Pros and Cons of health sharing plans like OneShare

We've written extensively on how health sharing plans work and more importantly, how to compare them.

You can read all about how health sharing works or how to compare health sharing plans here.

One of the common questions we get is this...

What are the pros and cons of health sharing plans like OneShare

Let's get into it based on experience from 100's of members that we've dealt with.

We're going to be as impartial as possible and really spell out both the good and the bad.

We'll also touch base on the reviews that can be found online and give some more background for those.

For a better understanding of how health sharing is different from ACA or Obamacare, go here.

We'll cover these main topics here:
 

Quick intro to  health sharing plans
Pros of health sharing plans
Negatives of health sharing plans
Key considerations between health sharing and obamacare plans

Let's get started.

Quick intro to health sharing plans

We have lots of different articles on this but a quick recap.

Health sharing plans have been around for decades but they really exploded onto the scene about 2-3 years ago.

When rate increases for ACA (Affordable Care Act) or Obamacare plans started to go up quickly for people with out tax credits, their popularity went up proportionally. 

With every open enrollment, this accelerates.

So what are they?

In the original ACA law, there was an exemption from the penalty of ACA health plans if a person had a qualified health sharing plan.

You'll notice that health sharing plans have a certain level of religious or faith eligibility language.

This was because, originally, the exemption was couched in a religious exemption in order to pass politically.

Health sharing plans are NOT health insurance.

They work like memberships where members share eligible health care expenses with other members.

The reason for their popularity (now that the penalty is gone) centers around cost and eligibility.

They generally run about 1/2 he cost of the bronze plan if we don't qualify for a tax credit.

A person can enroll on health sharing plans any time of the year

We'll get into all of this below in the pros and cons section.

You can learn how health sharing plans are different Covered California plans here.

Let's get back to the original question.

We'll start with the pros of health sharing plans.

Pros of health sharing plans

Many people on health sharing plans would probably like to have an ACA health plan.

Here are the main reasons that a person picks health sharing
 

• They can't qualify for a tax credit and can't afford an ACA health plan
• They missed open enrollment and can't enroll in an ACA plan
• They just want catastrophic plan designs
• They only want short term health plan options

It's really the first two that drive 80-90% of OneShare

Short term (especially in California and States that banned short term health insurance) is an outlier and has a very specific function.

Let's look at cost first.

On average, a health sharing plan can run about ½ of what the bronze ACA plan (assumes you don't qualify for a tax credit).

Make sure you're not eligible for a tax credit!

We're happy to help you walk through the basics of how that works.

Most of the calls we get are from people who cannot afford their new ACA plans or find out during tax time that they have to pay it all back.

A couple in their 60's may be looking at $2K monthly for a bronze plan with higher income.

Simply put, that's not an option for them in terms of cost.

Of course there are trade-offs and we'll look at those in the con section below.

That's an actual decision where people have two options (health sharing versus ACA health plans).

What if we don't have an option?

Missed Open enrollment or Lapse coverage

Many people during the year may find that they can't enroll in an ACA plan.

For ACA plans, you have to enroll during open enrollment (usually Nov 1-Jan 31st depending on State) or if you have a special enrollment trigger.

The most common special enrollment triggers are:
 

• Loss of qualified coverage (usually from employer or medi-cal/medicaid)
• Marriage
• Birth 
• Move

This trigger has to happen within 60 days.

Health sharing plans (both short and long term) can be started anytime of the year.

That is a major pro of health sharing plans and in some cases, they may be the only option.

Plan design and options really depend on the health sharing company.

There's a comparison of major 6 health sharing plans here.

We only deal with OneShare for a few critical reasons:

• Large PPO network
• Voluntarily keeps reserves
• Least restrictive in terms of religious requirements
• Large and fast growing base (very important)

You can quote or enroll in OneShare plans here:

Again make sure to check our more comprehensive explanation of health sharing here.

On to the cons or negavies.

Cons or Negatives of health sharing plans

To offset the cost difference, there are definite considerations.

We'll use OneShare plans since they are our most trusted option in that space.

Here's the major items to understand:

• Not DOI regulated or protected
• Not required to pay by law the way health insurance is
• More catastrophic plan design
• Waiting periods for pre-x
• Only has prescription discount card
• Mental health is not covered on standard plans

Let's look at these cons of health sharing in more details.

Not DOI regulated or protected

Health insurance is heavily regulated and protected by the Department of Insurance in each State.

That's not the case for health sharing plans since they are not insurance products.

They are memberships.

Health sharing plans are missing the following requirements of DOI oversight among others:

• Requirement to keep reserve
• Requirement to pay for eligible claims in a timely manner
• Protection to pay claims if company goes out of business.

One of the reasons we only deal with Aliera HealthCare is because they voluntarily keep a reserve.

This a huge deal as any organization whether health insurance or health sharing will go through a bad run of expenses.

The big question most people have is simple...

Will OneShare pay out if we have expenses?

Online reviews for health sharing or health insurance for that matter, are notoriously bad.

People don't like health companies across the board.

We've had 100's of clients with health sharing for a few years now.

What's our experience?

We've only seen two issues.

One is where a provider contracts with the PPO network but bills through a different medical group that doesn't.

This happens with health insurance as well.

We've been able to get this resolved by having the provider resubmit the expense under the correct provider ID#.

The second is where there was a delay in paying for expenses with a new enrollee.

This reminds us of the old days when someone signs up newly and has medical expenses (usually big) that typically have a pre-existing element.

The companies will research medical records to make sure everything was disclosed on the application.

Otherwise, it's been relatively smooth.

It still speaks to the point that we want best in breed if we're going the health sharing route.

More catastrophic plan design

There's a reason health sharing plans like OneShare are priced so much less.

The plan designs are more similar to what we had before 2014.

They are definitely more catastrophic in design.

For many people drawn to them, this is the intended result.

Make sure to look through the member's guide which can be requested by email here.

Let us know which plan you're looking at and we'll send the updated member's guide.

It really gets into how the plans work and we like people to have these before they buy.

Make sure to check out big differences in our health sharing plans versus Obamacare plans here.

Let's discuss an important consideration.

Waiting periods

Similar to what we have before 2014, there can be waiting periods depending on the plan.

The Standard plans with OneShare have more of these waiting periods.

 Again, make sure to request the member's guide for a list of specific waiting periods by plan type.

You can compare the different OneShare plans here.

Only has prescription discount card

The OneShare health sharing plans do not have a defined prescription benefit.

The plans have an RX discount option.

You can actually see the negotiated pricing once a member.

Keep in mind that we can change to Obamacare plans at the end of each year.

Mental health is not covered on standard plans

Mental health is not a covered expense for health sharing plans except for the Comprehensive plans.

Again, make sure to check the member's guide for more detail (request by email here).

This is a big difference between health sharing plans and Obamacare or ACA plans to consider.

Key considerations between health sharing and obamacare plans

So a quick recap in practical terms.

• Can you enroll right now in Obamacare (open enrollment or have a special enrollment trigger)?
• Do you qualify for a tax credit?
• Do you have more serious health issues?
• Can you afford Obamacare or ACA plans?

Those four questions that usually point one way or the other.

For many people, Obamacare may not be an option do to availability or cost.

Those are the primary drivers for health sharing plans.

We then have to understand that the health sharing plans are more catastrophic in design.

The backup is that we can switch to Obamacare plans at the end of each year.

Special enrollment triggers (move, marriage, birth, loss of eligible coverage) are also triggers.

We're happy to walk through the pros and cons of health sharing plans for your situation.

We're happy to walk through any questions you have at 800-320-6269 or by email.

You can run your OneShare health sharing plan Quote here to view rates and plans

Again, there is absolutely no cost to you for our services.  Call 800-320-6269 Today!