WINDSOR–Yvonne Mitto didn’t have health insurance when she had sinus surgery this winter, and she couldn’t be happier. She had her bills covered and, along with them, people across the country praying for her.
“It was amazing,” she said.
Mitto belongs to Medi-Share, a health care sharing ministry in which she and other members contribute money each month that pays other members’ medical bills.
Medi-Share and other ministries like it are based on biblical principles of mutual aid. Members must be church-going Christians and agree to live by certain rules, such as not smoking, using drugs or having sex outside of “traditional” marriage.
Leaders stress that the ministries are not insurance, and more than a dozen states have laws exempting them from regulation. But the estimated 110,000 to 120,000 people who participate in the ministries nationwide–including more than 350 in Connecticut–will be able to use them as an alternative to insurance under the federal health reform law. Participating in a health care sharing ministry is one of the few ways to get out of the law’s individual mandate.
Mitto chose Medi-Share over the insurance offered by her husband’s job, and she said her family is likely to stick with it. She likes being part of a community of people with similar beliefs, and says it makes her scrutinize health care spending more carefully. Other Connecticut members say they like knowing who their monthly payments go to and relish the support from fellow members when they need it. And the monthly costs are significantly less than most insurance plans.
“It’s an uplifting experience,” said Kathleen Cane of Staffordville, a member of Samaritan Ministries International whose medical bills from a heart attack were covered by hundreds of other members. “You get so much more than if you had an insurance company that…is fighting you.”
James Lansberry, president of Alliance of Health Care Sharing Ministries and vice president of Samaritan, said lawmakers were open to exempting the ministries from the individual mandate because they fulfill the mandate’s intent. While people without insurance often can’t pay for their care, leaving others to absorb the costs, Lansberry said ministry members’ bills get paid, not passed on to others outside the ministry.
But some insurance regulators have taken issue with the ministries. The Connecticut Insurance Department considers the work of health care sharing ministries to be insurance, but since they are not licensed, the department cannot ensure that they will be able to pay members’ claims or meet other standards insurance companies are held to.
“There’s no consumer protections built in, from our standpoint, because we can’t look at their books,” spokeswoman Donna Tommelleo said.
Under federal health reform, insurance plans by 2014 will have to cover preventive care at no cost to the members and will be prohibited from putting caps on annual or lifetime benefits.
By contrast, health care sharing ministries generally do not cover routine care; Medi-Share and Samaritan begin covering expenses associated with an event or condition once members spend a certain amount. They also have limits on benefits paid to members–$250,000 per “need” in Samaritan and $1 million per year in Medi-Share for members under 65.
But members say there are benefits that make them worthwhile.
Cane joined Samaritan after she switched from a fulltime job to a part-time one that didn’t provide insurance. Until this year, she didn’t have any health problems.
Then she had a heart attack. In 17 days in the hospital, she got a stent, six bypasses and had a valve repaired. She expects the bill would have been more than $250,000, but discounts for not having insurance brought the bill to about $100,000.
Cane, who sends $135 a month to other Samaritan members for their bills, admitted to being a bit nervous about getting her medical bills covered. But members sent money and, often, cards with encouragement and word that they were praying for her. She got so many cards the postmaster asked if it was her birthday.
She contrasts that with her colleagues at the nursing home where she works. “I hear so many complaints at my work about how bad the insurance is, and how much they’re paying and they don’t get anything out of it,” she said.
Cane says she would stick with Samaritan even if she were offered insurance. She said she sees tremendous waste in the health care system, and Cane said telling doctors she is “self-pay” can make them more careful about what tests they order. Like insurance companies, the ministries, or members themselves, can negotiate with health care providers to get lower rates.
Because her income is low, Cane gets some of her preventive care, including mammograms, free through other programs.
Some Samaritan members qualify for government insurance programs like Medicare and Medicaid but don’t use them, Lansberry said. Close to half fall below 200 percent of the poverty level–the equivalent of less than $44,700 for a family of four. That’s in part because people with higher income tend to get health insurance through their jobs or worry that being uninsured could put their assets at risk, Lansberry said. And those with higher incomes might not be as motivated to explore other options.
“If you’re looking at $1,000 a month insurance premiums and that’s 5 percent of your income, there’s not as much incentive to start looking outside the box,” Lansberry said. But someone paying a third of their income in insurance premiums is more likely to look for alternatives.
Mitto and her husband had access to employer-sponsored health insurance when they joined Medi-Share. Mitto had worked in human resources and understood insurance benefits. But her family had been healthy and only used their insurance for wellness care.
Then her son tore his meniscus, and she was amazed by what it was like to navigate the insurance system, and surprised at how many bills her family was responsible for. She learned about Medi-Share when she asked a friend, a financial planner, what insurance he used, and he told her, “I don’t have health insurance.”
After learning more, Mitto said she determined, “As a believer, this is the way I want to go.”
To join, she had to state her faith and get a recommendation from the leaders at her church. She agreed not to live a promiscuous life or do unhealthy things that contribute to higher health care costs. Medi-Share does not cover abortions, drug treatment or other “unbiblical lifestyles.” That wasn’t a problem, said Mitto, who is now the executive director of Compass-New England, which provides financial guidance based on biblical principles.
Mitto worked at United Technologies for 15 years, until she left in 2007 when she felt called to the ministry. If her husband did not have insurance through his job, she said, she would have been concerned about how she could still cover her three children after leaving a corporate job with benefits. Now they’re covered through Medi-Share, and she says health care sharing ministries can make it easier for people to change jobs and pursue fields they want.
Unlike Samaritan, Medi-Share handles the distribution of money between members, moving money between credit union accounts that members establish. Each month, Mitto looks online to see whose bills her payments cover, and she prays for them.
Because Medi-Share does not cover routine care like check-ups or mammograms, Mitto and her husband set aside money for those expenses. When doctors suggest tests or procedures that aren’t routine, such as a CT scan when she had sinus problems, she asked for more explanation before agreeing. When your employer’s insurance is covering your bills, you tend not to pay them any mind, Mitto said. But when it’s your responsibility, you tend to review them carefully.
“I keep saying, ‘I wish everybody would scrutinize their bills,'” she said.