The Bible says that Christians should share each other's burdens, and for some, that means sharing the burden of medical bills. They join together in health care sharing ministries, usually paying monthly "shares" of a few hundred dollars or more to cover other members' health care expenses. They then get their own expenses covered in turn. The ministries divvy up the money to cover that month's "needs," as they're called.
Under the health care overhaul, health care sharing ministries can continue to operate, and their members won't be subject to the penalty that will be levied on individuals starting in 2014 if they don't have health insurance.
Even though the ministries aren't providing health insurance, they wrestle with some of the same issues that insurers do: What to do about would-be members who have possibly pricey pre-existing medical conditions? Just how far should burden-sharing go?
The answer: It depends. Medical sharing ministries — which have about 120,000 members nationwide — each have rules that limit coverage of new members' pre-existing conditions to some extent. Christian Healthcare Ministries, for example, will cover up to $15,000 in needs for a pre-existing medical condition during the first year after a new member joins, says the Rev. Howard Russell, the ministry's executive director.
At Samaritan Ministries, the policy is more restrictive: It doesn't share expenses for medical conditions that a member has upon joining, says James Lansberry, executive vice president at Samaritan. (Once a member goes for 12 months without being treated for a particular condition, however, the ministry no longer considers it pre-existing and will share those expenses.)
Although the health law requires insurers to cover everyone without regard to pre-existing medical conditions starting in 2014, those provisions don't apply to health care sharing ministries, says Kansas Insurance Commissioner Sandy Praeger, who is also chair of the health insurance and managed care committee of the National Association of Insurance Commissioners. "As long as they are not regulated as insurance entities, those new rules will not apply," she says.
Noting that nearly half of the ministry's 56,000 members have incomes of 200 percent or less of the federal poverty level ($44,700 for a family of four in 2011), Lansberry says, "If we shared all needs whenever they occurred, our shares would be too high."
In addition to affordability concerns, there's another reason to restrict coverage of pre-existing conditions for new members, Lansberry says: "Human nature being what it is, people will wait to join until they're sick."