Health insurance

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dualstow
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Re: Gold's Time To Shine?

Post by dualstow » Fri Feb 07, 2020 3:11 pm

•^ Those pluses and minuses are referring to the military system, not the past five years, right, kbg?
Xan, this is turning out to be a good subthread. If you get a chance, would you mind splitting and calling it self-insuring or something? If you search for

Code: Select all

10:14
on the page before this or 'Canadian wait times', I think that's where the new branch begins.
Three-Letter Initialism of the day:
CML = Canadian Maple Leaf
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Re: Gold's Time To Shine?

Post by sophie » Fri Feb 07, 2020 3:53 pm

Xan, that is really good to know.

Some of the more well known health sharing ministries feature some potentially serious limitations - like, a limit of 120 days of drug coverage per occurrence. If you needed multiple rounds of chemotherapy after a cancer diagnosis or an expensive immunomodulator after, say, a liver transplant you'd really be up a creek.

It's hard to compare that to the numerous examples of people with legitimate private insurance who somehow got stuck with tens or hundreds of thousands in medical bills. It may well be that the risk of that happening with a cost sharing ministry is no worse than with traditional insurance, but it would be nice if someone studied that.
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Re: Health insurance

Post by Xan » Fri Feb 07, 2020 4:05 pm

That would be an interesting study, for sure.

And you're right: CHM doesn't cover "maintenance prescriptions", although they do cover "incident-related" prescriptions. I think the chemo in your example would be covered, but you may be right that the post-implant drug wouldn't. Huh.

Well, I'd just have Smithy ship me some from Canada if it came to it. :-)
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Re: Gold's Time To Shine?

Post by Maddy » Fri Feb 07, 2020 4:55 pm

sophie wrote:
Fri Feb 07, 2020 3:53 pm
Some of the more well known health sharing ministries feature some potentially serious limitations. . .
Yes, like having to go to church and to attest to a multi-faceted statement of belief with which a large number of Christians would not necessarily agree--requirements that apparently get interpreted and applied according to entirely subjective standards that have more to do with evangelical culture and the maintenance of institutional authority than anything else. It's a bit unnerving to have your health insurance depend upon somebody else's view of what is, and is not, sufficiently "Christian."

So far I've managed to keep my membership in a health sharing ministry without donning mascara and poofing my hair up with hairspray, although the thing about my not being "under a man" may eventually get me booted.
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Re: Health insurance

Post by sophie » Sat Feb 08, 2020 11:02 am

So which health sharing ministry are you a member of, Maddy? If you are ok with posting that.

The restrictions vary across organizations, but...didn't think that there might be special restrictions on single women. Sigh. The pink tax strikes again.
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Re: Health insurance

Post by Maddy » Sat Feb 08, 2020 2:32 pm

sophie wrote:
Sat Feb 08, 2020 11:02 am
So which health sharing ministry are you a member of, Maddy? If you are ok with posting that.

The restrictions vary across organizations, but...didn't think that there might be special restrictions on single women. Sigh. The pink tax strikes again.
I'd rather not say, Sophie. At the moment this is the only type of health coverage I can afford, and I don't want to risk losing it. I would guess that even citing Bart Ehrman with intellectual enthusiasm (see the "Figuring Out Religion" thread) would be enough to get me booted. Suffice it to say that it's one of the more well-established and financially stable health sharing ministries.

P.S. I was being a bit tongue-in-cheek when I made the comment about not being "under a man." That's not, strictly speaking, a requirement of membership, but on one occasion I was indeed pulled aside by a church leader (who was required to sign off on my HSM membership form) for counseling on the subject of my marital status and the fact that I was not "under a man." The fact that I had actually chosen to be single was, according to this leader, "selfish." The whole episode was so completely bizarre that I was tempted to quip, "So I'm personally responsible for condemning some poor schlub to Saturday nights at home with his right hand?" But I didn't think my humor would be much appreciated.
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Re: Health insurance

Post by pugchief » Sat Feb 08, 2020 3:17 pm

Maddy wrote:
Sat Feb 08, 2020 2:32 pm
I was tempted to quip, "So I'm personally responsible for condemning some poor schlub to Saturday nights at home with his right hand?" But I didn't think my humor would be much appreciated.
;D I appreciate it. Another Maddy gem!
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Re: Health insurance

Post by pugchief » Thu Feb 13, 2020 7:23 am

For a devil's advocate take on healthcare sharing ministries:
https://www.mymoneyblog.com/do-not-buy- ... istry.html
  • -HCSMs are not health insurance. This also means they are not overseen by state insurance agencies. There no government oversight, nobody to appeal to and have them say “hey that’s not right, you can’t do that”.
    -HCSMs provide no guarantee of payment. The ministry looks at each claim and has sole discretion as to whether they want to provide payment.
    -HCSMs do not have to accept or cover pre-existing conditions.
    -HCSMs cap lifetime payments at relatively low amounts like $250,000. ACA-compliant health insurance has no lifetime limits.
The problem is that by design, yes, MOST people will be satisfied by these programs. MOST people get their bills paid. MOST people can thus leave a positive review. MOST people won’t have an extreme event that requires $500,000 of medical care over time. However, that is not the point of insurance! Insurance is there to protect you from bankruptcy due to a catastrophic event out of your control. Insurance is there so when your child is sick and dying, you don’t have to worry about taking out a second mortgage or skipping the best treatment because it costs too much.

Think of an Amazon product that has overall 4.5 star reviews, which means mostly 4 and 5-star reviews, but the 1-star reviews are from people with cancer or a child with a serious illness and are denied coverage! Also, don’t forget that once the healthcare sharing ministry rejects your child’s claims and the family is bankrupt and desperate, they’ll likely end up falling back on taxpayer-funded Medicaid to cover their healthcare needs. Is this how we want the system to work?
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Re: Health insurance

Post by Xan » Thu Feb 13, 2020 8:08 am

ACA advocates really have no standing to lecture people on the "point of insurance", but they are correct that the point of insurance is to cover unexpected events which could bankrupt you. The lesson is to not pick a plan that has a coverage max.

Covering pre-existing conditions is very much not the "point of insurance", for example. But CHM does cover pre-existing conditions after a phase-in period.

It's true that they don't have to pay. That's what makes it technically not insurance. If they reneged on a promise, though, it would be the end of their service. Has anyone ever found one of these organizations to actually renege, or is every such "they won't pay" a result of buying insufficient coverage?
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Re: Health insurance

Post by pugchief » Thu Feb 13, 2020 9:07 am

Xan wrote:
Thu Feb 13, 2020 8:08 am
ACA advocates really have no standing to lecture people on the "point of insurance", but they are correct that the point of insurance is to cover unexpected events which could bankrupt you. The lesson is to not pick a plan that has a coverage max.

Covering pre-existing conditions is very much not the "point of insurance", for example. But CHM does cover pre-existing conditions after a phase-in period.

It's true that they don't have to pay. That's what makes it technically not insurance. If they reneged on a promise, though, it would be the end of their service. Has anyone ever found one of these organizations to actually renege, or is every such "they won't pay" a result of buying insufficient coverage?
I don't know that the author is necessarily an advocate of ACA; he is just not a fan of HCMs. Your point about not having a health incident bankrupt you is I think what his article all boils down to. If they reneged and went out of business, what would happen to all of the members expecting reimbursement? And do you want to be the one they decide not to pay on when you need it most? I don't disagree with your points, but his are also very valid.
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Re: Health insurance

Post by Xan » Thu Feb 13, 2020 10:14 am

pugchief wrote:
Thu Feb 13, 2020 9:07 am
I don't know that the author is necessarily an advocate of ACA; he is just not a fan of HCMs. Your point about not having a health incident bankrupt you is I think what his article all boils down to. If they reneged and went out of business, what would happen to all of the members expecting reimbursement? And do you want to be the one they decide not to pay on when you need it most? I don't disagree with your points, but his are also very valid.
Honest question: what happens if your traditional health insurance company goes bankrupt? Maybe it depends on who the president is. Under Obama, the federal government took care of everybody's car warranties when the manufacturer went under. (What a joke.) Would the federal government step in and pay for people's medical bills if (say) Humana went under? Seems likely. Would they do the same if an HCM went under? Hard to say. I'll admit it's less likely the government would step in than with a traditional insurer, mostly because the traditional insurers are all so enormous these days.
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Re: Health insurance

Post by Maddy » Thu Feb 13, 2020 10:16 am

HSMs vary greatly both in terms of their scope of coverage and their financial stability, so it's hard to generalize. Several have supplemental programs that extend coverage beyond the ordinary limits. A number cover preexisting conditions after a certain number of years, or have phase-in periods. There's also a great deal of difference between organizations when it comes to how they are structured and in terms of who, exactly, is responsible for making payment. Some HSMs receive monthly premiums and make payments out of their reserves, while others merely act as administrators of a program whereby members make payments directly to other members.

There is a huge demand for alternatives to mainstream insurance, so new HSMs seem to be popping up everywhere. The problem is that they are largely unregulated--which is something that I expect will change in short order as more and more fly-by-night organizations enter the marketplace and state insurance regulators wise up to the fact that these organizations have developed some pretty creative ways of concealing the fact that, from a functional standpoint, they are very much in the business of selling insurance.

Meanwhile, I think it's unavoidable that many of these newer market entrants are going to find themselves with insufficient reserves to meet their contractual (or quasi-contractual) obligations to members. Even now, I frequently hear rumblings from members of even the most well-established HSMs about protracted delays in reimbursement or about repeated, unavailing attempts to communicate with the organization about unreimbursed claims. It's hard to know from these anecdotal reports just how prevalent these problems are, especially when members are required, as a condition of membership, to submit to a statement of faith that purports to bind them to highly controlled dispute resolution mechanisms and to preclude them from going through the usual legal and regulatory channels.
Last edited by Maddy on Thu Feb 13, 2020 10:32 am, edited 3 times in total.
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