Sarah Barazza doesn’t have health insurance, but money was the last thing on her mind as she and her 15-month-old son raced to the hospital in an ambulance last year. The toddler’s airway had become swollen from croup, and he struggled to breathe.
“Wow, I’m so grateful I don’t have to worry about finances,” the Plainfield woman said. “I’m just focused on taking care of my child.”
Her son Moises recovered. The family’s out-of-pocket cost for the episode? Nothing.
The Barazza family belongs to a health care sharing ministry, a religious nonprofit in which members pay for each other’s health care needs. Compared with traditional health insurance premiums, ministries’ monthly member costs are often much lower. But unlike traditional insurance, members must often commit to religious principles. The ministries generally won’t pay for services that don’t align with those principles, such as abortion and substance abuse treatment, and they often limit coverage of pre-existing conditions and prescriptions.
Despite those differences, people in Illinois and elsewhere are turning to the ministries amid frustrations over the costs of traditional health insurance and Obamacare’s mandate that everyone buy insurance or pay a penalty. Ministry members are exempt from that mandate, which will end after this year.
The ministries are another way many people are thinking outside-the-box, trying to find creative solutions to pay for their health care needs without spending sometimes large amounts on health insurance.
It’s hard to say exactly how many people take part in the ministries, but the IRS estimates that in 2016, more than 330,000 people claimed exemptions to the health insurance mandate because they were members of a health care sharing ministry.
More than 20,000 people in Illinois are members of three of the larger Christian ministries, some of which have been around for decades.
But experts, and the ministries themselves, caution that they’re not the same as health insurance and they’re not right for everyone. No one regulates health care sharing ministries, and they’re not subject to the same standards and requirements as health insurance, such as those meant to ensure prompt payments and financial solvency.
“They’re not insurance,” said Karen Pollitz, a senior fellow with the Kaiser Family Foundation. “There’s no contract. This is just a group of people who say God wants us to pay for each other’s medical bills, and then they either will or won’t send money.”
The uncertainty isn’t stopping people from choosing ministries over traditional health insurance.
Michael and Sarah Johnson, of Carol Stream, joined Samaritan Ministries about five years ago after Michael decided to change careers and went back to school to become a pastor, at which point he no longer could get insurance through an employer. Getting coverage through Samaritan was cheaper than buying health insurance, allowing the couple to save for a house down payment and not go further into debt.
They pay a little more than $500 a month for Samaritan. That money goes straight to other members most months, with Samaritan telling the Johnsons where to send their checks.
When it comes to their own medical needs, the Johnsons generally pay for services and incidents that cost less than $300 out-of-pocket. Samaritan also doesn’t cover their preventative care. But as relatively healthy people in their 30s, they estimate they’re saving thousands of dollars a year over what it would cost to pay for traditional plans’ premiums and deductibles.
“At first, you think, ‘Is this really going to work? Will people actually send us money, or are we going to be left high and dry?’” Sarah said.
So far, it’s worked. When Sarah gave birth to the couple’s second child in 2014, Samaritan members sent them about $18,000 to pay for the cesarean birth, the cost after discounts from providers. Many of the checks, from Samaritan members across the country, came with prayers and notes with well wishes.
Samaritan’s religious foundations also appeal to the couple. Like other members, when they joined, they had to sign documents agreeing not to smoke, drink excessively or use drugs. They also had to promise to go to church regularly and be faithful in their marriage. Their pastor had to affirm to the ministry that they were active in their faith community.
“With Samaritan, we’re not supporting things we have a moral objection to,” Michael said.
Samaritan, based in Peoria, has about 80,000 member families nationwide, including about 4,500 to 4,600 families in Illinois. Members often get “self-pay” discounts that doctors offer to people without insurance.
Other large ministries operate similarly, though each has its own rules and payment structures. Some ministries have networks of doctors so patients can get discounts on services.
Another ministry, Florida-based Medi-Share, asks members to pay an “annual household portion” of their medical expenses before kicking in money – similar to a deductible in traditional insurance. That portion can range from $1,000 to $10,500, depending on how much members contribute, or share with others, each month.
Another large ministry, Liberty HealthShare, has about 98,000 families across the country, including about 2,526 households in Illinois. Members pay $199 to $579 a month, depending on which program they choose and their age and family size. They pay $2,250 a year for medical expenses before Liberty members will start sharing costs.
Unlike some ministries, Liberty, which is affiliated with the Mennonite faith, doesn’t require members to be part of a church community or even be Christian. Members are, however, asked to agree to a set of shared Christian beliefs, including that everyone has a “right to worship the God of the Bible in his or her own way” and that “it is our spiritual duty to God and our ethical duty to others to maintain a healthy lifestyle,” among other points.
“It really arises out of the Mennonite belief system and world view that essentially believes we’re called to assist others who are in need without necessarily confinement or restriction as to who that aid or assistance goes to,” said Dale Bellis, founder and chairman of Liberty, based in Canton, Ohio.
“We’ve abandoned the health insurance model and instead rely on each other to pay our bills,” Bellis said.
Obamacare, formally known as the Affordable Care Act, generally prohibits insurers from denying coverage for pre-existing conditions and from limiting how much they will put towards a patient’s medical expenses. The law also requires insurance companies selling plans to individuals to pay for things such as prescription drugs and mental health care.
Health care sharing ministries face none of those requirements – and many don’t meet them.