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Editorial Roundup: Buyer Beware On 'health Care Sharing Ministries'

Published 8:50 pm Tuesday, November 28, 2023

Open enrollment is the window of time at the year's end when consumers make a critical health care decision — which health insurance plan to buy for the coming year to cover themselves and their families.

Those with coverage through a job typically have a handful of plans to choose from. Those who buy on their own — such as early retirees, farm families or entrepreneurs — have a dizzying array of choices. It's that latter group, currently right in the middle of open enrollment, who should take heed of recent data from Colorado underscoring an old truth:

If something sounds too good to be true, it probably is.

The Colorado state regulators' information concerns a product known as "health care sharing ministries" that may be marketed to consumers shopping for a health plan. In a Health Care Sharing Ministry (HCSM), "members follow a common set of religious or ethical beliefs and make monthly payments to help pay the qualifying medical expenses of other members," according to the Commonwealth Fund, a nonpartisan health policy organization.

It sounds like health insurance. And to someone on a budget, it likely sounds like a good deal, with monthly payments often less, perhaps substantially so, than the monthly premiums for insurance sold through MNsure and other trusted marketplaces.

But the National Association of Insurance Commissioners has long cautioned that health care ministry plans "are not insurance." The consumer protections provided by the Affordable Care Act don't apply, and in some states, ministries may fall between regulatory cracks.

That can mean big problems. "HCSMs are under no obligations to pay members' claims," Commonwealth said in a new warning last week. Coverage for pre-existing conditions such as cancer, diabetes or asthma may be excluded. So might be other needs, such as preventive care or mental health treatment. In contrast, traditional medical plans "must cover essential health benefits and all pre-existing conditions."

The regulatory gray zone in which HCSMs operate has provided little visibility into their operations. But in 2022, Colorado legislators passed a measure requiring the state to collect data on them. State regulators have issued two yearly reports since then. Open enrollment is a smart time to highlight the findings:

1. In 2021, nearly 68,000 Colorado residents were enrolled in an HCSM. That's about 30% of those who bought insurance in the state on their own that year, an alarming number.

2. The yearly medical claims far exceeded what the HCSMs paid out — $362 million in medical claims were submitted, while $97 million in fees were collected — enough to pay for 28% of members' medical costs. HCSMs contend that the $362 million included duplicate and ineligible charges and didn't reflect discounts or what members had agreed to pay. But even when adjusting this sum to reflect that, the amount collected by HCSMs only covered 74% of total eligible share requests. Translation: Members are at risk for significant out-of-pocket medical costs.

3. Many HCSMs reported excluding important types of medical claims, such as those for mental health and alcohol use disorders, ADHD treatments, contraceptives or prescription drugs for chronic conditions. In addition, some excluded or limited maternity care unless the pregnant woman belonged to a certain membership tier (one likely more expensive) for a required time.

4. Members in some HCSMs had to petition clinics or hospitals to write off or discount medical care, or request charity care or government assistance before the organization would pay the bill.

A recent Commonwealth analysis of the Colorado data adds further troubling perspective. One HCSM recently surveyed members, and found that 42% of them had incomes below 200% of federal poverty guidelines. That means they probably could have qualified for medical assistance programs or Affordable Care Act financial subsidies. Either could provide low-cost or no-cost coverage without the gaping benefit loopholes.

There are HCSMs operating in Minnesota. On Monday, the state Department of Commerce advised "consumers seeking affordable insurance options to research legitimate plans available through MNsure." Officials also noted that the agency "does have the ability to take enforcement action should an unlicensed entity engage in the business of insurance."

Consumers, as always, should be on guard during open enrollment, which began Nov. 1 and runs through Jan. 15. Minnesotans are also welcome to file complaints with Commerce about insurance or insurance-like products. They can file a complaint online, via email at consumer.Protection@state.Mn.Us or call 651-539-1600.

— Minneapolis Star Tribune, Nov. 20

About Editorial Roundup

Editorials from newspapers around the state of Minnesota.

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Local Tech Startup Wellconnected Lands Multiyear Deal With Independent Health

Duane Conners, co-founder and CEO of wellconnected, displays the company's allco platform. The Cheektowaga-based company, formed in 2021, has signed a deal with Independent Health. 

Libby March

Partnership could boost member outcomes

Duane Conners describes the multiyear deal that his fast-growing technology startup recently signed with Independent Health as one of those "awesome local visionary contracts."

In the partnership, Independent Health will use wellconnected's flagship product, allco, to connect its members to community services such as food and nutrition assistance, transportation services, housing assistance, income support and employment, educational programs and mental health counseling.

"They just get what we can do," said Conners, co-founder and CEO of Cheektowaga-based wellconnected. "We're working together on how we can actually go and do those things. But there's a distinct value proposition for both of us to each other."

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Wellconnected's allco is a centralized digital platform that links health insurers, social care agencies and patients. Independent Health said allco's "user-friendly and accessible interface" will help its representatives to easily connect members to needed resources, which the health plan believes will boost access to services. Access, the insurer noted, is one of the key social determinants of health, the conditions that contribute to health outcomes and inequities. 

"While many services and organizations are available in our community, it can be hard for individuals to know who to call when they need help," said Roberta Rifkin, senior vice president of government affairs and strategic partnerships at Independent Health. "That's why we're glad to have partnered with wellconnected to make things easier for our members to connect them to the right resources they need."

Conners and co-founder Jamie Bono started wellconnected in March 2021. Both left long careers in the health care industry to do consulting work, bringing modern technology solutions to nonprofit organizations and non-hospital-based health care providers. After a while, they noticed they were helping community-based organizations in Western New York with the same things.

That's when they decided to form wellconnected, seeing the need for an all-in-one technology solution to bridge communication gaps in care and to improve collaboration between community-based organizations, community members and funding agencies.

"We always knew health care was going to find value in what we did and how we do it and the data that can be curated and all the back end stuff that goes along with it," Conners said. "But in the real human element of it, it's really just designed to connect people to all the things that surround them in a way to make them more successful and healthy."

Wellconnected, headquartered near Buffalo Niagara International Airport, has six employees and is "growing exponentially," Conners said.

And while the Independent Health partnership isn't the largest deal wellconnected has done, Conners said it might be one of the most meaningful because of the local ties.

"Having been in the startup scene here in Western New York for quite some time, it's really cool to be a local startup that's being used by, for lack of a better term, an enterprise-level agency in Western New York," Conners said. "And that's a really cool feeling."

Welcome to Buffalo Next. This newsletter from The Buffalo News will bring you the latest coverage on the changing Buffalo Niagara economy – from real estate to health care to startups. Read more at BuffaloNews.Com.

UB makes health insurance change for students

University at Buffalo in mid-November announced it will no longer require health insurance for domestic students as of next fall. It also is discontinuing the university-sponsored insurance plan offered to them.

The university said that health insurance will still be mandated for UB's international students, those studying abroad and intercollegiate athletes. 

John Della Contrada, vice president for university communications, said that fewer than 1,000 undergraduate and graduate students are enrolled in the university-sponsored plan that will be discontinued after the current policy year ends July 31. That's down from more than 4,000 enrollees at the plan's height, he said.

To date, he said, UB has received "very few inquiries" from students about the change and is helping students, on a case-by-case basis, select a new plan.

Della Contrada said the decision was based on two factors: the sharp decrease in the number of enrollees, which increased the plan's cost as well as the cost of health care services covered under the plan, as well as the broad availability of health insurance options for students through the public marketplace and due to New York's Medicaid expansion.

"Given the availability of alternative options in the marketplace, the university is confident that students' well-being should not be negatively impacted," Della Contrada said.

And while UB is eliminating the health insurance mandate for domestic students in fall 2024, the university said it still strongly recommends that all students carry health insurance. Typically, young adults can stay on a parent's health insurance plan until they turn 26.

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Medi-Share: Health Care You Can Afford, Values You Can Support!

Most people have experienced frustration with their health care option at some point. Health care can be confusing. It's hard to know what's included and what's not, and you may end up paying way more than you expected for a procedure or doctor's visit. On top of any unexpected costs, the regular monthly payments can be a major financial burden for many families.

Medi-Share was born out of a belief that there had to be a better way to handle the cost of health care, especially for the Christian community. We are believers to bear one another's burdens, and the cost of health care has certainly become a burden for many families.

In 1993, Medi-Share was established under Christian Care Ministries as the biblical way to do health care. Medi-Share is a community of believers sharing one another's medical bills, supporting each other with prayer every step of the way.

Over the last three decades, more than $7 billion in medical bills has been shared between members. Medi-Share is a nationwide health care alternative with a satisfaction rating.

Medi-Share's Program Options

Medi-Share has unique programs tailored to meet everyone's needs and budgets.

: This is the best option for families.

This program is an alternative budget conscious self-pay option that offers individuals the care they need for as low as $500 should an emergency arise.

: A supplemental health sharing program for Medicare parts A and B, this offering is designed for individuals aged 65+.

: This is designed specifically for Christian churches and non-profits who want to offer Medi-Share membership to their Christian employees.

Medi-Share isn't health insurance. Our members say it's better!

Medi-Share's programs have provided access to affordable, quality health care for members for over 30 years, creating a supportive Christian community that bears one another's burdens every day. As the first nationally accredited health care sharing ministry, Medi-Share gives their members the peace of mind of a ministry they can trust and a Christian community they can depend on. 

Learn more about Medi-Share to see how much you could be saving on your health care and join a Christian community that cares, at . 

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