For approximately 103,000 Minnesotans on Blue Cross individual or family plans (obtained independently, through an agent/broker or through MNsure), current coverage will be ending as of December 31, 2016. Blue Cross Blue Shield states that claims for medical care have far exceeded the revenue generated from plans.
According to Blue Cross and Blue Shield of Minnesota, their presence in the individual market will be limited to the Blue Plus HMO (Health Maintenance Organization) plan. Group policies offered through employers and the administration of state public programs will not be affected by this change. Blue Cross/Blue Shield attributes this change to “shifts and changes in health plan participation and market segments that have contributed to a volatile individual market,” and they state that costs and prices have been escalating at unprecedented levels projecting a loss of $500 million in the individual segment over three years. Their website states that they look forward to working toward a more stable path with policy leaders here in Minnesota and at the national level.
Blue Cross/Blue Shield has not been the only one to drop their individual plans since the Affordable Care Act came into effect, and when President Obama said, “If you like your health insurance plan, you can keep your health insurance plan.” PreferredOne and Medica (for small business group coverage under 50 employees) have also dropped individual plans.
For Pine County residents and dairy farmers, Jeff and Chris Johnson, who have had their health insurance plan and have liked their plan for the last 29 years, keeping their insurance wasn’t an option. And for Shari Lawson, formerly of Pine County, she and her family have been on a family plan for 19 years and have been dropped, expecting to pay an additional $300 per month (approximately $800 per month for her and her husband) through MNsure.
Last month, the Minnesota Department of Commerce announced that premiums in the individual market would jump an average of 50 percent to 67 percent, depending on the carrier. To help offset these costs, Governor Dayton has proposed a 25% premium rebate that would apply to people who buy individual health insurance plans but whose income makes them ineligible for premium subsidies. This proposal is pending, however.
People being dropped by their healthcare coverage providers are now weighing all their options and looking for alternatives to traditional health care coverage.
A new form of coverage on the rise
Healthcare sharing ministries (medical bill sharing programs) have been around for over 30 years but are now greatly increasing in membership as a response to the Affordable Care Act signed into law in 2010. People have found themselves searching for options after losing their current plans or if they are wanting to avoid financial penalties or if they have experienced increased monthly premiums from their existing coverage.
There are a number of organizations that provide this type of alternative healthcare coverage. Some of which are Christian Healthcare Ministries, Medi-Share, a program of Christian Care Ministry, Samaritan Ministries, Liberty HealthShare, MCS Medical Cost Sharing, and Altrua HealthShare. One of the largest organizations was contacted by the Courier and agreed to answer some questions about their organization.
Michael Gardner, Director of Marketing and Communication for Medi-Share, a medical bill sharing program, said of this alternative form of healthcare coverage, “One point of clarification is that healthcare sharing is not an alternative to Obamacare or an insurance, but rather is an option within the law. The Affordable Care Act includes a special provision for members of Health Care Sharing Ministries. Medi-Share members are exempt from the mandate to purchase insurance or face financial penalties.”
For those who are questioning what to do with their healthcare coverage, Gardner responds, “If the federal healthcare reform laws have you seeking a wise and God-honoring choice for your healthcare, you’ll find it in Medi-Share. Unlike health insurance where you pay a premium to a company, Medi-Share is a community of Christians who share each other’s medical bills. Your share dollars are never used for unbiblical procedures or treatments like abortion or the morning after pill. And you know your share is going directly to help a fellow member with an eligible medical bill.”
How it works
How the program works is that members voluntarily come together to share the cost of one another’s medical bills, much like the early biblical model of giving to anyone who has a need. Members choose to share with each other, governed by member-voted guidelines. Although there is no guarantee of sharing, Medi-Share members have been faithfully sharing each other's medical bills for more than 20 years, according to Gardner. Since 1993, more than $1.5 billion in member bills have been shared or discounted, he added.
The average monthly cost for a family is about $350. Most members, according to Gardner, report significant savings compared to traditional health insurance.
When asked if members receive the kind of healthcare they need, as compared to traditional coverage, Gardner responded, “Our members have said they are very happy with their Medi-Share membership. Members have access to a large PPO (Preferred Provider Organization) network, but can also receive care from the provider of their choosing. Our members have shared in medical bills related to cancer, liver transplants, the birth of children and other items like broken bones and the flu.”
Gardner stated, when asked if members received medical care in a timely fashion, “Yes, Medi-Share members can seek medical care whenever they need to. If someone is sick, they make an appointment; if someone needs to go the emergency room they go. In addition, members have no-cost, 24/7 access to board-certified physicians via phone or video through a telehealth portal. These physicians can diagnose common health conditions (e.g., colds, sore throats, rashes, etc.) and even prescribe medications, if needed.”
When questionned of the benefits of healthcare sharing versus traditional care, Gardner responded stating that many people join because of the cost savings and the opportunity to be a part of a community. “Our staff prays with members during phone calls. Many members also receive words of encouragement and prayer via postcards, email, or our PrayerStream app when someone in their family has been ill or has had surgery. Members can also join at any time during the year as there is no limitation on enrollment dates. Medi-Share is portable so even if someone changes jobs, they and their family can remain Medi-Share members.”
Requirements vary from organization to organization but are all very similar in their accountability. Gardner states that Medi-Share is not for everyone and that they ask members to sign a statement of faith, confirming they agree with the program's specific set of beliefs. In addition, they review members’ medical backgrounds and notify them of conditions that will or will not be eligible for sharing. Members are fully aware of Medi-Share’s member-voted guidelines, which govern the Medi-Share program, he added.
When asked if there are instances where people are turned down for healthcare, Gardner responded stating that members are never declined for health reasons. He added that there are sharing limitations, however, for bills related to pre-existing medical conditions. And some people, he said, have not been able to agree to our statement of faith. “Since we are a community of Christians who have agreed to a specific set of beliefs, this is an important part of our community and program,” said Gardner.
The faces of a new healthcare coverage option: Judee Klumb
Judee Klumb, of Finlayson, said she and her husband had been purchasing health insurance on their own from Blue Cross Blue Shield since 1993. She said her portion was always higher than her husband’s and just kept going up.
When she heard of a healthcare sharing program on the radio, she liked the idea of not participating in a plan where others are engaging in risky behaviors. But the big reason she was drawn to the organization, Medi-Share, was the cost.
When asked how the program works for her, Klumb responded, “Fortunately, I don't go to the doctor a lot, and it's been pretty easy. You get a card to present at the doctor’s office. My co-pay is $35.00. The clinic submits the charges to Medi-Share and sends me a bill for my portion.
Gateway, Klumb stated, has been good about working with her plan. She said that the clinic has a plan that reduces the bill for those who pay with cash or out-of-pocket. The clinic then sends the bill to Medi-Share who in-turn applies the amount to the annual household portion, similar to a deductible, and once it is met, Medi-Share pays the rest. She added that the medical service has to be eligible, but members are able to request to have extra shares (money) go toward the covering of an ineligible expense once the Household Portion has been met.
Klumb states that her monthly premium is $191.00 and that there is an option to pay extra to help others pay for their medical expenses that have been deemed ineligible called an Extra Blessing.
“People have had high bills, in the 100’s of thousands paid,” said Klumb. “It’s a good will type system, and anyone can receive help with those more costly things.”
“They have a patient portal, and I can go online and see what has been submitted and where things are at,” stated Klumb. “They also have a health coach, prayer chain and email updates. I’ve even gotten recipes for healthy eating.”
“I'm just really satisfied with it,” said Klumb. “I would highly recommend this group. You do have to be fairly healthy though. I had some basal cell carcinoma spots take off, and they don’t cover that because it was pre-existing. But I am able to negotiate with the clinics to get a lower rate because of the out-of-pocket cost. Medi-Share does help with catastrophic care though. If the bills are much higher than we could cover, I can apply for the extra share. And they share names of people with you who can help pay for your care. I have received personal notes from other members thanking me or encouraging me which is completely different than any other company.”
She added that the organization won’t pay for regular check-ups or illnesses relating to pre-existing conditions unless it has been five years or more since the condition. They will pay for labs and treatments, however, said Klumb.
The faces of a new healthcare coverage option:
John & Patrice DeGray
Other residents of Pine County, John & Patrice DeGray, are enrolled with Samaritan Ministries. The DeGrays say they sought this type of plan to avoid the financial penalty associated with foregoing health insurance. Prior to partnering with Samaritan, they had paid for their bills out of pocket since she and her husband are both self-employed.
The DeGray family pays $495 for their monthly share (for three or more family members enrolled). When they receive their monthly newsletter, it includes the name, address and health treatment of the person in need. They then send that amount directly to the person and not to a company. If the total amount of need for the month is below the total needed, their share is reduced. They said that for the month of November, their share was reduced by five percent. They have also chosen to be included in the Save to Share program where they put money away in savings each year to give extra to a person that has over $250,000 in medical bills, which makes them eligible to receive Save to Share amounts if they have over $250,000 in medical bills.
When asked about any requirements or qualifications for enrolling in such a plan, Patrice DeGray responded, “Members must be professing Christians who attend a Christian church regularly. They must agree to abstain from sinful practices such as drug abuse and sexual immorality. Tobacco usage is not acceptable and a stumbling block for many who would otherwise wish to be a member. The use of alcohol is not a total rejection if used in moderation. They must also be accountable to a pastor or other Christian church leader for the needs they submit and their pastor must sign the application.”
When asked about any challenging aspects to using the program, they said that they have not had to request a share yet but have had several friends who have done so and they have been very satisfied.
“Although we could have submitted a share in 2015, it is our belief that you pay what you can afford to pay so you don’t break a good system,” said Patrice DeGray. “If our overall health care outlay for the year is less than premiums plus what a deductible would be, we feel we have won and come out on the positive side plus we have helped a lot of Christians in between.”
Overall, the couple feel that this way of doing healthcare coverage is more biblical than other approaches. “The Bible does not say that the government is responsible to take care of people via forced submission of taxes but rather we are to take care of each other on an individual basis voluntarily and cheerfully,” said Patrice DeGray. “We enjoy sending money right to a person with a medical need instead of sending money to an insurance company so they can pay all of the middlemen/women. We can also send a get well card and pray for the family, which we appreciate.”
Criticisms of this type of coverage have been that there is no guarantee for coverage and that the organizations aren’t obligated to pay for things like mental health, preventative care, birth control, dental and vision, or the management of pre-existing conditions. Lawsuits have also been brought up against these type of organizations, and under Obamacare, these groups are now subject to annual audits by independent accounting firms which will provide the results of the audit if requested. Overall, one has to decide what route to take for their health care coverage on an individual basis.
For more information on companies available through MNsure see: https://www.mnsure.org/assets/2016-MNsure-healthcare-coverage-plan-rates_tcm34-182250.pdf. And for more information on health care sharing ministries, simply google the names of the companies listed above to find their website.