A new report has provided the first national count of Americans who rely on health care sharing plans \u2014 arrangements through which people agree to pay one another\u2019s medical bills \u2014 and the number is higher than previously realized.<\/p>\n

The report from the Colorado Division of Insurance found that more than 1.7 million Americans rely on sharing plans<\/a> and that many of the plans require members to ask for charity care before submitting their bills.<\/p>\n

The total membership numbers are likely even higher. The state agency collected data from 16 sharing plans across the U.S. but identified five other plans that did not report their data.<\/p>\n

\u201cThese plans cover more people than we had previously known,\u201d said JoAnn Volk<\/a>, co-director of the Center on Health Insurance Reforms at Georgetown University.<\/p>\n

Under the arrangements, members, who usually share some religious beliefs, agree to send money each month to cover other members\u2019 health care bills. At least 11 of the sharing plans that reported data operated in or advertised plans in all 50 states in 2021.<\/p>\n

Sharing plans do not guarantee payment for health services and are not held to the same standards and consumer protections as health insurance plans. Sharing plans are not required to cover preexisting conditions or provide the minimum health benefits mandated by the Affordable Care Act. And unlike health insurance, sharing plans can place annual or lifetime caps on payments. A single catastrophic health event can easily exceed a sharing plan\u2019s limits.<\/p>\n

In Colorado, at least 67,000 people were members of sharing plans in 2021, representing about 1 in 4 Coloradans purchasing health care coverage on their own. That rate concerns Kate Harris, a chief deputy commissioner of the Colorado Division of Insurance, which she said regularly receives complaints from sharing plan enrollees.<\/p>\n

\u201cWhat we hear from consumers is that when they purchase one of these, they do think there is some guarantee of coverage, for the most part, despite the disclaimers on many of the organizations\u2019 websites,\u201d Harris said.<\/p>\n

The Colorado report found that health sharing arrangements often require their members to seek charity care or assistance from providers, governments, or consumer support organizations before submitting sharing requests. Those costs are then shifted to other public or private health plans.<\/p>\n

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Katy Talento, executive director of the Alliance of Health Care Sharing Ministries, which represents five of the largest and longest-operating sharing plans in the country, said sharing ministries encourage members to act like the uninsured people they are. Such requirements to seek charity care reflect a desire to be good stewards of their members\u2019 money, Talento said.<\/p>\n
\u201cThink about it like a soup kitchen,\u201d she said.<\/p>\n
Fourteen sharing plans reported that Colorado members submitted a cumulative $362 million in health bills in 2021, and nearly $132 million of those requests were approved. The remainder, sharing plan executives told the division, reflected duplicative bills, ineligible charges, negotiated discounts, and the members\u2019 agreed-upon portion of medical bills.<\/p>\n
\u201cIt\u2019s not like every claim line on a health care sharing request is going to be eligible for sharing,\u201d Talento said. \u201cThey have to submit the whole bill. They can\u2019t just pull out a piece of it.\u201d<\/p>\n
But consumer complaints to the Division of Insurance and to consumer assistance programs, such as the Colorado Consumer Health Initiative, show that members do not always realize what sharing plans will cover.<\/p>\n
\u201cWe have seen firsthand the risks that people face when they sign up for these arrangements without recognizing the magnitude of the risk that they\u2019re assuming for their health care costs,\u201d said Isabel Cruz<\/a>, the initiative\u2019s policy director.<\/p>\n
Talento disputed the notion that members don\u2019t know the parameters of their sharing plans.<\/p>\n
\u201cThat\u2019s just suggesting that our members are dumb,\u201d she said. \u201cIs it likely that somehow our people are going to be willy-nilly jumping blindly into something?\u201d<\/p>\n
Theresa Brilli, a small-business owner in Longmont, Colorado, said she and her partner signed up for a direct primary care plan in 2017 that covered primary care visits for $179 a month. Direct primary care plans are payment arrangements between patients and providers for receiving health services without billing insurance. The plan had an arrangement with Liberty HealthShare<\/a>, a Canton, Ohio-based sharing plan with more than 131,000 members nationwide, to cover additional services like preventive screenings, emergency room care, and hospitalizations for $349 a month with a $1,000 deductible. The rates increased to $499 a month, with a $1,750 deductible, in 2020, Brilli said.<\/p>\n
But Brilli said getting payments was a major hassle.<\/p>\n
\u201cIt took about four to eight months to get reimbursed,\u201d she said. \u201cIt was a fight, every bill.\u201d<\/p>\n
When she heard about enhanced subsidies for ACA marketplace plans in 2022, she decided the hassle was no longer worth it and switched to a Kaiser Permanente plan for $397 a month.<\/p>\n
\u201cI will never go back to Liberty Health or a health care sharing plan,\u201d she said. \u201cI didn\u2019t agree with the whole ministry thing. They made you sign off saying you believed in God, which was like, \u2018Whoa, I guess that\u2019s what I have to do to get my health insurance.\u2019\u201d<\/p>\n
Laura Murray, 49, of Aurora, Colorado, said she signed up for a Liberty HealthShare plan in 2017 as a more affordable alternative to her husband\u2019s employer-based plan.<\/p>\n
\u201cWe kind of felt we were cutting out the middleman in a way, and it was a helping-out-your-neighbor sort of deal,\u201d she said.<\/p>\n
But when she became pregnant unexpectedly, she had trouble getting her health bills paid. Initially, Liberty paid only a portion of the tab, and her bills got sent to a collection agency. It was only through multiple calls that she learned she needed to send the bills to a third party that would negotiate with the providers.<\/p>\n
\u201cIt took years to get it cleared up,\u201d she said.<\/p>\n
Timothy Bryan, Liberty\u2019s vice president of marketing and communication, disputed many of the details of Brilli\u2019s account and attributed some of the delay in payment to her \u201cfailure to submit the required supporting documentation.\u201d Murray\u2019s payments, he said, were delayed more than 10 months because she had failed to provide the required pre-notification.<\/p>\n
Mike Quinlan, 42, of Denver, turned to a health sharing ministry in 2014 after the birth of his first child cost him more than $17,000 out-of-pocket, on top of nearly $24,000 in premiums that year, under an employer-sponsored health plan. He said the births of his three youngest children were covered in full by Samaritan Ministries International<\/a>, a Peoria, Illinois-based sharing plan with 359,000 members, to which he contributes $600 a month. When he incurs large health expenses, he receives a slew of $600 checks from other members, he said.<\/p>\n
Every year, Quinlan attests that he is a Christian and identifies the church he attends.<\/p>\n
\u201cThis is a group of like-minded people who have said voluntarily we\u2019re going to trust each other to cover each other\u2019s health costs,\u201d he said.<\/p>\n
The rules differ from plan to plan. Some sharing plans require members to pledge to abide by Christian principles, and some exclude payment for out-of-wedlock births or health issues that arise from drug use. Many sharing plans exclude coverage of contraception, mental health services, and abortion, often with no exceptions for rape or safety of the mother.<\/p>\n
Regulators in Colorado and other states have also expressed concerns that health sharing arrangements are paying brokers much higher commissions for signing up members than health plans do. That could create financial incentives to push sharing plans over health insurance without adequately educating consumers about the differences.<\/p>\n
In 2019, Covered California, the Golden State\u2019s ACA marketplace, instituted a requirement that its certified agents who sell both sharing plans and health insurance provide consumers with a list of disclosures about sharing plans and show them the subsidies they could receive for buying traditional health insurance coverage.<\/p>\n
\u201cIt\u2019s really important that consumers understand what these arrangements are, and what they are not,\u201d said Jessica Altman, executive director of Covered California.<\/p>\n
Harris said the Colorado Division of Insurance is investigating multiple health sharing arrangements based on consumer complaints but declined to name them.<\/p>\n
Colorado officials are also concerned that health sharing arrangements might appeal primarily to people who don\u2019t expect to use many health services. That could increase the proportion of sicker and more expensive patients among enrollees in traditional health insurance plans, driving up premiums.<\/p>\n
Harris said many consumers can get a health plan for less than the cost of a sharing plan, particularly with increased federal and state subsidies put in place in recent years. State officials are also working to inform consumers of the financial risks associated with health sharing arrangements, some of which have gone bankrupt in recent years.<\/p>\n
\u201cIt might look cheaper on its face, month to month,\u201d Harris said. \u201cBut if they do really actually need their costs covered, there\u2019s a real risk that they may not be.\u201d<\/p>\n
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