Covering What Membership Doesn’t

HELPcare Clinic is a primary care clinic.

It’s not a hospital or a surgical center.

We don’t have X-ray, CT, or MRI imaging capabilities.

We don’t have specialists such as cardiologists, neurologists, or oncologists.

While membership provides most of the care you need for most of your life, sometimes you may need services HELPare Clinic doesn’t (yet) offer.

When you have a serious injury or illness that requires surgery or specialist care, HELPcare Clinic providers will coordinate referrals as needed to larger medical establishments.

Or you may need to visit a hospital emergency department.

In planning for both your physical and financial health, you should have a way to cover your expenses for this kind of care when you need it.

As we discussed last week, traditional health insurance is (or should be) a safety net to cover these types of expenses. Because it has become involved in routine care, however, costs have spiraled.

The total annual cost for (employer and employee) family coverage in a group plan is typically over $20,000. For many employers, and especially for small businesses, it’s simply unaffordable.

In the next few weeks, we’ll review traditional insurance options, including deductibles and coinsurance provisions that affect your monthly premiums. And with the tax credit subsidies available through the state insurance marketplaces, such as MNsure.org in Minnesota, those who don’t have access to employer-supported insurance can get monthly premiums reduced, depending on their income.

Many HELPcare Clinic members have used another method to cover large, unexpected medical bills: Christian health sharing ministries. These organizations do not provide insurance but are instead means by which people of faith come together to share medical bills.

When the Affordable Care Act was passed, this type of arrangement was recognized as an alternative to ACA-compliant insurance policies. Options include:

• Medi-Share
• Zion Healthshare (no religious affiliation required)
• Samaritan Ministries
• Share HealthCare

It’s beyond the scope of this post to evaluate the pros and cons of the individual programs. In general, however, you will find:

• Your monthly contribution will be significantly less than the price of insurance. 
• Because this is not insurance, hospitals may not treat it the same way as insurance. For example, they may require payment from you in advance of a procedure, and then you may have to wait to get reimbursed. Or you may not be required to pay in advance, but you may need to deal with hospital collections departments while you await funds from the sharing program.
• There isn’t an open enrollment period as there is for health insurance. You can typically start any time. However, pre-existing conditions may be excluded from sharing.

These sharing programs may or may not be right for you. Many HELPcare Clinic members are using them and have expressed satisfaction, while others have decided to switch to an insurance program. 

Please share your perspective and experiences with health insurance or other cost sharing avenues in our community discussion forum.

For more information on how you can save while receiving most of the care that you need for most of your life, request a free copy of our informational booklet, Saving Through Membership today.

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Lee Aase

Lee Aase is the founder of HELPcare LLC, which provides comprehensive membership, marketing and management services for provider-owned HELPcare Clinics, as well as metabolic health education and coaching for people interested in restoring health and reversing disease through lifestyle changes. Lee and his wife Lisa live in Austin, MN and have six married children and 18 grandchildren.