Surprise! After 5 years with no rate changes, Liberty this morning announced a few changes intended to make sure the health sharing organization remains viable. Yes, rates are going up. No, benefits aren’t. But if you’re a purchaser of your own insurance, you’ve seen worse. You’ll be perhaps pleasantly surprised to know that the increases are only $50 per month according to the announcement. This post is long, and goes over each of the changes in the guidelines that govern the sharing agreement.
But there’s more to it than that. There seems to be some inconsistency between the notice mailed to members, linked here, and the updated rates posted on their website here. For now, I’ll assume the website is what’s relevant for a potential new member. If so, I take issue with it. I’m fully aware of how cheap, generally, health sharing can be. But the breakdown of rates between singles, couples, and families doesn’t appear to be well correlated to increases in medical costs. If we’re sharing, it shouldn’t matter how long we’ve been sharing in determining our fair share. At the very least, it should be made clear to potential members that those joining before them may contribute less each month than they do.
We don’t know all that well what the typical family size is, or the breakdown between the three categories in terms of membership numbers. But we do know that there are two people for every couple, and one for every single. You would expect couples to submit twice the expenses of a single member, and you’d expect their premium to be twice the amount, less some consideration for administrative savings (e.g. fewer mailings, payments, etc.).
Previously, that discount for the second member making the couple amounted to 50%. I’m considering primarily the Liberty Complete plan, for ages 30-64. Under the new e-mailed rates, that second person gets a 60% discount. Compared to the rates on the website, the discount is 67%. That might make sense if we were saying the discount applied to administrative, rather than sharing costs. But couples and families already pay nothing in administrative expenses for their additional members. $24 per month, from each subscription, whether individual, couple, or family, goes to administrative expenses. Here’s what it looks like:
|Member Type||Old Sharing Amount||New Sharing Amount (existing members)||New Sharing Amount (new members)||Administrative Contribution per Person||Old Sharing Contribution per Person||Sharing Contribution per Person||Increase per Person|
|Family||$449||$499||$529||$8, $6, $4.80*||$141.67, $106.25, $85*||$168.33, $126.25, $101.00*||$26.66, $20.00, $16*|
*Families with one, two, and three children, respectively.
If increases in costs of medical services drive the sharing expenses, why aren’t these proportional? As it stands, Liberty already does quite a bit to limit costs associated with unhealthy people, with both HealthTrac and pre-existing condition requirements. A chronically unhealthy person shouldn’t be significantly affecting these numbers. Why, then, is there such a discrepancy?
Especially as single members would tend to be younger, and presumably healthier members, why would Liberty seek to discourage their membership?
Ok…political warning here: not taking sides, simply asking a question.
Recall that Liberty HealthShare doesn’t prohibit LGBT members from participating, but does define marriage as between man and woman, so a married gay couple would apparently have to join as two single members. (It’s unclear to me how they’d treat a family with gay parents with regard to family membership)
Why, in a month where the United States Supreme Court ruled that generally-applicable anti-discrimination laws have a place in our society, even when religious beliefs conflict, would we increase the degree of disparate treatment of gay versus straight couples? It’s not like Liberty covers things like contraceptives, prophylactics, PrEP, gender reassignment, or any mental health services that might be more necessary in that community. If Liberty doesn’t want LGBT members at all, that would be one thing–like the other healthcare sharing ministries, they could probably choose to reject LGBT members outright.
Here, it would seem as though it’s simply a case of charging them more. Does it make sense to charge a straight couple $399 while charging a gay couple $598? On its face, it would seem to be about the recognition of marriage, but the actuarial math is the same, married or not, with regard to expenses. From the standpoint of being good stewards of our money used for sharing, I want to make sure everyone is contributing and benefiting on comparable terms, with no one more or less likely than another to “make out” on their “investment” on the basis of anything other than their own personal health outcomes. That’s true whether we’re talking about gay versus straight couples, or married couples versus say two siblings who share a home. Maybe the “couples” rate has outlived its practical utility. Perhaps the family rates need to account for family size. I certainly value the simplicities and clear presentation of rates. But it seems we either need to see some justification for the differences, or work to get rid of them.
Ok…off the political soap box, and back to the other changes in the sharing guidelines.
My Thoughts in General
If you understand the limitations of health sharing in general, rates after the increases still are more than competitive for what you get. My criticisms here are intended to improve upon the product and encourage the sharing pool’s financial stability and longevity. There are a lot of people out there frustrated with conventional health insurance, and amenable to the sharing concept, but to the extent they’re younger, healthier, and more likely single we need to make sure we aren’t doing the same thing as with the ACA and asking them to foot the bill for the rest of us. There’s a balance between not covering services objectionable to those of certain brands (mainstream or extreme) of Christianity and opening the doors to people that would benefit most (spiritually) from interacting with the Liberty membership.
Other Changes to Sharing Guidelines
For most people, you probably aren’t all that interested in the rest of the stuff here. It’s policy stuff, trying to capture the minutiae in the sharing guidelines. With only a few exceptions, most of it has pretty minimal effect currently. These changes are essentially in the order they appear in the guidelines.
Initial and Annual Dues
This section doesn’t exactly change, except that the dollar amounts are no longer included in the sharing guidelines. Previously, you paid $125 on signing up, and $75 in each subsequent year. The annual amount doesn’t change, but new members will now pay $135 upon joining. I’m not thrilled about the move, as not having it in the sharing guidelines means you have to go to multiple places to figure out what it costs you and what you’re required to pay. It’s also not as easily archive-able, in the event there was some sort of dispute.
Similar to most major medical plans, ordinary corrective eye care isn’t included. The guidelines previously excluded procedures and services relating to the correction of nearsightedness and farsightedness, but slightly expand that to include “any other vision problems that could be corrected with corrective eyewear.”
A new exclusion is added for medical marijuana:
Expenses related to medical marijuana use, regardless of whether use is
legal in a particular state.
While it wasn’t covered previously, I’m guessing this was added to prevent conflict over medical marijuana treatments and whether they’re medically sufficient, fall under experimental treatment guidelines, or have other issues, as social and clinical acceptance become more common. It’s use is still prohibited as a matter of federal law, but the FDA has now approved a marijuana-based treatment–something that would directly conflict with its classification as a schedule I substance with no medical benefit.
With Canada and a few states removing their prohibitions, it’s anybody’s guess as to where things end up on the subject. As far as Liberty is concerned, whether covered or not, a clear position is beneficial.
Personal Comfort Items, Outpatient Pharmaceuticals, Non-Emergency Transportation/Travel
Exclusions in these categories now contain an exception for services arranged/approved in conjunction with the Medical Stewardship Advisory Program. No details about the program are in the guidelines, so I’ll have to check in to what that program is.
Hormone Replacement Therapy/Testosterone Injections
Perhaps realizing that testosterone injections were just one of several treatments associated with sex reassignment therapy, Liberty has replaced an exclusion for testosterone injections with one for hormone replacement therapy. Testosterone supplements for maintenance as you age still aren’t covered (it is still a hormone), even though the word no longer appears by itself.
35) Testosterone injections. Testosterone injections or supplementation, except in children where
prescribed by a physician for short-term (not maintenance) use.
21) Hormone Replacement Therapy. Except in children, where prescribed by a physician for short-
term (not maintenance) use.
The exclusion for expenses arising out of war is now only “for active-duty or reservist military personnel only.” Should I incur medical expenses as a result of war, I’d now be eligible for sharing. This should have been written slightly better, to apply not to those specific people (as in military personnel) but to expenses arising in connection with military activities.
Annual Unshared Amount
Instead of including the annual amounts in the sharing guidelines explicitly, they’re now in your enrollment documentation. Previously, it was $500, $1,000, and $1,500 for singles, couples, and families. Now it’s $1,000, $1,750, $2,250. Like the dues amounts already discussed, I’m not thrilled with having these only on their website, but the bigger issue I have here is how the numbers have changed. Previously, each half of a couple had to pay the same amount out-of-pocket before coverages started as did a single member. Now the couples get a $250 “discount,” and families a $750 “discount” for the first kid, with no additional costs for bigger families. The program already gave a benefit to multiple-kid families in terms of the AUA, by requiring only a single kid’s worth before meeting the AUA.
It may all be justified by expense submission history, but Liberty provides no rationale for the disparate increases:
|Member Type||Old AUA||New AUA||Increase||Increase %|
This is a minor tweak, unless you’re diagnosed with cancer at day 61 with a 31-day month, or if you enroll in January or February. Net effect is a wash really–instead of a 60-day waiting period for certain routine expenses when you join, it’s now 2 months.
What’s covered in this section isn’t changed, other than the requirement that it treats a medical condition is modified to require that it treats a “medical condition diagnosed by an MD or DO.” In other words, it has to treat a conventionally diagnosed condition (regular doctor) as opposed to one diagnosed by a naturopathic doctor. That makes sense to a point–it should be a medical need first before we consider paying for alternative ways to treat it.
The system that provided no sharing benefits for the first three of a four-tier drug benefit system now provides the same limited benefit for all tiers. This removes the restriction on sharing for more common drugs, but also removes some guarantees. This would seem to be a means of simplifying keeping the sharing guidelines consistent with the SavNet benefit that’s provided.
So you’ve quit smoking or lost weight in order to graduate from HealthTrac? Great! Just don’t head to the corner store and resume your old habits. Liberty has added a post-graduation requirement:
After graduation from HealthTrac, graduates will be monitored quarterly for 36 months to ensure goals have been maintained. Annual physicals will be required. If unable to maintain goals, participation in HealthTrac will be reinstated.
Now you can’t just meet your targets in order to get out of the program, you’ll have to prove that you can maintain those healthy habits. It adds a little bit of compliance overhead, but the benefits both to you and to the expense pool are likely far greater.
Minor edit to capture change from 60-day to 2-month waiting period for certain types of expenses as already mentioned.
Direct Primary Care
Unlike a lot of conventional insurance, Liberty does have provisions for Direct Primary Care costs. What are those? They’re the subscription-like fees you pay to a provider for access to certain services at a discount or minimum cost. Often, it’s referred to as concierge medicine, as you have a doctor on-call, and can generally chat or visit without incurring an additional cost. The new guidelines adds a provision to allow people who enroll in DPC to submit bills for office visits with their DPC provider, but only on the condition that their subscription hasn’t also been submitted for sharing.
If a practice bills separately for an office visit, those bills are eligible for sharing if the member has not also requested a reimbursement for DPC monthly fees.
End of Life Assistance
Language for payment of fixed death benefit adds “upon receipt of a copy of death certificate.” Seems reasonable–we don’t want people claiming the death benefit if they’re still alive, and just cancelling membership. Was this actually a problem? No idea.
Then they remove this sentence, which seems surplus:
Such financial assistance is to be used by the surviving family for end of life expenses, including, but not limited to, medical, pharmacy, ambulance/emergency transportation, funeral/burial expenses.
Basically, that statement says you can use it for any end-of-life expense, at your discretion. I’m not sure if they required any reporting, but it was a lump-sum payment anyways.
Sharing Member Responsibilities
This would seem to be completely redundant with an agreement to live by certain ethical and Christian principles, but I guess it was necessary?!?! The following language was added:
You have the responsibility to: Treat Liberty HealthShare SM employees and representatives in a considerate and courteous
There are just a couple of additions here, for terms that would seem to have a pretty ordinary meaning:
17) Ineligible means not eligible for sharing and not subject to the AUA.
18) Incident means any medically diagnosed condition receiving medical treatment and incurring
medical expenses for the same diagnosis.
Alaska, Massachusetts, Michigan, and Wyoming notices were added (most states were already there). This is just a listing of state-required disclosures making sure you understand that they don’t regulate this product. Interestingly, Massachusetts considers Liberty Complete (and not the lower-tier Liberty options) as insurance, for meeting their mandatory insurance law.