Leap Of Faith: Will Health Care Ministries Cover Your Costs?

Leap Of Faith: Will Health Care Ministries Cover Your Costs?

Martin Estacio was shelling out $800 per month for a health plan that didn’t fit his two-state lifestyle.

The retired San Bernardino firefighter lives between Oklahoma and California. But his health insurance policy, purchased in Oklahoma, didn’t cover non-emergency care outside the state.

So Estacio dropped his plan this month and took a leap of faith. He joined Christian Healthcare Ministries (CHM), an alternative to health insurance that offers a religious approach to covering medical bills.

Health care ministries such as CHM are essentially cost-sharing programs. Members’ monthly fees are applied directly to other members’ medical bills, no matter where they live in the U.S. Members also pray for each other, and often send notes of support and encouragement.

“What led me to look into it was financial,” says Estacio, 58. “When I started to realize it’s based on biblical principles where you help your brother out, that’s what really clinched me.”

A health care sharing ministry is primarily a “community of faith,” says Michael Gardner, spokesman for Christian Care Ministry, which operates the Medi-Share program. Medi-Share has roughly 300,000 members as of June, he says.

But let’s be clear: Christian health care ministries are not insurance. You must attend church regularly. You must agree to abstain from certain behaviors, such as “sexual immorality” and drug abuse. Preventive care, routine prescriptions and mental health care may not be reimbursed. Forget about abortion. Coverage for your preexisting conditions will likely be limited — at least initially.

Estacio pays $150 per month for his membership, plus quarterly payments of about $30 that offer him a higher level of reimbursement.

He’s responsible for the first $500 on each medical incident before the ministry’s sharing kicks in, but only for allowed services. CHM’s list of non-covered services includes “psychological treatment,” medical supplies and equipment, immunizations, maintenance prescriptions and bills related to drug abuse.

“You have to try to live a good lifestyle,” Estacio says. “You can’t be drinking and smoking. It’s on you.”

Membership in health care sharing ministries has ballooned since passage of Obamacare, in part because the health law provides an exemption for members. If you belong to a qualified health care sharing ministry, you don’t have to pay the Obamacare tax penalty for not having insurance.

About 1 million Americans participate nationwide, according to the Alliance of Health Care Sharing Ministries. Texas has the most members; California places second.

There are more than 100 ministries across the U.S., though the vast majority are small Mennonite churches, says alliance President Dave Weldon, a doctor and former Florida congressman. The three largest ministries are CHM, Medi-Share and Samaritan Ministries International, he says.

All the ministries are Christian at this point, though Weldon says there’s an attempt to start a Jewish sharing ministry.

“It’s our Christian practice of how we bear one another’s burdens,” says James Lansberry, executive vice president of Samaritan Ministries, which has about 227,000 members nationwide.

Samaritan members, who share about $23 million a month, mail their monthly fees directly to other members facing medical bills, along with notes of support, Lansberry says.

Each ministry works differently, but you can generally expect to pay a monthly membership fee. You may be responsible for all of your own routine and preventive medical costs in addition to paying a set amount before reimbursements kick in.

“In effect, they become sort of like catastrophic programs,” Weldon says. “But that’s true for a lot of plans on the Obamacare exchanges as well.”

Unlike catastrophic insurance plans, there’s no contract with health care sharing ministries, he says. That means there’s no guarantee that your bills will be covered.

“However, most of them have always paid their members when they have medical bills,” Weldon says.

Because there’s no guarantee, and because the ministries limit coverage, Sabrina Corlette has two words for you: “Buyer beware.”

“Read the fine print,” says Corlette, research professor at Georgetown University’s Center on Health Insurance Reforms. “Make sure you truly understand what you’re getting with these plans.”

Coverage Caps And Covered Services

Some of these ministries put dollar limits on coverage, a practice that Obamacare ended for most commercial health plans.

“If you’re fairly young and fairly healthy, you may never face that,” says Janet Coffman, associate professor of health policy at University of California-San Francisco. But “some people have catastrophic illnesses that may cost millions of dollars.”

Most health care sharing ministries don’t cover preventive care such as mammograms, colonoscopies and birth control, and some don’t cover mental health care, addiction treatment and other services, Coffman says.

Since monthly fees are generally less than health insurance premiums, members can save money on those costs, says Medi-Share’s Gardner.

“Because it’s so much less expensive, I can be a good steward of my finances and set some money aside,” he says.

Preexisting Conditions

Health care sharing ministries aren’t required to cover preexisting conditions.

As a result, “a lot of these plans have waiting periods or limitations” on them, says Coffman.

You may have to wait one to three years — or longer — to be reimbursed for preexisting conditions. And you may face a limit on reimbursement.

Providers ‘Willing To Take Cash’

Medi-Share has a network of providers with which it has negotiated rates, though members are not limited to it, Gardner says.

Samaritan does not have such a network.

“Patients are treated by providers as cash pay,” Lansberry says. “Members make their own choice.”

In these cases, if you have a doctor you want to keep, would she be willing to see you as a cash customer?

“We’ve never had trouble with members losing their doctors,” Lansberry says. “Doctors are almost always willing to take cash.”

But remember: You may have to cover the entire cost of the bill and wait for reimbursement.

“Should you have to be hospitalized, could you afford it upfront?” Corlette asks.

The ministries encourage you to negotiate for lower prices with providers, though they usually go to the bargaining table for you when the bills are large.

Right To Appeal

Health care sharing ministries are not regulated by government agencies that oversee commercial health insurance.

If you don’t agree with how much you’re being reimbursed — or whether you’re being reimbursed at all — your only recourse will likely be an internal appeals process.

State regulatory agencies wouldn’t have any power to help you, says Janice Rocco, deputy insurance commissioner at the California Department of Insurance.

We “encourage people to obtain commercial health insurance, which they know they can count on if they have a serious health crisis in the future,” she says.

Estacio hasn’t had to request reimbursement from his health care ministry yet, and he has money set aside for health care expenses that wouldn’t be eligible for reimbursement.

But he’s not worried.

“I’m confident,” he says. “I have faith in it.”

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

For Africa’s people, culture and heritage are a form of liberation

For Africa’s people, culture and heritage are a form of liberation

Malagasy people take part in famadihana, the ritual of the dead, to honor their ancestors. Tee La Rosa/Flickr

Today, much effort is made to retell the stories of political activists who advanced the liberation of South Africa from apartheid. The heroic actions of Steve Biko, Chris Hani, Nelson Mandela, Winnie Madikizela Mandela, as well as lesser-known activists like Dulcie September, are being excavated. They’re presented in memoirs, recovered sites, and memorabilia.

The thinking is that the journeys, actions and philosophies of these activists are the nation’s “liberation” heritage. But the reality is that the country’s “liberation” heritage goes much further back, and far deeper. For centuries, ordinary South Africans have used culture to liberate themselves from the yoke of oppression.

In this, they echo Africans the world over who have employed language, belief, ritual, clothes, hairstyles, stories and food to resist and transform colonizers’ religions and cultural practices. From Candomble and Capoeira in Brazil to Santeria in Cuba, from blues and jazz music among African-Americans in the southern states of the US, to the dub culture of black British Jamaicans in the United Kingdom, Africans have steadfastly responded to oppression through culture.

In the African diaspora of the southwest Indian Ocean, islanders have relied on culture in times of slavery and colonization. The Malagasy still practice rituals that revive belief, emphasize self-knowing and obtain the ancestors’ blessings. Through famadihana, the ritual of the dead, the Malagasy honor their ancestors.

Mauritians also commune with their ancestors. Every January 2, Mauritians of African descent visit the graves of their loved ones. There they place cigarettes, alcohol, food, and special gifts; things that their loved ones would have enjoyed. The ancestors are regularly spoken about and unusual events are discussed as potential intervention on the part of the dead.

Evidence of culture as liberation can also be seen today in the revival of indigenous dress and hair styling. These communicate alternative worldviews and challenge dominant style and beauty norms, globalizing the rich material and symbolic culture of Africans.

South Africans are no different. They also use ritual and other cultural practices to respond to and challenge oppression. This is revealed in a recent survey by graduate students from Nelson Mandela University in the Eastern Cape province. It reveals the liberating potential of intangible cultural heritage.

The case of South Africa

In South Africa, inhabitants developed beliefs and practices that breached already porous “racial” boundaries. The apartheid state could not manage such practices. It was impossible to police millions of people into cultural submission. No amount of ideological work and violence could achieve that feat.

For example, some Christian churches advanced apartheid ideology but could not stop people from venerating their ancestors or blending indigenous and colonial belief systems.

Ironically and despite the social fragmentation caused by apartheid, a rich cultural heritage flourished in South Africa. The reason? Apartheid’s ideologues depended on the preservation of culture, believing it to be necessary for achieving segregated development.

In a public lecture, the South African storyteller, playwright, director and author, Gcina Mhlophe said that heritage is key to South Africans’ dignity, identity, and sanity. She added that through songs loosely described as “spirit callers”, Xhosa and Zulu people can connect to an ancestral world that lies beyond their present, often difficult reality.

Burning imphepho, a herb which the Nguni people use as a ritual incense with the purpose of invoking the ancestors, some South Africans are able to connect with the world of the dead.

Today, imphepho still provides many with a means to escape the realities of life after apartheid, as it spiritually transports believers to a world beyond the present reality. The smoke from the herb facilitates communion for believers with spirit beings in the ancestral realm.

In some groups, grandparents are equally important to the liberation process. Their stories and ancient ritual practices activate memory, evoke symbolism and impart wisdom. Their sharp admonishments also liberate through humor. For instance and as Mhlophe tells, grandparents are known to have scolded by saying, “you can never earn a cow by sleeping” (meaning that one cannot achieve greatness by being lazy) or, “you are a like a buck in an endless forest” (referring to someone who is shiftless and indecisive).

Cultural riches

Understanding, valuing and embracing these parts of South Africa’s cultural heritage is crucial. The richness of those cultures and their persistence to this day, compels a rethinking of the idea of liberation heritage.

The cultural evidence shows that, for centuries, Africans and South Africans have been liberating themselves through their heritage of music, song, dance, poetry and language. Instead of promoting a narrow conception of freedom, those in power should use this knowledge to diversify perceptions of liberation in the country.The Conversation

Rosabelle Boswell, Professor of Anthropology and Executive Dean of Arts, Nelson Mandela University

This article is republished from The Conversation under a Creative Commons license.