Alternatives to Health Insurance

I was originally planning to post this on Tuesday morning, but just after we finished breakfast, our 4-year-old fell off the picnic table bench and busted the back of her head open (on a flimsy plastic storage drawer that holds Legos, of all things), and we spent the morning at the ER instead. In the wake of yet another hospital visit (this time with SIX staples), it seems especially fitting to share our experience with this non-insurance option:

With the Affordable Healthcare Act deadline looming on March 31 and the increase in premiums for many people, I’ve been asked several times over the past few months about our family’s choice to forgo traditional insurance.

For six years now, we’ve been members of Samaritan Ministries, a Christian non-profit that operates not as a charity to cover medical costs but as a “medical needs sharing organization.” Each of the 30,000 member families helps share the cost of the other members’ bills, and Samaritan steps in to coordinate this sharing, assigning needs and making sure everyone is fulfilling their commitment.

What does that mean on a practical note? It means that each month we send a check of between $370-$385 to another family to help cover their medical bills.

It means when we have a medical need, we submit our bills to Samaritan and they split the cost among other participating families who then send us checks to cover those expenses.

It means we pray for each another – for healing and comfort, thanking God for healing and new babies – and send encouraging notes.

It means our monthly share is just a fraction of the cost of regular insurance, and we pay less out of pocket for each hospital visit or medical incident as well.

It means we have the flexibility to make our own medical decisions rather than worrying about what insurance does or doesn’t cover.

And it means that for each of our last two births, we’ve paid exactly $0 out of pocket.

In fact, Jackson was our second baby born while we were part of Samaritan, and we’ve also had several ER trips, tests for various things, and a pretty severe blood disorder with one of our daughters, and we’ve been very happy with the program over the last 6 years!

And because I know you have them, here are answers to a few common questions:

Can anyone join?
Samaritan is a Christian ministry, and they do require that members be professing Christians who are active in their local churches and accountable to their pastors.

Is there a deductible?
Because Samaritan is not insurance, there is no “deductible,” but the first $300 for each individual medical need (a pregnancy, an ER trip, etc.) is the responsibility of the member. However, any discount from a medical provider is applied to that amount first, and because our local doctors and hospitals offer discounts, most of our bills end up being reimbursed 100%.

So, for example, if you end up at the ER and receive a $2200 bill but are able to negotiate a cash discount of $450, the remaining amount that you need to pay would be publishable by Samaritan.

For families with more than three needs in a calendar year, the $300 “deductible” is waived for any additional needs, so the most that ends up costing you is $900 out of pocket for the year.

Do you have an insurance card?
While there are membership cards that can help explain what Samaritan Ministries is, we’re cash patients in the eyes of the ER, doctor’s offices, etc., so we’re responsible for making payment arrangements ourselves and they don’t submit anything directly to Samaritan.

How do you pay medical bills?
As cash patients, we’re responsible for making our own payment arrangements. Once a need has been processed through Samaritan and assigned to other members, we then receive checks from individual members to cover those costs.

We’ve held off on making payments until we’ve received the checks in the past, but we now keep a credit card specifically for medical bills. We pay the bill with the card and then pay off the card with the checks from Samaritans. By using a rewards card, we’ve earned quite a few free hotel nights over the past year!

Are well visits covered?
Well visits are not publishable. Normal sick visits are not publishable either because you pay the first $300 of each “incident” out of pocket, and most illnesses don’t exceed that.

While this can be a lot out-of-pocket, especially during the first year of a baby’s life, because the monthly cost is so much less than traditional insurance, it’s pretty easy to put some of the extra in savings and then use that when you need to pay for the things that aren’t publishable through the program.

How much did you really pay for your pregnancies?
We had traditional insurance when I was pregnant with our third daughter, and after her c-section, we ended up paying $3,000 out of pocket. However, because our hospital and OB both offer cash discounts, we’ve literally paid $0 out of pocket for my last two pregnancies. Everything is included, including up to 20 chiropractic appointments (which I’m kicking myself for not taking advantage of).

Please note that there is a limitation on pregnancy coverage if you are already pregnant at the time you join.

What about dental and eye care? Prescriptions?
Unfortunately, dental, eye care and maintenance prescriptions are not publishable under membership. However, like well visits, we’re able to budget for these with the savings over traditional insurance. I have not looked into getting separate, private coverage for these, but Samaritan does partner with an (optional) prescription network that offers discounts on prescriptions. Also, many grocery and drug stores offer basic prescriptions — like antibiotics and pain medicine — for $4-20, so we haven’t found prescriptions to be especially expensive for our family either.

Update: In addition, the Samaritan Ministries Guidelines do include prescriptions related to a medical need as a publishable expense for a 120 calendar day window.

How long does it take to receive shares from other members?
Bills are published two months after the month they’re received. So the bills I sent in in December for Jackson’s pregnancy/delivery will be published in February.

It can be a lot of money upfront, depending on the payment policies of the doctor/hospital, but the credit card system is working for us, and we’ve generally found it easy to set up a payment plan when needed.

Is there a list of participating doctors?
Because Samaritan is not insurance, there’s not a list of participating doctors/hospitals. However, you could call and ask the billing offices of any places you’re considering about their policies for cash patients to help you choose the best one upfront.

Our pediatrician, who we love, does not offer a cash discount other than for immunizations, which are $15 each, but they’ve been easy to work with as far as payment plans, etc. when we’ve needed them. On the other hand, the family doctor that Sean and I see offers a 50% discount if you pay at the time of your visit.

What’s the biggest downside?
There are two things that are hard about the non-traditional option, but we’ve learned to deal with both and I still really, really appreciate this program:

1. Sometimes a share is sent late. Honestly, I’ve been guilty of this myself because we’re self-employed and at times I’m just waiting for a check to come, so I try to be understanding. Samaritan offers members a few months to get caught up and get their shares sent before they reassign the needs, so that can be nerve-wracking, whether you have a provider waiting for payment or the money sitting on a credit card.

2. Most doctors and hospitals don’t understand what a need sharing ministry is, and I get offered assistance applications often. Or they just look at me like I’ve lost my mind while I try to explain it. But really, that’s a small inconvenience, and our regular providers all know that we are “covered” even if they don’t understand how that works exactly.

Are members subject to penalties under the new healthcare laws?
The new healthcare laws contain specific provisions that allow for healthcare sharing ministries to operate. Samaritan Ministries is working with the IRS to draft instructions for how members will show their membership on their tax return, but that won’t be needed until next year when we file 2014 taxes.

For more frequently asked questions, refer to the Samaritan Ministries website

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Do you have traditional insurance? Have you participated in a healthcare sharing ministry?