.
- Fourth birth: Switched to Samaritan Ministries before this birth. Had the baby in a hospital with midwives because I got to pick my provider. Had a successful and wonderful v-bac. Negotiated “self-pay” discount and pre-paid using the money we saved. Submitted to Samaritan and was reimbursed for the total cost (more on how that works below). The total cost of birth was $0.
- Fifth and sixth births: Still with Samaritan. Chose homebirth midwives who offered pre-pay discounts. Submitted to Samaritan, received money from other member shares and paid midwives before the birth. Due to v-bac/home birth option, we paid $0 out of pocket by the end.
We Actually Help Someone Each Month
This is perhaps my favorite part. Sure, I love saving money and getting to pick providers, but our family also really loves feeling like we are directly helping someone each month. With Samaritan, each month we receive the name and address of a person with a medical need. We send our share (payment) for the month directly to that person, usually along with some hand-drawn cards from the kids.
When we’ve submitted needs (bills) in the past, it was incredible to see this from the other side. Each time we had a baby, we got shares in the mail from other members along with cards and notes of congratulations for the new addition. When my husband’s appendix ruptured, we got shares and dozens of get-well cards (read that story below).
I don’t have personal experience with other programs, but from my understanding, only with Samaritan do members send payments directly to each other each month. With the others, the money goes to the organization and is redistributed. All of them technically meet the guidelines for the Affordable Care Act, but Samaritan seemed the most airtight to me since no money goes directly to the company. Do your own research on this for sure though!
Friends Loved It Already
In our own decision making, it was helpful that we had friends who already used Samaritan and loved it. (I’d also heard from friends who had tried the other three big programs and had bad experiences.) This is also why I’m sharing our experience and decision with you today. Health care sharing has been such an amazing option for us, but I wouldn’t have considered it without hearing from trusted friends how it had worked for them.
This isn’t to say anything negative about other options other than what my friends have said, and again I don’t have any personal experience with them. I just know that for us, Samaritan has been a great option and we’ve never had any problems.
On the other hand, we also don’t run to the doctor unless we need to and work hard to stay healthy, which probably factors into our overall experience.
Downsides of Healthshare Ministries
As I said, I absolutely believe this option is the best for our family, but there are some important caveats to understand that could be a downside for some families. With any ministry or program, please make sure to read all of the fine print, call and ask questions and make sure you really understand it before switching. The full Samaritan Ministries guidelines are available here.
There are some rules on pre-existing conditions and if/how they can be shared. Make sure to read the guidelines to understand especially if you have a specific condition. In most cases, a pre-existing condition cannot be shared. There are exceptions though after certain amounts of time and after meeting certain conditions.
There are also some rules and exceptions relating to certain fertility treatments and other conditions…. so read the rules. Healthcare sharing may not be the best option for a person or family with pre-existing conditions, especially serious ones.
Healthcare sharing ministries are not insurance and are not considered to be by the medical community. I actually view this as a benefit, not a downside, but there are some important things to know. Since a doctor or hospital will view healthshare members as “self-pay” it is sometimes possible to negotiate a discount. Often, these discounts are bigger if a person can pay the day the service is provided. This saves the provider/hospital a lot of money and hassle of filing with insurance so they benefit as well.
Our family keeps a separate checking account (and a credit card) for times when we have a medical need. Then, we negotiate a self-pay discount if we can, and often an additional discount for paying immediately. We submit the need and copies of the bills to Samaritan Ministries and members reimburse us.
For us, this feels like a benefit, but it does require a lot of saving up and planning ahead.
With Samaritan Ministries, the maximum payout is $250,000 for a single event (or more if you also enroll in Save to Share, which we do). There’s a lot of other details related to this and some healthshare ministries do cover unlimited amounts but also cost more. Definitely do your research here.
Motorcycle Accidents, DUIs
This has never been an issue for us, since we don’t even have a motorcycle, but motorcycle accidents are not considered a shareable need (covered need) by Samaritan Ministries (or most healthshare organizations). This is because they consider this an avoidable risk. For the same reason, any accidents that occur under the influence of alcohol or drugs are not covered. Nor are any conditions relating to alcohol or drug use/abuse.
Only Available to Christians
The four big healthshare ministries are Christian by nature and only available to Christians. To join, a person or family must sign to verify they agree with certain principals. This is part of keeping the cost low and also means that certain things that conflict with Christian guidelines are not covered.
There are new organizations, like Knew Health, that are creating healthshare platforms that are not faith dependent and that focus more on the health side.
Not Usually Covered by Employer
Another potential downside is that health care sharing ministries are not often covered by traditional employers. Many companies provide insurance but don’t give healthcare sharing as an option. That said, I have heard of cases where people were able to negotiate for their company to increase their salary to cover a healthshare membership because it was cheaper for the company, but there is no guarantee of this.
For anyone whose employer already provides amazing insurance, healthshare like Samaritan Ministries may not be the best fit because it does require coming out of pocket. For entrepreneurs, musicians, or those who have to purchase insurance privately, it can be a great option.
What Is the Cost of a Healthshare Ministry?
This is a slightly more complicated question that you’d think. The “share” (monthly price) is easy to determine and it varies based on the company and network. Samaritan Ministries is, at most, $495/month currently, no matter how big the family size.
But the “cost” comparison goes far beyond just the monthly price. Compared to our last insurance plan (over $1,000/mo), Samaritan is a tremendous savings (over 50%). But the savings extend beyond monthly price.
Insurance often has deductibles that are also required. Samaritan Ministries members pay the first $300 of any medical need they submit and any needs under $300 can’t be submitted. But, and this is important, this $300 is waived if a member is able to negotiate that amount or more in discounts.
As an example, the midwife for one of my births charged around $5,000 but offered a $500 discount for paying early. Since I was able to take advantage of this and it was over $300, I was reimbursed for the all costs.
Again, this is different for each organization so read the guidelines carefully.
How Does Samaritan Ministries Work?
This was the most difficult part to understand when I was first researching this. It seemed so risky to walk away from traditional insurance, especially with all of the rules about enrollment and time with a company and the idea of starting from scratch if healthshare didn’t work for us.
As I said, this isn’t insurance so there is no guarantee that events are covered and in times where the amount of needs exceeds the amount of the shares, an event may not be covered. Still confused about terms like “share,” “need,” and “publishable amount?” Hang tight, as I’ll be explaining the terms as we go.
I spend dozens of hours reading and asking questions, and to be honest, I didn’t completely understand how it all worked until we submitted a need. I’ll share our specifics below, but I do finally understand how the system works:
Step 1: Signing Up
Unlike insurance, there is no open enrollment period and the requirements look a lot different. For Samaritan, for instance, they are more concerned with your values than your weight or medical history (though they do ask about medical history to understand pre-existing conditions). With Samaritan, you sign a form at sign up and once a year after sign up certifying that you agree with core aspects of the Christian faith. If you aren’t Christian, options like Knew Health are now available too.
The application process is easy and you can even do it online now. Please let them know I sent you!
Samaritan now has over 250,000 members/families and shares over 27 million a month in medical needs.
Step 2: Monthly & Yearly Member Obligations
As a member, each month, you receive a notice of who to send your “share” to. The share is the monthly amount you pay. For instance for our family, we pay $495/mo. Singles pay $220 and there are now even cheaper plans with less coverage.
The share can be paid online or via mail and each month the share goes directly to a family or person who needs it. Our kids like making cards to send along with the share.
Step 3: If You Have a “Need”
A “need” or “medical need” is a medical event that you can share with Samaritan Ministries so that members can send shares to you to cover the need. In order to be shared, a need must be a qualified need, meaning it meets the guidelines. (Seriously, spend the time and read these guidelines if you’re considering switching).
To submit a need, a member collects all the itemized bills from the event (doctor, hospital specialists, and so on). The member submits these bills to Samaritan Ministries. When received, the Samaritan team reviews the bills to make sure the need meets the guidelines.
If it does, the need is considered shareable. The next month, other members are assigned to send their share to the member who submitted the bills. Once received, the member uses these payments to pay the bills (or to reimburse himself/herself if bills were already paid to get a discount).
An Example From My Family
In 2012, a year or two after we joined Samaritan Ministries, my husband said he was a little nauseous. Later in the day, he didn’t feel like eating and said his stomach hurt a little. Thinking it was a bug, we treated it like such and he rested, hydrated, and didn’t eat much.
The next morning, he wasn’t feeling better and as soon as he said his stomach hurt a little more on the right side, I shoved him in a car and took him to the ER. By the time we got there and they confirmed it was his appendix, it had already partially ruptured. After a little longer than expected surgery, everything seemed fine and we went home a couple days later.
Except he started feeling worse and not better.
At his 3-day post-op appointment, his fever was up and he wasn’t looking good. Another trip back to the ER revealed a nasty secondary infection including c-diff. After another week in the hospital and all the antibiotics, he was finally on the mend. (And yes, we did all the probiotics, and eventually had to treat for SIBO too).
Spending a week in the hospital with him, I researched what I needed to do for Samaritan Ministries to submit the need. I also asked the hospital if they offered any kind of self-pay or cash discount. They offered both, which was good since the original bill was over $132,000!
With the 79% (yes, for real) self-pay discount, another 20% discount for paying before checking out and a couple other discounts, we got the bill down to about $12,000.
[Side note: This is why I personally also recommend having a savings account or emergency fund available for things like this to take advantage of maximum discounts.]
Submitting the Need
We submitted the stack of itemized bills showing the discounts to Samaritan Ministries. Since we’d negotiated more than $300 in discounts, the entire amount was eligible to be shared. There were enough shares available to meet the entire amount of needs that month.
Over the next month, we received checks from members to fully reimburse us for the bills and we replenished our emergency savings. We ended up with a fully healthy dad/hubby and not having to pay out of pocket at all for the bills.
Other Important Things to Know
I tried to cover everything above, but here are a few important points and questions to consider when thinking about switching.
Well Child Visits and Physicals
Well child visits and physicals are not a shareable need with SM or many health sharing networks. For Samaritan, these are usually under $300 and wouldn’t be shareable anyway. We plan for these each year, and use a local clinic that is inexpensive for physicals when needed.
We also use a concierge medicine option called SteadyMD in conjunction with health care sharing. This allows us to have video, phone, and text access to our primary care doc (who gets functional and alternative medicine) at any time without having to go into the doctor. This only costs a couple hundred dollars a month and with the combination, I feel like we are truly getting the best medical care possible and saving money.
Vision and Dental
Also not a shareable need by Samaritan Ministries (or most sharing organizations). Again, these are something we budget for and we find that providers often offer family plans or discount plans. Since researching oral health is somewhat of a hobby of mine and I have very specific dentists I’ll go to, this has worked best for us anyway.
Preventative and Wellness
Most preventative care and wellness-oriented things are not shareable in a healthsharing organization. This means you can’t submit a colonoscopy, the cost of vitamins, or a cleanse as shareable expenses. With the exception of things like colonoscopy, many of these things are also not covered by most traditional insurance either.
Our family makes healthy food and natural remedies a priority (and we would whether we had traditional insurance or healthcare sharing).
Labs and Bloodwork
These are covered if related to a specific medical event (like my husband’s appendix). Preventative labs are not covered. For us, this is still not a big issue, because I use things like EverlyWell or local labs ordered by my SteadyMD doc when needed. Our local hospital offers 80% self-pay discount at their lab and a local place also has really inexpensive labs.
Taxes and ACA
Samaritan and other health care sharing organizations are permissible alternatives to insurance under the Affordable Care Act. As Samaritan’s website explains:
This approach satisfies the federal health care law’s (Affordable Care Act, U.S. Public Law 111-148) requirement that you have insurance or pay a penalty-tax (see 26 United States Code Section 5000A, (d), (2), (B)). Members of health care sharing ministries demonstrate their exemption by using IRS Form 8965 when filing their tax return. If you are not required to file a tax return, you do not need to do anything to prove your exemption.
This has absolutely been the best option for our family but it isn’t for everyone. Health care sharing is not traditional insurance and needs are not guaranteed to be shared. It does require more effort and I highly recommend saving some money for unexpected needs until they can be shared.
As entrepreneurs, this is the least expensive option available. We find it comparable to insurance for catastrophic coverage and we’ve come out of pocket less since switching. There is a lot to know and understand, so do please feel free to ask questions below.
Our family chose Samaritan Ministries and we’ve had only positive experiences. There are other options, both faith-based and not, but I don’t have any direct experience to be able to share.
If you do decide to check out Samaritan, please consider letting them know that Wellness Mama sent you. As I said, none of the links to Samaritan are promotional or affiliate links, but our family qualifies for a small reduction in our monthly share if you decide to join.
Are you a member of a health care sharing or healthshare ministry like Samaritan Ministries? What has your experience been? If you’re not, would you consider joining?
Source Link – https://wellnessmama.com/395133/samaritan-ministries/