But when you get sick, there is no guarantee your ailment will be covered in part or in full. These programs are strictly voluntary, both Lansberry and Meggs point out. The members or a member-elected board determines what types of conditions are eligible for sharing. For example, Medi-Share doesn’t cover routine wellness visits. Samaritan Ministries won’t share dental or vision costs. The factors surrounding a sickness or injury may also make a difference. For example, Medi-Share states on its website that members won’t pay for injuries from a car accident if the vehicle “was used in a race, to perform a stunt, or in the commission of a crime.â€
There may also be limits to how much an individual can receive. For example, Medi-Share will pay up to $1 million per year for an individual, with a $5 million lifetime limit. There are also cases in which pre-existing conditions won’t be covered, prompting criticism from consumer advocates.
“These programs often discriminate against those who have pre-existing medical conditions and may decide to exclude a member who develops a medical condition after becoming a member,†says Ronda Sloan, a spokeswoman for the Kentucky Department of Insurance. “This could have devastating financial and medical impacts on a consumer.†There are other reasons consumers should think twice before signing up for such plans, Sloan says.
– You won’t have consumer protections offered by your state insurance department, which regulates insurance companies that operate in your state.
– You lose a key benefit of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. If you change insurance providers, you can avoid lengthy waiting periods for the coverage of pre-existing conditions if you haven’t had a break in insurance coverage of more than 63 days. Since medical sharing plans aren’t health insurers, “consumers who buy one of these products could encounter a waiting period before pre-existing conditions are covered under any future health insurance plan [before the new law is implemented in 2014],†Sloan says.
– You risk hurting your credit if the medical sharing plan refuses to pay or pays slowly.
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