Ok, you’ve survived the ethical and religious qualifications test. Next up is an overview of what medical qualifications you’ll have to meet, or what might be excluded from coverage based on your medical history.
Will you qualify?
Unlike traditional health insurance under the ACA, health sharing organizations can (and do) ask a series of medical questions when you apply for membership. Legally, they can deny membership for just about any reason; in practice, it’s quite different.
In this post, I’ll go through what each of the organizations publishes as far as medical qualifications for membership, and how they treat pre-existing conditions. In general, you can expect to be accepted for membership, but with limitations placed on sharing expenses for treatment of stuff you already have.
Christian Healthcare Ministries
CHM addresses the medical qualifications very simply in their list of Frequently Asked Questions:
In other words, provided you meet/agree to the religious and ethical requirements discussed before, you’ll be accepted. They point out that ineligible expenses, which include certain forms of pre-existing conditions, still aren’t shared–but you can join, satisfy the ACA’s individual mandate, and get coverage per the terms of the sharing guidelines just like anyone else.
As far as pre-existing conditions, CHM distinguishes between “active” and “maintenance” treatment. If it’s something being treated with more than routine medication, it’s not eligible for sharing. In other words, you can’t break your leg, sign up on the way to the ER, and have CHM foot the bill. That would be an active pre-existing condition.
If the incident is over and you’re getting maintenance treatment–high blood pressure comes to mind–there’s a schedule for new Gold-level members. The condition is eligible for sharing up to $15,000 the first year, $10,000 in the second year, $25,000 in the third year, and after that it’s no longer pre-existing.
Of course, other conditions that are not pre-existing are eligible despite any limitations on pre-existing conditions. In other words, if you join in the middle of treatment, whether active or maintenance, for something like cancer, it’ll be subject to limitations. But if you have cancer and break your leg, it would be treated just like anyone who didn’t join while battling cancer.
For expenses subject to the limitations on pre-existing conditions, there is a “Prayer Page” where members contribute above the monthly membership amount. These contributions are used to help share in other members’ medical expenses associated with pre-existing conditions.
CHM’s application is available online, in a single-page format so you can see exactly what they’ll ask before giving them any personal information.
Like others here, Liberty will accept anyone for membership. The application process can be done electronically, but they also publish a printable application form here, which lets you see just what kinds of things they ask about.
If you happen to be a tobacco user, overweight, or other similar conditions that result from modifiable behavior, Liberty may assign you to a program called HealthTrac. While participating in HealthTrac, you pay an extra $80 per month, and meet by phone regularly with a coach to help you kick the bad habit–whether quitting smoking or losing a few pounds. So long as you’re making progress and meeting as required, you remain a member. If you fail to progress or don’t meet with your coach, they can show you the door:
Some individuals who qualify for our medical cost sharing program but have certain pre-existing health conditions that can be improved through lifestyle changes will be enrolled in HealthTrac℠. This required program is in place for Sharing Members to improve their health while reducing the risk of developing or exacerbating serious diseases.
My dad fell into this category, and his goal is to lose 15 lbs over the course of a year. The sooner he loses it, the sooner he graduates from HealthTrac. For someone who’s wanted to lose a few pounds for a long time, the savings over traditional insurance, the $80 a month more he can save by graduating, and his coach combine for a lot better motivation than he’s had in the past. He’s well on his way to meting his goal.
Before that scares you off, they’re not asking you to become a professional athlete, bodybuilder, or anything along those lines. There’s a simple chart that lists weights that you need to be below based on height and gender to avoid the HealthTrac program.
As far as other pre-existing conditions, Liberty looks at a 3-year period prior to enrollment. If a condition is identified as pre-existing, it’s excluded from sharing in the first year, subject to a $50,00 maximum in years 2 and 3, and is no longer considered pre-existing after that.
One new thing that Liberty added during 2017 is a limitation on certain types of sharing during the first 2 months of membership. During that time, “medical expenses for any reason, other than accidents, acute illness or injury, are not eligible” for sharing. In other words, you can’t join and immediately get coverage for preventive care–like a physical or colonoscopy.
Unlike most of the other sharing organizations, Medi-Share’s guidelines indicate that they may not accept members with certain conditions:
Applicants provide medical and lifestyle information during
the application process. This helps determine qualification
for Medi-Share membership.
They go on to indicate that medical records may be required before acceptance, Medi-Share also looks back further, limiting coverage for pre-existing conditions for up to 5 years. During the first 3 years, a pre-existing condition is excluded from coverage. After that, coverage is limited to $100,000/year; for years 4 and 5 coverage is limited to $500,000/year. Only after 5 years of membership, or 5 years after symptoms/treatment, is a condition no longer treated as pre-existing.
Like Liberty, Medi-Share has a program for addressing medical conditions treatable with lifestyle modifications, in this case called Health Partners. It sounds very similar in its structure and operation.
Altrua says anyone who meets the religious/ethical guidelines is eligible for membership, but those who exceed their weight criteria will have an additional monthly share amount. It appears that weight is the only criteria with additional cost, and it is not obvious what the terms are for that. Unlike Liberty, it doesn’t appear that there is any coaching to help you meet the weight targets.
Altrua indicates that they may define “membership limitations”, as in conditions for which coverage will not be extended based on your health history. They will notify you of any limitations when you apply.
As far as pre-existing conditions, Altrua looks at a 24-month period prior to enrollment. Within the first 90 days, any of the coverages requiring pre-authorization, surgery (unless delay would cause certain harms), or resulting from recreational activities are ineligible for sharing. They also exclude any cancer diagnosis within 12 months of joining.
Altrua’s only application process requires creating an account and logging in before you can find out what kinds of questions they ask as part of the enrollment process.
AlieraCare is somewhat silent on the application process and who might qualify. They look back 24 months for pre-existing conditions, and after 2 years of membership, no longer regard a condition as pre-existing. For cancer, however, there are additional limitations, and any occurrence within 5 years prior to enrollment is considered pre-existing.
Samaritan has a blanket guarantee of acceptance for membership as far as medical qualifications. Their rules for pre-existing conditions are somewhat more complex than some of the others, depending on the specific condition. It would be imperative that you look at the details here if you’re considering this path, but it basically breaks down into a couple of categories:
- Conditions cured and symptom free more than 12 months are covered
- Conditions that have been symptom free, not needed treatment, and not deteriorated for 5 years prior to enrollment can be covered
- Pre-existing type 1 diabetes is not covered at all
- High blood pressure, even if not symptom free, is not considered pre-existing as long as it’s controlled and you haven’t required treatment at a hospital in the past 5 years.
- Elevated cholesterol (including taking a statin drug) is not considered pre-existing, but if it’s prescribed for arteriosclerosis for a particular location, it would be pre-existing for that location.
It looks like with the exception of possibly AlieraCare and Medi-Share, you can enroll regardless of your medical history, and none of the organizations base your monthly share amount on your health history. Liberty and Medi-Share charge a flat fee for their health coaching programs, but only until you meet your goal.
All of the sharing organizations have some form of waiting period for pre-existing conditions, ranging from 12 months to indefinitely, most generally falling in the 2-3 year timeframe.