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Disclaimer: Medical cost sharing is not health insurance. This article is meant to share my personal experience using medical cost sharing and should be used for information only. Health care decisions are not to be taken lightly, and I recommend you thoroughly do your research into your needs and options before making a decision.
My history with chronic illness and health insurance
Like many Americans, especially those experiencing chronic illness, I’ve had a complicated and frustrating experience with our healthcare insurance system over the past decade. In the early days of my illness, I was in my 20s and uninsured, as neither my husband or I were working jobs that offered insurance, and we could not afford to purchase a policy on our own. The first nine months or so of my health crisis we paid out of pocket for all of my doctor’s visits, and when I had my first hospital bill, the hospital adjusted it from thousands to hundreds of dollars after we applied for financial assistance (those hoops were hard to jump through, but we were so grateful to qualify!).
A few months later, I lost my job due to my declining health, and my husband and I decided that a health insurance policy would be better than paying out-of-pocket to help manage the ongoing expenses. Unfortunately we could only afford a high-deductible, high-coinsurance plan that ended up being much worse for us financially in the long run, as we were no longer getting the lower cash prices for services and labs and ended up going into a lot of debt due to continued visits to specialists, advanced testing, and hospital stays.
Once I got back on my feet due to diet and lifestyle transition, I was able to begin working again. It was at this point we made the decision to cancel our insurance. The policy we had did not cover visits to my naturopathic doctor or non-standard thyroid medication, which were both my biggest ongoing expenses and integral parts of my feeling well again. We also needed to start paying back that debt I incurred over my illness and prioritize our finances to accommodate the new cost of supplements and higher-quality food.
Now, I am not advocating that anyone go uninsured — in the case of an accident or major unexpected illness, this could have been a terrible circumstance. We made it through the next two years though, and I had eventually transitioned to self-employment and my husband and I were considering purchasing an insurance policy since we could now (barely!) afford one. When we scanned the marketplace, we were truly shocked at the prices. They had tripled in only a few years for the exact same, high-deductible plan that had gotten us into so much trouble before. We weren’t ready to do that again, so the research into alternatives began.
Enter medical cost sharing
I was introduced to the concept of medical cost sharing after seeing an acquaintance post about their positive experience on Facebook. Because we were considering using medical cost sharing as an alternative, not an addition, to a traditional health insurance policy, my husband and I needed to find an organization that offered an ACA exemption (at the time, it was the law that everyone needed to obtain insurance, or pay a penalty, which would cancel out the cost-saving benefit for us). There were three companies at the time who qualified for exemptions, and after a lot of research, we settled on Liberty Health Share.
We relied on Liberty’s medical cost sharing program as a health insurance alternative for two years, until my husband obtained insurance through his new employer this year. Since we had done our research thoroughly, we were not surprised how the medical cost sharing system worked and found it easy to use (any negative reviews we had seen online were from people who thought medical cost sharing operated exactly like insurance–while there are some similarities, there are some major differences).
So how did it go in terms of us using it? Over those two years, my husband had four visits to urgent care, both of us developed musculoskeletal injuries/issues requiring about 2 months of physical therapy each, and I developed some new inner ear symptoms and saw an ENT specialist for further diagnosis and testing. As expected, Liberty paid 100% of the bills past the $500 annual member share amount (this is similar to a deductible), directly to the providers. We could visit any urgent care, PT, doctor or specialist we wanted, no inquiring about networks. Needless to say we were pleased and it saved us a lot of money.
What about preventative care? Our research found that many health share programs don’t cover pre-existing, chronic conditions, or preventative care (or if they do, they have a 1-2 year wash-out period). Because of this, my husband and I purchased an affordable monthly membership to a local doctor’s clinic that was convenient and where we liked the providers. By becoming members, we could have as many office visits as necessary, for no additional fee. This meant that we could both get our annual preventative checks (bi-annual or sometimes more frequently for me, due to my Hashimoto’s) covered by our membership, and not have to pay for an office visit if an issue came up.
Even after factoring the monthly sharing amount for Liberty, the doctor’s office membership, and all our annual labs out-of-pocket, we ended up spending less than half as much as we would have with a traditional insurance policy, and not even a “good” one–and that is not counting any co-insurance or high deductibles we’d likely be responsible for. It wasn’t a no-brainer, but we decided to take the risk with medical cost sharing and funnel that savings into creating a larger emergency fund should anything come up that was not sharable under their plan.
Looking back, medical cost sharing was worth the risk for us, as we were able to get out of a bad financial situation due to my illness, and finally get back on our feet. We would not have been able to pay off the debt I incurred during my illness so quickly had we gone back to an insurance policy. I was pleasantly surprised that they covered every bill we ran through them–including physical therapy, a specialist, and urgent care. While Liberty grew a lot in the time we were with them and had a slow, outdated website system for submissions, everything ended up working out as intended and we were grateful for having the option to use medical cost sharing for this phase of our lives.
Before we get into the details, here are three quick facts about medical cost sharing:
- It is not health insurance. Medical cost sharing operates on the monthly amount that every member submits to the pool. There are no legal requirements for these programs to pay your bills if they run out of money.
- It is meant for unexpected expenses. Medical cost sharing is meant to be used for new illnesses, injuries, accidents, and other unexpected health events. While some programs accept people with pre-existing conditions, they have limits on what related expenses can be shared, and most limit or don’t cover preventative care.
- It has strict guidelines on membership. Because members are paying into a pool and sharing each other’s expenses, applicants have to meet certain conditions in order to become a member.
What is medical cost sharing?
Medical cost sharing was started over 20 years ago as a way for faith groups to band together to care for each other’s unexpected or high medical expenses. Each organization has their own rules, but generally each member or family voluntarily pays a monthly amount into a pool, which is then used to pay other member’s medical bills that are submitted according to the organization’s guidelines.
Generally, monthly sharing amounts tend to be drastically less than insurance, but the expenses that can be shared are more limited than what an insurance company will accept.
How many people use medical cost sharing?
According to the Alliance of Health Care Sharing Ministries, there are currently over 1 million Americans using medical cost sharing. Medical cost sharing groups have paid billions of dollars of their member’s medical bills.
How does it work?
You pick the provider you want to see, inform them you are a cash-pay patient and submit any eligible bills you receive for your service to the organization’s portal to be paid. In situations where you pay more than your unsharable amount, many organizations have systems set up to reimburse you for paying upfront.
Introducing Knew Health
I’m happy to report that there is a great medical-cost sharing company making waves in the health and wellness community, and that is Knew Health founded by functional medicine advocate James Maskell. They observed the model of faith-based organizations to develop a new program that is inclusive and specifically designed for people who are proactive and engaged in maintaining their good health.
Knew Health believes that many of the current problems in the healthcare industry are caused by the loss of freedom and responsibility due to insurance companies paying for medical costs. Their plan allows members to both have complete freedom to see the providers they want, take personal responsibility for their own health, and share each other’s medical expenses.
Their program operates similar to the one I’ve used in the past, with a few differences:
- Free health coaching – Members get 2 visits per year with a qualified health coach.
- 35% off supplements – Order high-quality supplements from a variety of companies at cost through their online portal.
- Discounted lab testing – Members get to order low-priced labs, panels, and specialty kits.
- Billing concierge services – Knew will assist in negotiating all medical bills whether or not they are shareable (averaging in a reduction of health care costs by 48-50%).
- 24/7 telemedicine services – Members can contact a physician at any time for a family health concern.
- 2nd opinion services – Members can consult a physician to get an opinion and assess options/necessity for any available alternatives.
If Knew was around when we were using medical cost sharing as an alternative to health insurance, we would have definitely been members of their organization! These extra benefits go a long way in helping manage expenses for those who are proactive, run their own labs, and take supplements.
If you are curious to learn more about Knew Health and medical cost sharing, they have a downloadable cost savings guide and program information.
You can also use their health care cost savings calculator to estimate how much medical cost sharing will save your family.
Tell me in the comments–do you have experience using medical cost sharing as an addition or alternative to health insurance? What has been your experience?