OVERLAND PARK, Kan. — From presidential debates to mom-and-pop diners across the U.S., healthcare is a hot topic.
But is there a way to save money on it?
One local couple says there is, and they’re among a growing number of people buying into healthcare sharing ministries.
The rising costs of healthcare
“Our cost just kept going up and up every year,” Matt Couch said.
Laura and Matt Couch have four active kids. Like many young families, they make several trips to the doctor’s office every year.
“Originally it was about $700-800 a month for our family,” Matt said. “But as the third and fourth kids came along and the healthcare changes happened, the latest quote we got was for $2,200 plus a $13,000 out-of-pocket expense.”
That totaled out to nearly $3,300 a month for the Overland Park couple.
Matt and Laura are both self-employed, so they don’t have a typical employer-based insurance.
And the cost of what they called “regular” insurance was rising at a rate they just couldn’t stomach.
“We spent around $46,000 in 2016 just on medical bills out of pocket,” Laura said.
That was a big year for their family. Their daughter Greta was born, and their son Graham broke his elbow and wrist. That was all on top of regular trips to the doctor for things like ear infections.
‘What do I have to lose?’
Then Laura heard about healthcare sharing ministries from a friend — but she wasn’t sold on the idea.
“I thought it was weird,” Laura said. “For about a year, I thought, ‘This is just too weird.’ But the more I researched it and talked to people who it worked for, then I was like, ‘What do I have to lose?'”
After two years of research, the Couches decided to join a “healthshare” called Solidarity.
“Solidarity Healthshare is an answer to the healthcare crisis,” Solidarity’s CEO Bradley Hahn said.
He said healthshares are the future.
“So far this year, we’re saving about 60% off our clients’ medical bills,” Hahn said.
But how is that possible?
Here’s how it works
Hahn said Solidarity is a Mennonite/Catholic healthshare ministry, but you don’t have to be either of those religions to join. But the company follows those churches’ beliefs to determine what is covered and what isn’t.
The CEO said there are two basic principals. Solidarity vets medical bills for fair and reasonable pricing.
“We demand transparency in pricing, and then we make sure we don’t overpay for our medical expenses,” Hahn said.
That’s a relief for the Couch family.
“She’s not on the phone for two hours, begging basically for them to lower the fee,” Matt said. “The people at Solidarity do that on our behalf.”
Then members of Solidarity share in medical expenses, in essence, since they pay the healthshare each month. Hahn said if it’s an eligible medical expense for sharing, then Solidarity pays for it.
“Members helping members; families helping families,” Hahn said.
So what’s not covered?
What medical expenses are eligible may pose a problem for some.
Vicki Schmidt, Kansas commissioner of insurance, said her office doesn’t regulate healthcare sharing ministries, and they don’t have to cover everything.
“They are not required by law to cover several of the things by law that some people have come to expect,” Schmidt said.
She said each plan is different, so you need to do your research.
“Are medications covered? Are pregnancies covered? Are surgeries covered?” Schmidt said.
They’re all questions the Couches asked before signing on.
And the Overland Park couple said it was easy to see what Solidarity pays for and what they don’t.
“It was very self-explanatory,” Laura said.
For example, Solidarity doesn’t cover medical expenses for contraceptives, abortion, drug or alcohol addiction, artificial insemination and in vitro fertilization, among other things.
In the Couch family’s case, their plan doesn’t cover medications, so they lean on pharmacy cards to get better deals.
And pre-existing conditions are also not covered for the first year. That’s something that the Affordable Care Act made into law, requiring insurance companies to cover people with pre-existing health conditions and not charging them more.
Schmidt said healthshares aren’t required to comply with ACA.
And what’s covered?
But one of their kids needs special therapy, which Solidarity does help with. Their plan covers 10 visits per year for occupational therapy and speech therapy.
And things like doctor’s appointments, emergency room visits, home health care and mental health services, among others things.
Another perk for the Couch family: They can see any doctor or specialist they choose.
“Say this particular doctor we want to go to isn’t in our network, then what do you do? You’re just out of luck,” Matt said. “But since there’s no network, there’s no preferred providers.”
“So if someone tells me this provider is the best doctor, we can go straight to them,” Matt continued. “You don’t need a referral.”
But some doctors won’t accept insurance from a healthshare ministry. In those cases, the Couches pay out-of-pocket, get itemized receipts and send them in to get reimbursed.
Again, knowing what you can get reimbursed for is essential.
Do your research
At $459 per month for their family of six, plus a $1,500 family deductible (not individual like some other plans), healthshare costs add up to about $8,000 per year for the Couch family.
That’s about one-fourth of what they were paying.
“It’s life-changing from a medical standpoint,” Matt said.
According to the Alliance of Health Care Sharing Ministries, more than 1 million Americans are participating in the plans as of February of this year.
But the Wall Street Journal reports that some states, including Washington, Texas and Ohio are investigating certain health share ministries, claiming they aren’t legitimate and are misleading consumers.
Your commissioner of insurance can help. Call the office in your state to help navigate all kinds of health plan options, including health care sharing ministries.
For the Couch family, it works.
But you need to weigh the pros and cons for your family after doing your research.