Health care sharing programs have a lot in common with short term medical plans. Both won’t cover pre-existing conditions, there is maximum benefit the plans will pay, and there are a slug of restrictions on coverage for injuries caused by high risk activities. But the monthly dues for the health care sharing ministry plans can be significantly less than a short term medical plan. If you are interested in short term medical for major medical and catastrophic events until more comprehensive health insurance becomes available, then you might want to consider a health care sharing ministry plan for a short period of time.
Health Care Sharing Plans For Short Term Medical
One of the first things you notice on the AlieraCare Healthcare sharing ministry plans marketing material is the disclaimer that it is not insurance. To the extent that AlieraCare, a health care sharing ministry program, is not insurance, the same could be said for short term medical policies. Both types of medical expense plans have lots of exclusions, restrictions, and caps on the amount they will pay. On the flip side, both plans also cover many different types medical expenses from the routine to the medical emergency, and hospitalization.
As I explain to clients that need a short term medical plan because they are in between creditable health insurance, short term medical plan should be viewed as asset protection. If you are in an accident or develop a nasty illness, the short term medical plans will generally limit your maximum out-of-pocket to $10,000 or less. While that may sound like a big chunk of change, an emergency room visit and follow up surgery can easily cost $25,000 – and that is after you negotiate the rates down with the hospital.
IHC Short Term Medical vs AlieraCare Rates
You can’t accurately compare the rates of a short term medial plan to a health care sharing program because of the variety of different exclusions and restrictions. The best I could do was looking at comparable plans that had a $10,000 Maximum Out-of-Pocket (MOOP) for a short term plan versus a $10,000 Maximum Member Shared Responsibility Amount (MSRA) of the AlieraCare program. IHC rates based on gender = male. Based on September 2017 quotes.
- Note that the IHC has $25 enrollment fee and the AlieraCare has a $125 enrollment fee.
- Women will pay more for short term medical plans.
- There are medical underwriting questions for the short term medical plans, see below.
I know people hate health insurance companies and their health plans. But once you read some of the restrictions contained in the health care sharing and short term medical plan, you begin to get a sense of how comprehensive creditable health insurance really is. Seriously, I could have a couple beers, hop on my motorcycle; lay the bike down at 35 miles per hour going around a corner in a 25 MPH zone, and my Affordable Care Act health insurance would cover my injuries related to my stupidity.
But either a short term medical or a health care sharing program plan is better than no health insurance. However, you need to be aware of some of the restrictions and exclusions of both plan types you refrain from certain activities. For short term medical you will have to answer some health questions.
Typical Short Term Medical Questions
Will you have other health insurance in force on the policy effective date or be eligible for Medicaid?
- Been denied insurance due to any health reasons for a condition that is still present?
- Now pregnant, in process of adoption or undergoing infertility treatment?
- Over 300 pounds if male or over 250 pounds if female?
Within the last 5 years have you been diagnosed, treated, or taken medication for any of the following: cancer or tumor, stroke, heart disease including heart attack, chest pain or had heart surgery, COPD (chronic obstructive pulmonary disease) or emphysema, Crohn’s disease, liver disorder, degenerative disc disease or herniation/bulge, rheumatoid arthritis, kidney disorder, diabetes, degenerative joint disease of the knee, alcohol abuse or chemical dependency, or any neurological disorder?
Within the last 5 years have you been diagnosed or treated by a physician or medical practitioner for Acquired Immune Deficiency Syndrome (AIDS)?
If you are not a US Citizen, do you expect to legally reside in the US for the duration of the policy?
Answering YES to any of these questions will usually result in a denial of a short term medical plan.
With health care sharing ministries, you may not have to answer medical questions, but the plan may not cover any pre-existing until you have met a waiting period, and some conditions may never be covered.
Both traditional short term medical and health sharing ministry plans have limits on how much they will pay either for the enrollment period or by specific medical service such as a surgery. Neither type of plans are really any good for coverage of chronic health challenges. But unless you are engaging in some risky hobbies or sports, your common accidents or surprise illness that put you in emergency room should be covered. For short durations, the health care sharing ministry plans might be an attractive alternative for some folks who want some asset protection against high unforeseen medical expenses until their regular health insurance becomes effective.
Notice that the exclusions for both the IHC and AlieraCare are very similar. Some of the exclusions of both plans are covered under regular health insurance such a pregnancy related services and mental health. Plus, regular health insurance does not distinguish between a normal biking accident or if you happen to be in a professional race. However, just like short term medical and health care sharing plans, regular health insurance won’t cover services deemed cosmetic like hair growth or replacement procedures.
These are the exclusions from the IHC short term medical policies
- Expenses for the treatment of pre-existing conditions; expenses incurred prior to the effective date of a covered person’s coverage or incurred after the expiration date;
- Expenses that do not meet the definition of or are not specifically identified under the Policy as covered expenses;
- Expenses to treat complications resulting from treatment, drugs, supplies, devices, procedures or conditions which are not covered under the Policy or are experimental or investigational services or treatment;
- Expenses for purposes determined by Us to be educational;
- Amounts in excess of the usual and reasonable charges made for covered services or supplies or which you or your covered dependent are not required to pay;
- Expenses to the extent that they are paid or payable under another insurance or medical prepayment plan,
- Medicare paid expenses or expenses for care in government institutions;
- Expenses paid under workers’ compensation or an automobile insurance policy;
- Expenses incurred by a covered person while on active duty in the armed forces, expenses from war;
- Expenses incurred while engaging in an illegal act or occupation or during the commission, or the attempted commission, of a felony or assault;
- Expenses for the treatment of normal pregnancy or childbirth, except for complications of pregnancy and normal newborn care unless medically necessary due to sickness or injury;
- Expenses for voluntary termination of normal pregnancy or contraception; infertility treatments or sterilization;
- Expenses related to sex transformation or penile implants or sex dysfunction or inadequacies, physical exams, prophylactic treatment;
- Expenses for the treatment of mental illness or nervous disorders; alcoholism or drug addiction;
- Expenses incurred for loss sustained or contracted in consequence of the covered person being intoxicated or under the influence of any narcotic;
- Expenses incurred in connection with programs, treatment or procedures for tobacco use cessation;
- Expenses resulting from suicide or attempted suicide;
- Expenses for dental treatment or temporomandibular joint dysfunction (TMJ) of any kind except as specifically covered;
- Expenses for radial keratotomy; vision exams, eyeglasses or contact lenses, including the fitting of; treatment of cataracts; routine hearing exams or hearing aids;
- Expenses for cosmetic or reconstructive procedures, services or supplies including breast reduction or augmentation or complications except as specifically covered; outpatient prescriptions, unless shown as included in the Schedule of Benefits;
- Expenses incurred in connection with any drug or other item used to treat hair loss; treatment of feet unless due to injury or illness;
- Expenses incurred in the treatment of acne, or varicose veins; weight loss programs or diets;
- Expenses for rest or recuperation cures or care in an extended care facility, convalescent nursing home, a facility providing rehabilitative treatment, skilled nursing facility, or home for the aged, whether or not part of a hospital; transportation expenses, except as specifically covered;
- Expenses for services or supplies for personal comfort or convenience;
- Expenses provided by immediate family;
- Expenses for sleeping disorders;
- Expenses incurred in the treatment of injury or sickness resulting from participation in skydiving, scuba diving, hang or ultralight gliding, riding an all-terrain vehicle such as a dirt bike, snowmobile or go-cart, racing with a motorcycle, boat or any form of aircraft, any participation in sports for pay or profit, or participation in rodeo contests; participating in interscholastic, intercollegiate or organized competitive sports;
- Expenses for the purchase of a noninvasive osteogenesis stimulator (bone stimulator);
- Expenses for services or supplies of a common household use; medical care, treatment, service or supplies received outside of the United States, Canada or its possessions;
- Expenses for spinal manipulation or adjustment;
- Expenses for acupuncture;
- Expenses for marital counseling or social counseling; private duty nursing services;
- Expenses for the repair or maintenance of a wheelchair, hospital-type bed or similar durable medical equipment; orthotics, special shoes, spine and arch supports, heel wedges, sneakers or similar devices unless they are a permanent part of an orthopedic leg brace;
- Expenses incurred in connection with the voluntary taking of a poison or inhaling gas;
- Expenses incurred in connection with obesity treatment or weight reduction including all forms of intestinal and gastric bypass surgery, including the reversal of such surgery even if the covered person has other health conditions that might be helped by a reduction of obesity or weight;
- Expenses for replacement of artificial limbs or eyes; removal of breast implants; or expenses for a service or supply whose primary purpose is to provide a covered person with: 1) training in the requirements of daily living; 2) instruction in scholastic skills such as reading and writing; 3) preparation for an occupation; 4) treatment of learning disabilities, developmental delays or dyslexia; or 5) development beyond a point where function has been demonstrably restored.
Exclusions for AlieraCare medical expenses not eligible for sharing
1. Abortion. Services, supplies, care, or treatment related to an abortion unless the physical life of the mother is endangered by the continued pregnancy and that treatment via a cesarean section has been determined by a neonatologist to be inadvisable.
2. Alcohol/Drugs. Services, supplies, care, or treatment to a sharing member for an injury and/or disease and/or bodily malfunction which occurred as a result of that sharing member’s abuse and/or use of alcohol or drugs/ pharmaceuticals, including drug and/or alcohol rehabilitation treatment.
3. Breast Implants. The placement, replacement, or removal of breast enhancement devices and complications related to breast implants unless related to reconstructive mammoplasty.
4. Diagnostic Testing or Cancer Diagnoses. Diagnoses within one year of effective date will render that cancer diagnosis ineligible for sharing until the member’s first year anniversary.
5. Charges before or after Membership. Medical care, treatment, or supplies for which a charge was incurred before a person was a sharing member or after membership ceased or became inactive.
6. Complications of Noneligible Treatments. Care, services, or treatment required due to complications from a treatment not eligible for sharing.
7. Custodial Care. Services or supplies provided mainly as a rest cure, maintenance, custodial care, or other care that does not treat an illness or injury.
8. Dental Care. Dental prostheses and care or treatment of the sharing member’s teeth above or below the gums, except the repair of sound natural teeth due to injuries that occur while the person is a sharing member.
9. Durable Medical Equipment. The purchase, rental, or replacement of durable or reusable equipment or devices, including, but not limited to, orthotics, hearing aids, tubing, masks, and their associated expenses.
10. Emergency Room Charges When Not an Emergency. When treatment at an emergency room is not judged to be an emergency by normal standards of medical care and when less costly treatment was available by taking reasonable measures to seek such care. Emergency room visits are subject to a per incident MSRA, defined in each plan.
11. Exercise Programs. Exercise programs for treatment of any condition, except for physician-supervised cardiac rehabilitation and/or physical therapy.
12. Experimental, Investigational, Unproven, or Unapproved Services. Care and treatment that is either experimental, investigational, or unproven, or that has not been approved by the American Medical Association, FDA, or other industry recognized authoritative bodies, or that is illegal by US law. Eligibility for sharing of such expenses may be reviewed on a case-by-case basis.
13. Eye Care. Eye exercise therapy, radial keratotomy, or other eye surgery to correct near-sightedness. Also, routine eye examinations, including refractions, lenses for the eyes, and exams for their fitting. This exclusion does not apply to the initial permanent lenses following cataract removal.
14. Gross Negligent Acts. Expenses resulting from an illness or injury in which the sharing member has acted with gross negligence or with reckless disregard to safety, as evidenced by medical records and as determined by Unity HealthShareSM.
15. Hair Loss. Care and treatment for hair loss, hair transplants, or any drug that promises hair growth, whether or not prescribed by a physician.
16. Hearing Aids and Exams. Charges for services or supplies related to routine hearing exams, hearing aids, or exams for their fitting.
17. Hazardous Hobbies. Care and treatment of an injury or illness that results from engaging in a hazardous hobby. A hobby is hazardous if it is an activity which is characterized by a constant or recurring threat of danger or risk of bodily harm. Examples of hazardous hobbies include, but are not limited to, rock/cliff climbing, spelunking, skydiving, or bungee jumping.
18. Hospital Employees. Professional services billed by a physician or nurse who is an employee of a hospital or skilled nursing facility and paid by the hospital or facility for the service.
19. Illegal Acts. Charges for services received because of injury or illnesses caused by engaging in an illegal act or occupation; by committing or attempting to commit any crime, criminal act, assault, or other felonious behavior; including but not limited to, illegal drug activity, crimes against persons, crimes against property, and gun offenses.
20. Impotence. Surgical and non-surgical services for the treatment of impotence.
21. Infertility. Diagnostic, surgical repair, non-surgical repair, surgical impregnation, and prescription drugs for the treatment of infertility.
22. Mental Health Services. Charges for psychiatric or psychological counseling, mental disability, learning disability, bereavement counseling, biofeedback therapy, psychological testing, treatment, medication, and hospitalization.
23. Non-emergency Transportation. Expenses resulting from transportation by ambulance for conditions that will not seriously jeopardize the sharing member’s health or life are not eligible for sharing. Also, the additional expense for transportation to a facility that is not the nearest facility capable of providing medically necessary care is not eligible for sharing.
24. No Obligation to Pay. Charges incurred for which the sharing member has no legal obligation to pay.
25. Not a Medically Necessary Service. Care and treatment that does not meet the criteria of a medically necessary service or is not specified as a medically necessary service, or care, treatment, services, or supplies not recommended and approved by a physician; or treatment, services or supplies when the sharing member is not under the regular care of a physician. Unity HealthShareSM reserves the right to review billing submitted by providers for payment, and upon review by a qualified medical professional, decline to share expenses deemed to be not a medically necessary service.
26. Outpatient Prescribed or Non-prescribed Medical Supplies. Outpatient prescribed or non-prescribed medical supplies including, but not limited to, over-the-counter drugs and treatments, elastic stockings, tubings, masks, ostomy supplies, insulin infusion pumps, ace bandages, gauze, syringes, diabetic test strips, and similar supplies.
27. Personal Comfort Items. Personal comfort items or other equipment, such as, but not limited to, air conditioners, air-purification units, humidifiers, electric heating units, orthopedic mattresses, blood pressure instruments, scales, elastic bandages or stockings, non-prescription drugs and medicines, first-aid supplies, and non-hospital adjustable beds.
28. Professional Racing or Competitive Events. Charges for treatment of injuries or illness while racing or competing as a professional. Professional racing means that such activity is one’s primary vocation and means of financial support. Professional racing and competitive events include, but are not limited to, automobile, motorcycle, watercraft, ski, or rodeo races or competitions.
29. Relative Giving Services. Professional services performed by a person who ordinarily resides in the sharing member’s home or is related to the sharing member as a spouse, parent, child, brother, or sister, whether the relationship is by blood or exists in law.
30. Replacement Braces. Replacement of braces of the leg, arm, back, or neck, unless there is sufficient change in the sharing member’s physical condition to make the original device no longer functional.
31. Self-inflicted Injuries. Any medical expense due to an intentionally self-inflicted injury, while sane or insane.
32. Sex Changes. Care, services, or treatment for non-congenital transsexualism, gender dysphoria, or sexual reassignment or change. This includes medications, implants, hormone therapy, surgery, or medical or psychiatric treatment.
33. Sports-related Safety/Performance Devices and Programs. Devices used specifically as safety items or to affect performance primarily in sports-related activities. All membership, registration, or participation costs related to physical conditioning programs, such as athletic training, bodybuilding, exercise, fitness flexibility, and diversion or general motivation are not eligible.
34. Professional Sports. An individual who participates in a professional sport as a means of income is not eligible for sharing.
35. Extreme Sports. Sports that voluntarily put an individual in a life-threatening situation including-, but not limited to, rock-climbing, parachuting, fighting, martial arts, racing, cliff diving, offshore powerboat racing, wakeboarding, water skiing, air racing, gliding, motorcycle racing, rallying, motocross, surfing, windsurfing, kiteboarding, skiing, snowboarding, wingsuit flying, sailing, skateboarding, mountain biking, mountain boarding, BMX racing etc.
36. Competitive Sports. Plan holders who participate in organized and/or sanctioned competitive sports are eligible for $5,000 (max) of sharing per incident at an emergency room, subject to the member-shared responsibility amount.
37. Surgical Sterilization or Reversal. Charges for care and treatment for, or reversal of, surgical sterilization, including vasectomy and tubal ligation.
38. Travel or Accommodations. Charges for travel or accommodations, whether or not recommended by a physician.
39. War. Any cost incurred that is due to any declared or undeclared act of war, act of terrorism, or military activity.
If you are interested in apply for AlieraCare, contact me and I will get you an application. If you want a quote on short term medical plans you can visit IHC Anthem Blue Cross Quotes.
Aliera Health Care Sharing Ministry Literature
IHC Anthem Blue Cross Short Term Medical Literature