The Center on Health Insurance Reforms recently drew attention to health care sharing ministries' by publishing a commentary on possible concerns about the ministry programs.

Sabrina Corlette reports in the commentary that she has heard of some health care providers running into patients in the ministry programs.

She notes that the programs are exempt from many of the Patient Protection and Affordable Care Act (PPACA) requirements that normally apply to new individual and small-group major medical coverage, such as the requirement that policies cover childhood immunizations and other preventive services, or even a requirement that the programs submit to any kind of solvency oversight.

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She also notes anecdotal evidence that providers are seeing more patients with ministry coverage.

Religious groups and community groups have been organizing member-funded "friendly society" benefits programs since the 1600s. Members were supposed to pay cash into the programs in good times to get the right to draw cash out in hard times.

Insurance companies that build up formal reserves to pay claims now dominate the modern U.S. health insurance industry, but religious organizations began setting up health care sharing ministries as an alternative to for-profit insurance companies, or reserve-based nonprofit carriers, in the 1960s.

PPACA drafters helped draw attention to the ministries by giving consumers who join established health care sharing ministries from the PPACA provisions that require most individuals to own what PPACA and the U.S. Department of Health and Human Services (HHS) classify as minimum essential coverage (MEC).

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HHS and the Internal Revenue Service (IRS) have not yet published any readily available statistics on the percentage of consumers who have applied or received MEC exemptions based on membership in a health care sharing ministry.

For a look at some of the ministry information that is available, read on.

Increasing numbers bar chart

1. The ministry programs may have a significant number of members.

The ministries' advocacy group, the Alliance of Health Care Sharing Ministries, says that its two member plans have a total of about 286,000 members in about 93,000 households, and that the five ministries recognized as such for MEC exemption purposes by federal regulators have a total of about 430,000 members.

Vegetables

2. One ministry admits enrollees who agree to a nondenominational set of principles.

Traditionally, many health care sharing ministries set membership requirements that were a better fit for members of Protestant denominations than for Catholics, or for members of non-Christian faiths.

Some consumers who liked the idea of getting an alternative to PPACA-compliant major medical coverage could not honestly agree to the best known ministries' membership requirements.

Liberty HealthShare, an arm of the Gospel Light Mennonite Church Medical Aid Plan, which has been sharing costs since 1995, has established qualification principles that may have more appeal to applicants who are not Protestant.

Applicants may qualify if they do not use tobacco or illegal drugs; do not abuse alcohol or prescription drugs; are healthy and lead a healthy lifestyle; and agree with the ministry's "shared beliefs."

The ministry states in its statement of shared beliefs that, "We believe that our personal rights and liberties originate from God and are bestowed on us by God, and are not concessions granted to us by governments or men," and that, "We believe every individual has a fundamental religious right to worship the God of the Bible in his or her own way."

The ministry wants applicants to exercise regularly and "worship regularly with others," but it does not say how applicants must worship.

U.S. Capitol, with the dome in scaffolding

3. A member of Congress is trying to make ministry members eligible for health savings accounts (HSAs).

The health care sharing ministries usually have their own equivalent of a deductible.

Liberty HealthShare, for example, sets the "unshared cost" at $500 for a single member and $1,500 for a family.

Rep. Mike Kelly, R-Pa., has introduced a bill, H.R. 1752, that would change the Internal Revenue Code to let enrollees in any health care sharing ministry treat their coverage as high-deductible coverage.

Federal tax law normally requires HSA holders to have deductibles over a minimum level.

In theory, if H.R. 1752 passed as written and was implemented as written, ministry members might be able to get HSAs even if they had unshared cost levels lower the usual minimum HSA deductible.

A balance

4. One health care sharing ministry offers a cost calculator that consumers can use to compare the cost of ministry membership with the cost of PPACA-compliant major medical coverage.

Members of a health care sharing ministry have to have faith in other ministry members to put cash in, and faith in ministry managers to administer the ministry in an orderly way.

But, because a ministry is exempt from the usual coverage mandates that apply to health insurance, and from the PPACA ban on use of personal health information other than age, location and tobacco use in selling and pricing coverage, ministry membership may be much cheaper than comparable insurance.

The Christ Medicus Foundation has set up a cost calculator that helps consumers compare the cost of ministry membership and typical premiums for PPACA-compliant coverage.

For a single 50-year-old, for example, membership in the foundation's CURO health care sharing ministry might cost only about half as much as the typical unsubsidized cost of gold-level PPACA exchange coverage, according to the foundation's calculator.

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