There are a few Christian Health care Sharing Ministries available which are ACA exempt if you are looking for an insurance alternative. The comparison between Samaritan Ministries and Christian Care Medishare was an easy one for us. Samaritan’s monthly cost structure is based on family types (couple, single, family unit). Medishare’s cost structure is based on which personal responsibility limit (AHP, annual household portion) you choose. Similar to a deductible/co-insurance combo the AHP is the amount of bills you are responsible for each year before Medishare starts paying. The levels are setup accordingly, and the higher your AHP, the lower your monthly cost.
If this page is your first glimpse of Samaritan and you are interested in more details about how Samaritan Ministries works, please read through the pages at the right as I go into a lot of detail about everything. If you have questions don’t hesitate to ask! 🙂
Samaritan has two membership levels. Classic plan (yellow chart) and the new Basic level (purple chart) which offers lower monthly costs in exchange for higher personal responsibility amounts during each medical event. Both are great options. My personal favorite is still Samaritan Classic in order to keep the potential bills lower (or zero). If the monthly share price is an issue then I recommend Samaritan Basic and there are many members using this new Basic plan.
COST AND BENEFIT COMPARISONS
| Updated | SAMARITAN CLASSIC |
SAMARITAN BASIC | MEDISHARE | ||||||
| PERSONAL RESPONSIBILITY AMOUNT BEFORE SHARING STARTS | $750/incident | $1500/incident (can be reduced to $0 with discounts) | $3,000 | $6,000 | $9,000 | $12,000 | |||
| MONTHLY COST |
Standard rates | ||||||||
| family of 4 (adults age 49) | $665 | $383 | $898 | $665 | $523 | $362 | |||
| couple age 28, no kids | $591 | $218 | $506 | $377 | $299 | $211 | |||
| (see full cost structure here) | (click for cost calculator) | ||||||||
| SHARING PERCENTAGE | 100% of shareable amount | 90% of the amount that is shareable | 100% | ||||||
| CO-SHARE | n/a | 10% (up to maximum of $2500) | n/a | ||||||
| MATERNITY SHARING | 100% of shareable | max of $5000 | included, but no maternity sharing on $1000 AHP plan | ||||||
FEATURE COMPARISONS
| SAMARITAN (BOTH LEVELS) | MEDI-SHARE | |
| MONTHLY COST REDUCED WHEN THERE ARE FEWER NEEDS | YES | NO |
| PERSONAL RESPONSIBILITY REDUCED WITH DISCOUNTS |
YES (on $1500 Basic PR amount, all the way to $0) | NO |
| DISCOUNTS FOR BEING HEALTHY | NONE | reduce medishare cost by up to 20%, requires submitting health data. Potential blood work or physical may be necessary depending on circumstances. |
| $1000 AHP available (no maternity) for those 18-29. Senior assist with $1250 AHP available for Seniors. | ||
| EXTRA FEES FOR CERTAIN CONDITIONS | NONE | some health conditions like high cholesterol, obesity, diabetes require an extra $80/month fee and mandatory health partner program |
| ANNUAL FEES, APPLICATION FEES | No annual fee, $200 application fee | $50 application fee, one time $120 member fee, $5 ACCU setup fee (total of $175 up front) |
| MISC FEES | NONE | $2/month ACCU credit union admin fee $3/month Paper Statement Fee, waived if you choose E-statements $75 fee to change AHP levels |
| PROVIDER NETWORK | NONE, see any doctors | PHCS PPO network |
| GUIDELINES OF COVERAGE | Samaritan guidelines | click this link for Medishare guidelines |
| METHOD OF PAYMENT | send direct to Members | payment runs through account at America’s Christian Credit Union |
| AVAILABILITY | all states | Not available in Montana |
| PT and CHIROPRACTIC CARE | All inpatient PT sessions, plus 40 outpatient sessions per need. 40 per need is the combined total of all therapy, whether chiropractic, PT, OT, etc. Maintenance visits are not shared. Chiropractic xrays and 120 days supplements are shareable. | Chiropractic – 20 visits in 6 weeks, only if surgery is the only other option. PT/OT – 20 visits per referral |
| REFERRAL PROGRAM | $100 credit | $100 credit |
| WHO SENDS BILLS | patient sends bills to Samaritan | provider sends bills to Medishare |
| COVERAGE LIMITS |
Save to Share program for everything above $250,000. No lifetime limits |
no lifetime or incident caps |
| PRE-EXISTING CONDITIONS | 1. For most issues if the condition has been considered “cured” with no treatments or symptoms or meds for 12 months, it’s no longer pre-existing.
2. For cancers and heart conditions the timeframe is 5 years 3. Type 1 diabetes is always considered pre-existing. 4. New, unrelated cancers are shared right away, even if you had a different cancer previously. |
1. up to $100,000/yr if no signs/symptoms/treatments/meds for 36 months or if person has been faithfully sharing as a member for 36 mo.
2. up to $500,000/yr if no signs/symptoms/treatments/meds for 60 months or if person has been faithfully sharing as a member for 60 mo. 3. Pre-existing conditions always maintain their pre-existing status. 4. No sharing for pre-existing until at least that 36 month mark is reached.
|
| FAQ | Samaritan FAQs | Medishare FAQs |
| PRESCRIPTION DRUGS | All drugs related to an incident/treatment and those as part of hospital treatments are shared plus four calendar months of maintenance drugs. Cancer drugs are not subject to this limitation. | Six months of drugs per incident. Exceptions may be made for cancer/transplant cases. |
| PHONE NUMBERS | (888) 268-4377 | (800) 772-5623 |
| WEBSITE | samaritanministries.org | mychristiancare.org/medi-share/ |
Samaritan’s Basic level plan is great for those who need a lower monthly cost and still want great protection against medical expenses. It does have a higher personal responsibility portion of $1500 per need before sharing kicks in and a 90%-10% co-share (so Samaritan members will share 90% of the need costs above the $1500 and the member pays 10% up a max of $13,500 the member would pay on any one need). This would be similar to a 90-10 co-insurance on an insurance plan. It also reduces maternity sharing to $5000 per pregnancy. My recommendation is to have your family on the classic level if you have the possibility of more children in your future. In the Basic Samaritan plan the $1500 can be reduced to nothing by getting discounts.
Medishare’s pricing structure is more complicated and a lot more like regular insurance.
Since Medishare operates more like insurance this is appealing for those who want to be more hands-off with their need payment.
Samaritan has no provider network so you can see any doctor without out-of-network penalties. Medishare’s PPO works just like insurance plans. Patient has a bigger share and bill for out-of-network.
Medishare has a nice step up plan for pre-existing conditions, with no sharing prior to being a member for 36 months unless the condition shows no signs/symptoms/treatments/meds for the immediate prior 36 months timeframe. So if you’ve gone 3 years with no treatment/issues and then join, it sounds like you can get sharing up to $100,000 on that condition right away. But please confirm with Medi-share that I’m reading their guidelines correctly. The limits of $100,000 and $500,000 once the 36 and 60 month marks have been reached are pretty generous I think, especially since you can reach those amounts simply by staying a member for that time frame. Samaritan’s policy is that if the condition has been considered “cured” with no treatments or symptoms for 12 months, it’s no longer pre-existing, so the wait time is shorter (12 mo vs 36 mo). For heart conditions and cancers the timeframe is 5 years, while type 1 diabetes is always considered pre-existing. With Samaritan, new, unrelated cancers are shared right away, even if you had a different cancer previously.
My analysis of all that is that Samaritan’s pre-existing program is better if you have something that is not going to show itself for 12 months (or 60 months if cancer/heart related) because it will no longer be pre-existing and get full sharing pretty quickly, but if you have something that keeps popping up then Medi-share’s would be better for you if you can hold on as a member with them for 36 months and cover those costs yourself during that time frame.
If you’re willing to have a very high AHP it is possible to have a super cheap monthly share payment with Medishare. Samaritan monthly shares are based on fewer factors.
SIMILARITIES
- They both have similar statements of faith required.
- No tobacco use.
- No s-e-x outside of marriage.
- Must be a Christian and attend church regularly.
- Extra sharing plans available (not required) for members with non publishable bills. Samaritan’s is called Special Prayer Needs, Medishare calls it Extra Blessings.
- Routine care not published/shared on either one.
- No coverage for abortion
MAJOR DIFFERENCES
- Personal responsibility limits are higher with Medishare.
- Medishare’s monthly rates slide higher every year as you get older. Someone age 64 would have an individual monthly cost of $496 (couples rate is $1011 for $3000 AHP). Samaritan’s monthly rates only change in large age bands on the Basic plan and doesn’t change at all with Classic plan.
- Medishare has specific Senior plans starting at age 65, secondary to standard Medicare coverage.
- Medishare has a reduced rate for seniors on medicare, Samaritan does not.
- Samaritan’s Classic plan will reduce the personal responsibility portion (the amount the member owes for each need before sharing starts) dollar for dollar down to a potential of $0 owed when discounts are obtained,, Medi-share does not reduce a members AHP.
- Samaritan will reduce the monthly share during any months that have fewer needs, Medishare does not.
- Members have mentioned on blogs that Medishare also requires members to participate in Medicaid and get hardship financial assistance if they qualify. Samaritan does not. (I do not wish to be on Medicaid since I have a choice, even if we did qualify.) UPDATE — a statement direct from Medi-share on another blog states that they do not require it, but they will let you know if you qualify for medicaid and help you apply. If you choose to get medicaid then Medi-share will give a discount on your monthly share. I’m glad to know it’s not required, but it seems counter intuitive that they would want you to get back on a gov’t program.
- Medishare requires submitting health data for joining (height/weight/blood pressure, BMI, waist size, etc) including potentially needing to submit blood work, and or data from a physical depending on circumstances, Samaritan does not.
- Samaritan has an optional program for incidents that go above $250,000. Medishare doesn’t require an additional program.
- Medishare has a PPO network just like insurance does, including office visit and ER copays. It functions the most like insurance. Samaritan has no networks, you can choose whichever doctor you want without penalty.
- Samaritan has you send shares direct to other members, Medishare members send their money to personal credit union accounts for distribution
- Medishare has prenegotiated rates with providers due to the PPO network, Samaritan does not. This means Samaritan members are able to ask for even bigger discounts, Medishare discounts are already fixed.
- Medishare has a $100,000 sharing limit for motorcycle accidents.
- Medishare receives the bills direct from the provider, Samaritan members receive the bills themselves and send those on to Samaritan to be shared.
- Medishare has no payment for alternative treatments (like alternative cancer treatments), Samaritan will pay for alternative treatments if they are preapproved by Samaritan and the cost isn’t excessively higher than a standard treatment.
REVIEWS
When I was reviewing these programs, I couldn’t find a negative review for Samaritan members. In fact they were gushing their love for it. However, I found several complaints about Medishare. Some of them were older, but there was even a lawsuit against them which is why they aren’t allowed to operate in Montana. Medi-share had reports of taking longer to pay the bills, Samaritan members very much enjoy process of sending their shares direct to other members. Overall, the reviews I found showed that Samaritan members had a much happier experience than those on Medishare. I’m sure there are very happy Medishare members, though. People who choose Medishare are drawn to its similarities to regular insurance. It’s familiar. In a similar fashion, it appears to offer familiar headaches with many “claims” being denied, and some payment delays. The process of pooling member shares for distribution by the main office has gotten Medishare into trouble with a few states for operating too much like insurance but without being subject to state insurance regulations. Samaritan doesn’t have those headaches with the states because of the method members have for sending shares direct to each other. Medishare does have a fairly attractive pre-existing policy, although pre-existing conditions never fall out of that status. The annual limits are generous though, once you reach the 3 year mark of being either clear of issues or 3 years of membership.
We found that Samaritan Ministries was cheaper, easier to join, easier to understand, offered more personal sharing with members thanks to the direct sending of cards and shares, and the overwhelming positive reviews from other members spoke highly to us. We didn’t want to have a very high personal responsibility (deductible) and with Samaritan Classic plan it’s only $400 per incident (higher $1500 on Basic plan). With Medishare (for a similar price/month) our AHP responsibility would now be $5500 before Medishare would pay anything. That’s pretty high for us. With Samaritan that responsibility is $400 per incident, and that can actually be reduced to nothing based on discounts we get. Using that comparison it makes Samaritan a considerably better deal “dollar wise” vs Medishare. Especially since Samaritan $400 amount (or $1500 on Basic) can be reduced to $0 by getting discounts and Medishare’s AHP is fixed, no reductions. Financially we are on the hook for a lot more with Medishare.
OUR NEED EXPERIENCE
We experienced a surgical need while Samaritan members and found it to be a very simple, straightforward, rewarding experience (as much as any medical event can be). The big question is always, “will it work?” and I can honestly say, without any hesitation, YES IT DOES. We had 100% of the costs of my husband’s surgery shared by Samaritan members and all of it was received 2 1/2 months after the surgery was performed. That is faster than any insurance payout we’ve had in the past, and the Samaritan staff was wonderful, as were the medical staff upon hearing that we are self pay and learning we are ministry members. You can read more about it in my blog posts (links at right), but overall the process demonstrated that need sharing is simple, the staff were supportive and we loved the cards and prayers from members, and we had the entire cost shared (we got an immediate 50% discount for being cash pay). The doctor was thrilled to be dealing only with his patient, and we received the best care from our preferred surgeon. This is how health care should be. Without question. If you are looking for something that better fits your family please give Samaritan a look. I think you’ll be thrilled with what you find. 🙂
UPDATE: We experienced a second need this year and I’m happy to report that it was also 100% shared within 2 months of submitting the paperwork. It was fast, easy to submit the bills online, and we received lovely notes from members along with the checks to pay the bills. We absolutely love being Samaritan members.
Click here to request an information packet direct
from Samaritan or signup online.
Thanks for your writeup!
It seems you are being a little misleading though stating that Medishare REQUIRES you submit “health data for joining (height/weight/blood pressure, BMI, waist size, etc) including potentially needing to submit blood work…”. In actuality, they don’t. IF you’d like a healthy lifestyle discount, THEN you may submit that information, but they certainly don’t require it.
I do find it comforting that I don’t personally have to haggle for discounts with hospitals and clinics, nor do I have to deal with bills and accounting. Medishare takes care of all of that without a hitch and I rarely ever have to get involved. They’ve been a true delight since I joined in 2012.
Unfortunately I found myself on the other side of the bedrail and ended up with close to $500,000 in medical bills. I didn’t have to handle a single one of the dozens and dozens of bills during recovery as Medishare took care of all that – and paid all but $25,000 without blinking.
Samaritan sounds truly wonderful, but Medishare is as well. 😉
Hi Omar. So glad to hear you’re pleased with Medishare! 🙂 Yes, I was trying to indicate that the submission of health data is to get the discounted rates they offer, but not necessary if aren’t trying to get that lower price (which we’d all want to get 🙂 ). Medishare handling the bills is a nice feature, makes it function more like insurance, but that also means I’ve heard of some similar insurance frustrations if the facility isn’t in network, etc. I do have a friend who was on Medishare for a while several years ago and seemed to like it. I’m hoping your statement about them not paying $25,000 of your bills was a typo though, that would be a LOT left over and worse than a traditional insurance policy co-pay. Ouch. I’m so sorry to hear you had to face such a large medical event, and so very glad you feel taken care of with your membership. I also hope you have recovered and are healed! These health care sharing ministries are just a God-send for so many who were priced out of traditional coverage and/or didn’t want to participate in that limiting and frustrating system. Those of us who have ventured into ministry membership have often found it to be much better for our families. Thank you for writing!
Thank you for your comparison between SM and the other ‘share’ options on the market. My wife and I are looking to join the SM family but have a few questions, the first of which is Classic or Basic. Do you have anything comparing the Classic and Basic options of SM? I’m not seeing a strong comparison on their site.
Thanks!
Hi Jonathan, thanks for writing. I have comparisons of the different pricing structures for Classic vs Basic on this page: https://samaritanministriesreview.com/monthly-costs/ and Samaritan’s page here https://samaritanministries.org/classicbasic also has the differences. Classic and Basic are fairly similar expect for the amount of expenses that members shoulder themselves.
Wondering…..I had back surgery in December of 2017. I have not had any back issues since then (so nearly 18months). I read the guidelines but it is not clear to me whether this would fall under the 12month or 5 year pre existing category. I needed an mri prior but I don’t want to pay oop for another one just to ‘prove’ the surgery 18months ago was successful. That is quite a large unnecessary medical expense for us! Or maybe this would fall under the ‘12 month’?
Also. I have a genetic condition (blood clotting issue) I found out in 2012. I have to proactively be put on blood thinners while pregnant but I have never had any issues it was simply a proactive measure. I have never had any blood clots or anything so it hasn’t really ever caused me any issues BUT I have been on medication for it. BUT only while pregnant (and would that be pregnancy related or genetic condition related?) anywho. My youngest is almost two so I haven’t been on the med for about 2 years (and no more children) so would this fall under the 12month? Or 5 years? or not be an issue at all since it hasn’t caused me any issues ever?
Please help. Looking at switching
Also wondering how the ‘discounts’ work to not have to pay the 300? Do I have to negotiate the bill a certain dollar amount? Or percentage of the bill? Or???? I can’t find anywhere how this discount works?!?!
Hi Julie. To find out if your situations fall into 12 months or 5 yrs you’d want to speak directly with someone at Samaritan. I don’t expect them to require an MRI to prove anything, I’ve never heard of that. In fact checkups after an incident are on our own anyway so Samaritan requiring one seems very unlikely. Usually they go off doctor information if there’s a question, so really you just need to know where back issues fall within the timeline. With no symptoms, no meds, no issues, I’m leaning toward it being a nonissue at this point, but only they could say for sure. Same for the blood clotting condition, I’m definitely leaning toward it not being an issue based on what you’ve said here; they are still the final word on that. I think you will be pleased with your discussion when you call them.
Discounts: any discount we get (usually for paying cash) on a bill reduce our portion dollar for dollar until our $300 responsibility is wiped out. So if you have a medical need, you ask for a cash pay discount. The bill is reduced, the discount needs to show on the bill, then we submit that bill to Samaritan. If the total need (all bills combined) show at least $300 in discounts, then Samaritan shares the entire set of bills and doesn’t deduct our $300 responsibility portion from what they share/what we receive from members. If the discounts total $250, then Samaritan shares all but $50 worth ($300 minus $250). Getting at least $300 in discounts is pretty easy for larger needs, not as much for smaller needs. And it’s not just up to us; Samaritan will also help us get discounts on bigger bills that aren’t paid in full yet, especially anything over $1000. If Samaritan also gets us a discount, or gets one that we couldn’t get ourselves, that still reduces our $300 portion by the amount of the discount they got on our behalf. It’s based on dollars discounted. For example we had a surgery need and we asked for the cash pay discount price. It ended up being 1/2 off, about $5000 that we saved. Because the $5000 discount was more than $300, we had 100% of that need shared and we received the full amount of that surgery cost. The cash price was so much less that we paid up front and the shares we got just reimbursed our savings account. Most places have discounts in place for cash payments, it’s just a matter of asking for them. If we don’t feel like the discount is enough then it’s best not to pay it in full, in case Samaritan can get more. We don’t want to aim for only $300 in discounts, the goal is to get the most possible, so that it’s down to a fair price for us, and fair for the doctor (healthcare is not free). Every discount helps the entire membership, as the money is coming from other members, which then helps keep our monthly shares lower. To reward us for our efforts Samaritan reduces our responsibility portion accordingly. Hope that helps!
Any experience with the facility not giving an adequate discount? “If we don’t feel like the discount is enough then it’s best not to pay it in full, in case Samaritan can get more. We don’t want to aim for only $300 in discounts, the goal is to get the most possible, so that it’s down to a fair price for us, and fair for the doctor (healthcare is not free). ” my experience is if you don’t take the ‘early pay’ discount and pay remaining negotiated amount in full by the ‘early pay’ date that they are not willing to negotiate more and you loose out on the ‘early pay’ discount….so is there a process for this? say total is 10000. I get a 20% discount but don’t think its adequate (so negotiated down to 8000 saving 2000) but if I don’t pay the 8000 in full then I don’t ‘get’ the discount. so I would just say ‘ok I don’t agree with that amount Samaritans will be calling you but I will make a 200 (or some amount) payment right now. Thanks!’ is that how that process would work?
note I have seen exact same procedures be negotiated down to about 20% of cost and others only get a 20% discount (so 80% of cost) so want to make sure to get the cheapest price possible to save everyone! and not ‘just’ be happy with 20%! (sometimes 20% may be ‘fair’ other times it may not be!)
I haven’t but I’m sure it happens. Every location and situation will be different. I’d once heard that Samaritan didn’t really want us paying in full up front unless we got at least 40% off for anything we would be submitting to them. But, it’s certainly possible to be unsure if what you’re being offered is ok. Fortunately it’s rarely a situation of “this offer expires in 10 seconds”, which would give us time to call Samaritan later and ask their advice/preference. For emergency situations we have to be treated and then work out the billing later. For non emergencies there would be time to present the discount to Samaritan and see what they think. Either way we are not left on our own, Samaritan is there to guide us. You wouldn’t need to say, “Samaritan will be calling you”, for one thing they may not need to. Medical billing doesn’t move very fast and a lot can happen behind the scenes. If I felt it wasn’t enough I’d thank them for their info, work out a payment for any minimums they require and then check with Samaritan and proceed as they instruct, using their language and advice. You’re right, it’s not just about a percentage, it’s also about the dollars. But that’s why we don’t have to do it on our own. And what if you accept their offer and pay it because the situation was warranted? Well, Samaritan can’t get any further discounts for us, but it’s not like they cut off our hands or refuse to share the need. Samaritan wants us to try for discounts, do the best we can for ourselves and the ministry members, but above all get the treatments we need the way we need it.
Our family of 4 has been on Samaritans for 3 years. We have had an outstanding experience. My 46 yo husband (190 lbs 6’2”) had major heart attack into our first year. Samaritans did a superb job. Since then, we have changed our diets to a whole food (unprocessed) mostly plant based diet. Just by our diet change, my husband is no longer on meds and lost 20 lbs in the process. My only disappointment is that Samaritans doesn’t offer discounts for personal responsibility on the foods we choose. I have read more books than I care to learn about nutritional science. The standard American diet is equally if not more deadly than smoking. Samaritans need to include health metrics to the equation. They leave out the biggest predictor of future health: our diet! Other than that, I love that I can send notes of encouragement to other Christians around the country. I even send extra money to people who live close to me that may need extra money for expenses that weren’t covered. What a great way to be the Acts church for one another!
Thank you for sharing your experience! So glad to hear about the improvement in health and your husband’s recovery. 🙂 God bless.
My question is this about 10 years ago when I was pregnant my midwife found a tumor in my thyroid. After I had given birth the tumor was removed and benign. I still have one thyroid and am supposed to have routine bloodwork just to make sure everything is still working. Does this count as pre-existing condition? Or would it fall under preventative/maintenance. I have 3 children and we never go to the doctor(and I mean never). We have been self pay all these years (for the few incidents that have occurred)but as my children and I get older I see the benefit to having something to protect us in case of an emergency, or accident. My husband is covered 100% through his job so he doesn’t need anything. I am mainly concerned because even at the basic level $300 a month is a stretch for us on one income. I’m having a hard time weighing the benefits because of the unknown. I’m wondering if for us it is better to just keep a savings account and paying out of pocket should something arise. Any thoughts?
Hi Amber. It’s been long enough I suspect it’s no longer considered pre-existing, but Samaritan would need to say for sure. Checkups and routine things are always out of pocket anyway, so the question is whether any future thyroid tumor would be shareable. Sounds like you’re used to be self pay so you’re familiar with getting cash discounts. I understand the monthly cost can be a strain. I think the savings account to pay as things come along is a great plan, but it’s only going to get you so far, which is a tiny fraction of the cost if something major happened. Most big events run into the tens of thousands within just a few minutes; big ER visits, surgeries, cancers, accidents, any one of which could bankrupt most people without some kind of safety net. The thought makes me shudder. For emergencies you’d still get medical care, but I wouldn’t want to be saddled with a 5-6 figure medical bill that would take a lifetime to pay for, and that’s just one potential big event. I agree you should have a savings account to fund the little things, but I would try to find a way to budget the $300/mo for membership for you and the kids. You’re right, the future is unknown, but that’s a small price to pay for the assurance of knowing that if something does happen, you aren’t stuck paying everything yourself. Depending on the age of your kids you could be heading into the prime of their accident prone years; broken bones, sports injuries, random stuff kids do. None of that is cheap and I’d much rather go through it knowing that Samaritan is there to support us should anything happen. The unknown is why you need some kind of financial safety net. I would strongly suggest finding a way to make membership possible. I sympathize with the financial strain, it is a tough thing to manage when the budget doesn’t stretch far enough. But it could be catastrophic to get a medical surprise and be stuck burdened for life with the cost. God bless you and your family and good luck with your decision. I can wholeheartedly recommend Samaritan as an amazing ministry that really does support its members, even far beyond money.
Hi, I tried to search but did not see if it was already answered. Do you happen to know if Samaritan would consider past Kidney stones a pre-existing condition for 5 years or would it be less? Thanks!
Hi Bill. With Samaritan kidney stones are no longer pre-existing at the 12 month mark, as long as it went without treatment, symptoms or meds for that year. Hopefully that is good news. 🙂
Thank you! Horrible things that they are!
Thank you for the great information on these ministries. I wish I had known about this sooner, could have saved a lot of money in insurance over the last few years. I will definitely be checking these out and probably joining one very soon. Question: do you think my previous history of high blood pressure will matter?
Hi Mark. Samaritan does not consider highblood pressure to be a pre-existing condition as long as you haven’t been hospitalized for it. Assuming that’s true for you, it should not matter. Christian Care Medishare may see it as pre-existing, I’m not sure about their thoughts on that. Good luck with your research, and let me know if I can answer any more questions. I also recommend speaking with Samaritan as they are very friendly and supportive.
Thank you for this, I was wondering the same question. I am on ongoing blood pressure medication, but recently was able to reduce from 2 to 1 med after losing weight. I will be checking into/joining Samaritan when I am laid off (early retirement) from my job in September.
One question – how long does the application process take? I need to know how far before my job termination date to apply. Thank you for putting all this great information together, it is extremely helpful.
Hi Patty, the application process is actually very fast. You can choose to have your membership star the day they get your application or set it for a certain date in the future. Samaritan doesn’t reject membership for health reasons, so pretty much the only way to be rejected is to not agree with the statement of faith, or not have a pastor sign for you. We chose to give it a 2 week overlap from our old insurance to Samaritan, but it wouldn’t have been necessary. And that was mostly because we signed up during open enrollment and during that time it takes a couple extra days to hear back from them, but we were members the day they got our application in the mail. I’m so glad the site is helpful, we love being Samaritan members!
I keep reading stories of people who get health care for much cheaper if they don’t use their insurance. Is that an option for people who use this program?
Hi Carla. I’m not sure if you’re asking about Medi-share or Samaritan so I’ll address both. Medi-share has agreed upon rates with providers as part of their network, so further discounts aren’t really possible, and higher out-of-network costs and higher personal responsibility amounts are also part of it. It’s similar to insurance in that regard. Samaritan members are considered self pay so we are able to get significant discounts from providers and don’t have to worry about networks. The average discount is almost 50%. We had a surgical need as Samaritan members that was discounted by 50% immediately because none of it needed to go through insurance. It made our out of pocket portion zero because the discount was more than our $300 responsibility and Samaritan reduces our portion owed by the same amount of our discount. That can’t happen under insurance, or with Medi-share. Samaritan offers the best of both worlds in that regard. Members can get the benefit of lower healthcare costs for their own care, providers don’t have to deal with insurance paperwork, and Samaritan members help share in those lower costs saving money for everyone. It’s a win-win-win scenario.
Actually, Medi-Share members can ASK for a cash price unless the medical provider refuses to look. Most of the time, when I ask, billing departments are happy to look up cash price vs. the negotiated rate. If less, we pay cash and file the bill afterward with Medi-Share. It works both ways.
Can you talk about the method of paying people directly? I’m trying to imagine sending my monthly payment to a person instead of a company. It seems so unusual. I’ve seen people say they like it though.
Hi Erin! Thanks for asking. Person to person sharing is actually something I’ve seen mentioned many times as the main reason people choose to join Samaritan Ministries. They really like the personal nature of it. What it means from a practical standpoint is that with your newsletter each month Samaritan will give you the name, address, amount and description of the need for a member who has a medical issue. You can pray for them, write them a note and send a check (or pay online if that member has allowed it). The next month its the same process, just a different person with a different need. I look forward to my newsletter each month because I love reading it, but I also really want to know who I’m sending money to that month. I usually can’t wait and login early to my online account to see it sooner. 🙂 I get a kick out of seeing what state they’re in. I’ve even sent to people not far from us (nearby towns). I feel an instant connection to them if they’re in a town I’ve been to, or have friends or family nearby. We’re all used to sending money to a faceless corporation, but Samaritan breaks down those barriers and brings healthcare to a more personal level. Not ‘in your face”, just a connection to another like minded person who needs help with a medical issue right now. It’s honest, wholesome, and feels amazing to be part of. All I can do is encourage you to join and step out in faith about the process. I think you’re really going to love it.
Hi! I’m looking at switching from Medi-share to Samaritan’s. Your article was very helpful in my research. I have not had the best experience with Medi-Share. Do you happen to know how much extra Samaritan’s charges for the separate maternity care coverage? It would more than likely be just me on the plan.
Thanks!!
Hi Kadee. I will check with Samaritan to be sure, but I think it’s essentially equivalent to have a two person membership. I will update this comment when I have confirmed it. Assuming that’s true, I would recommend you and your spouse both join anyway, that way anything that his insurance doesn’t cover can be shared by Samaritan, and you’ll automatically have the full maternity sharing. Once a baby is born you could take him off membership and keep the baby on, which would essentially be the same cost per month.
Confirmed, I checked with Samaritan and it’s the same as having a two person membership. I also recommend the Classic level as the Basic level limits maternity sharing to $5000. Thanks for asking. I’m sorry to hear your Medishare experience wasn’t so great. We have been extremely happy with our Samaritan membership and I think you’ll be quite pleased with how everything is handled. Need sharing is quick, the support from the staff is tremendous and we just feel so at ease about our health care sharing dollars and the protection we have for any potential need we may experience. The two we have submitted already went really well. If I can be of any further assistance please let me know. Have a great day!
Hi. I was wondering how often Medishare changes their share amounts…It looks like they had a big price increase recently, along with raising the AHP. Do you have any additional information ?
Hi Eric. Medishare makes a standard annual increase, and also increases as the members age, very similar to insurance company methods. However, Medishare is also now changing their AHP levels (personal responsibility portion) as of July 1, 2018, going up by $500 at each level, and the monthly pricing for those levels also increased dramatically. Compared to last year’s calculations, the lower AHP levels went up by a higher amount than the big AHPs. So the $1250 level jumps to a $1750 level and also went up almost $200/mo for my example family (4 members, oldest age 42) but the $10,000 AHP goes to a $10,500 AHP level and went up by about $60/mo. This is the largest change I have seen them make in a while. I have already changed the AHP levels and monthly share amounts to the new levels for my examples in the grid. I don’t know the reason behind it, but as they are structured closer to insurance with fixed pricing and no options for further discounts, that may be hurting the numbers a little. Since the lower AHPs had the highest jump it seems logical that Medishare is pushing members to take more responsibility for costs by encouraging them to move to higher AHPs which would be more affordable monthly, although the pricing really doesn’t seem very affordable until you get to some pretty high AHP levels. I’m not surprised by them increasing since they do every year, but the amount of increase and AHP change does surprise me a bit. Thanks for asking. God bless!
Thanks for the info. I like that new Basic tier with Samaritan Ministries. We’re a pretty healthy family and probably won’t have much need to use our membership, but “just in case” I want to be sure we are members, never know when something could happen. That lower monthly costs just fits our budget better. Can we go up to the Classic level later if we want to?
Hi Cassie. Yes, you can change tiers. However there are a few rules to note: 1. If you submit a need on one tier, and then change, that need is closed so no more add-ons can be done (such as if a problem came back, it would be a new need, can’t be part of the old one anymore). 2. Going from Basic up to Classic, from a pre-existing standpoint it’s as if you’re starting as a brand new member. As the guidelines word it: “That means that any condition/injury occurring prior to the switch date, even if it occurred while the person was a Samaritan member participating in either membership level, is now pre-existing until it meets the new time/symptoms/treatment requirements in relation to the switching date. A new Special Prayer Need could be opened to request assistance for medical bills related to pre-existing conditions. (See Section V.A.)” 3. There is a $100 switching fee to change levels. The basic level can offer significant savings in exchange for more personal responsibility from the member. For members who rarely need medical care it can be a way to have excellent peace of mind about a “big event” being supported while at the same time having very very little out of pocket each month for the monthly share cost. Thanks for asking!
Just wanted to say thanks for all your hard work and information. I’m excited to join Samaritan Ministries and be part of something wholesome and good while getting protection for any future health needs. I can’t wait to send my money to another family and hope I get lots of people who are having new babies! I love babies.
Hi Jessica! Your enthusiasm brings a smile to my face. It is wonderful to send our share directly to another family. There are many families who have new babies as members, so I’m sure you’ll get you wish and see several of them assigned to your monthly share as time goes on. You will also get to help people pay for surgeries, broken limbs, heart problems and cancers. Every month I look forward to finding out which new family needs our help, who we can pray for and share in their burden. Let me be the first to say, Welcome to Samaritan!
I have been doing an actuarial analysis of Medishare’s pricing structure. I am wondering if you have any enrollment figures for 2016 and prior. I have it that they had 297000 members at end of June 2017 and 315000 at end of Oct 2017. They have it that they added 97489 members in most recent fiscal year. Any additional date you might have would be helpful. Thanks
Hi Eric. I don’t track their enrollment data, but the photo section of their facebook page has some of that information updated monthly. I’m not sure how far back it goes, but that may be helpful to you.
Hi, you answered a previous question for me a couple months ago and it was very helpful, thank you. We have decided to go with a health care cost sharing ministry for 2018 and are now finalizing which one. Samaritan is high on our list. I wanted to ask whether meds for ADHD are shareable with Samaritan, as well as anything considered mental health-related. Thanks!
Hi Zoe. To my knowledge none of the ministries do much with mental health related sharing. However, some issues fall under medical and not mental health, so you’d want to ask someone at Samaritan and provide the specifics of the issue to see where it falls in the classification. (Alzheimers is an example of something that is considered medical and not mental health, so it is shareable.) Long term meds are not shared with any ministry (cancer meds are an exception), although they all have varying lengths of time that they do so. Samaritan is 120 days of meds for any incident. If you’re already aware of needing ADHD meds, it would likely be seen as pre-existing, but something like goodrx.com could be very useful to find the cheapest possible cash rate for what is needed.
Hello,
A member of our family has an inflammatory eye condition (Uveitis.) The Shingles virus did not present in a typical way and got into the eye and wreaked havoc. After several years of eye visits/meds it is now in maintenance mode and requires 2 checkups a year with ocular tests and daily pills to control or prevent a flare-up or inflammation from occurring ever again. It is a lifelong possibility that will need to be managed but not active, just in maintenance with meds as no current inflammation in eye for quite some time. As a result of steroid drops now have secondary glaucoma managed with meds and cataracts, which may take years to develop, also in maintenance mode. Will that forever be preexisting or uncovered?? If you have an issue do you have to be off medicine entirely for it to ever count as shareable? Thanks!
Hello Beth. I have been thinking about your question for a bit and my thought on whether that is pre-existing changes with the wind. There are still meds being taken, so it may be seen as pre-existing, but there’s also no symptoms right now, so it might not. I cannot answer with confidence either way and want to have a good answer for you. I would suggest speaking with Samaritan to present that situation and see what they say as they are the definitive answer source. Generally the rule is that it must go a year (5 yrs for some things) with no symptoms, treatments or meds. We all have lifelong possibilities of things, that in itself doesn’t make something pre-existing. Please call Samaritan to get their official word. I will also be contacting them as I really want to know the answer, but you may beat me to it. 🙂 God bless.
So my wife (35) and I (38) have 5 kids – 8, 6, 3, years old and a set of 1 year old twins. Shuuuubuddy. Thankfully, we are all healthy and rarely have a need to go to the doctor except in the case of well visits and an occasional severe sickness that pops up from time to time. We are definitely interested in medishare and Samaritan but have not put pencil to paper yet. Do you have preliminary advice for large family and what it might mean for us. 7 well visits and the occasional sick visit is a lot of trips to the doctor each year. Honeslty, not sure if I like the idea of my wife having to constantly submit paperwork for doctor visits – not sure how the process breaks down. We are pretty busy as it is and we try to find ways to streamline and simplify our lives vs make more paperwork and hoops to jump through.
Hi Colin. Blessings to you and your wonderful family! 🙂 A big family would likely save considerably with a ministry membership vs insurance premiums. Part of the savings from that would be used toward the well visits you mentioned as those are out of pocket. She wouldn’t need to submit any paperwork for those, just pay the cash discount rate and go on with life. Bill submission would happen if there was an illness or injury that cost at least $300. Then the grouping of bills for that specific incident can be submitted online to Samaritan (pretty easy process) and the members would send you money to cover the costs, arriving in a couple of months (Samaritan payment process is quick). There are ways to save on the little illnesses and visits, too, as Samaritan offers free access to a 24 hr nurse line, and telemedicine at $25 to talk to a doctor. That can potentially cut down on some of the visits you used to have saving you time and money (like the sick visits). Samaritan and Medishare are pretty different in terms of processes. It’s nice that with Medishare the bills are submitted by the doctor just like in the insurance world, but not every location accepts it and the rates are already fixed, no further discounts (check your local places). You would not only need to pencil out monthly cost comparisons, but also look at the differences among the types of needs which are shared (ie: Samaritan shares for alternative, Medishare doesn’t), and ask at your local doctor what their policy is for cash pay (discount percent, payment timelines) and also whether they take Medishare. Some places have bigger discounts for cash payments (Samaritan members). Depending on the level you buy, Medishare will likely give you a much higher out of pocket number to meet before sharing starts, Samaritan begins sharing at $300 on those bigger needs which I really like.
Being part of a health sharing ministry puts health care back in your control. The trade off is that you’re also much more involved in the pricing and billing and paperwork. I feel that Samaritan does a great job of making the process as smooth as possible. Without two sets of EOBs from insurance I think it’s actually a lot LESS paperwork than with insurance. Little things we handle ourselves, big things are shared by members. The right answer is the one that fits your family best. Analytically you should compare costs and features I outlined above, then ask your clinic about cash pay policies and if Medishare bill submission is in their system. If you are on any medications check out their cash pricing using something like goodrx.com as long term meds also aren’t shared and sometimes those little illnesses need a quick dose of meds that would probably be out of pocket. The $37 sinus infection is real… $25 doctor call, $12 medication. Pretty efficient and cheap. No insurance copay or office visit, no spending 1-2 hrs getting it all checked out. And no giant deductible. Once you get used to health care this way, you’ll probably find that it’s much simpler and more straight forward, even for a large family. Good luck with your research, I’m so glad you’re looking at health care sharing. We love it! God bless.
I have started a new job which is paying my personal health insurance, but if I want to add my family (pregnant wife due in April, and my 2 year old daughter) its going to be over $1,500/month, so that’s a no go. My past experience with private insurance when I was self employed was horrible, I was paying $800/month for united healthcare HMO and it was a waste, out-of-network with virtually everyone and half the time found a way to not cover things. My question is what would be a better fit for my wife, 26 year old female who is expecting in April, and a 2 year old daughter? I will remain on my work insurance because its paid for.
Hi Austin. Health care sharing could be a great option for your family, certainly more affordable! You don’t say if your family still has that other insurance, but as your wife is currently expecting, her maternity needs would be seen as pre-existing by all ministries and could only be shared as part of Samaritan’s Special Prayer need voluntary giving program. I think they’re the only ministry which will allow for any sharing on an existing pregnancy. While that is voluntary giving and there’s no way to know how much you’d receive as a Special Prayer need, I have heard that giving for pre-existing maternity expenses tends to be very good. The family rate with Samaritan is $495 and only a $300 threshold before sharing starts on a need (think low low deductible). You may as well join on the family rate, too, even though you have work insurance because Samaritan could then share any qualifying expenses for you that insurance didn’t. The monthly rate for a family (mom, two kids when baby gets here) is higher with Medi-share vs Samaritan unless you want a larger household responsibility. Samaritan’s sharing would start at only $300 per need, whereas Medi-share’s would be at $3750 annually before sharing would start to have a similar monthly cost.
From the perspective of lower monthly cost combined with a lower personal responsibility amount I would say Samaritan is a better fit for your family. From the standpoint of an existing pregnancy Samaritan is definitely the best choice, although if she’s already on an insurance plan that may be something to stick with depending on the deductible, at least until the pregnancy is over. If it’s a high deductible insurance plan then you could probably switch to Samaritan anyway and still be money ahead, but you’d need to evaluate your specific numbers to know for sure. You can join a health sharing ministry anytime, but I don’t know if you’re allowed to cancel her insurance plan (if she’s on one now) except during open enrollment (which was shortened to Nov 1-Dec 15 this year). So a few things to consider about the timing, but from a cost perspective, plus the incredible ministry support for your family’s medical needs, Samaritan seems the way to go. Good luck with your decision and my prayers for a healthy pregnancy. Life is precious!
How long id the application process for Samaritan? My husband is retiring and we will need insurance starting September 1st.
Hi Laura, it’s very quick. You can have it activated the day they receive it or you can future date it to a specific date you like. I did have ours overlap by a few days when we cancelled our insurance to be sure there were no gaps, but it’s extremely fast on Samaritan’s end.
My husband is changing jobs in the next month and he will be considered self-employed. I’m looking at different options. It was suggested I look into Samaritan as well as Medishare. My question is…I have been on high cholesterol medicine for several years and my husband has been on medicine for his thyroid for several years as well. Both condition are being well manged with the medicine. Would these be considered “pre-existing”? Thanks for your help.
Hi Pam. Thanks for asking. Since you’re actively taking medications they would likely be seen as pre-existing issues. You would need to go a year without symptoms, medications or treatment for something to fall out of PEC status. Long term meds aren’t shared anyway (and any doctor visits for it wouldn’t be either — (though they can be shared as SPNs), but likely those are pretty low medication costs, so the issue then is whether something would develop as a result of the cholesterol or thyroid. If a heart blockage, for instance, happened then the doctor would have to sign off on a form that the treatment/surgery need for a blockage wasn’t caused by the cholesterol or any condition existing prior to membership. If the doc says the two are not related, then it’s fully publishable. Heart attacks can be caused by a number of things, having high cholesterol doesn’t automatically mean heart attack in the future. And Samaritan always goes with doctor verification if there’s a question; not every ministry does that. Same with the thyroid. Visits and meds aren’t shareable, but what could develop as a result? His doctor would know the likelihood of anything else being a risk. Here’s my thinking, but see what your doc says. Since you’re on the meds, and the issues are under control, the risk of anything directly resulting from it is probably pretty low. The bigger risk is if the meds quit working, or if you quit taking them and cholesterol/thyroid numbers change for the worse. IF you have specific “what-if” scenarios related to those two issues I highly recommend speaking to someone as Samaritan as they can answer those questions with knowledge about how the situations have been handled for other members. They are very kind and helpful. God bless!
Your article states that you could not find a negative review for a Samaritan ministries, but I can give you one.
My friend was a member and got colon cancer. He was very sick, and as a single person, it was very difficult to handle all the paperwork involved. And it required a lot of time receiving, recording, depositing the SEVERAL checks he received reach month from each of the members helping pay his many bills. It was so much of a hassle that he dropped his membership after that year. He would not recommend it for anyone who is single.
I am also single, and do not looked the idea of being to send a check to a different person and place each month. (or as i understand it, potentially two people). I do have friends who are members and appreciate the co-op, but I lean more toward MediShare personally.
Hi Eric. I pray your friend has recovered from his cancer. Unfortunately, a health issue as big as cancer would have a lot of ongoing paperwork to manage no matter what ministry or insurance plan someone had. Paperwork in medicine seems unavoidable anymore. For a single person facing cancer I would hope that person would have a local support system (a church body?) to help them through not just any paper management, but also to be by his side during his sickest times. The ministries do seem to cut down on some paperwork compared to insurance as we get a bill once; instead of an initial bill, an insurance EOB, a final bill and maybe a re-submission to insurance during a payment dispute. With a couple of the ministries (Samaritan included) we would be left with very little to nothing out of pocket at the end of the treatment; that complete financial support and the prayer support are important to me. I cannot say the same about insurance as some patients are facing giant deductibles and crazy out of pocket expenses. So while it can be a lot to manage the money coming in, money is coming in for what we need. I’m glad to hear he was getting the financial support from the Samaritan members that he needed during that time and hopefully the prayers and cards he received were also uplifting.
I’m glad you are looking into the ministries for yourself. If you are leaning toward Medishare it does offer a more hands off approach with fixed networks, but you’ll want to contact your local facilities to make sure they accept it and read through their guidelines about what they share and don’t share and the differences in out of pocket costs left over. Both ministries have their pros and cons, and we each need to find the one that best fits our personal needs and habits. 🙂 God bless!
Hi Heather,
I sent an email about this earlier but I don’t see it on here so I guess I didn’t hit submit or something, I don’t know. Anyway, what I was asking is that we have been on Samaritan for about 2 months now and our thinking was when we went to a doc or ER or had a procedure, we would pay whatever they require upfront and then make a payment plan with them for the remaining. But what we have run into twice now, once at an urgent care and once at the kids pediatrician is that to get the cash payer discount they are requiring us to pay the ENTIRE cash discounted amount up front in order to receive the cash discount. That was fine at the Pediatrician but the urgent care visit was very expensive and we just don’t have it to pay up front. What would you suggest the best way to handle that?
Hi Tim. You actually posted the question on a different page. Here’s what I wrote (and added a couple things)…
Every location handles they’re payment rules their own way. In most cases I would consider one of the following… 1. If you have options for providers, call around to see what their payment policies and prices are for those kinds of things. You may find better pricing, as well as more flexible payment options. 2. If it’s a small enough amount, go ahead and prepay the whole thing for the discount (Samaritan recommends this only if its a big discount, like at least 40%) and get reimbursed later. We did this for my husband’s surgery and got 50% off. It made the amount tiny enough to fit on our credit card (or come from medical savings). However you said you didn’t have it in those cases so…3. If it’s a bigger amount, I would be sure they understood how Samaritan works to see if that changes their mind (speak to a higher level billing person, or even the doctor to make sure the person in charge knows), offer a number affordable to you as prepay that will still qualify for discount and payment plan and if they still don’t budge then politely thank them, choose the payment plan, and contact Samaritan at some point so they know (not required, just keeping them in the loop if it’s a need that qualifies for sharing). Samaritan uses Karis for these kinds of negotiations and often is able to get that discount later anyway. If not, well, there’s only so much you can pay ahead, and Samaritan doesn’t actually encourage paying ahead in full unless you can get a big discount and you can afford it. If you can’t afford it, then they definitely don’t want you to do it. You are in control here. We always try to get the discounts we can, but not every situation will allow for that. The main thing is to get the care you need and know that the ministry is backing you. It may be that once the facility has more experience with you as a patient and Samaritan member then they may allow it in the future. Anything is possible. ? You should do your best, but don’t feel bad if the facility causes a change of plans. And speak with Samaritan in those situations for further guidance. Having a small medical savings account will help with budgeting for checkups and small unexpected events to cash flow those situations. But sometimes it can take a while to build that up. God bless!
Awesome advice, thank you Heather.
My family is looking into Samaritan because we absolutely cannot afford the rising health insurance costs. I had a question about pre-existing conditions. I read through several of the other questions. I realize that a condition is considered pre-existing if you have been treated for it in the last year. However, if you sign up for samiritan and you have this pre-existing condition, but you don’t receive any treatment or meds for it for a year, can pre-existing conditions be “erased”? For example, I have had treatment and surgery for GERD in the past, but have not seen my doctor for it for almost a year now. If i sign up for Samaritan right now before that year is up, can this condition cease to be “pre-existing” after the one year period? Or will it always be on the record and never eligible for sharing? Thanks in advance.
Hi Kelly, thanks for writing. Samaritan is symptom driven. So qualifying pre-existing issues fall out of that status if they haven’t had treatment, meds or symptoms during the previous 12 months (5 years for some things). GERD is probably in the 1 year timeframe, but it will depend on whether you’re having any issues. If you’re seeing your doctor just as a checkup, (those we pay on our own anyway) having a checkup without symptoms doesn’t restart the timeline. Having symptoms again would restart the timeline. I also recommend asking Samaritan as they would be able to confirm the 1 year timeline for GERD. I’m not very familiar with it, so I don’t know if it’s something that goes away with surgery or hangs around. If it’s “gone away” and you’re not having symptoms then the timeline is probably nearly up. Any costs associated with it would be allowed submission as a special prayer need until the pre-existing timeline is up. That will also help a little. Hope that helps a little. You and your doctor would know best if this is considered resolved at this point. God bless.
Thank you for replying so quickly! So I guess my question was if pre-existing conditions can be taken off once you have Samaritan if you don’t need treatment for it for a whole year? And then after the year is up, you can then have it published and shared as a need, instead of a special prayer need because it is no longer considered a pre-existing condition after 12 months? I guess I was unclear in my question.
No, I think I was unclear in my answer. 🙂 It’s not just a matter of going without treatment. The member also can’t have any symptoms of the condition. Some conditions can be tolerated without treatment but still have obvious symptoms that the member is dealing with (something measurable/quantifiable beyond just being tired… we’re all tired 😉 ). Those would still be pre-existing because the symptoms are still there even if a doctor isn’t being seen for it. It isn’t just not having treatments that matters, it would also mean no drugs, or symptoms either. If you are saying you have no treatments, no meds for it, and no symptoms of GERD (I think that’s what you’re saying) then yes, it would fall out of pre-existing status after a year and be available for regular sharing; a year from the last problem, not necessarily a year from membership start. Some people join and only have to wait a couple weeks before their issue is no longer preexisting because they’ve already gone so long with no issues even before they became members. Some wait longer than a year because the symptoms come back before the year is up and it starts over. It all depends on the person and what they are experiencing (or not experiencing). I hope that helps.
Hello, I am not currently a member of any of these plans, and I did a thorough investigation of these some time ago. After some time away from it all, I am recently considering a Health Care Ministry option. One thing I noticed in particular: Samaritan Ministries used to have this policy that after the 3rd time expenses go beyond $300, all future expenses for the year get published. It seems that as of Oct 31st, 2016, this is no longer true? Just wanting to confirm your interpretation of the following statement:
“3. More than Three Needs in 12 Months—The special exception for an initial unpublishable amount on a 4th or more need in a 12-month period will not apply to needs created after October 31, 2016.”
Thank you!!
Oh! And what is the definition for an “incident,” if the Samaritan AHP is $300/incident? Do regular doctor visits count? Those can be upwards of $250!
It kind of depends on the reason for the visit. Annual checkups generally don’t count because those fall under preventative and we pay those on our own. However, if that checkup reveals a problem (heart issue?) then the cost for that visit can be included in the total expenses for treatment because it was part of the diagnosis, and not a checkup anymore (hopefully nothing is a problem though, then it’s just a checkup we pay on our own.) Once that heart issue is resolved, then checkups for it are on our own.
Doctor visits for an illness (or injury) usually count, as you’ll pay for the visit, the tests/treatments, and the meds, Those costs could easily combine to cross $300 (before discounts) and be shareable as one incident (the illness or injury is the incident, all non-checkup costs associated with it count toward the one need). If that total is under $300 then we pay on our own. We cover the smaller needs ourselves, and Samaritan members share the bigger needs crossing $300. What it has done is help members be more aware of cost and ask questions about price and necessity of a test because we know we are responsible for those expenses. Members also get pretty good at finding deals, getting care in less expensive places (an imaging center vs a hospital), using telemedicine (only $25 to talk to a doctor, free for a nurse using Samaritan’s membership portal), getting drug discounts through goodrx and/or Samaritan’s drug discount program, etc. There are lots of ways to get great health care for less money and members tend to find them. 🙂 This does mean we could have some out of pocket medical costs throughout the year (and should be budgeted for), but most people find they are saving so much on the monthly “premium” costs vs insurance that covering those other small things throughout the year is still much cheaper, especially as they start asking for cash deals and discounts. It’s how healthcare used to be, where people only had insurance for hospital stays and big issues, but did everything else on their own (for reasonable cost). Samaritan emulates that and gives us back independence and control of our health care with freedom of choice. However, knowing costs can be an issue the threshold is set low at $300 so as not to burden the ministry members and help us keep costs lower for the ministry overall. I have found it to be a very logical and highly supportive system.
Hi Tyler, yes, that is correct. From a practical standpoint it helps keep costs down and encourages members to continue seeking discounts and fair pricing on needs, but my feeling is that most families won’t actually feel the difference in their pocketbooks simply because discounts are usually available when we ask. I think a lot of people will still continue paying $0 or at least quite a bit less than $300 most of the time. A $1000 need getting a less than average 30% discount would result in the member still owing nothing ($1000 minus $300; member owes $0, Samaritan shares the remaining $700). The bigger the need the easier it is to get at least $300 discounted off. If a family had 5 needs in 12 months (that would be a lot for us) and got no discounts, they’d have $1500 out of pocket. It’s a little more than $900, but that would match the deductible of the good insurance we used to have before the ACA and is still significantly less than the $13,000+ deductible of insurance offerings today. But based on all the reviews I read of people getting discounts for cash pay I’d say that probably this will just help encourage people to continue asking for those discounts (which helps everyone) and not really result in much more out of pocket. When I asked around my area I found that the providers all had a policy and a discount for cash pay. The amounts can vary, but they all were aware, we just needed to ask.
Hi, I have a couple of questions please. I know that Samaritan does not cover vision but what if I have to go to an Ophthalmologist which is a MD (not an optometrist). Would that be shared? Also, my daughter has bad acne and the dermatologist told her she needed to get 2 dermabrasions. Is that shared or is that considered cosmetic?
Hi Tim. Samaritan does share some vision related needs such as expenses related to cataracts, glaucoma, and other diseases or injury (including cornea replacement due to disease or injury). So if you’re seeing an Ophthalmologist for those issues and they aren’t per-existing then they’d be shareable. Routine and corrective optometric services, exams, or tests, including eyeglasses, contacts, eye refraction, LASIK surgery, cornea replacement, surgery, or other services when done primarily for corrective or cosmetic reasons unrelated to disease or injury are not publishable, regardless of which type of doctor you see. They can be submitted as special prayer needs, though.
Cosmetic procedures necessary to fix disfiguration as a result of injury, disease, and breast reconstruction are shareable, but acne is excluded from that list. Acne surgery would count as cosmetic. I do think it’s allowed for special prayer need sharing, though. Healthcarebluebook.com says a dermabrasion fair price is about $1500 in my area, that may vary a tad in yours. I would suggestion asking what their cash pay rate is. You may find an even better deal.
Thank you. I appreciate the info.
I haven’t signed up yet, still doing research, but I hope it’s okay that I respond to this post. I’m hoping this is what members do as part of helping each other! 😉 Acne is often a gut health issue. I would suggest researching gut health and acne. You might find that a really good probiotic helps clear up her skin. Just a thought. Hope that helps!
Thanks for your input Linda. 🙂 Yes, this is exactly how members like to help each other. If you join you’ll find that Samaritan also has a member forum inside their online accounts where we can connect and offer advice, get questions answered, etc. Very helpful. It’s pretty new but I’ve seen some great participation already.
Our two sons have Hemophelia. How does this affect our joining??
Hi David. Samaritan does not restrict membership based on health so your family would be welcome to join. The condition would be seen as pre-existing, and likely as something not “curable”, so expenses directly related to the hemophilia would be shared as special prayer needs and not as part of regular sharing. However, I don’t know what kind of expenses you have due to hemophilia, other than clotting agents, and it looks like some meds are relative cheap while others are quite costly. While I suspect that many of the boys’ medical expenses would still be shareable (broken legs, appendicitis, etc), I would recommend speaking with Samaritan directly as I’m sure they have experience with members who have hemophilia and would be able to tell you what kinds of expenses weren’t shareable as a result (ie: special costs as a result of managing the hemophilia while fixing the broken leg). Long term medications aren’t shared anyway, so if they have ongoing medication costs you would want to find the cheapest cash price using something like goodrx.com or a manufacturer discount. I don’t know enough about the condition to give good advice, other than to seek the direct input of Samaritan staff and how it’s been handled by other members. God bless you in your journey.
Hello: I’ve got a pretty good idea of the workflow. But to whom do I send my monthly contribution to? Do I simply pay to those in need, until I meet my monthly amount? Can you explain that workflow for me?
Thank you!
Hi Rick. Samaritan will send you a monthly share assignment along with a newsletter, and the person listed on your share slip for that month is who gets your share. The entire process is coordinated by Samaritan and they’ll have you send to a different family/need each month. You just send to one person each month, and on your anniversary month you send to the main office instead (administrative cost). So that’s 12 months shares, 11 going to members, 1 to the office. You’ll get your newsletter at the beginning of the month, and your share must be mailed out by the 15th to whomever you were assigned. It’s a really neat system, but also very simple. Nothing complicated. We always include a card/note along with our share, and pray for their healing. We received money for my husband’s need last month and most shares arrived between the 10th and 20th of the month. From the postmarks I could tell that people mailed their shares within a few days to a week of receiving their share assignment. The notes that came along were nice, also. We’re keeping those. 🙂
I am getting ready to go on Medicare…do you all do a “supplemental” plan to Medicare? Sounds like it would be a good thing.
Hi Jody, Samaritan does have several members who also have medicare. The rates are the same as those without medicare. Samaritan is 2nd payer so they share all qualifying expenses that medicare doesn’t pay. For some people this is a cheaper supplement to medicare than insurance, for others it’s not. Good question!
Hi, thanks again for your helpfulness.
Do you know whether there is any discussion of allowing shares to be paid through paypal? That seems like it would be so much simpler for those who have paypal, and more certain for those of us with unreliable mail delivery. It would still be payment directly to another member.
Yes, I have heard they are looking into online payment as an option, but I don’t know if paypal is part of that. One aspect that has to be dealt with are the transaction fees (depending on the method used) so I’m hopeful that whatever they go with either has low or no fees. I don’t know what kind of process Samaritan is considering, but it is being considered. I hope they are able to find a solution that works for everyone. And I hope that mail is still an option for those who are uncomfortable with online transactions (I’m pretty confident of that part, at least until our mail system collapses). 🙂
Update: Online sharing is now available using paypal.me. Members can choose to activate this option through their online Samaritan member dashboard.
Hi … thanks for the informative comparisons. Question: You mention that there is a $300/incident personal responsibility (deductible) but this can go down to zero with “discounts”. What is a “discount” and how do you obtain one from a provider or Samaritan?
Thanks Much
Hi Tom. Discounts come from the healthcare provider. So if you go the ER and they bill you $1200, and their cash pay discount gets it down to $700, then you got a $500 discount. Since you got at least $300 in discounts from the hospital, Samaritan will share the entire $700 net charge and you won’t owe anything out of pocket (the reduction must show on the invoice the hospital gives you). If the hospital only discounts down to $1100, then that’s a $100 discount. Samaritan would share $900 and you would owe $200 out of pocket ($300-$100 discount). Whatever you get as a cash pay discount from the provider counts toward your responsible portion first. For bigger needs it’s usually pretty easy to get at least $300 in discounts just by asking for the cash pay discount rate. That reduction in what we owe out of pocket is great motivation to at least ask the question. We had a surgical need in December and got a 50% discount right away just by being cash customers. Samaritan shared 100% of the need and all shares arrived in February (we had our bill submitted by the end of December). It was a great experience and quite easy to do. Discounts for cash pay vary considerably; place to place and city to city. Still, even without a discount, owing $300 on a big need like that would be very reasonable compared to the massive deductibles offered to me by insurance. But discounts tend to be easily obtained if we just ask. 🙂
Thank you for your quick response, this site is so helpful.
What happens if a member’s check to you bounces after you deposit it, such that you don’t have that person’s share, and you also now have a returned check charge from your bank?
Hi Tricia. I’ve been told that if it ever happens Samaritan contacts that member and has them resend the original share amount, plus any incurred fees. Fortunately it’s a pretty rare thing. 🙂
Thank you so much for your blog. It’s very helpful. I am concerned about the approval process. How strict is Samaritan? I attend church regularly, but I am not close with any clergy that they would know my name. I can ask someone after mass to sign my form, but does Samaritan call or email to confirm? I don’t know what the time lag will be from application to approval and my concern is they may wonder who they are asking about. Am I over thinking this? I read online that someone’s church was not approved. I can’t imagine why not.
Hi Rita. I’m not aware of any churches not being approved (unless it’s not Christian I suppose). Now if the member isn’t able to agree with Samaritan’s statement of faith then it doesn’t work for them. But any Christian church would likely be fine. It’s more about the member than the particular church I think because even brand new church plantings and missionaries are members. There also really isn’t a time lag, you can have your membership start as soon as Samaritan receives the app, or you can set it to start at a specific future date. It doesn’t have to be a clergy member who signs it, just someone else to whom you are accountable. That could include Sunday School teachers, group leaders, church council or board members, etc. Just explain the relationship and it’s fine. I’m close enough with my clergy (and Samaritan membership in our church is still rare) so I would have heard about a phone call and they didn’t tell me of any (I doubt those calls are made). Many members are in huge churches and don’t have much or any contact with their clergy. A phone call about the specific member wouldn’t reveal much if the church doesn’t take attendance. It will be fine. I definitely think you’re over thinking it. 🙂 But that’s good! It means you care, you’re serious, and you want to abide by the rules! You will be welcomed with open arms. Samaritan has members from a wide range of Christian denominations. God bless, and hopefully I am welcoming you to Samaritan soon!
Thank you!
Hi again. I’m also wondering does Samaritan cover the cost of your yearly health visit/gynecological visit? What about breast ultrasounds, pap smear, etc? And what about blood work for your yearly health visit?
Also does a member of the clergy need to sign every needs request you submit? I’m a bit concerned about privacy of health issues.
No, that was an old rule, it no longer applies.
Annual checkups are something we pay ourselves. Samaritan is there to help us pay the bigger burdens. So physicals, mammo’s, blood work, etc we budget for and pay out of pocket. The good news is that the cash pay rates for those things can usually be found for reasonable cost (for instance our bloodwork at the annual health fair is $45), and if during those checkups something is found requiring more tests or treatment, then everything becomes shareable including the initial checkup/mammo. The biggest non-shareable preventative item is a colonoscopy, which members would want to save for. But again, if the colonoscopy reveals issues then Samaritan will share the colonoscopy cost, too. The trade off is much lower monthly costs, and owing so little ourselves when a big need comes along. My husband’s surgery is being shared at 100%. That’s remarkable. But we pay our own checkups and $45 bloodwork. And we save about $12,000 per year vs an insurance premium. That’s huge! I won’t spend $12,000 in mammos and checkups. 🙂
Thank you so much for taking the time to answer my (and everyone on here’s) questions! Although I really like Samaritan Ministries “homey” feel, I love that it feels like a close knit community, that there’s a newsletter sharing tips, and that we can pray for one another, plus that you can put in prayer requests or ask the community if you need help paying for something else, I spoke with Liberty HealthShare today and I am going to go with them. The things that seemed to bother me about Samaritan is that they exclude so many people of other religions or if you don’t go to church regularly. That was bothersome to me and hurt my heart, as there are so many people out there that I find to be deeply spiritual, but don’t feel the need to attend church regularly or at all. They have a direct connection to God. So the exclusion thing kept me up at night. The other thing is privacy – where your name and address is published for other members to send you good wishes, cards, and checks. On one hand I see this as very nice and personal and I think it would be a great blessing (and fun) to have this sort of surprise come to your home when you are in need, it also bothered me as I am a private person and don’t like the idea of everyone in the ministry knowing what may be a health issue I am or someone in my family is dealing with. With Facebook and LinkedIn used for business and personal and so easy to look up someone, this concerned me as well. And also, when you pay your monthly dues, since you are paying directly to a member and I understand that, but that means you have to issue a check (which I don’t like doing, I like paying for things via credit card as you get points, etc) and you are constantly adjusting where you are sending payment with name and address, so I found this to be a hassle too. Again, I see how it’s nice and personal and I would feel happy sending the money, but just sharing the pros/cons as they stuck out to me. As for Liberty, it looks like the rate for a single person is less ($200/year), I just cover up to $500 out of pocket for the whole year — and the rest is covered by Liberty, and they allow you to have 12 massage appointments and 20 chiropractic (don’t quote me on that) a year, that the cost of those services can count towards your out of pocket pay (the $500) I pay for the year. They also include 1 yearly exam free of charge, which would include blood work, mammos, ultrasound, etc. The blood work is a huge thing for me and something I think is important to get each year and in the area I live (tristate) the lowest gyno yearly check up is around $200 or a bit more and a full lab work up is over $1000. So there you go. I am surprised that more people don’t post about Liberty and this still seems to confuse me, as there is so much positive stuff written about Samaritan. If you or someone reading this knows something that’s not good about Liberty, please let me know, as I am going to think about this choice and pray about it for a few more days before I commit. Thank you again for this resource and for all your help! Bless you.
Hi Rita. Liberty reviews have been pretty mixed, with several very upset members and others who are thrilled. Some of it may be from growing pains as they are fairly small yet, but some of the reports of payments taking up to a year have me concerned. I have a comparison page for them here: http://samaritanministriesreview.com/samaritan-ministries-vs-liberty-healthshare/ there are both positive and negative comments posted in the comment section. Whichever you choose, I’m so glad you’re looking into healthcare sharing. It’s a great way to do health care! God bless! 🙂
Hi Heather,
I am currently looking into sharing ministries as we were not able to afford the healthcare options given to us in the marketplace.
Our biggest expense looming is my four year old son’s evaluation for autism and then the possible therapies and such that would come after a diagnosis. Trying to find any info on Samaritan’s stance on autism spectrum disorder has confused me a bit. They’ve touched on other neurological issues like ADD and ADHD, but not autism. While he doesn’t have a diagnosis yet, it would seem to me that the “symptoms” that led to his evaluation referral would disqualify him from help from Samaritan. But then again, it’s strange to refer to them as symptoms when in reality they are behaviors resulting from a neurological condition which cannot be cured. All this to ask, would autism be considered a pre-existing condition, and would evaluations, testing, therapies, or medications relating to it not be covered? All that I’ve read leads me to believe so, but autism is never explicitly mentioned, so I can’t be sure. As much as I hate it, with all the expenses that may be in our future I can’t help wondering if it would be worth it to somehow fork out the money for a conventional healthcare premium so that at least our need is covered.
Thank you for all of your time and hard work, it is very appreciated 🙂
Hi Laura. I’m checking with Samaritan to get more detail on how autism is classified by them. However, from your description it seems that either way those needs wouldn’t be shared for a while, except as special prayer needs possibly. Since he already has “symptoms” it would likely be pre-existing, at least for a bit, possibly always if it is truly autism, as you’re correct, it is a long term condition. I don’t think it’s considered a mental health issue, but I could be wrong. I will add to this comment when I know more. However, while I am concerned the answer may not be what you want, there are still cost saving options here. Your family could still join a health sharing ministry and have a different/additional insurance plan for him. Typically I don’t like to suggest multiple policy/membership combinations, but in this case it could save you money overall. His own insurance plan would surely be cheaper without anyone else on it, and there could still be significant cost savings by having a ministry membership for yourselves with the additional policy for him. If you are putting other children on a ministry membership then he could also be on Samaritan without extra cost (family rate is 3+ no matter how many kids are on it). The bonus to that is his insurance would be first payer for his needs and the ministry would be second payer for anything qualifying that insurance didn’t cover (including high deductibles, etc). It wouldn’t necessarily help with autism related costs if they are seen as pre-existing, but it would for any other expenses he had (broken bones, unrelated hospital stays, tonsil surgery, etc). That provides an extra layer of protection for some of his costs, and the rest of the family can save money by being part of the ministry and not having traditional expensive insurance. Something to consider at least.
I wish I had more solid information right now, but I will update this when I know more. Also, I recommend calling Samaritan directly as they are so friendly to speak with. God bless you as you walk this journey.
Update: I spoke with Samaritan and learned that autism doesn’t fall neatly into a particular classification. Testing for autism is publishable, as are some treatments like biofeedback, but other treatments (such as certain medications), aren’t publishable as they doesn’t meet the guidelines. Sometimes the doctor discovers the problem isn’t true autism, it’s a different medical problem resulting in treatments that do meet guidelines. So it all varies. His case would be seen as pre-existing, but I wanted to let you know what I had learned. God Bless.
Thank you for taking my questions as I research our options!
First: My child is diagnosed with ADHD and takes medication that requires a re-check visit every 3 months to monitor for potential side effects and discuss how symptoms are being managed. I looked up the cost of her medication on GoodRx.com and I understand that this wouldn’t be a shareable expense. Would the doctor visits be shareable if grouped together at the end of the year to go over the $300? Also, because this is an existing diagnosis, this would be a PEC, so this would not be shareable for a year, correct?
Second, If you have a shareable bill of $1,500 that you submit for services received in January, can you explain the time frame of receiving checks in the mail and are you guaranteed to have the full amount provided?
Hi Jennifer. Thanks for your questions. The ADHD doctor visits would only be shareable as special prayer needs. Checkup visits are always on our own (unless a new problem is found that needs treatment, the checkup costs can be included in the treatment sharing), but if they become a burden we can submit them as special prayer needs. They must be less a year old, so maybe group 10 months worth together. The ADHD is a PEC, but it can only fall out of pre-existing status if it is in “cured” status, meaning no symptoms, treatments or meds for a year. Likely the ADHD would always be pre-existing, but please check with Samaritan to be sure.
Qualifying bills are published/shared 2 months after they are submitted, assuming all the proper detail is on the bill. So bills submitted in January would be shared in March. Those January submissions could be for services in December (or earlier) if the provider is slow to send a bill, or they could be for services done in January if the provider is fast. We had a surgical procedure done in early December, got the bills a week later, and submitted them right away. So our December surgery was submitted in December and will be shared in February. It’s amazingly fast and one of the things I love about Samaritan.
On the SM’s website, on page 2 of the downloadable “Guidelines” it states that “the local Christian church should be the next ‘line of defense’ to provide for the needs of its members” and “SMI is intended to support and supplement this work of the local body, not replace it. We seek to avoid undermining what should be done locally. We also depend on the leaders of the local Christian church to provide accountability for the SMI members under their care.” I understand this is a biblical principle, but I am personally from a small country church that could in no way assist me with potential medical bills. Everywhere else I read about how costs are “shared,” but would like clarification on this. Thank so much! 🙂
Hi Ashley! I remember asking about that very thing when we were doing our research, and there are many members in similar situations. As it was explained to me, that portion of the guideline is two-fold. First, Samaritan wants to be sure that members are participating in their church fellowship and not relying only on Samaritan for spiritual assistance and prayer when a need happens (especially a bigger need, though of course those prayers are happily given and heartfelt). Second, all qualifying needs are shared and members are not expected, or even asked, to have the church provide money for needs (though it would be a wonderful thing). However, as part of the guidelines, Samaritan recognizes that members still must bear expenses of the non-shareable medical needs themselves through checkups, needs under $300, prorated needs that aren’t caught up yet, and non qualifying needs. In times when that may be a burden to the member Samaritan doesn’t want to undermine the efforts of the local church if support is available there. The local church may be able to assist and shouldn’t be forgotten as a resource if available. So yes, that is a biblical principle, and I see it as emphasis of how important Samaritan values each member’s church family, but money from the church is not part of the standard need submission/sharing process (unless a church would want to make that available). We are going through our first need as members and it is not on the need submission paperwork at all. Merry Christmas! 🙂
Thank you so much for responding so quickly! By, “We are going through our first need as members and it is not on the need submission paperwork at all,” do you mean you have had a medical need/sought medical care and you’ve not had to request for any of it to be covered (I’m assuming the cost was over $300, etc)? Thanks so much and Merry Christmas to you too!!!
Correct, our need is over $300, and the need submission forms do not say anything about asking the church for money. It does ask if any other entity is responsible for the bill (medicare, insurance, workman’s comp, etc). Since health sharing ministries are 2nd payer to other responsible parties, that’s why the question is on the form. 🙂
First off, Thank you for this website and answers! I have referred many people here over the last couple of weeks!
Are heart murmurs that are deemed “innocent” considered a heart pre-existing condition? Two of my children have murmurs. Both were diagnosed over 5 years ago when they were infants and tested by cardiologist at that time that deemed them innocent. Neither have ever had an issue, however, they still have murmurs of course that have been heard at various times over the years. However, we will need to follow up appointments to check on the murmurs at some point. One child is starting new meds (unrelated to the heart) and we should test them sooner than later. So is a verified-innocent murmur considered pre-existing? I just don’t want to go in and then be denied that the murmur (which we know they do have) is considered a symptom and deniable! I honestly forgot he even had it until we brought it up about starting new meds!! If you can offer any insight I would appreciate it! Thank you for any advice you can offer!!
Hi JR, thanks for the compliments. I’m so glad the site is useful. Officially I would refer you to someone at Samaritan for the heart murmur answer, but based on Samaritan’s guidelines and what you are describing I’m pretty confident any potential future issues with the murmurs would be shareable. I don’t know if they would classify it as genetic or heart related (or both). If it’s seen as a heart issue, as their murmurs are past the 5 year mark and had no issues, it seems fairly clear to me that those are no longer pre-existing under that classification. If it is classified as genetic, the guidelines on page 26 say: Genetic Defects are publishable when at least one of these is true:
a. Neither the condition nor a symptom of the condition was discovered until after membership had begun;
b. The condition has not required treatment or produced harmful symptoms, and has not deteriorated for at least five years (there are 2 more in the list but they don’t apply to you).
If it’s considered genetic anything should be publishable based on letter b above (it doesn’t meet condition A, but it does condition B and only one of them needs to be true. C & D, not shown, don’t apply). So it appears that under either classification there should be no issues regarding full sharing. However, please get that confirmed by someone at Samaritan as they know best.
The new meds you are starting would make that other issue pre-existing for a time. The future checkups for the murmurs you mention would be out of pocket costs as checkups fall under the portion we handle on our own. But overall I think when you speak with Samaritan you should be very please with the results of the conversation based on the terms of the guidelines. God bless and Merry Christmas!
Thanks again for the quick reply. Just tricky because it really isn’t a condition (innocent murmurs), but it is still there. But it has been five years with no issue so it should be fine anyways. I know they are quite common in kids so I’m surely it is dealt with quite a bit. Anyways , I guess I just needed to talk it out loud and it makes sense. Hopefully! Please keep up the fabulous work, your site has provided many with understanding of SM! Very helpful when so many of us are lost and in desperate search of something other than the insurance nightmare!
Hi there! Thanks so much for your comprehensive review. It has helped so much. I have a question. I am trying to decide between Medishare and Samaritans ministries. My work insurance offered to me was $300 a month for me and my husband with a $5000 deductable per person. After the deducatble is paid I would still be in charge of paying 30% of medical costs. I just turned 26 and so I am learning all of this insurance stuff since I am used to being under my mom’s insurance. I don’t normally go to the doctor but in the last year I have had a few incidences of urinary tract infections. I am concerned about how much money this can rack up going to the doctor or getting antibiotics if it happens a few times a year. Also since I am of a child bearing age I think about what would happen if I were to become pregnant. I can’t decide between Medishare and Samaritans ministries. It seems like Samaritans ministries is about $440 per month for me and my husband and medishare could be around $200 a month But with an AHP of 3750 or so.
Samaritans ministries just seems like a lot per month compared it to Medishare even know each visit can be shared if it’s over $300
It’s really hard to decide!
I don’t imagine needing to go to the ER. And we are very healthy individuals but you never know. I just want to be prepared. Any comments or advice on this? Thanks!!
Also, would UTIs not be covered? Would that be pre existing? It is not tied in to each other and is a singular incident. But I am just wondering.
I will check on this and answer back. 🙂
Sorry it took a while to respond. I found out that UTI’s are generally seen as unrelated to each other, even if in the same year (so not really a pre-existing concern). However, some medical conditions can cause reoccurring/chronic problems with UTI’s. If this is the case, then the condition behind the UTI is pre-existing.
Hello there! 🙂 I will do a little thinking out loud to help weigh in on your options. From a monthly share perspective, Medishare is definitely cheaper. But the trade off is the $3750 AHP so if you get pregnant, you’re probably going to pay the full or close to the full $3750 toward the delivery. You will have to decide if $3750 is acceptable to you. That would be pretty high for us. I think you should consider a lower AHP. With Samaritan the birth would cost $300 (but probably zero because it’s usually pretty easy to get enough discounts on a cash pay birth to wipe out your share completely). I will need to check on the UTI’s and how they are viewed, but the costs for treating that would almost certainly be way under the $300 mark anyway. If your doctor is aware that you get them, you may not be required to be seen by the doc each time it happens. I know some docs will just prescribe the necessary antibiotics and you get them without a visit, especially because many women know their bodies well enough to know exactly when they have one. Generic meds to treat UTIs run from $4 to about $15 using the goodrx.com app. Cash pay pricing for those meds is negligible so if no doc visit is required each UTI could cost about $10 average. Before joining a ministry I would contact your doc to see if he/she will require you to be seen each time. That will help determine if there are extra doc visits involved. On Medishare those visits would count toward your AHP, but I’m not sure it’s going to cost enough to really matter.
Since these two ministries operate differently (direct sharing vs the credit union account, self pay vs fixed doctor pricing, etc) I would suggest calling each ministry to get a list of people in your area who have each membership and see how it works where you live. That will help you determine how well it works with your local docs/hospitals and whether they have encountered any issues. I know Samaritan will give you a list, I don’t know if Medishare does, but I’m guessing they do. With medishare you aren’t cash pay (it’s a PPO network), which means your discounts are already fixed and won’t go lower, and are likely going to be fixed at a higher rate than what cash pay is (at least if their PPO is anything like the insurance PPO we used to have). Some locations don’t take it, but some also don’t take cash patients and prefer insurance. Being on a network would also mean higher costs when going outside the network, just like insurance does. Call around to your local docs/hospitals to see what their cash pay discounts are. Also, find out how long the wait is before Medishare will share pregnancy needs, in case it happens right away after joining. I know with Samaritan the due date has to be 250 days after joining, which means you can get pregnant pretty much right away. With Medishare I think they allow for it start in your beginning month, but you’d want confirmation of exactly when. I couldn’t find an exact date or number in their guidelines.
No matter which one you join, you’ll want to start a small savings account to cover small medical costs. If you pick Medishare you’ll want at least $3750 in it. You could probably get away with less in it as a Samaritan member, but either way it will be good to have one so you can pay those small bills or AHP responsibilities.
I don’t have medishare so I can’t easily speak to its ease of use, but I know how easy it’s been to get medical care in this area as a cash patient. We’re in the middle of our first real need as Samaritan members and it has been the easiest process ever. Where was this back when I had my babies!? 🙂 I know both ministries have happy members.
In your shoes I would compare costs, preferred methods of operation, risk of meeting that AHP, and ease of use from members in your area. Good luck! 🙂
Hi, I have a question please.
On page 3 of the application, #14, it says that any health condition DIAGNOSED OR NOT prior to the membership will not be eligible for publication as a regular need until 12 months elapses without any symptoms…
My question is what if after I sign up, I go to the doc and they discover something I had no idea I had, like a heart condition of some kind or cancer or anything for that matter I did not know I had and had never been diagnosed with. The stipulation on the application is “DIAGNOSED OR NOT”. So what happens then?
In my last complete physical I had no health issues at all but what if on my next physical, they discover something, and its after I signed up for Samaritan?
Hi Tim. Samaritan is symptom driven, so the part about “diagnosed or not” means that if you’ve had symptoms but never been seen for it or had an official diagnosis then it still counts as pre-existing because symptoms existed. The hypothetical issues you’re describing would not be pre-existing because you have no symptoms or issues right now. If something shows up after you join on your next physical, it’s part of a new need and will be shared (if it crosses the dollar mark and meets the other guidelines.) If it shows up before joining then it’s pre-existing. Thanks for writing and God bless!
Thank you for your reply but I guess I’m still not really getting it. How would Samaritan know if me or someone in my family had symptoms?
Say I signed up for Samaritan and then a week later went to the doc and found out I have cancer. In the doc exam I tell him that I had been feeling tired. Then Samaritan says tiredness is a symptom of cancer and then wont cover it. Being tired can be a symptom of many diseases or no disease at all.
Who stipulates what symptoms indicate what disease and how long you had to have had these symptoms before you went to the doc for them to disqualify coverage?
Samaritan has told me that if there is ever a question on those things then the doctor would need to provide the determination. But they don’t use tiredness as a symptom, if they did then nothing would ever be shareable. 🙂 Samaritan shares a lot of needs and actively looks for ways to help people. Insurance looks for reasons not to cover something. Samaritan is truly the opposite. They would be looking for more measurable symptoms like test results, lumps, blood in the stool, coughing up blood, a rash, etc. When you go in to your doctor to get something checked, one of the many questions is “how long has this been going on?” It’s part of the process for determining tests and treatment. That discussion will help determine if it’s truly pre-existing or not. Some of those cancers may have been building for a long time without the patient knowing. Nothing showed on blood tests, there was no measurable sign/symptom like the things I mentioned; it was there just not revealing itself. Nothing was indicating an issue before membership. Those are still shareable because you clearly didn’t know about it/couldn’t know about it. If Samaritan would have a question though, (and I’m guessing they probably would if it’s a week after joining) your doctor would be the one to say if it’s pre-existing before a membership date, based on what you’ve been experiencing, what you’re aware of and test results. The big key here is that Samaritan doesn’t look for reasons to disqualify something, they just make sure everything meets the guidelines. And as members we need to be honest with our doctors and ourselves about issues. It’s hard to be dishonest on some of those things because we don’t want to risk getting the wrong diagnosis or missing something by being dishonest with the doctor. Correct information would be necessary for proper treatment and usually that all comes out during the process of seeing the doctor.
Actually this question you have is something I was concerned about after reading reviews for a different ministry. I read several reviews from members who said medishare had determined something was pre-existing even when the doctor said it wasn’t. That was scary to me for exactly the reasons you listed above. Samaritan goes with the doctor’s determination if there is ever a question. Even if someone had cancer before joining, new cancers are still shareable. A recurrence of the same previous cancer isn’t shareable unless they’ve gone 5 years “cured”. Well, who says if the new cancer is a recurrence or not? If it’s not obvious to Samaritan then the doctor makes that determination if there’s a question and Samaritan shares or doesn’t share the need accordingly.
My answer was too wordy, but hopefully it helps makes sense of it.
Not too wordy at all. I appreciate your time. Yes, that makes a lot more sense now. I feel much better about it now after reading your reply. Thank you.
Forgot to include this along with my last comment but do either of these cover you while traveling, state to state within the country or even out of country. -‘d if not while in the foreign country, what about an illness that comes up after you come home that you got there? I ask because I travel frequently as a full-time missionary.
Samaritan has several missionary members, and they do fully share needs happening outside the US. Bills must be converted to English and US dollars. My understanding of foreign medical care is that most want cash up front anyway; so you’d pay it, get the statement, convert to dollars and submit to Samaritan. I don’t know how Medishare would handle that. I’m sure they also have missionary members, but I don’t know the details of how those are handled. Samaritan is very missionary friendly, that I know for sure, so yes, there would also be sharing for anything you picked up while traveling. As a semi related side note, medical tourism tends to be quite a bit cheaper, so for those willing to travel for cheaper healthcare Samaritan will even share in reasonable travel expenses if it will save a lot on the bills. I don’t know of any insurance company willing to do that! 🙂
I am not a missionary, however my husband and I will be spending 4 months a year in Canada. I am seeking a plan for myself; my husband is covered my Medicare. I understand I would pay for any expenses myself while travelling and potentially share depending upon the details. Will Samaritan share my foreign expenses, whether in Canada or any other foreign country and including prescriptions, while on a cruise, etc. as long as I meet all the criteria for sharing the specific incident/condition? I have no pre-existing conditions and only see a Dr. as necessary. Thank you for your information. I did not know of alternatives to MediShare.
Hi Elaine. Yes, Samaritan shares expenses for care outside the US. Bills must be translated into English and the final amounts into US Dollars. Also members living outside the US must have a US based point of contact for sending and receiving shares. You can get your newsletter and share assignments online, though. I don’t know how Canada does it, but I know that many foreign countries want money for the medical care paid in full right away. Care outside the US can often be so much cheaper, too. You’ll want to call Samaritan to discuss your situation with them due to changing residences that frequently and whether they are aware of any potential issues, but as far as sharing needs it should be no problem. 🙂
Since Samaritans purse states 300/incident, does that mean that all Dr visits wouldn’t be covered? Most doctors, even urgent cares are under $200 for a sick visit/check up. Even with a prescription and follow up appointment it may or may not be more than $300. In the long run if I’m understanding this right, it would seem like Samaritan’a would cost more out of pocket.
A separate question, are eye and dental all out of pocket as well for either program?
Hi Andrew. Checkups/routine physicals aren’t shared anyway, with Samaritan or Medishare (and they don’t count toward medishare’s AHP number). Those are part of the portion we bear on our own. For a visit related to an illness, yes it would need to cross $300 before discounts to become shareable. You’re correct that some of those would be under $300, especially for those good at finding cash discounts. But not all, especially if they run expensive lab tests and require lots of medications. If someone is prone to going to the doctor a lot then it may become cost prohibitive if the visits are always under that mark, but something would have been paid if having insurance also as there are copays and deductibles to deal with. However, members tend to get pretty good at finding cheaper ways to do things (and the cash rate members get is often close to what insurance copays are), and/or waiting to see if a doctor visit is really necessary (some check with nurse lines first before going in). Telemedicine is also becoming more popular because of it’s low cost and efficiency (it’s not appropriate for everything though). Having a little more skin in the game tends to make us better healthcare shoppers. 🙂 If you had 5 illness visits a year at $300 each, that’s $1500. If we got a 50% discount on those visits then it’s 10 visits at $150 to reach $1500. That would be unheard of for us as a family of 4, but a bigger family could more easily reach that. If one person had that many visits in a year, there’s a good chance it’s related to the same illness, which means they’re all part of the same need. So it really depends on each situation. Our household won’t spend $1500 a year on checkups and illness visits, and even if we did, it’s a drop in the bucket compared to the $12,000 a year we save in premiums. Each family must determine on their own what their scenarios are. Looking back at the past few years and how many visits your family has had would be a good way to determine what your potential out of pocket would likely be. We have a small savings account earmarked for medical expenses in case we have those things come up. It’s easier to have since our monthly share is $495 vs $1100 for insurance this year and about $1500 for in 2017.
Routine vision and dental are out of pocket with both ministries. Samaritan will allow dental to be shared as a special prayer need, I don’t know about medishare. There is some sharing for certain types of vision/dental, but it’s big things like cataract surgery, broken teeth from an accident, mouth bone surgery, etc. Around here there’s no insurance worth doing for dental/vision as it basically just pays out whatever premiums we’ve put in, so we’ve almost always paid cash anyway, long before the ACA. We get an immediate cash discount and pay out of pocket, we just budget for those things since they’re pretty routine. 🙂
I’m turning 65 in January, 2017. I need to make decisions on Medicare. I was initially going to go with a Medicare Advantage plan with Humana or BCBS. I have no ongoing health issues and take no medications. Is it your opinion that I take Medicare A and then join Samaritan as a supplement, take the Medicare Advantage OR join Samaritan and reject Medicare altogether?
Hi Pam. Thanks for writing. My first instinct is to join Samaritan somehow, but unfortunately I’m just enough removed from medicare that I’m not informed enough about how it works to offer much true guidance. It seems really confusing and complicated when I hear my medicare age family speak about it and I’m a big fan of simple right now. Medicare may offer some great benefits, I just don’t know. If it was me I would be evaluating costs, potential penalties, and ease of getting medical care under all the scenarios you mentioned. I suspect those answers could vary depending on region and income. I would personally lean more toward a sharing ministry as a medicare supplement, if I felt that medicare was unavoidable. But I don’t know enough about whether medicare is avoidable or what the penalties are for skipping it. I haven’t been able to get a straight answer regarding that. And perhaps your income would make the advantage plan cheap enough to win out even with deductibles (I think they’re income based, not sure). I know that Samaritan doesn’t require medicare for those who qualify and a couple of the other ministries do. Beyond that I would suggest calling Samaritan to get a feel for how it works for their members who have chosen the options which include ministry membership either as primary or secondary. Wish I could offer more insight. I hope you find a clear path soon. God Bless.
I am considering the seniors plan with Medishare. It would only cost me $70 per month with a $1250 deductible if I had claims. I am on medicare parts A and B which costs around $105 per month. I currently pay all the costs that medicare does not cover. Of course the medicare part A has a substantial hospitalization deductible. Would it make sense to put $1250 into a medical savings account and go with Medishare, or does Samaritan Ministries have something better?
Hi Paul, I had to do the math on this one to see which would be best. The results were interesting and not entirely what I expected.
1. Medishare/Medicare part A&B combo: Medicare at $105 x 12 = $1260. Medishare is $70 x 12 = $840. Total annual is $2100. Have one small/medium need adds $1250 AHP. New yearly total is $3350.
2. Samaritan by itself/no medicare: $220 x 12 = $2640. One small/medium need is $300. New total of $2940.
3. Samaritan/medicare combo: $2640 (samaritan/yr) + $1260 (medicare/yr) = $3900. One need is $300, new total of $4200.
With no needs the medicare/medishare option (#1) is cheapest. If you assume one need (actually with 0-2 needs), it would be cheaper to do Samaritan as a stand alone (#2) without medicare since Samaritan doesn’t require medicare participation and shares needs above $300. If you feel compelled to be on medicare then we’re back to the medicare/medishare combination (#1) as the next cheapest option. So it’s a guess on how many needs you might have and whether you want medicare. I’ve heard there may be a government penalty to NOT be on medicare, but then heard it may only be $1 a month or something. No one really seems to know for sure. There’s also the drug portion of Medicare (part D?) which adds another level of decision making. I definitely recommend stashing $1250 in savings for that rainy day. That’s always a good idea no matter which option you choose as being able to cash flow a few bills is helpful. Thanks for the question, I enjoy a good math puzzle. 🙂
The biggest question I have when comparing Samaritan to Medicare is this: Do members have problems actually getting treatment and/or needed hospitalizations because they are “self-pay” on Samaritan? And thus dependent upon either paying their bills up front and hoping Samaritan can help, or the doctors or facilities rejecting to treat someone because they can’t pay up front?
Hi Steff. Both scenarios are possible. Some people are currently having trouble getting care with insurance and/or medishare plans because certain plan types aren’t accepted, or the facility only takes cash. The reverse can also happen if the office only wants insurance, and rejects a cash customer. Anything is possible. The vast majority do not have an issue. Once the office knows you are supported by the ministry it tends to make all the difference. Sometimes they think cash pay equals non pay. Once we tell them about the ministry and how it works, it’s usually no big deal (plus ministry membership continues to grow giving medical providers even more experience with it). Samaritan gives us a membership card we can show, and a flyer for more information. Most places have a policy in place for cash patients, it’s a matter of finding out what that is. For a standard office visit, payment at the time of service is typically expected. For a bigger issue a prepay is often required, amounts will vary. Prepays are being required of insurance customers, too, because of the giant deductibles many people have now. Many places have different payment plans available, with or without interest. Where I live cash pay is no big deal, and the offices/hospitals all have payment plans and requirements in place. Since every location will be different I always recommend that people considering a ministry membership call around to their local hospitals/doctor offices to find out what their cash pay policies are. I don’t like surprises. 🙂 Samaritan can also give you a list of people in your area who are members and have submitted needs so you can get a feeling of how it works where you live. When I called around to my hospitals/clinics I was very well received. I recently learned of an office in my area that gives an automatic 50% discount for cash pay. Another one is only 4%. One gives 90 days no interest, another gives 18 months requiring a small payment. It all varies. Emergencies have to be treated regardless. Many places are more used to insurance, but cash is usually easier for them which is why the discounts appear. It takes less time and paperwork to deal in cash. As a result we get discounts, sometimes very big discounts.
I am a Medi-Share member since August. We’ve gone to the doctor roughly 5 times since then, and we’ve had roughly 5 hard times with the program. Most doctors have no clue what it is, and many will say they don’t accept it even though they are in the PHCS network. I am most likely going to change to Samaritans very soon.
Is it possible to have a family plan with Samaritan while maintaining a separate health insurance plan on one individual until the preexisting condition period has passed? If yes, would non-preexisting expenses for that individual be shareable if they are under the health insurance plans high deductible?
Hi Scott. Yes that would work for the non-preexisting expenses. Samaritan is second payer to an insurance plan, so anything insurance didn’t cover Samaritan could share (assuming they meet the guidelines of course). That would include expenses that fell into the deductible. You’d have to wait until the insurance had done all their processing first, but it is allowed.
I have a question about Samaritans 120 day supplement/prescription limit. I am a Samaritan member and recently i was in the middle of the treatment of a disease that requires special supplements to facilitate the healing of the disease. I didn’t know about the120 day limit and was denied reimbursement on my supplements after that period. I was right in the middle of treatment and wasn’t completely healed and i could not afford to pay for the supplements on my own so treatment had to stop. This made me start thinking about the possibility of something catastrophic occurring such as an accident that causes damage to the heart and requires expensive, necessary for life, heart medication the rest of your life in order to keep your heart functioning and with Samaritan, it sounds like they would only pay for the first four months. I have save to share so i thought i was covered in the case of something catastrophic but im thinking now that i am not. Do you have experience with people having problems with this120 day limit? I have LOVED having Samaritan and want to stay with them but I don’t think i can if they would leave us hanging with long term supplement or prescription needs in a situation like that. I talked to a Samaritan rep and they confirmed that the120 day limit is firm but i just can’t imagine that being correct. I want to make sure i have heard from all sides and really know what my coverage is before we find something else. Has anyone had an issue like this?
Hi Cara. I don’t have direct experience with the scenario you describe. My understanding of the guidelines is that medications are fixed at 120 days (everything in hospital counts so if someone was in the hospital past 120 days the meds continue to be covered, and cancer treatments also continue to be shared as they don’t have the 120 day rule). The example you gave about the heart meds, even though required, would usually fall under maintenance and would have the same long term med limitations with all the ministries, assuming I’m reading the guidelines correctly. It becomes an ongoing, but not cured, illness/condition. The ministries differ in their varying timelines and a couple won’t share supplements, only traditional meds, but they all have a limit. Members who run into that situation likely do a couple of different things.
1) They would find the best price on the meds they need using something like goodrx.com to get a better cash price through a different pharmacy, manufacturer discount program or switching to an entirely different med or generic and
2) They then compare their new monthly medication costs plus the monthly share to what it would cost with insurance premiums and drug copays. For some people it’s still cheaper with a ministry, for others they may find insurance is the lower alternative. Every situation will be different because the needed meds can sometimes be very cheap, other times they’re pretty expensive.
Statistically I don’t think that kind of situation happens very often, as most incidents wouldn’t have such life changing repercussions, but I’m sure it has come up and the members made that decision according to their circumstances. That can even include submitting bills as Special Prayer Needs for additional giving.
It could be that this time limit changes in the future, as I know it used to be shorter and was changed to 4 months a few years ago. Samaritan is always evaluating costs and looking for opportunities to expand sharing. I want to make sure I’ve considered all the nuances of this so I will get further clarification on Monday and update this comment. Thanks for writing. God bless.
edit: Save to Share is a great idea as it does protect against the massive expenses associated with an accident, heart attack, etc. Samaritan’s largest need to date was $1.5 million, discounted down to $700,000 and all shared because the member had Save to Share. I believe it was for a heart related issue. It seems likely that member is paying for some longer term meds, but that entire $1.5 million burden was taken off his/her shoulders and carried by Samaritan members. With insurance he/she would have had some hefty bills (probably more than with Samaritan because of deductibles and copays) and some long term medication costs also. Unfortunately I don’t think a perfect system exists this side of Heaven. Until then we all do the best we can. 🙂
Cara, here is the information I got from a Samaritan representative (sorry it’s late, my schedule was busy).
“Typically when there is a need for medication beyond 120 days a person is probably taking it through IV’s anyways at the doctors office. This would make it publishable. It’s important to remember that treatment at the hospital or through the doctor’s office remains publishable as long as it is in the treatment phase.
However, when this is not the case and the prescription is being taken over the counter, we have found that the prescription drugs are usually not more than a few hundred dollars a month. This certainly isn’t great, but most of our members are still less burdened by these costs then they would be by premiums and deductibles through an insurance policy.
What about if the drug is extremely expensive? Rare as this is, it can happen. Many times the various discount drug programs that can be located through our resources will help take the edge off these costs. Beyond that, many of our members have found incredible deals by skipping the pharmacy and contacting the manufacturers directly.
Many times, for certain conditions that are longer term, we can actually start a new need and restart the 120 day counter because there is a new medication that is being prescribed by the doctor to address a new complication that has arisen from the treatment of the original condition.
Last, but not least, we recognize that at the end of the day there might be times when the Guidelines don’t allow us to publish as much of a need as we would like. (i.e. because there is 120 prescription limit) For those situations, I would recommend continuing the treatment, and submitting the bills for the supplements or prescriptions as a Special Prayer Need.”
Thank you so much for all of this information. I was ready to look elsewhere for something different but this gives me some new things to think about. It seems that Samaritan is still the best option by far. (btw, i signed up under your name as a referral for Samaritan 2 yrs ago! I appreciate this website a lot!)
I’m glad it was helpful Cara. With all the turmoil happening in health care right now, I find tremendous peace when I think about our Samaritan membership. That alone is worth so much to me as we process the onslaught of noise and fear facing our country right now. God bless us all as we walk this journey together.
ps. thank you for the referral! I very much enjoy maintaining this site and helping people find their way to health care sharing. It has become a passion of mine.
Do you know much about Liberty Healthshare? It all looks good but you don’t hear much about them. Any insight?
Hi Pam. Unfortunately the comments and reviews from their members lately haven’t been very encouraging. Membership is still pretty low, someone reported their membership at 28,000 vs over 200,000 with the others. The comparison page to Liberty can be found here. http://samaritanministriesreview.com/samaritan-ministries-vs-liberty-healthshare/
I’m employed at a hospital part-time and am offered insurance. Is it possible to drop my insurance through my employer and sign up for Samaritan Ministries? Or is this option only available if you have no other insurance means offered to you? Thanks so much!
Hello Ashley. Thanks for asking. You can join Samaritan at any time during the year with or without other insurance being available. In fact, you could even choose to have both. Since you’re part of a group plan, I think you can only drop your work insurance during open enrollment (Nov 1-Jan 31), but check with your employer to be sure. The rules from one job to another may be different.
I am considering moving from Medi-Share to Samaritan? Is that easily done?
Hi Karin. I would think it’s very easy. You would just notify medishare that you’re canceling and then signup for Samaritan and set it to start either the same day as your other cancellation or maybe a day or two ahead. It would be trickier if you have a need in the works, as Samaritan would see it as pre-existing and I don’t know if that would complicate your exit from medishare, but otherwise I see no issues at all. It’s not much different than switching from insurance to Samaritan. I made sure that our “coverage” overlapped by a couple of days just in case. The key is to make sure you cancel medishare before their next month’s share assignments are due so you don’t have double payments to be concerned with. Let me be the first to say, welcome to Samaritan!
Hello,
I recently lost my job and am therefore in between jobs. I have a couple of good opportunities waiting on me but will require time to obtain licensing and certifications (2-4 months).
With that said, my option of gap coverage from my former employer (COBRA) is extremely expensive and I will not go that route as I simply cannot afford it due to being unemployed for a couple of months. Therefore, I’m looking into one of these Share plans to keep me from being penalized by the ACA.
My main questions are, which is the best option for family coverage to allow us to be exempt of ACA penalties and also, do any of these help with prescriptions? I have Asthma and must take a daily pill to help regulate that.
Thanks for your help!
Michael
Hi Michael. All 4 ministries I compare on this site will exempt you from the ACA penalties. So its a matter of choosing which one best fits your needs in terms of cost and what they “cover”. None of them share long term medications, so for your asthma pills you’d want to look at something like goodrx.com to find the cheapest cash price at a pharmacy in your area. Prices can vary by hundreds on some meds so it’s worth a look and it will still be a lot cheaper than paying COBRA. Even though you’re looking for gap coverage, something could change during those months so you still want to pick the ministry as if it’s a long term choice. Many people sign up assuming it’s temporary and end up staying on because they like it so much. I don’t recommend any sharing level that isn’t the top available because I don’t like the exposure that gives to big expenses or unshared events. So you’re best off comparing Samaritan vs the CHM gold vs Medishare. Samaritan family rate is $405, CHM gold is $450, Medishare will likely be higher than CHM gold, but will depend on your ages. Since the asthma is pre-existing you’d want to compare how each one handles that. CHM and Medishare have 3-5 year step up plans if the condition is in maintenance mode. Samaritan removes conditions from PEC status if they go 12 months with no meds/treatment/symptoms… so with your ongoing meds that may not be a good solution for you. If you’re not concerned about a big event with it then that may not matter. IF you are, then look at CHM. Good luck with your decision during this transition period. And I hope you find health care sharing so enjoyable that you decide to stick with it long term! 🙂 God bless.
Thanks so much for the info. God is leading and it is wonderful to know there are other believers out there providing info and support such as these sharing plans and for you providing this service.
God Bless to you and your family!
Michael, I just wanted to reach out and recommend that you read the ACA penalty information. I was worried like you and was very surprised to see that it turns out the penalty is relatively small. For me, the annual penalty turns out to be about what I was paying in one month for our family in Obamacare (and not using). Also, it is pro-rated for the months and the amount you did pay into “insurance” that calendar year. Your accountant can help you with any other deductions off that penalty fee at the end of the year too. (Here’s a basic calculator: https://www.healthinsurance.org/obamacare/obamacare-penalty-calculator/)
That said, I am here searching for a Christian-based sharing program now! Good Luck with your job search! God Bless!
I’m getting close to making a decision and need to know if medi-share or samaritan ministries will cover expenses or are people direct billed and its up to them to get the money from medi-share or Samaritan ministries?
Hi John. With Samaritan members are direct billed by the doctor, and we submit those bills to Samaritan for sharing (payments come direct from other members, coordinated by Samaritan). One of the many benefits is that we can choose any doctor we want. Medi-share is more similar to insurance in that they have a PPO network, copays, and the providers send the bills to Medishare. Some places don’t accept it and there are larger out of pocket expenses for going out of network, just like insurance. Each method has their pros and cons. Medishare cost more for us, and had a higher out of pocket amount. It also has the most negative reviews during our research (familiar insurance type headaches of rejected “claims”, unpaid or late paid bills, hoops to jump through). Samaritan’s monthly rate is less for us and we like the low $300 personal responsibility amount. We also very much enjoy sending our shares to other members to directly help with their needs. Both ministries are serving a real need for their members. If you are on the fence between the two I would recommend calling each one to see which best fits your needs, in addition to comparing the two with the chart above. Good luck with your research! 🙂
i have a few questions. I have a son that was born with congenital heart defects, he will be 2 this June. He also requires 6 month check ups with his pediatric cardiologist, and has had an open heart surgery and 2 pediatric cath prodecures done. He is expected to have at least 2-3 more open heart surgeries in the next 18 years and who know how many cath procedures to manage his heart. Now my question is, would he be able to get coverage? And also would his heart condition be considered pre-existing even though he was born with it? I know some insurance companies have different policies on pre-existing vs congenital. Thank you so much for the amazing information and God bless you for all this organized hard work you did for us 🙂
Hi Gina. First of all, let me offer my prayers for you and your son as you walk this journey. Samaritan doesn’t reject membership due to health issues so he could definitely join. Assuming you are not already members, it sounds like that would fall under the pre-existing category with sharing as a special prayer need. According to their guidelines Samaritan does share for congenital issues when at least one of the following is true:
a. Neither the condition nor a symptom of the condition was discovered until after membership had begun;
b. The condition has not required treatment or produced harmful symptoms, and has not deteriorated for at least five years;
c. The condition exists in a person who has been included in a membership from birth and the mother was included in a membership prior to the pregnancy; or
d. If the condition exists in a person who was adopted, the person has been included in a membership since the adoption, and the adopting parents were unaware of the condition at the time the adoption was finalized.
If a congenital issue meets even one of those conditions then full sharing is possible for it. He would have full sharing for issues unrelated to the defect if he does join. I wish you the best in your research as you look for the best possible options for your family. God bless!
Hello,
I am thinking about either Medishare or Samaritans, however I have just a few questions I am hoping I can have answered. First of all I was diagnosed with tachy-brady Syndrome about 5 years ago. I have a pacemaker and have it checked every 6 months. Because this is considered pre-existing under both plans and I have to have this checked every 6 months, would this ever be considered “sharable?”
I also just had a double mastectomy due to a strong family history of cancer and a cancer scare myself (PTL there was no cancer). But I will be facing reconstruction in the next 3 months. Is this something that would be considered “sharable” or would I essentially have to pay out of pocket?
Hi Sarah. Samaritan’s pre-existing wait period for heart issues is 5 years, so if you’ve gone 5 years with no issues then I’m pretty sure that would not be considered pre-existing anymore (please confirm that with Samaritan, but I’m thinking if a checkup did determine a problem then it would likely be shareable). However, checkups themselves following an incident aren’t shareable anyway. Those are part of the preventative and routine checkup aspect that members take care of on their own as they are known scheduled events (they become shareable if a problem is found). If the cost for those is a burden you can submit them as special prayer needs, but there’s no way to guarantee how much you might receive. I think the reconstruction surgery would also likely be shared as a special prayer need. You didn’t have cancer (I agree, PTL!), so you don’t have a pre-existing cancer issue, but the mastectomy was a prior incident regardless and finishing that would be seen as a pre-existing incident. Since you really don’t have a pre-existing cancer issue, if something developed later there would be no wait period for sharing it.
I’m not entirely sure how Medishare would handle either one. I know the heart issue would always be pre-existing, whereas it can fall out of that status with Samaritan after 5 years. I don’t think medishare would share the reconstruction since the mastecomy is a recent event, but I’m not entirely sure (they don’t start sharing on PECs until 36 months “clear” have passed, it’s possible they could fully share it if you waited 3 years to get it done). You would want to confirm with each of them. I think Samaritan would probably be the best choice because of the heart issue, but I could be wrong and I want you to choose the one that best fits your needs. I hope that helps a little, and I pray you stay problem free on both issues. God Bless!
I have a question about things covered. Our daughter may need to be checked for precocious puberty (age 8). If her levels are high enough the doctor will want to medicate. She would get a Lupron shot every three months or an injection in her arm that lasts a year. I know you can’t answer for sure but in your opinion, do you think Samaritan would share this as a need?
Thank you!
Hi Michael. My guess is this would fall under pre-existing conditions if you aren’t already a member. If you are a current member there’s a chance it could be shareable, but I’m not completely confident of it because I’m not sure if it would be seen as a long term medication and Samaritan’s limit on longterm meds is 120 days per incident. I did some research on Lupron because I’ve never heard of it. Goodrx.com shows that drug ranges in price (cash rate non-insurance) from $139 to $535 for one kit (wow, that’s a huge range). Walmart has the cheapest pricing of $139 where I am. I would assume getting it through a hospital would be astronomical, so if you do end up going this route, shop around for where to buy it. $139 x 4 is $556 for a year’s worth. I don’t know how that compares to the other injection you mentioned. I also don’t know if a nurse (have any nurse friends?), pharmacist or if even you can administer the shot or if it has to be done by a doc. That could also affect cost. If it ends up not being shareable hopefully with this info and a little creativity on getting it administered you could keep the cost down to a more reasonable level. Wish I could tell you with more certainty. Someone at Samaritan will likely know a lot better. If I learn anything more I will update this comment. Thank you for giving me something new to research. 🙂 God bless you and your daughter on this journey.
Wow! I had looked on goodrx and thought it was thousands. I must be plugging it in wrong. The other med is supprelin injection. We are current members of Samaritan. We don’t have Walmart pharmacy where we live. We have CVS and some other local ones. Could we have it filled out of state and sent to us? This is all new to me.
Sorry I didn’t respond sooner, I missed the notification about your comment. I don’t know about having it filled out of state, I suppose it would depend on whether the particular pharmacy is willing to mail it. Mail order medication is pretty common, so you could see what one of those outfits charge and as a result having it sent from a walmart may also be possible. I don’t know what the shipping rules are. I looked up the default dosage, your cost could be higher if her dosage would be different, there also appears to be a difference between a vial and a syringe, and short form vs long form. I would trust your numbers more since you likely have the exact drug name and dosage, but I’m guessing you found the long acting version I may have found the short acting one. You’ll want to take that app to your doctor and look it up with him to verify you’re checking the exact right med. The only supprelin pricing I found was $26,000. Yikes. If the high numbers are correct, then check with her doctor to see about alternatives. And definitely call Samaritan to see if this is something they share, get confirmation from them. It really depends on how it is generally classified. I think there’s a good chance it could be. Good luck and God Bless!!
Hello,
First of all, thank you so much for the in depth information and time spent responding to all of these comments! We were about to sign up with Samaritan, but then came across MCS (medicalcostsharing.com) They offer some very good benefits, but I haven’t been able to find much information on them as they haven’t been in business as long as some of these other ministries. Have you heard of them? If so, any thoughts?
Hi Melissa. I did some research on them last December in response to someone else bringing them up on a different page. They are new, starting July 2013, so they are not ACA exempt. To get around that MCS offers to pay up to 2% of the tax penalty, but with penalties increasing that could leave members open to paying a large remainder. And you’d have to prove it each year by submitting your tax paperwork to them. They make a couple of great offers which are mathematically questionable to me. I’m not sure how they can cap “premiums” for life and return premiums after 10 years without running into financial problems down the line, or unless they intend to limit how much they will share needs. I’d want to see the math behind it before joining. They compare themselves to other ministries but don’t give full credit to the other ministries for what they offer so I find the comparison bothersome. Maternity is covered after 18 months, preexisting conditions are shared gradually from 12-36 months until no longer pre-existing. The list of what they cover and don’t cover on the site is pretty generalized and open to interpretation. Maybe their printed guidelines have more details. For a family with 2 kids on their gold plan the cost is $655/month and there would still be a $1000 personal responsibility. To lower the monthly cost to get closer to Samaritan the PR amount jumps to $5000. They know they can’t offer as much yet because they are small and new, and as with anything their offerings could improve as they grow. I would suggest asking how big they are, and what if big expensive needs happened? They do have membership and lifetime caps for sharing needs, they may or may not be high enough for you. Their facebook page membership has gone from 36 in December to 97 today so interest is growing.
Not being ACA exempt means they aren’t on my radar, I don’t want to risk the penalties going higher than MCS is willing to reimburse (and is that reimbursement taxable?), plus the hassle of providing all my tax paperwork to prove it wouldn’t be worth it to me. If I was going to join I’d want to know how many members they have, and how they would handle a really large expense. Do they suggest temporary supplemental insurance until their organization is bigger, or are they big enough now to handle a $1/2 million or $1 million incident? They may be big enough now to handle it. All the ministries started small on shoestring budgets. It’s not a fault to be new, but members should factor that and adjust accordingly. I’m also a little confused on the difference between their membership and lifetime limits (just found it, membership limits are per year, that is not clearly stated everywhere). I like information, so anyone considering them should definitely give them a call and ask all the questions to make the most informed decision. MCS is making a go at being successful and get around the ACA “established” ruling, and it will be interesting to see how they develop over time.
I’m seriously contemplating switching to Samaritan, but I’m wondering about the pre-existing stuff. I don’t technically have any diagnosed problems, but I have a mole on my back that I’d like to get checked because some of my family members have had pre-cancerous spots removed. If I were to join Samaritan and then get the mole checked and/or removed, do you know if this would this be considered pre-existing?
Hi Valerie. Generally yes, that would be pre-existing because you’re aware the mole already exists. Check with your doctor, but usually those don’t cost a ton to deal with especially at the cash pay rate (assuming non cancerous), and may be manageable for you (a GP would be less than a specialist). Otherwise you could submit the charges as a special prayer need. It may not even get that far above the typical $300 personal responsibility amount anyway.
I have a question about the preexisting conditions – I was born with a heart murmur, my aorta valve had only 2 flaps instead of the normal 3. I never had any issues with it, and doctors said I probably never would, and if I did, it would be in my old age. Well, a few months ago (at age 41) my heart went crazy, and I ended up in the ER of a heart hospital. They determined that my aorta valve had completely worn out, and the mitro valve had gotten damaged as well. Long story short, I had open heart surgery and both valves were replaced. Had I been a Samaritan member, would this have been considered preexisting? Also, could I become a member of Samaritan with these mechanical valves? Would any future complications be covered?
Hi Terry. First of all, Praise God that you are now healing after having those valves replaced. I’m so glad to hear you’re on the other side of that scary event. 🙂 If you had been a member when you had the valves replaced, I’m pretty sure they would have been fully shared and not seen as pre-existing. The reason is because the guidelines state that genetic defects which haven’t required treatment or produced harmful symptoms, and has not deteriorated for at least five years are eligible for sharing (it sounds like that would have been the case for you since the replacements were a surprise). (VIII.11b, page 26). Since you have now had an issue, the 5 year clock has restarted. You could certainly join with mechanical valves. Heart issues have to go 5 years without treatment/symptoms/meds before they are no longer pre-existing. So expenses related to treatment for it would be shared as special prayer needs instead of regular sharing until you get to that 5 year mark (but the clock would restart each time there’s a symptom/problem). If there’s a piece of this I’m misunderstanding then you’d want to run the details by someone at Samaritan to be sure. But according to what I read in the guidelines your heart issue falls out of pre-existing status after 5 years with no issues related to it. If you and your doctor think there’s very little chance of a problem then waiting out the remainder of the 5 year timeline may be no big deal. But you and your doctor would know best.
Thanks so much for all the great info.
Having been licensed before in Health / Life Insurance i’m fairly savvy on the various fees, loopholes, etc.
We will probably be joining Samaritan this week but I had 2 questions after reading much of this website and all Samaritans documentation.
First, I have a 4 year old son we decided not to circumcise at birth, but need to 🙂 He’s the only one of our 5 (home births) and I wished we had now. He’s a fairly uncomfortable lad fairly often. Would this covered after the $300 or considered preexisting?
The 2nd is that we are in a unique situation as a family. The Lord moved us to the oil patch of North Dakota a few years back and we can only attend Church bi-weekly. Having been a Pastor & Missionary, it’s most certainly not a case of being committed to the Lord 😉 Also, should we be called into ministry if there is a period during planting where there are no Deacons or Elders yet, what is Samaritans policy concerning it?
Thanks for the help and the faithful dedication to maintaining this informative website!
His richest leading and blessing in your life today!
CWC
Hi Charles. The circumcision would almost certainly be seen as a pre-existing issue since he’s having symptoms to cause the procedure to be necessary. It could be shared as a special prayer need if the charges were burdensome. Assuming there isn’t coverage for it now, I would suggest checking with his doctor to see what the cash pay rate is to get it done. Maybe it won’t be too high. As for the church situation, Samaritan would want you to attend more often, but there are reasons why people miss which are ok. Not knowing the reason for that schedule I would run it by Samaritan to see what they suggest. Ultimately it comes down to whether your pastor can vouch for you and is willing to sign the form. If yes and you’re making every effort to be part of fellowship then I would think it would be ok. Maybe the opportunity for greater attendance will present itself. As for the church planting issue, there’s no hurdle, you can also have someone else who is part of that planting effort who can vouch for you. The form says it can be someone else to whom you are accountable (which makes more sense during a church planting). You would just explain who that person is on the form and all would be fine. Samaritan is used by many missionaries so I’m sure that scenario has come up more than once. God bless you for all your ministry efforts! 🙂
Hi! Our insurance premium is $850 per month for a family of 5. I’m trying to wrap my brain around this new way of covering health expenses and I came up with a few questions. Please correct me if I’m not understanding. For well visits and sick visits, we would pay for the entire visit up front without being reimbursed because they are under $300? How do the “discounts’ work? For preventative procedures (blood work and other lab testing, mammograms, colonoscopy due to family history, etc.) we would pay out of pocket regardless of cost? All prescriptions are paid out of pocket regardless of cost? Does this program prevent the Obamacare penalty for people without insurance? Say someone was diagnosed with a terminal illness 2 years into membership, what are thw coverages and how would they be handled? Sorry for all of the need for clarification. I’m ready to make a change, just trying to see if this would be a fit for our family) Thank you!!
Hi Andrea! I’ll try to answer you question in order.
1. Well visits are on your own, regardless of cost. Usually they are under $300 but may go over if you have a procedure like mammo. Sick visits are reimbursed once the original total before discounts goes over $300. That would include any meds, labs, the visit, etc. Usually those total under $300 (out of our pocket then), but sometimes they go over and then that portion gets published for sharing.
2. The discounts come from your providers. So if their visits are usually $150, but they give you a cash pay discount of $30 down to $120, you just got a $30 discount. If all the bills are $450, you get $200 in discounts, you then pay them $250. But $150 can still be shared because $450 is $150 over $300. The discounts come off what YOU owe. So your final out of pocket is $100, with $150 coming from other members, and $200 was wiped out by the clinic in discounts.
3. Preventative is out of pocket, regardless of cost, even colonoscopies (which are expensive in my opinion). We know those visits are coming so we are expected to save for them and handle it on our own. Because of this members tend to get pretty good about finding deals; cheaper cash rates, free clinics for immunizations, etc. Now, if we have those visits and they find a problem which needs more attention, then the visits just became publishable/shareable. So if your routine colonoscopy comes up with polyps or other issues, you can submit the bill for the colonoscopy and it would be shared. It is recommended to have a small medicals savings account to help cover those routine expenses. What we save on premiums each month, part of that is used for medical savings. Then if we have a need we pay it, and reimburse ourselves later if the need was shareable.
4. Samaritan will share 120 days (about 4 months) of meds for an incident. So if you get sick and need lots of meds, they will share 4 months worth. After that the meds are ours to pay. Total for all bills related to that incident/illness still have to cross the $300 mark, but if it does the medication costs are also shared up to 4 months. I use goodrx.com to find the cheapest cash rate for meds in my area. Saves a lot. That can sometimes mean members buy meds at different pharmacies as pharmacy A is cheaper for one drug, but B is cheaper for another. The savings can be significant though.
5. Joining a health care sharing ministry does exempt you from the ACA fines/taxes. It’s an easy form you submit with your taxes each year, you do NOT do anything on the exchange.
6. A terminal illness would likely be very expensive, could probably easily cross the $250,000 limit for the regular membership. However, if you are a part of Save to Share (I strongly recommend) then there are no cost limits to what total bills can be shared. The patient would be treated, there would be a lot of bills (even with insurance there are a lot of bills), some prepay to the hospital would surely be expected (they’re asking everyone, including insurance customers, to prepay something these days because of high deductibles), the bills would be submitted to Samaritan, Samaritan would work for negotiate a discount on the bills (patient can also get discounts on their own), what’s left beyond the discounts are shared with members, patient gets a bunch of checks in the mail to pay the bills. Some of those illnesses can drag on a long time. Each new set of bills would be submitted monthly as part of the same illness. Checks would likely flow in every month as each month would likely have new bills submitted. Samaritan would share those bills as long as the need qualifies for it. That means it can’t be from a pre-existing condition still in the waiting period, it can’t be from a something against guidelines (abusing alcohol/drug, patient’s own drunk driving, etc). The important thing is Samaritan will hold your hand through the whole thing. Members are never left alone. In addition to the sharing of bills and financial assistance, Samaritan staff would pray for you, put you on prayer lists, I’ve heard they even call members to check on them during their time of need. That kind of attention and hand holding is exactly what we need during such a trying time. For Samaritan its about supporting the soul not just paying the bills. Members would send a lot of cards and checks, and would prayer for the patient. The thing is, a terminal illness is difficult for anyone, insurance customer or ministry member. There is always paperwork and big bills. But with Samaritan you will get prayers and bills are shared above the first $300 (not a $12,000 deductible). It helps to be a bit organized in a situation like that. But it would help no matter what as there would likely be a lot of bills to deal with. In my opinion paperwork could be cut in 1/2 in some cases, as you would not have an EOB and a bill. Just the bill.
Edited to add: Hospice care is also a shareable expense. From the guidelines: Hospice care services will be published for 90 days upon prescription by a physician or certification that the person is terminally ill. Additional 90-day periods will be published with a renewed prescription/certification subject to the per-need dollar maximum (that’s why you join Save to Share…no max).
You have good questions. I suggest you also call Samaritan and ask them for their viewpoints. They are very nice and reassuring about how this works. I also suggest watching some of the videos on mysamaritanstory.org Some of those members have had some HUGE needs shared, and the bills were all paid. You’ll notice how much they enjoyed the cards and were spiritually lifted by them. God bless you in your research! 🙂
Hi would would like to know if min IVF is covered? My wife has bad tubs and this would be a great option for us to grow a family but struggling on if it goes against Christian beliefs. We both go to church every Sunday and pry about it every month. We were blessed with one beautiful girl she is 4 now. We just have a feeling we were ment to have more. We lost one child which caused my wife’s tubs to not work anymore. I know too much info for one simple question but thanks for all the info so far I have found on here it’s really helpful.
Hi Darren. Thanks so much for writing. I did some checking with Samaritan to confirm and learned that unfortunately IVF is not something that is publishable. The guidelines state that fertility treatment or testing is not publishable, including bills for prescriptions, tests, treatment, in vitro fertilization, or other procedures related to infertility. However, medical expenses for an embryo adoption and implantation will be eligible for sharing as a Special Prayer Need, which is a little different procedure than IVF from what I understand. I don’t know if that if helpful in your situation or not. God bless you and your wife as you take this journey and I pray there is a beautiful new baby in your near future!
Thank you we just found out about embryo adoption today and are looking to go that path. Thanks so much again for your wonderful help and keep up the good work. Have a blessed day 🙂
Are truly preventative items covered? Most of my medical care is monthly chiropractic visits simply because I have noticed a huge difference in how I feel. And what about massage therapy? Is anything like these a publishable event?
Preventative visits are typically not shared. If you go in for a preventative checkup and they end up finding a problem (for example a colonoscopy at age 50 where they find something wrong) then they become shareable, but typically preventative visits are on our own. Samaritan will share a set number of chiropractic visits related to a specific need (not pre-existing) but general visits as you’ve described are not publishable.
I have been reading here to see if Samaritan’s might be an option for me. I have only one pre-existing condition which is high cholesterol, as defined by the shared timelines. My husband is on Medicare. So I only need coverage for me. I will be 55 when I separate from my current job that provides my current benefits. I also, have an HSA account, can that be maintained as a tax deductible vehicle if I am with Samaritan? What would my single person monthly cost be?
Hello Wanda. The single rate is $180/month. I also recommend being part of Save to Share, which means putting $133 in savings each year to be used only when Samaritan requests it. HSA’s are not currently connected to health care sharing ministries, but there is legislation in the works to make them work that way. For now we cannot use their tax deductible benefits as ministry members, but you might be able to use the amount you currently have in there, just not get any more benefits on future contributions until that legislation is passed. You will want to check with your tax professional to be sure. It sounds like Samaritan would be a great fit for you. Good luck with your research and God Bless!
I would think that someone could use their HSA accounts to pay their out of pocket expenses (not covered by Samaritan) such as the $300 minimum, extra meds not covered, colonoscopies, preventives, etc. Am I wrong?
My research shows that existing HSAs can be tapped to use on qualified medical expenses (probably like the ones you mentioned), it’s just that the legislation isn’t approved yet for people to continue adding to an HSA tax free if they are ministry members. We’ve never had an HSA so I don’t know what the list of qualified expenses is, but what you listed sounds like it would fit. Your tax professional would probably know better what that list is. Assuming the list you gave qualifies then I would absolutely use an existing HSA in that manner, but I’d want to know for sure so I didn’t have any penalties. I can’t imagine why it wouldn’t be allowed. 🙂
Hi Heather! My husband was laid off from his job last week. We will lose our insurance at the end of this month (roughly 20 days). We have a family of six. I am looking into options for affordable health care. We haven’t been to the doctor in over 2 years so we rarely “need” it but as you know, must have it. My question is this, with Samaritan I assume you pay everything up front at the doctor’s office and then wait to be reimbursed through member’s sharing. What do you do in the case of something outside of what you can afford but is an emergency situation? I have heard stories of some hospitals/doctor’s offices refusing treatment until bill is paid up front. Also, have you ever experienced or heard of anyone else experiencing a doctor’s office giving a member trouble with what they consider to be “not insurance”? My family had Medi-Share for many years, probably about 15 years ago, and did not experience this. However, my mother-in-law is still on the program. She had to find a new general doctor about a year or so ago and ran into trouble with several offices refusing to take her as a new patient because they would not take CCMS (Medi Share) or her offer to just pay up front. Thanks for your help. We obviously are on a tight time schedule here to get “insurance”.
Hello Penny! I’m sorry to hear about your husband’s job situation and losing your coverage. Yes, for most clinic visits you would just pay on the spot. Most clinic related visits will be under the $300 anyway so you just pay cash and go on with life. But whenever the total bills for the visits related to a single incident exceed $300 then you would be reimbursed through member shares. If the clinic charges start to get pretty high, say, for a procedure, you can sometimes set up a payment plan like you would at a hospital, or you may opt for putting it on a credit card. Either way, reimbursement would arrive a couple months after you submit the need.
For very large needs those would usually be done through a hospital and you would likely pay a portion up front (most are now making insurance patients do that, too, because of the high deductibles people have), and then set up a payment plan for the rest. You would pay off the plan early because of the shares that would arrive in a couple of months. Most hospitals have a policy in place for cash patients. I strongly advise that you contact your local hospitals to ask them how they handle it. I did that before I joined Samaritan because I don’t like surprises. 🙂 At my hospital they give a fixed cash rate discount and I have 90 days interest free to pay the bill. At the one 30 min away its 18 months to pay the bill interest free (with a payment plan). Logically most of your care will be close to home so by knowing the local policies you will be on solid footing. Away from home are more likely to be emergencies and those are treated anyway.
It can happen where a doctor or hospital can refuse non emergency care if there’s no insurance, emergencies must always be treated). It doesn’t happen often, but it can happen. It also happens where the facility only does cash because of the headache of insurance processing. And some don’t take ACA subsidy insurance plans, only private plans. No matter what, as patients we now have to do our part to find out what payment policies they have and proceed accordingly. I think you’ll find the majority of the time there’s a policy in place that you can deal with. There will be the occasional speed bump, but there is in the insurance world, too. Even Medicare and Medicaid patients are finding that they have to change doctors because their doc no longer takes it (reimbursements are too low in many cases).
Samaritan can assist in cases where the prepay is crazy high, but that is very rare. Most of the time people are able to get a reasonable prepay that their credit cards can handle if the savings account can’t, and then do a plan for the rest. Too high of a prepay prevents Samaritan from getting any further discounts so if we’re going to do a full prepay they like us to get at least a 30-40% discount. Often times a big discount will accompany full prepay. In those cases I would use a credit card or two if I could handle it. Each situation will be a little different. But I felt enormously better after speaking with my local providers (sometimes it’s on their websites) and knowing they have a policy in place for cash patients. Sometimes the billing person you speak with isn’t sure about the policy if they don’t have many cash patients, so ask for the billing head person if necessary.
Good luck with your research and short timeline. The good news is you can be on Samaritan as soon as they get the application in the mail. God bless!
Hi. I will definitely be applying for this plan. It looks like a great match for me! My dilemma is with my 21 year old daughter, a born-again Christian who attends church regularly, but is involved in a co-habitating situation with her boyfriend. Though I don’t agree with her decision, I do not have control over her actions. I asked her if she could agree to Samaritan’s requirements, and she said yes, but I am not confident she will comply. What are your thoughts, please?
I’m so glad Samaritan is a good fit for you! Your daughter would be required to sign the application as being able to meet the lifestyle guidelines. As you said, she makes her own decisions. If her pastor cannot sign the form that she meets the guidelines then she couldn’t join yet. Some of this will be an honesty issue between her and God. Financially she risks having medical needs not shared if needs develop because of maintaining lifestyle choices that go against the guidelines, but she says she can do it so I have to believe her, and sometimes things like this are great motivators. 🙂 If she says that she can meet the requirements, has read them and understands them all, then the rest is up to her and God. 🙂 She will do fine.
Also, would the removal of an IUD (contraceptive) be considered sharable?
And what about hysterectomy?
I know that is on opposite ends of the spectrum, but these are just the things I could find clear answers for as I read through the guidelines.
I did read where getting a “tubal” wasn’t shareable. Does that include if it is done immediately after birth?
Sorry for all the questions, thanks in advance for your help. And thanks for your extremely extensive research and effort that you have put forth to help all of us understand!
Hi Mandi. I did a little digging in the guidelines and called Samaritan to confirm. THe guidelines state Elective sterilization such as tubal ligation and vasectomy, or the reversal of the same, is not publishable. But, reversals may be publishable as Special Prayer Needs. See Section V.A. Procedures that result in sterilization are publishable if the reason for them is to treat a medical condition.
As confirmed by Samaritan, hysterectomy’s are shareable only if treating a medical condition, but not if elective. In regards to the tubal, those are not shared even if right after a birth (like a c-section). The hospital would always split out that section of the charges (they want to be sure to charge extra for it), and that portion of the charges wouldn’t be shareable. The IUD removal would be non-shareable as a regular need. However, it could be shared as a special prayer need. Elective procedures to reverse sterilization are shareable as special prayer needs, but procedures to incur sterilization are not shareable in any way (unless medically required), not even as SPNs.
Hope that helps! Have a great day.
It does help! I listed that I was referred by you yesterday when I took the plunge! I love the warm, fuzzy feeling I got knowing that I’m helping someone with a special need by referencing you as my referral. I think I will feel the same, when I send my monthly share to a family paying for their actual medical bills. Never in my life have I felt warm or fuzzy when paying any insurance premium, quite the opposite actually. Thank you so much for your patience, time, and effort! Best Wishes, Mandi
I’ve understood iud’s to be abortive. Definitely something to check out.
I’m currently employed and carry the medical insurance (BCBSNC) and I pay, pretax, around $350 bi-weekly for medical, dental (and vision for my wife). So, we are around $700+/month.
We are a healthy family that rarely has major sickness, but have an occasional broken arm or kneecap (we have 2 super competitive soccer players and a wild 6 year old)
I’m trying to understand the cost “benefit” with trying Samaritan Ministry versus traditional pretax medical health insurance and can’t seem to get a good simple overview.
Help?
I’m not sure there is a simple overview because each family’s situation is different. Samaritan’s family share is $405/month, which is $300/month cheaper than you pay now, but then you would have slightly increased taxes because of losing the pre-tax benefit, a benefit that will vary depending on your tax bracket. You also lose the dental and vision benefits you have now, so that would also have to be considered. Given all that Samaritan may still be just a tad cheaper per month, but maybe not enough to matter to your cash flow. The other issue is deductible amount. You don’t say what yours is, but many people now face very high deductibles they can’t afford in the event of a medical need. With Samaritan it’s a responsibility of $300 per need, so it’s a very low “Deductible” comparatively (ours would be over $12,000/year if on insurance). There are benefits beyond the financial that members are also striving for. Knowing that their money isn’t supporting immoral activities and the spiritual benefits of sharing needs with fellow Christians are often as big a draw as the financial benefits. But each family is different. Some cannot afford the $700 you pay now, others have no problem with it. Some face huge deductibles, others don’t. Some don’t have the dental and vision benefits you mention, others do. I generally suggest that people make a list or spreadsheet to work out their own numbers, but for us the non numerical benefits are also a very big draw and it’s hard to put a dollar figure to them. The freedoms are priceless compared to many of the restrictive insurance plans.
Based on the description of your family Samaritan would be a wonderful ministry for you. But you may decide you don’t need ministry membership yet if the financial benefit isn’t high enough and the non-financial issues aren’t a big enough draw. It’s also a different way of doing health care and some people need more time to consider how it will work with their own lifestyles. If you typically have broken limb type expenses each year, that may be where your big savings comes in depending on your deductible size. The ability to pay only $300 for an injury like that, or maybe even $0 if you receive discounts, that can be a big savings over a potentially large deductible expense in the thousands. But only you can decide if the benefits are great enough. For us they definitely are, both financially and spiritually. It’s not true for everyone though. Best wishes for your decision. And I’m glad you’re looking into it, someday you may find that a healthcare sharing ministry is exactly what you need. 🙂
You should consider an accidental injury policy. I’m married with 3 daughters in competition cheer. Always concerned about broken bones, etc. I took out an accidental injury policy which supplements my MediShare policy. It has a low deductible ($250) and a limit of $15,000. It convers everything from x-rays to casts to an ambulance ride. Keep in mind, it only covers accidental injury. My family policy is with American General and the monthly cost is $40. Pretty cheap and well worth it.
Dear Admin, your have blessed many with your work, and I thank you! You are a Godsend, and I am not writing to overwhelm you but I have a question that is based on some facts. According to what I have understood reading all of your information I personally would go with Samaritan’s if I would be allowed to join. My situation is a bit different than most, though.
I am now 60-years-old. In 1984, 32 years ago this April, I was hit by a man who fell asleep behind the wheel. My Cervical Spine was broken from C4-C7. I am quadriplegic due to Spinal Cord Injury. In 1991 my healthcare company (my employer prior to my accident) settled with my lawyer to cover 40% of my accident related costs including my much needed 24 hr in-home care, medical supplies, etc., but that ended when the new healthcare law was enacted. They then did away with their health plan for their employees, disabled and retirees, me included. I must now pay 100% out-of-pocket for my 24/7 in-home care which exceeds $100,000 per year. The insurance company had breached our court contract before 2014 more times than I can keep track of but in 2 years I have not found an attorney or group to help me regain my insurance coverage. I am left with only Medicare where I don’t qualify for the in-home care that I need.
Long story short, God Willing I will be able to continue paying for my in-home help for 2 more years but the extra out-of-pocket costs of doctors, prescriptions, medical supplies, vision, dental, wheelchair maintenance and repairs, wheelchair batteries, prosthetics, Barrier-Free Lift maintenance and repairs, etc. that Medicare won’t help with, cuts into my remaining resources that pay for my in-home caregivers thereby shortening my life at the other end.
My question is, do you think either Samaritan’s or Medi-Share would allow me to join to help relieve me of at least a small portion of my other out-of-pocket medical needs?
Thank you for listening.
May the Lord bless you and keep you;
May the Lord make His face to shine upon you and be gracious to you;
May the Lord lift up his countenance upon you and give you His peace.
Hi Cindy. I’m sorry it took me so long to respond, I had a family obligation today. First of all, you are in my prayers. The information you presented is heartbreaking and also alarming in regard to the hurdles you have faced with insurance companies. My best advice is to speak with Samaritan and Medishare regarding your situation. While Medishare has a step up pre-existing condition plan, I don’t know if the health portion of their rules for joining would affect your application or not. You can surely join Samaritan, but I would suspect a large portion of your needs would be shared as special prayer needs. However, it’s worth speaking to both of them regarding your situation and the best way to proceed. Thank you for sharing your story so that I may pray for you and others can, too. I pray for a solution, for healing, and for peace during these uncertain times.
Thank you for so much information and feedback! My husband and I just got married and we would like to wait 1-2 years before trying to start a family. I am having a hard time locating anything about both programs coverage for contraceptives. It is the only prescription I am on and I have only been taking it since we got married … I prefer to continue using it but am concerned it would not covered under either MS or Samaritan.
Hi Heather (great name!) 🙂 Samaritan does not share for contraceptives. None of the ministries will because it’s a long term medication and preventative, but some also don’t for religious reasons. However, check on goodrx.com to see what the lowest price is for what you need. Many of those aren’t very expensive at all (generic, common ones especially). $10-$15/month for a lot of the ones I’ve seen. It may require you to change pharmacies in order to get the lowest price.
Is dementia considered mental illness? How would a future diagnosis of Alzheimer’s disease be handled?
Thank you!
Hi Terri! Alzheimer’s is shareable as a medical issue and doesn’t fall under mental health. Dementia is more of the blanket term for impaired thinking usually due to aging, of which Alzheimer’s is a specific type. Dementia is a little more vague I suppose and Samaritan would likely want specifics about it, and I don’t know a lot about it, but if there’s tests/treatment going on for dementia (perhaps to pinpoint alzheimer’s, huntington’s, parksinson’s, etc), then yes those are shareable. Long term meds aren’t shared beyond the 120 days per need rule. Praise God Samaritan hasn’t had a lot of those come through, but the gentleman I spoke with said he had seen a few Alzheimer’s needs and they were shared. Hope that helps. 🙂
Wow, what you are doing here is amazing! I am looking into a HCSM for 2016 after paying ridiculous premiums for almost no benefits on the “affordable” ACA exchange. I have been reading through all your comparisons and all the questions other people have asked. One thing I would not have thought to research is mental health, but I have seen it mentioned that it is not typically covered. Is that all the HCSA’s? I have never dealt with mental health issues, and I know almost nothing about potential medical problems in that area. I know that they happen though, so what happens if there is one? I.E. my kid gets to middle school and gets diagnosed with ADHD that is unmanageable without medication? Or bi-polar, or schizophrenia? Also, what about physical therapy for sports related injuries? Thank you so much for doing this ministry!
Hi Lisa. I have read through the guidelines of all the HCSMs I’m comparing here and as a general rule mental health is not shareable. Now, they all have varying degrees of that. For instance some may share in ER visits to stabilize a member, but nothing beyond it. They generally don’t share in long term medications anyway (except for cancer treatment meds) so in your example the long term meds for ADHD, etc would be out of pocket regardless. For those long term meds I recommend either using Samaritan’s prescription discount card or a free coupon site like goodrx.com (or both). Goodrx says the most popular ADHD medication is adderall, which runs about $45/month at the cheapest cash/coupon price in my area. The most common bipolar meds are even cheaper. Your doctor may recommend something else so a quick check of pricing on goodrx would help that discussion with your doctor on finding something effective and affordable. That’s what we would do for any medication really, regardless of what it’s for. Pricing for medications vary wildly in the same town ($10 vs $250 — wow!) so doing a bit of quick research can save you a fortune should the need for meds ever happen for any incident.
Samaritan’s official guidelines on mental health state:
“Psychiatric Care—Inpatient psychiatric care due to involuntary commitment, and the treatment for injuries and detectable organic agents causing cognitive disabilities are publishable up to $50,000 per condition. Psychotropic medication to treat chemical imbalances not demonstrable by lab tests is not publishable except as a part of involuntary commitment. No other type of psychiatric care or services is publishable.
Psychological Services—Psychological services including psychophysiology are not publishable.”
If you are faced with a future mental health need they can be shared as special prayer needs if they don’t fall into the guidelines listed above. I have seen a few come across my special prayer need list over the past couple of years.
Physical therapy for injuries is shareable; Samaritan shares all PT visits while you’re in the hospital and 40 sessions done as outpatient (per incident). If more are required the extras would be shared as a special prayer need.
I’m so glad you’re considering a healthcare sharing ministry. Samaritan has been such a blessing to our family. Merry Christmas and a happy new year to your family!
Hello! Thank you so much for this site! It’s helping me to decipher through all the choices. I have a bottom-line, deal-breaker question. My husband has had Type 1 Diabetes and requires many office visits/check-ups and regular medications. This “condition” is not going away. Does this eliminate us as being a candidate for Samaritan Ministries? From what I’ve read, it seems like ALL his expenses would be out-of-pocket. Thanks for the feedback!
Hi Deanna. Type 1 Diabetes is always considered pre-existing. You would not be excluded as members for that, you could still join, but his bills associated with the diabetes would be shared as Special Prayer Needs and not as part of the regular membership (all his other unrelated qualifying needs would be fully shared). Having diabetes doesn’t mean every medical incident is because of it. Depending on the costs of his meds and what you currently have, look into something like goodrx.com to see if you can find cash rates for the meds cheaper than what you pay now. Also check with his doctor to see what cash pay rates are for his visits. Some people are finding they aren’t that much (just today I heard of a $125 office visit being only $40 cash pay). In yours shoes I would compare the costs of joining a ministry and paying those cash rate bills out of pocket VS both of you on an insurance plan VS him on insurance and you joining a ministry. You may find a creative option that is more cost effective. I wish I had a better answer for you. I can see where that would potentially put him in a tough spot depending on what is required to manage his condition. Thank you for asking.
What if you also have an indemnity type policy such as Aflac that pays a set amount for certain things such as so much per day for a hospital stay. Is Samaritan considered the 2nd payer in that case?
I don’t have an Aflac policy, I always thought they were for the NON-medical portion of bills… like money to help pay the mortgage and utilities while you are injured. If that’s true then it would likely be quite separate from Samaritan’s sharing totals as Samaritan is for sharing the actual medical bills not money for utilities. If instead its a policy to pay the hospital/doctor bills, then yes Samaritan would be 2nd payer as they are second payer to any insurance that would be responsible for covering the medical portion of the bills. If any portion of the Aflac policy is for medical I would suggest you speak with Samaritan to see how they handle it. From what you describe it’s just a fixed amount, regardless of what bills are left over. In those cases it makes me think they are completely separate.
Thank you for a wonderfully clear understanding between the two service options. It’s apparent you have put a lot of time and hard work into the comparisons, as well as answering so many questions. A blessing to anyone reading this site. Thank you, -Fred.
You’re very welcome Fred, thank you for your kind words. I enjoy helping others find their way toward healthcare sharing ministries.
I am 61 yrs old and soon to be 62. I am also retiring at the end of this year. My wife will be 58 then. I have been researching insurances and Christian share programs and have had good references for both Samaritan and Medi-Share from fellow Christians. I had a heart attack in February 2012 but have no issues since and take only one medication, a beta blocker, per my cardiologists recommendation. Would I be considered “cured” at this stage and clear of the pre-existing conditions rule? My wife has fibromyalgia which manifests itself in numerous ways from time to time but she takes no prescribed medications for it. Would her condition be considered a pre-existing one? Last question, are psychological therapy or counseling covered under Samaritan’s criteria?
Thank you for taking the time to have this ministry. This is a confusing issue as I head into retirement.
Hi Terry! Congratulations on being so far past your heart attack with no further problems. For heart issues Samaritan’s pre-existing wait time is 5 years. So in Feb 2017 if you continue with no issues then it falls out of pre-existing status. Incidents before then would still be shared as a special prayer need. Fibromyalgia is a pre-existing condition, though as you said it can manifest in many ways. She could have medical needs completely unrelated to the fibromyalgia which would be fully shareable (doctor would need to confirm). Anything related to it would be shared as a special prayer need until she goes entirely symptom free for a year then it should drop out of pre-existing status (please confirm that with Samaritan, but I think that’s only a 12 month wait time).
I found this information in the guidelines (page 30) about mental health sharing.
29. Psychiatric Care—Inpatient psychiatric care due to involuntary commitment, and the treatment for injuries and detectable organic agents causing cognitive disabilities are publishable up to $50,000 per condition. Psychotropic medication to treat chemical imbalances not demonstrable by lab tests is not publishable except as a part of involuntary commitment. No other type of psychiatric care or services is publishable.
30. Psychological Services—Psychological services including psychophysiology are not publishable.
I strongly encourage you to speak with Samaritan to verify my information and especially regarding your wife’s condition as you know your situations best. Samaritan staff are so sweet to speak with.
Has Medi-share ever had a coverage limits? I thought they used to?
I’m not familiar with the history of Medi-share so I did a little digging. A comparison someone did in 2010 showed medishare with a $1 million/year and lifetime cap of $5 million, but their latest literature says they don’t have that anymore. Digging into some of their materials online I found that they currently limit sharing on motorcycle accidents to $100,000 as of 2007 (file dated 7/1/15). There also appear to be some limits in a car accident if not wearing a seatbelt. So they have a few specific limits on certain needs, but not a blanket limitation anymore that I can find.
With Samaritan would we need to pay for all office visits that are under $300 out of pocket…..even if it would be the fifth visit in the same year? Meaning, what about the small bills? Are they shared or dealt with on our own?
Hi Michael. 🙂 General checkups are always on our own. The little visits (check for strep, feeling under the weather, etc) where you have just one visit and get some meds, those are likely to stay under $300 and we would pay those ourselves, even if it’s the 5th visit. But if that office visit is combined with other visits, pricey labs, meds, etc and all the totals for that same need add up to at least $300 (before discounts) then those become shareable. So it really depends on what else is involved in that office visit. Don’t forget that as a self pay patient the cash rate for those visits would usually be less than rack rate. I suggest calling your regular clinic to see what their cash pay rate is. Our family takes some of the savings we get from paying so much less than our old insurance premium and put it back for medical expenses like those little ones.
You are providing a wonderful ministry with this blog and answering everyone’s questions (even if a lot of them are repetitive). I’m foreign and looking to re-locate to America, but am really frightened of the cost of US health care. You pay soooooo much, and it’s a myth that it’s better than other countries, but I don’t want to get in an argument about that. I’m just thankful that there is an alternative to 100% self pay, or catastrophic insurance (which is really close to 100% self pay!), and that there’s prayer backing and goodwill to boot. Comparing the three options for us is amazing, so thank you, thank you, thank you — and bless you! I’m not so afraid to re-locate now!
Hi Kat, thanks for your very kind words, I am honored. 🙂 I’m glad you have found more peace about moving here and doing healthcare in the US. These ministries are a wonderful solution for many people. I hope you will contact the ministries you are considering directly, they will be able to answer even more of your “what-if” questions and give you an even better sense of how they will work for your family. I thoroughly enjoy speaking with Samaritan’s staff, they are so kind. Finding genuine kindness and helpfulness is so comforting during the tumultuous times we live in. Good luck with your relocation and God Bless!
Medi-Share does not require a physical to join.
I just applied to Medi-Share today, and they do not require a physical even to get their healthy-person 20% discount.
I have spent a little time checking out both share programs. I think they’re both appealing for different reasons. My concern with Samaritan’s was that I might not receive checks from participants in a timely manner, and also, having to gather and process all those checks, especially in a time of illness, injury, or duress, could prove to be a special challenge. (I’m single.) As I did my research, I could see how each sharing approach had specific benefits for specific situations and personal proclivities.
Finally, I feel it’s unfair to characterize the lawsuits against Medi-Share as though they have done something untoward. I was reading articles on litigation in Kentucky, and it’s really more that this Christian sharing stuff is a strange bird and difficult to classify/categorize inside the existing system. It’s more like this new approach feels threatening to “the powers that be” and is being challenged. As the saga had been unfolding, Medi-Share has made appropriate adjustments along the way to accommodate the rulings and concerns. But we all know that the “big dogs” are going to protect their territory and the money that comes with it. So I really feel like there was a bit of unfair villainizing of Medi-Share in your article. Your bias is understandable, but I think you went over the line on that point in tainting their reputation.
Mentioning that Medi-share isn’t allowed to operate in Montana because of a court case doesn’t villainize them or cross a line. It’s a statement of fact and each reader must determine how much those past issues concern them. Some care, some don’t. I agree the Kentucky case seemed more of a fear of the unknown when it comes to sharing ministries, and the gov’t apparently agreed as the ministries involved in the KY case were reinstated to full operation in that state. That particular case doesn’t concern me.
The suit I was referring to above was the Montana case where the court apparently did find Medi-share to be in the wrong and they were forced to pay a member’s heart infection claim they had previously turned down (medi-share said it was preexisting because of an undisclosed heart murmur). Medishare lost that judgement to the tune of $835,000 (I think the payout was too high). The other was someone with brain cancer. I don’t know if the brain cancer one ever got paid. But in the process of investigating the lawsuit the Montana State Auditor banned Medishare from collecting fees from Montana members (which effectively ceases operations there). Whether or not Medi-share was truly in the wrong, I don’t know. The Court decided on one, the State Auditor on another. Those were two pretty big headaches for Medi-share on the legal front (and the members in question). I’m glad they have made some adjustments to meet the rules of the states, but the Montana issue appears not be resolved in their favor since they are still banned. I do not wish to villainize, but instead to make available the information I found while doing my own research. I think the biggest legal problem during those cases was medi-share’s operations were far too similar to insurance, and thus they were classified that way. Their methods didn’t help their case and perhaps they were unfairly pegged as such. Thankfully those issues have been resolved in the other 49 states. It bothered me that Medishare turned down a couple of big expenses that (in my opinion) probably should just have been paid (the heart case didn’t appear to be truly pre-existing, a murmur is separate from an infection). I don’t know why the brain cancer one was denied. However, the heart one matched up with some other unhappy reviews saying needs were being turned down as pre-existing when even doctors said they weren’t. I don’t know the background of each review, but in my mind the precedent was set and it bothers me. Do those cases mean Medi-share is a bad choice? No. It was one of a few factors in why it wasn’t a good choice for my family. But there are many happy members and you will likely be one of them. Ultimately I found those Montana cases to be sad and frustrating for both sides. I’m so pleased you found a sharing ministry to be a good fit for you. I agree they are all fairly similar with some unique differences to better match up with each person’s unique requirements. That variety is healthy and keeps the growth alive. Nothing is one size fits all or perfect for everyone.
ref: http://www.bozemandailychronicle.com/news/medi-share-must-pay-claim-stop-collecting-premiums/article_f931f7be-bca7-523c-af0c-24ac49e7db60.html
Thanks for your thoughtful reply.
You don’t need a physical to get your blood pressure taken. I went to my local drugstore and used their free blood-pressure machine to get my BP readings for the questionnaire. I submitted that info, weight, height, waist measurement, and answered other health-related questions on a survey. I have the option of submitting blood test results to improve my overall score, but my BMI (body mass index) already qualifies me for the discount.
That does sound easier than getting a full physical. Other members (on other blogs) had mentioned needing one to join, so either it was long enough ago that the process has changed a little now, or they perhaps needed the extra data in order to achieve their 20% discount. Either way, it’s clear that supporting health data is necessary to join Medi-share, which is different than the other ministries mentioned on this site including Samaritan. Not a bad thing, just a difference in requirements. Thank you for the update. 🙂
I am just starting to look into samaritan vs medishare. My concern is that we have 4 young children and accidents happen. Do they cover things like injuries from playing sports, jumping on a trampoline and falling and getting hurt, falling off something and breaking a bone, and just those unexpected things that can happen if a kid gets adventerous and gets hurt. I saw Medishare doesn’t cover anything related to say a 4 wheeler accident if the kid isn’t of age to ride on one. How does Samaritan work for that? My in laws have 4 wheelers on the farm that the kids do ride some with supervision. They wear helmets and are riding slow/ not being careless, but things can happen. Would that not be covered if they got injured doing something like that? How about water activities like tubing/skiing. The list could go on. So far in 8 years we have had only 1 ER visit for a cut that needed stitches, but it’s the what ifs that could happen and we are wondering if those would be sharable. Thank you for all you helpful information.
We have two young boys and we are farmers so I completely understand where you’re coming from. 🙂 Yes, Samaritan shares for accidents that children have. They do have specific guidelines for some of the instances you mentioned but for the most part they are fully shareable. They do not share for 3 wheeler accidents, but they do share for 4 wheelers. The official guidelines state: “Publishable with Requirements. Needs from injuries in an accident where the member is an operator or passenger (in, on, or being pulled by the vehicle), of on-road, or off-road motor vehicles such as snowmobiles, go-karts, offroad motorcycles, four-wheel ATVs, tractors, farm implements, construction equipment, six-wheel ATVs, golf carts, personal moving devices, motorized watercraft of all kinds, and all aircraft, will be publishable for the amount of the need that is not the responsibility of any insurance or liable party, and if all of the following conditions are met. The operator and any rider:
a. were riding or operating the vehicle off public highways, or were lawfully on the highway, and
b. were not engaged in formal racing or stunt competition, and
c. were not operating the vehicle recklessly, or under the influence of alcohol or any illegal substance as defined by the applicable law”
Based on what you’re describing it sounds like your potential future accidents would be fully shareable without issues assuming they can always meet conditions ABC above. Samaritan is the 2nd payer on something like this if an existing insurance policy is in play (such motor vehicle accident medical policy portions, someone else’s liability, etc). If there’s no insurance claim to file then everything gets submitted to Samaritan. If you do file an insurance claim then Samaritan will share what insurance doesn’t. I also called Samaritan to make sure, and was told they do not have age minimums/maximums for sharing on 4 wheelers, it’s just those ABC terms above. Riding around private property is fine. Tubing/skiing, sports, no problem. No problem with trampolines either. I went through your whole list with them and they said all of it is shareable. In fact we agreed that 1 ER visit in 8 years with 4 kids is pretty low and you’re obviously pretty safe on these things. Congrats! 🙂
Thank you so much for your fast and thorough response and for taking the time to also double check with Samaritan. This was very helpful all with the rest of your site.
You’re quite welcome! I hope you’re able to find Samaritan a good fit for your family. Best wishes and God Bless!
Will my car insurance rate go up since Samaritan is the 2nd payer in a vehicle accident? My husband and I are looking at our options and am trying to learn as much as I can.
Thank you,
Mary
It will depend on your particular policy. For us there weren’t any changes (so far), but some policies might care. Ours doesn’t have a very high medical portion anyway. You will need to call your agent to know for sure since each company and policy are different. A gentleman on here last year was the first to introduce me to that concept, and his rates only went up $300/yr for his auto policy, which was less than he expected. He lives in Michigan which has pretty high auto insurance rates.
My wife works for a physician who will see us for just about anything for no cost because they do not pay for health insurance. We have a 6 month old daughter and we are all very healthy. The only reason we’d need to pay for a service is if it was a specialist. Would this make us good candidates for Samaritans? Our monthly premiums are currently about 15% of our take home monthly pay and is not feasible for us to keep on especially with them increasing yearly.
Yes, absolutely, it sounds like you would be a great fit for Samaritan! 🙂 Her employment situation would put your out of pocket costs at nearly nothing since any checkups that members regularly cover on their own are free for you. You would have a few medication charges (like antibiotics, etc so use something like goodrx.com or Samaritan’s discount drug card for those), but otherwise you are golden. Even some of your small non-checkup needs would be pretty small or zero. If a need crossed $300 in costs for you then you share it, but with your headstart on expenses it would take a bigger event than most for you to even reach $300. I would say Samaritan is the perfect answer for your family given your current situation and many would be envious to be in that position. I would say you should run, don’t walk, to join Samaritan. You will likely save a lot each month and it just feels so much better (my opinion) to be doing health care this way, in fact you kind of already do healthcare in this fashion…now you can do it for the bigger needs, too… directly helping other families and living out Galatians 6:2 Carry each other’s burdens, and in this way you will fulfill the law of Christ. I look forward to welcoming you as a member! 🙂
I currently am grandfathered in prior to ACA so my premiums aren’t too bad. In fact it’d be cheaper if we could just cover my wife and daughter under samaritan. Is this possible?
Yes, Samaritan’s couple rate of $360 can also include parent/child or husband/wife. So that should be just fine. If you ever decide to join them on their membership the rate would go to $405 so it’s not a large increase to add you to the membership.
You’ve done an impressive job with your website. Such a big help to those of us trying to make sense of options to the OCMess, and all of its ripple effects.
I’m thinking of signing my wife up for Samaritan, but was wondering about this scenario. She has been on an extended COBRA plan from my previous job. (I’m now under Medicare/Humana and was not planning to join Samaritan.) She hasn’t had large needs, but has been seeing a chiropractor frequently. She has been paying $30 per visit, with the insurance. In the future, she will likely be visiting the chiro about 2 or 3 times per month. It was more frequent in the past, and could possibly be again.
How would the Samaritan coverage affect the payments/reimbursements? I don’t know what the “cash” price is – the chiro work done recently is relatively minor, and would mainly be maintenance going forward.
If the cash price would be $50, would 6 visits trigger something at $300, or am I looking at that the wrong way?
Thank you for your response!
Hi John. If she’s seeing the chiropractor for an existing issue the cost would be shared as a special prayer need and not as part of regular sharing. You will want to find out the cash pay price, I’m guessing it’s more than $30, but it wouldn’t have to be a lot more. For any new issue she has after joining then Samaritan pays up to 40 chiro visits per need/incident. The official guidelines state: Chiropractic—Services are publishable, including ancillary items, such as prescribed nutritional supplements for up to 120 days and X-rays. Each office visit where adjustments, manipulations, or other therapy occurs counts towards one of the 40 total therapy-type visits allowed for any one need. See Section VIII.B.35. To be publishable, billings for each treatment must indicate the condition being treated. Maintenance treatments are not publishable. You would combine the visits until the bills reached $300 (before discounts) and then submit. Subsequent visits would be sent in as add-ons to that need. Not knowing why she’s seeing the Chiropractor I would suggest you give Samaritan a call to get their official answer in case there’s a nuance I’m missing and they know the guidelines better than anyone. Plus they’re amazingly friendly to talk to! 🙂 Thanks for writing.
We are self employed married couple with a 25 yr old son who needs to be on our policy up to age 26. (next June) We need family insurance effective Dec 1. Our group Anthem policy is doubling and we must leave it. I an intrigued by your company and plan. I am completely new to any insurance plans outside the mainstream, however I am so excited because we have lived our life that way, as my husband is a chiropractor, and I manage our office. So, if we see the providers of our choice, and obtain a super-bill, we can present that for payment? This would be very attractive as I go to an ND who has a cash practice. We are Christians and live a biblical lifestyle. I am interested in having a few more questions answered. Do you have agents to speak to ?
Hi Judy. It sounds like Samaritan would be a great fit for your family. If your son is living at your home he can be on your membership through age 25. He may even be able to stay on longer. The guidelines state single children age 26 and over may be on your membership if they are still living in your home and have an annual adjusted gross income (AGI) for federal tax purposes of less than 80 times the standard one-person membership monthly share. Example: For the current standard one-person monthly share of $180, the AGI limit is $180 x 80, or $14,400. I’m not sure if a super bill is the right term, but you would need to submit itemized bills from the provider for qualifying needs of at least $300 (before discounts) and then Samaritan would share those totals with members who would send you the money to pay your providers.
Samaritan isn’t an insurance company so there aren’t agents, but I definitely recommend calling the office and speaking with one of their staff with your questions. They are amazingly nice and wonderful to speak with. From what you’ve written it does sound like this would be a fantastic solution for you. You can reach Samaritan at (877) 764-2426.
I’m just curious about how strict Samaritan is about attending church 3 weeks out of 4 per month. We are Christian and agree with everything else that is listed for requirements. But getting to church that often is just not always possible.
Hi Kim,
Well, it’s not like we check a weekly attendance box (at least not at my church), so I suppose some of it is the honor system. I would guess they want to be pretty strict about it, but recognize that failing to meet it is something between you and God. I’m sure people have slipped on that once in a while, but you should have the overall genuine intention of meeting that requirement. Your pastor has to sign the membership/renewal form that you are attending regularly, still following the guidelines for alcohol, drugs, etc. If he can’t honestly do that then you would have a problem joining/renewing. Maybe some months you go all the time and other months you miss more. It could average out. But effort should be made to attend at least 75% of the time (illness/travel are exceptions of course). I would suggest that you call Samaritan and present your situation to them to see what their official answer is. I had a friend join Samaritan who wasn’t always a regular church goer either, but she stepped up and faithfully attended in order to honestly be able to meet Samaritan’s requirements. She said it was a very good thing for her. We miss church occasionally, but our pastors see us in the audience, in Sunday School, at choir practice every week and at choir. They know we’re involved and attending. But I don’t personally count weeks and if we need to miss then we do. We just keep the misses to a minimum. (I guess I could look at the checkbook register and count those)… Give Samaritan a call, they’re amazingly friendly and will probably leave you with warm fuzzy feelings by the end of the call. 🙂
I am seeking insurance for myself. I am married, but my husband’s work covers his insurance. I am a Christian, 51, healthy, take no medications, nor do I smoke. I work for a Christian non-profit that does not offer healthcare, so I pay for my own. The rates are killing me! I go for my routine well-person stuff, but that’s about all I need. Can you send me an email and tell me what I could expect if I were to join Samaritan? Thank you.
Hi Barbara! First, even after reading my answers I still suggest you call Samaritan to get a feel for any specific situations you’re thinking of. But I’d be happy to give you my perspective. Your rate would be $180/month (joining as single since hubby has insurance). I recommend that you also do Save to Share in case big things happen (major accident, heart issue, cancers, etc). For that you would put $133 in savings and spend it in tiny chunks only when asked. As a Samaritan member you would pay your routine well checks on your own, prices will vary by region and clinic, but I’m guessing $200-$300 for a mammo and $100-$150 for the annual physical. We get our bloodwork done at the county health fair because it’s SO much cheaper than through the clinic ($40ish for a complete blood panel).
Health care with Samaritan is pretty simple. You get your checkups, ask for the cash discount, pay cash. That’s it. Some places have bigger cash discounts than others, so do a little homework and ask your doc’s office what they charge so there aren’t surprises. If something’s too pricey and you have options, shop around. Any occasional medication you might need (antibiotic?) I suggest using something like goodrx.com to point you to the cheapest place to the buy the med prescribed. That is also very easy. Pay cash, walk out with meds. Being part of Samaritan means we cover all those easy things on our own (with cash discounts) and Samaritan steps up when something bigger happens (bigger as in non-routine and at least $300). Should something like that happen you still get the treatment you need, you just submit the bills to Samaritan so other members can send you money to pay for it. While you wait for money to come in you pay a small amount to the hospital for a couple months. Pay the rest off when shares arrives. The entire process is pretty simple, just different than we’re used to with insurance EOBs, high leftover amounts to pay, high deductibles, etc. Since you are so much like us (no health issues to speak of), your experience will likely be similar to ours. Pay cash for the occasional meds, pay cash for checkups, go on with life. 🙂 We LOVE getting the newsletter each month and seeing who our share is assigned to. We pray for them, write out a card, send our share. It’s so easy. And we know that if something bigger comes up we call Samaritan and they’ll walk us through the simple process of turning in our bills for sharing. The rest of the site has a bunch of info related to different areas of Samaritan, but that’s it in a nutshell. (also emailing this)
When I had a colonoscopy early this year they found a polyp and removed it. It turned out to be cancerous but they were sure they got it all. I have to have a colonoscopy yearly now for a few years, will those be covered?
I will confirm my answer on Monday, but I think it would fall under the 5 year cancer pre-existing rule (assuming you weren’t a member when this happened) and be shared as a special prayer need until the 5 years was up. I’m so glad they got it all! I will follow up Monday and write more when I have more details. Thanks for asking.
Update: This one is a bit nuanced but here’s what I learned after calling Samaritan. Pre-existing cancers must be treatment/symptom/med free for 5 years (page 23 of the guidelines) to become part of regular sharing. However, if you join now your future colonoscopies where they find something non-cancerous then the expense CAN be shared as a regular need, because it wouldn’t be part of your cancer issue. As a general rule members getting colonoscopies as a checkup/routine aren’t shared but they become shareable if they find something. Since you had cancer found before membership, if they find cancer again before 5 years of being symptom/treatment/med free after this first cancer they found, it would go back to being related to your pre-existing cancer (5 yr wait) and be shared as a special prayer need. The 5 year rule is tied directly to the cancer, not to the test type. I know that got a little wordy, so they also suggested that you call and speak with them directly because you would know more details about your situation and could answer those what-if questions that popup during your discussion. I also high recommend it, they are super wonderful people to speak with.
I’, a newly turned 61YR old self-employed woman, looking for genuinely affordable healthcare. I’m was to having a low premium ($269.00 per month) and and $5000.00 deductible. This is what we can afford without looking for another job just for to pay for health insurance! My husband is taken care of with Medicare and a good plan B- which he needs due to having stage 4 bladder cancer 5 years ago. The problem is for me! What would be the current cost per month for me through Samaritan? The only pill I take is once a day routine Levothyroxin and even that was just lowered in dosage. Want to have this all done for January 2016. Help! Thankyou! Can you send me an email in answer?
Hi Christine. Your rate with Samaritan would be $180/month. I looked up your medication on goodrx.com and it looks like one of the $4 meds you can get at Walmart so the price everywhere is probably fairly cheap as cash pay. You can join Samaritan now, or delay your application to start as of Jan 1, whatever you choose. I’m glad you’re looking into Samaritan, it is a wonderful health care sharing ministry and I recommend it highly! 🙂 (also sending you an email)
Our insurance has been denied and my husband had an issue where he had to be admitted to the hospital for a multitude of tests. He has high blood pressure that caused some stroke like symptoms. He is now on blood pressure meds, blood thinners and cholesterol meds. Would we qualify?
Thank you
Hi Brenda. 🙂 Samaritan won’t reject your membership because of those issues. Long term medications aren’t shareable beyond 120 days anyway, so his meds would be out of pocket (I suggest something like goodrx.com, Samaritan also recently sent us membership cards to another drug discount option but I forget what it’s called). The guidelines say that high blood pressure doesn’t count as a pre-existing issue as long as it’s well maintained with meds or diet, as long as the person hasn’t been hospitalized for HBP issues. His recent hospital stay may cause a wrinkle there, or it may not depending on why he was admitted. I would have to defer to the experts at Samaritan and suggest you give them a call for your husbands specific case. They are very friendly and love helping people get their questions answered. I’m so glad you’re looking at health care sharing ministries, and I’m sorry you’re having insurance frustrations.
Hi,
Whats happens in a catastrophic situation where a family of six gets hit by a drunk driver and all of them end up in the ICU? Lets assume a bill in the millions. How does this work with Samaritan?
Hi Matt. Samaritan has an optional program called Save to Share which covers those catastrophic needs, with no caps. The family rate is $399/yr, which is actually just money the family puts in savings until it is requested to help pay for the catastrophic needs of others. There are millions and millions of dollars waiting in member savings accounts to help with those very situations. Samaritan’s largest need to date is $1.5 million, reduced to $700,000ish and all fully shared because that member was also part of Save to Share. Typically ICU bills in the millions don’t stay that high. They would also be reduced and Samaritan uses Karis’s help to negotiate those reductions with hospitals. While those catastrophic events aren’t likely to happen, they surely can, and it’s why I strongly recommend members also be a part of Save to Share to help protect in just those kinds of situations.
Thanks you for the clarification. Is the Save to Share family rate $399/year (NOT per month, correct?)
So if I get this right, there are regular members that have a monthly rate based on family size and some of these regular members are also save to share members that contribute an additional $399 per YEAR?
Thanks
Matt
Yes, that is 399/year for the family to be part of Save to Share (avg of $33/month). There’s no guarantee that all $399 will be needed. In our first year as members we were asked to send about $75 of it over the course of the 12 months, so far this year we’re running even less than that. So it’s money kept back in our savings account just in case its needed, but it may not be. Some members are part of save to share, some aren’t. And the family rates are the same no matter what size family you have. Three family members or 20+, all still pay the same. When you think about it, the price is really amazing for the extra level of protection it offers. We don’t see a Save to Share need every month. Sometimes there are 2. But I think I heard they have about 9-10 S2S needs per year. Not very many. A lot of that is because Samaritan shares up to $250,000 at the regular membership level, which is a lot of money once you consider all the discounts people get off their hospital bills. It takes a really major event to reach that S2S level; car accident, heart attack, cancers, etc. They definitely can happen to anyone, they just don’t statistically happen often. I’d rather be safe than sorry, especially since they ask so little of us to obtain it. 🙂
I have had Medishare for about 9 months now. My 7 year old got a sore through 2 months back and at the tail end of his sore throat developed a large mass on the front of his adams apple. I called into Medishare and they (actually said) the surgery would be eligible for sharing. Fastforward to a couple weeks ago they denied the claim for sharing saying it was pre-existing because insurance codes classify the mass as an anomaly. My doctor said its no more pre-existing than a bunion that hasn’t formed yet and begins bothering you one day. my other son took a head to the face back in May and has been having some trouble breathing and now I am afraid to have his nose fixed because the surgery for my 7 year old which should have cost us $3750 is $10k and if my other sons surgery isn’t covered I will be in the poor house. Do NOT go with Medi-share. I am so disappointed. We give money to help others with non-covered expenses every month and cannot believe that they are insinuating that he had a mass when we joined. I feel like my help was merely a monthly donation because now that we have a need there is nothing here for us. I honestly have been laying awake at night wondering how I am going to cover these bills now and be able to help my other son as well.
Just checking in with you Angela, We just got accepted into medishare. Just wondering if you got this resolved or if they never did pay?
My husband is 61 and I am 60- we pastor a church and are looking into health insurance for both of us. The company I work for offers it but the cost you be $428.12 every 2 weeks. Are there policies less costly? We are looking at all our options.
Thank you.
Insurance policy pricing will vary considerably depending on which state you live in, if you choose a lower or higher deductible, and whether you are in a group or individual plan. Since we are outside the enrollment period you would need a qualifying event to get a new insurance policy before open enrollment begins Nov 1, 2015 (new job, got married, etc). On the other hand you can join a health care sharing ministry any time and their costs are often far lower than insurance plans. Samaritan’s monthly share for you as a couple is $360/month and doesn’t increase with age (unlike insurance) and their personal responsibility amount is $300 per incident vs the likely high deductible offered by your insurance. Samaritan not only has many pastors as members, but they can also assist churches with providing health care solutions for all their staff. $360 vs about $860 will save you about $500/month. That’s a considerable amount. I encourage you to give Samaritan a call and work through the options with them. Their biblical approach is comforting while also very pragmatic and financially sound. Good luck with your research! 🙂
We are interested in Samaritan. Our current insurance is outrageous! What if in a few years one of our children is diagnosed with something like Diabetes, something that requires long term medication. Is that medication shared?
Hi Michael. Samaritan shares 4 months of medications for each need. Long term maintenance meds beyond those 4 months (120 day supply) are not shared as part of the regular membership, but if they become a burden they can be shared as a special prayer need. Now, if a new incident develops (eg: ER visit) related to the diabetes and the diabetes appeared after joining, then the qualifying expenses related to that new need can still be shared. I don’t know tons about diabetes, so please talk with Samaritan for clarification. I have had several people tell me their maintenance meds for diabetes aren’t expensive at all, they can handle the costs just fine, but obviously that will depend on what the patient needs. Expenses can be cut even further by using a site like goodrx.com for price comparisons and discounts. Having a long term medication doesn’t have to mean expensive. There are many maintenance drugs which cost very little per month, especially once you get away from insurance propaganda and pricing. If that runs in your family you may know more about what to expect. I remember wondering about that very scenario. 🙂 Those unknown what-ifs can be mind benders, but for our family we decided that the risk is super low, the expenses don’t have to be high, we would trust in God to guide and protect us, and we couldn’t afford to insure ourselves into poverty just to give us a false impression of protection. Samaritan was clearly the answer for us to find that balance plus a comforting safety net. I’m so glad you’re considering it for your family.
I have a quick question regarding timeframe for a PEC or to phrase it better a enrollment ‘probation’ period during which issues discovered are considered PECs and not covered. Thank you
For new issues (unrelated to any PEC) that happen after joining there is no probation period. For known conditions (PECs) with Samaritan most have to go a year with no symptoms/treatments/medications before they fall out of PEC status. Some are 5 years (cancer, heart issues). Medi-shares has a step up period for PECs over a period of a few years, but I don’t know the nitty gritty about how they manage it. Hope that helps.
I’ve read most of this page and I thank you for all you information. If you don’t work for Samaritan Ministries, you should.
Thanks John! No, I don’t work for them, but I do think it would be fun! I’m glad the information is helpful. I still remember the panic I felt over our insurance plan changes and I want to show people another option. That trapped feeling was no fun at all. I have so much more peace about it now.
Hi, thanks for all the great info! Here’s my situation: I am not yet a member but it sounds like a great program for Christians to serve each other. I have had a pain in my side for a while, nothing has been diagnosed, I’m thinking it could be a hernia but I really don’t know for certain. Would I be able to sign up or would this be a pre-existing condition? Thanks!
Hi Austin. You can still sign up either way. Since you already have the symptoms expenses related to checking it/fixing it would be considered pre-existing and would be shared as a special prayer need. The doctor will probably be able to tell you if its a hernia just by feeling, so that visit wouldn’t be shareable anyway because it would more than likely be less than $300 for the single visit (assuming the doctor doesn’t do an ultrasound and assuming no further action is required). I don’t know your current coverage situation, but I would recommend you get that pain checked out regardless. If you are currently without any coverage, joining Samaritan and sharing as special prayer need is better than no help at all. As you said, Samaritan is a great way for Christians to support each other and the special prayer need avenue is a great way to do that when something doesn’t meet the regular guidelines. It’s one of my favorite parts about Samaritan because it’s like a bonus feature that no insurance company can provide. I wish you the best and pray you get an easy answer for that pain.
I had a colonoscopy yesterday and 2 polyps found/removed. 3 years ago, I had 2 polyps removed as well. The doctor said I need to come back in 5 years (they were smaller this time). Would that be covered? or is this preventive/pre-existing?
It sounds like that would be preventative. Colonoscopies fall under the preventative non-shareable area unless you’re having symptoms of something. That timeline would take them out of pre-existing status, but I don’t know if that would apply anyway, they’re just polyps, not cancer. At most it would be a 1 year pre-existing timeframe. Since the procedure likely isn’t shareable for being preventative, you could save up for it as best you can and then submit the rest as a special prayer need if needed. Check with your doctor to see what the all-in cost is on something like that for self pay patients. Pricing will be different 5 years from now, but it should give you a good starting point for what to expect. My answers are technically just a hunch in this case, so please contact Samaritan for confirmation. I’m happy to hear you are staying on top of that. 🙂
Funny, I actually called Samaritan about hypothetical polyps yesterday. They said that if you go in because you have a symptom (for example, some light spotting) and your doctor says the polyps should be treated, it is sharable.
They also said that if you go in for a preventative and the doctor finds something like polyps he wants to treat, that would be sharable.
The same would go for something like a mole or lump that concerns you. It doesn’t have to actually be cancer or some other disaster to be sharable, just so long as it’s something with a symptom and not completely preventative.
Hope this helps other readers. We are starting Samaritan on 10/1 after about 4 years of research and really looking forward to helping other members.
Good info. I was speaking from the viewpoint of the person not having symptoms and just going in for a standard 5 year followup (generally not shareable since it’s a checkup), I didn’t think about them finding something during that followup and making it qualify as shareable. Of course, if it’s a clean checkup and there were no symptoms then it may not be shareable and we’d want to know that’s a possibility as something we could be responsible for on our own.
Thank you for those examples and for sharing it with others.
I am signing up, thanks so much for your wonderful information! Please let me know your name if you’d like me to tell them I was referred by you
Hi Ryan, so glad to hear you are signing up! We love being Samaritan members! My name is Heather Peters. Thank you for the referral! 🙂
Oh sorry I just realized you had that info over on the margin of the page! It asks for your city/state as well, if you prefer not to say, I totally understand!
No problem. I think I’m the only one in their system with my name (so far) but you can put Nebraska on there to help them out and mention the blog if you want. 🙂
If a person or family has medicaid already, does Samaritan allow it to continue along with theirs as a “backup” or secondary “insurance” which would cover & pick up the personal costs involved such as routine checkups, meds, etc.that are not shareable with Samaritan?
If someone has Medicaid already and is keeping it then the Medicaid is primary, and Samaritan is secondary and would share anything meeting the guidelines that medicaid doesn’t cover. Members are allowed to have both, they just aren’t required to as with some of the other ministries.
I have type 2 diabetes and my wife was just diagnosed with borderline HBP. What would our cost be for us two and our 21 year old daughter still in college? Also, would these be considered shared or SPN coverages?
You would be on the family rate of $405/month for the 3 of you. Your type 2 diabetes would be shared as an SPN until you go 12 months without treatment/symptom/medications for it and you have an A1C test of 7% or less in the months directly before and after the 12 month period. Your wife’s HBP is not an issue as long as its maintained with medication or diet (so medical needs would be shared as part of the regular membership). Long term medications related to it are not shareable anyway. You would want to look at something like goodrx.com for cheaper med costs. The official Samaritan guidelines address both of those issues, and I have copied that data here:
For Type 2 diabetes, you will have met the 12-month limitation if:
a. at least 12 months have passed without any symptoms, treatment, or medication; and
b. in the month before and the month after the 12-month period, (and anytime you are tested in-between) your Hemoglobin A1C test level is seven percent or below. Documentation of these test results must be provided to the office.
High Blood Pressure Exception — High blood pressure will not be considered a “condition existing prior to membership” even if you have not gone 12 months symptom free, as long as you have not been hospitalized for high blood pressure in the past, and you are able to control the condition through medication or diet. Medication for treatment as a chronic condition will not be published.
We are a family of three with a 14 year old son. Our son is incredibly healthy. Both my husband are healthy as well except we are both on thyroid medication. (He takes Synthroid and Armour, a natural drug and I also take Synthroid.) I’m not able to use the generic due to a reaction I had when I tried it a few years ago. I also am on a low dose high blood pressure medication. I’m trying to find out how these are treated with Samaritan. We are starting the ground work and doing our homework in finding out a better alternative to our health insurance needs. Any feedback would be appreciated.
Hi Kari, thanks for asking. Your medications would be out of pocket, our family uses goodrx.com to find the best local prices. It tends to save us quite a bit. Since the thyroid is actively being treated any medical needs related to those would be shareable as special prayer needs and not regular needs, until they go a year without treatment/meds/symptoms. That may or may not be possible depending on why you take the meds. Regular checkups are not shareable anyway, and since it sounds like those issues are well maintained I’m guessing that’s all you’re looking at for expenses related to those things, but you know best what the risks are. Most people find that the discounts they can get on the meds make that OOP cost easier to handle, and the savings on monthly shares vs insurance premiums also makes it easier. If you are aware of any specific potential developments because of the thyroid, I would suggest calling Samaritan and asking them about those specific issues and they would tell you what would or wouldn’t be shareable. The quick answer is that if your doctor says your medical need is not related to your current conditions, then it’s shareable. If it is related/caused by… then it would be shareable as a special prayer need. The guidelines state the following for HBP: High Blood Pressure Exception—High blood pressure will not be considered a “condition existing prior to membership” even if you have not gone 12 months symptom free, as long as you have not been hospitalized for high blood pressure in the past, and you are able to control the condition through medication or diet. Medication for treatment as a chronic condition will not be published.
I would suggest running a cost comparison between 1. Samaritan share + out of pocket meds + covering own checkups with selfpay discounts vs 2. Insurance premium + insurance medication copay + checkup copays (included?). For most people option 1 comes out far cheaper, but that will depend on your specific costs. If you haven’t talked to Samaritan yet I hope you will. They are super friendly and very knowledgeable.
I had a small skin cancer removed back in 2008…no problems for a few years, then in the Fall of 2014 I had two more removed. Now, just a few months later the Dermatologist has determined I have two more very small Basal Cell Carcinoma that also needs to be removed. The recommended method is Moh’s Surgery. The cost is around $4K but with my discount (because I have Blue Cross insurance) it’s about $2K. My question, this seems to be now a recurring situation. I hope I don’t have anymore for a long time, but let’s say this is something that happens every year or two…would it be covered by Samaritan’s or considered a pre-existing cancer condition that never gets beyond the ‘5 years cured’ guideline?
I checked with Samaritan on this. If it’s a recurrence of the same type of cancer within the 5 years (so another Basal Cell Carcinoma in your example) then it would be considered as pre-existing and shareable as a special prayer need. But if you get a different type of skin cancer next time (let’s say after 3 years) and it is different than anything in the previous 5 year timeline then it would be shareable as a regular need. Because they are still skin cancer, your doctor would need to submit a letter indicating the difference if it in fact is a different type and then expenses for that different type would be shared. New unrelated cancers are still shareable as regular needs. According to a cancer center I found, about 80% of skin cancers are Basal Cell Carcinoma, so unfortunately chances are more likely that any recurrence would be related, but it wouldn’t have to be. You said the discount for having blue cross gets it down to $2000, I’m wondering what their self pay discount is. Often times that information isn’t offered up front. In my hospital the self pay discount would match the insurance discount, so self pay patients could get the same $2000 rate if they ask for it. If someone had a high deductible plan (our blue cross plan had a $5000 deductible), they would still be better off with a Samaritan membership because that $2000 could still be shared as a special prayer need and gifts received toward it would leave the resulting out of pocket even less. On insurance we would pay the full $2000 out of pocket with no help if we hadn’t met that huge deductible yet. I pray that your cancers never return after this, and that you are given a clear path making a decision regarding how to proceed. Thank you for asking. If there are nuances to this I’m unaware of I encourage you to call Samaritan, they are really nice and could provide further guidance.
What is considered pre-existing condition? I found a lump and am wanting to get it checked out but don’t want to until I have insurance or sharing. If I was to go to the doctor after signing up would it not be allowed for sharing since I found it before signing up?
That is correct. With Samaritan a pre-existing is anything that has treatment, medications or symptoms (with or without diagnosis) within the allotted time frame. For most things that would be a year. For cancers and heart issues its 5 years. So with prior knowledge of the lump that would be shared as a special prayer need. If the lump is checked as ok and you go 12 months without any more issues related to it, then it would fall out of pre-existing status.
Even if you are already a self pay patient (without insurance or ministry membership) I strongly encourage you to get the lump checked anyway. Check with your doctor/hospital about their self pay discounts, you may find that the cost after discounts isn’t nearly as much as what you’re thinking. Depending on your income they may even have in-house assistance. Most of them will have you put something down up front, and then set up a payment plan for the rest (if necessary). If the cost isn’t that much, they would probably have you prepay all of it. Look around at various hospitals and imaging centers for the cheapest cost, or use a service like medibid.com to help you find the cheapest place. If you join Samaritan, you can submit those costs as a Special Prayer Need if they are a burden to you and you would very likely get some contributions toward it. An ultrasound or mammogram will usually cost a few hundred dollars if you do a little looking/price shopping. I wish you the best and pray for God to show you a clear path as you decide the next step.
Thank you so much for all the information. If by chance it’s more than a cyst and I need more care the only help I can receive is through the Special Prayer Need? How does that work? Is it a one time help or can you submit more depending on the circumstances? Thanks!
If it’s more than a cyst and surgery is required for example, that surgery would also be shared as a special prayer need since it’s related to that cyst. (All other unrelated needs you may have are shared as part of the regular member sharing) If circumstances are such that an SPN needs to be submitted again it can be, with a 90 day wait time before submitting again. There is limited space for SPNs each month, and there are sometimes quite a few Special Prayer Needs in the pipeline so it may take 3-4 months before the first submission gets published; it’s a little slower process than regular need sharing. The good news is that members do respond to those and you will likely receive something, but exactly how much is not predictable.
I have Asthma and Copd and I realize that those are PEC and not covered. My question is, if I come down with bronchitis ( which happens ) is this illness going to be shared? My Dr visit and meds are my responsibility, but what happens if I need to go to the hospital because of complications due to my respiratory issues?
In those cases Samaritan would want doctor verification of whether the bronchitis was the direct result of the asthma/COPD (ie a worsening of your current issues) or whether it was a new source. You can get bronchitis from a virus or bacterial infection, and in those cases it would be fully shareable. If it’s chronic bronchitis inflammation directly resulting from the asthma or COPD (a worsening of those conditions) then it would be shared as a special prayer need (I called Samaritan to confirm this info). They will ask you for clarification from your doctor about the cause if there is any question. You know your medical history better than anyone, so if there are more gray area questions you aren’t sure of I highly recommend speaking with them directly. They are very nice and helpful. Thanks for asking!
Would Samaritan take us if my son is on growth hormone injections and will be indefinitely?
Absolutely. Costs associated with his injections would be shared as a special prayer need as long as he’s on them, but any other medical needs he has (not related to existing conditions) will be fully shared. It’s hard for me to think of any future issue he would have because of being on the injections, but his doctor would know best. Thanks for asking!
My daughter is Type 1 diabetic – how much would a family plan be based on this fact?
The family rate (3+ members) is $405/month for Samaritan members regardless of any health status. Needs related to her type 1 diabetes wouldn’t be shared as part of the regular membership, but they would be part of the Special Prayer Need giving. All her other needs not related to the diabetes would be fully shareable. Monthly costs for medi-share vary depending on joining members ages, so you’d need to run the calculator on their website to see what the cost would be since I don’t know your ages. Medishare costs go up as you age.
I have one child (22 yrs old) so how much would my monthly payment be for the two of us?
Hi James! It might depend. The guidelines read that the “couple” rate is 2 members of the same nuclear family, so that would be $360/month. But if you fit the description for the single parent family rate (widowed/divorced/legal separated) then it is $250/month. A child from 18-25 can stay on your membership as long as they live at home. At age 26 they must meet the income limits stated by the guidelines.
I am going to call Samaritan to get clarification, but that is how I read the guidelines.
UPDATE: I called Samaritan to confirm the couple rate is parent/child or husband/wife. Neat.
We are looking into alternatives for our health insurance and have been researching several healthshare ministries. Samaritan appeared to be attractive to us with the exception of the pre-existing condition policy. I have a hearing condition since childhood that is stable and not life threatening but will never be healed and could possibly (perhaps not likely) degenerate resulting in hearing loss. I have the condition checked every few years or so just to monitor it. Based on my understanding of Samaritan’s policies,medical costs resulting would never be covered if something drastic like complete hearing loss were to occur. Is my understanding correct? This would obviously be a “deal breaker” for me.
Thanks
Thanks for writing. Hearing aid expenses are not publishable anyway. However surgeries for hearing loss are, so in your case it would likely depend on whether your future hearing loss was a direct result of the condition you have now. If yes, then likely it would not be shareable as a regular need (but would be as a special prayer need), if no, then it probably would be shareable. Is the hearing loss likely to happen before you reach Medicare age? If not then the risk of a non-shareable expense may be even less of a concern if you plan to get Medicare (I’m only assuming medicare would pay for something like that, I haven’t researched it enough to know for sure, plus their coverage keeps changing). Since you know the most detail about what your condition is and its prognosis I would recommend speaking directly with Samaritan because they could connect the dots better by having the extra information. The other question is whether your condition would ever get out of the pre-existing time period. I don’t know if they would consider it as having symptoms or not (symptoms/treatment/medication indicate an active condition). Please call them to confirm and good luck with your decision. 🙂
Yes I realize that hearing aids are not covered. These are not covered in traditional plans either. However, coverage for hearing aids was not included in my question. I also have no plans to be on Medicare in the near future (the time will come). With all this said, I will call the office to get my question answered. I appreciate your help and response.
My wife and I are considering this type of insurance. We both use a Dr. of Naturopathy for supplements. There has not been any diagnosis of disease. Are these supplements covered? or do I need her to “diagnose an illness”? Also, if there is a diagnosis would you “publish” the cost of vitamins for treatment?
Thank you.
As of very recently treatments by a licensed ND are shareable. So any supplements/vitamins would also be shareable, but likely with the same limitations as prescription drugs (120 days per incident). However, if you are already receiving supplements for something, that “something” may count as a pre-existing issue. There doesn’t have to be a diagnosis, an issue is pre-existing if you are having symptoms, treatment or medication (with or w/o a diagnosis). I would recommend that you speak directly with Samaritan regarding your question because I am not well versed in the world of supplements and whether your particular situation would have any concerns.
Hello, I am married with two children. We just adopted the second child who has special needs and is covered by HealthCare USA (Medicaid). My insurance is covered through work – but the family rates are outrageous. I covered my wife and daughter with an outside plan which is getting more expensive with less coverage. Would Samaritan let me have my wife and daughter sign up? – or is it just for a whole family? Thank you for providing this website.
The single parent rate is for those who are divorced or widowed, so in your case the membership would still be at the full family rate. You could then add yourself and your adopted child on the membership as well (since you’re paying family rate anyway), which would provide sharing for anything your primary insurances didn’t pay.
MediShare claims to share burdens like Acts but not preexisting burdens…not sure if that is how they did it in Acts????
Most ministries do share pre-existing conditions at some point, just not all right away. Pre-existing conditions (PEC) can be a touchy issue. I wish it was easier, but it comes down to simple math. It’s a fallacy to assume that just because we are part of a Christian ministry that we would have unlimited funding. Offering everything to everyone just isn’t financially possible, no matter how much our hearts want to help. On the flip side, the ACA does offer (force?) everything to everyone including full coverage for pre-existings and has had to limit enrollment times to prevent people from gaming the system and significantly raise monthly costs (double/triple?) to pay for it all. The ramifications of that are hurting millions. Personally, I think the ACA could have found a way to help those with PEC’s without upsetting the entire applecart (and it would have been cheaper than what the ACA has cost so far), but that isn’t what happened.
Also, Medi-share does have a step up program for pre-existing conditions, similar to Liberty and CHM where they will share up to a certain amount of expenses each year related to PE conditions before allowing full sharing. Samaritan doesn’t do the step-up plans, but if most conditions go a year (some a bit longer) without treatment/symptoms, then they no longer count as pre-existing, which is far better than what insurance offered prior to the expensive ACA. I know that Samaritan is constantly evaluating their pre-existing policies, in fact they recently reduced the amount of time asymptomatic/cured pre-existing heart issues and cancers have to wait for full sharing from 7 yrs down to 5 yrs. And because members do want to help, all expenses related to those conditions can be shared as Special Prayer Needs right away; CHM and Medishare allow extra sharing for PE conditions, also. Many members have conditions which are well managed and while that PEC would have kept them out of insurance coverage entirely prior to ACA, ministries welcomed them with open arms. Any medical need unrelated to the PEC is fully shared right away.
Health care sharing ministries must find that fine line between affordable and providing the “coverage” people need; this is also why preventative/checkup visits are not shared. They are not insurance and thus operate differently. Each have rules and requirements that differ significantly from insurance companies. Those rules also help keep costs down. Ministries are not a good fit for everyone, but they do offer a great solution for those Christians who cannot handle Obamacare. It would be wonderful, and perhaps the day will come, when all pre-existings can be shared/covered without a drastic increase in monthly costs. Unfortunately I think that’s only possible if costs as a whole can be brought way down. Until that time we all just have to do the best we can with what we have and pray that someday it will be feasible.
Are vaccinations covered? We have two boys and are thinking of joining Samaritan.
No, vaccinations are not shared. They are part of the checkups/preventative portion which we take care of ourselves. Most members have been able to find very cheap or free vaccinations at their local clinics/free clinics. Our clinic has them offered for free or discount once a month for those who don’t have insurance coverage for those shots. Sometimes that runs through a county health office, too. It will depend on where you live, and your local doctors office should be able to tell you what the resources are.
Hello! Is acupuncture covered? I have allergies and am looking into natural alternatives. Thanks! Hannah
I can’t find anything about acupuncture in the guidelines, so we’ll need to call them to find out. I think I asked them once before but I can’t remember the answer and I don’t have it written down anywhere. I will try to find out next week, but you might beat me to it. 🙂
Update: Samaritan confirmed they will consider sharing acupuncture, but only if it’s prescribed by a licensed physician. Alternative treatments aren’t automatically shareable, they have to be approved, but that is one that can be approved if your Doc is involved. Good to know! 🙂
I am very interested in Samaritan, but I don’t like the idea of sending checks all over the place every month. I would like to just be able to go online to a website, and click on something like “Make Payment”. that would be a WHOLE lot easier than mailing checks everywhere. Also, I worry about people having my checking account number because with a check, one can go just about anywhere online and buy anything just by furnishing a valid checking account number. Is there some kind of payment option to pay via credit card online? Thanks..
Samaritan doesn’t have an online payment option as they prefer the more personal touch with direct sending of shares. Sending the check with a card and prayer adds a personal level that just can’t be duplicated through an online system. Members really enjoy that part of the process and so many have mentioned that the cards meant as much to them the financial side. The risk associated with what you’re describing is very very low. To me it’s no different than sending money to any business, because a person working at the business could do something fraudulent also, plus there are risks to online payments as well. Nothing is foolproof. Personally, I don’t really consider other members true strangers, as we are part of a larger Christian church family and members have made a commitment to help each other in this personal way, they genuinely care about each other and the ministry as a whole, I just can’t imagine any member would consider doing what you are suggesting. No matter which ministry I had picked I am trusting members to send money for my need, why would I trust them to do that but not trust them with my check? It’s just not something I worry about (and I am kind of a worrier sometimes) and honestly direct sending is one of the big reasons we PICKED Samaritan. We really really like that part. However, if that is a deal breaker for you, CHM and Medi-share both operate without the direct sharing. Finding the ministry which fits us best is important, and what works for one may not for another and that’s definitely ok. Diversity should be celebrated! 🙂 It’s nice to have choices among ministries as then it can appeal to a wider range of people. I wish you the best in your search and decision. 🙂
Could there possibly be consideration of an online option in the future? Or is there a way to get them to consider it? Our biggest issue is that our postal service is always sending our mail to our neighbors (and their mail to us). It would be a shame for our neighbors to always be getting the checks and lovely cards. I think I would love a kind, supporting word written online just as much as on a card. Especially if I never end up getting the cards.
I have heard recently that they are looking into ways of doing even more online. Unfortunately I don’t know what those processes will be, whether it would include sharing, or even a time table for it. For those who prefer more online options I was glad to hear they are looking into those scenarios, but I do think it could still be a while before anything develops, if it does. I’ll always love my snail mail method, but that’s also because I have a great local post office and mail carriers. And if our neighbors ever got our mail we would quickly get it back, they’re also great people. 🙂 I can understand your position with the mail troubles you have. Thanks for writing and God bless!
You could send cashier checks. Our bank offers them for free. This would keep your personal banking information private.
Your blog states there are 3 health share agencies. What is the 3rd one? Christian Ministries and Medishare are the same thing, right?
Christian Healthcare Ministries and Christian Care Medi-share are different ministries. I have comparison pages on all of them. There are more than 3 now, but not all of them are ACA exempt with 100% certainty. When the blog was started I knew of the 3 which are for sure ACA exempt (Samaritan, CHM and Medishare).
Care to share the link of your comparison of all the ministries?
Thank you.
I found on this page the comparison for Liberty. Do you have a page showing comparisons for all?
Yes, you can find links to the 3 comparisons I did at this link: http://samaritanministriesreview.com/compare-to-other-ministries/
Hello,
My question is how financial strong are the 2 above?
My concern is what would happen if something BIG say were to hit like EBOLA or new damaging flu strain that hit major cities and now you have a LARGE number of people all at once needing LARGE amount of medical care and medical expenses. Are they financial able to handle something like this-?
Hi Marc,
Interesting question and I encourage you to ask each ministry as only they would have numbers to align with what you are thinking. I don’t know Medishare’s details, but I do know that Samaritan’s administrative financial status is very sound and they are debt free. I have absolute confidence that anything statistically likely to occur they can handle. The strength of the ministry is in its membership, they are not an insurance company with contracts or risky investments of our money, so the comparison is apples to oranges. The ministry’s membership is very strong. 42,000 households (mid Jan) and growing by leaps and bounds. I’m not an employee of Samaritan but my gut tells me that Samaritan could probably handle those big events better than insurance companies because of the makeup of the membership. If an outbreak hit 15% of insurance subscribers, its likely to hit a smaller percentage of ministry members (maybe 10%?) because members tend to be more health and cost conscious and statistically our exposure/risk level would be less. That’s partly why the monthly shares are so much less than insurance rates and I feel safer financially because of it.
However, I’m curious how you would define large. I would break it into 3 levels.
1. A month with lots of big needs and there are more needs than share money. (This happens sometimes and Samaritan prorates accordingly. Medishare pays first come first serve, money could be late)
2. A mid level national crisis event with needs well above shares like never seen before. (hasn’t happened yet, but Samaritan would just prorate accordingly and the prorate may take longer to catch up. Medishare members would be waiting even longer than #1)
3. An epic event not ever seen before in our lifetime (like 50% of the country having some kind of epidemic)
The first one happens, not a big deal. Read more about prorating here. The 2nd and 3rd haven’t happened yet. Samaritan is adaptive and well managed so they would adjust accordingly to the benefit of its members. Likely members would have a bigger proration and wait a little longer for the remainder of the shares. Probably similar to what insurance subscribers would face, as they also only have so much money when big events happen and sometimes money is slow (sometimes insurance money is slow even when they have it). My opinion on the 3rd scenario, 50% type outbreak, is that it would change the entire face of our country, especially ebola, and money really wouldn’t matter. We’d be dealing with something so huge it’s beyond the scope of anything we could truly imagine and that is something only God could handle. It wouldn’t be about money, it would be about our ability to even find medical care as the entire medical system would be overrun. But it’s just not likely to happen. Statisticians have done the math on the likelihood of the severity of the outbreaks that big and you’re more likely to be killed by a shark. It’s a 1 in 13.1 million chance of catching ebola, so the chance of an outbreak must be in the trillions or higher. 200,000 are hospitalized each year for flu, out of 316 million US residents, which is .06%. Even if you took that times 100, its still not going to be a big enough problem. If the implication is that somehow insurance would be stronger, I would disagree. I don’t think the insurance company contract and risky investment pool makes them stronger, in fact the contract likely explains exactly how they will bail on their customers. I have to draw the line somewhere and insuring myself against a minuscule likelihood event isn’t practical or logical. I’d rather put my faith in God and Samaritan’s members who share my faith, than in an insurance company with a good lawyer and a profit margin. I don’t want to “insure” myself into poverty. Knowing that Samaritan has a plan to handle (and has previously handled) what is more likely to happen such as the typical variations in needs (even very large numbers of needs and very large dollar needs) makes me feel secure that my medical bills would be shared quickly and like any other. Any situation where they couldn’t be means something much bigger is happening nationally and that is covered only by God, He will provide according to His will.
If you have answered this I am sorry. Can the monthly share amount ever be less that the 405.00 depending on needs in a given month
Yes, if there are more shares than needs for a month then Samaritan will do a reduction for that monthly share. In fact Jan 2015 is now the 4th month in a row where the shares have been reduced; we’ve had reductions of 10%, 5%, 8%, and now 17%.
Hi, I liked my plan but couldn’t keep it. Now I’m forced to go to the .gov website if I want traditional insurance. This forces my kids into applying for medicaid which I am totally against. So I’m looking at Christian sharing versions. I am liking everything I have read so far but have a few questions.
1. How much work is required keeping track of where to send payments? What I mean is do I have to spend time writing out a check and sending it to Joe blow in Dubique, IA one month and Mary Jones in Chesterfield, MA the next? Or is there a website that will automatically debit my account and send it where it needs to go?
2. What happens if I do not receive shares reimbursed from members (slow or non payment of monthly dues)?
I understand the whole idea of being responsible for routine visits, etc… I just worry about the administrative keeping track of where to send the checks.
Thanks
1. I consider it basically no work. The process is very simple. As a member, every month I get a newsletter. Included is a customized form telling me where to send my payment that month and what that person’s medical need is (broken bone, surgery, birth, etc). It tells me how much to send (mine can vary a little because I’m in Save to Share, or maybe there’s a reduction like the last 3 months we’ve had!) and who gets it. I write the check, write a note to that person, pray for them, and mail it. Easy. There is nothing automatically debited through Samaritan, they prefer the more personal touch so we hand mail them. It doesn’t have to take more than a couple minutes, but I like to take my time reading and reflecting. In this hectic world I thoroughly enjoy getting my newsletter, and taking a few minutes to do those things. It grounds me, gets me centered in Christ as I focus on the needs of another instead of myself. I prefer this personal touch to the automated way. The admin portion is really handled by Samaritan because they are the ones assigning the needs to us every month. Our part is pretty simple.
2. Members are supposed to mail their shares by the 15th. A few could be late and come more toward the months end, but there aren’t many who miss it entirely. if they do they are reminded or that share is reassigned to someone else by the main office. You are given a checklist of what you’re getting and from whom. You report back to the main office what you got (reporting can be done online). If something is missing they make sure it’s made up the next month from someone else or remind that person to send it… depending on situation as to why it didn’t appear. Doesn’t happen often and we are covered in case it does. Never left high and dry. This is a personal touch system, but its very well managed. I can’t tell you how many times I’ve read or heard from other members about how getting their Samaritan newsletter is the one “bill” they look forward to every month. They are excited for it, pay it quickly, and love the process. Insurance bills never gave me that warm fuzzy. I’ve only read one testimony from someone who didn’t receive one share (all others came in), and it was reassigned the next month. Everyone else has indicated all shares arrived timely (in that month). It doesn’t worry me at all. Love it, love it, love it. 🙂
Thank you. Could I bother you with one last question? I was looking at the health co-op which uses Samaritian ministries for the health care portion. It looks like a bunch of added benefits, but the only thing I see I would need would be Prescription discounts, maybe cheap dental insurance and of course vision discounts. Everything else is pretty much covered by my church (chaplain and counseling).
What ideas do you have that other members use for prescription drugs and optical?
For prescriptions we use goodrx.com for coupons and it’s been great. There are other options such as mail order Canadian pharmacies, discounts direct from drug companies (depending on need/income), and online pharmacies. Samaritan’s website also lists OpusHealth.com, PharmacyChecker.com, Rxdrugcard.com as good options. For vision we are just paying out of pocket with self pay discounts. But another member had recommended zennioptical.com for cheaper glasses, plus there are online sources for contact lenses.
Hi, I just have a few questions
sure. what would you like to know? if it’s something I can’t answer I also encourage people to talk directly to each ministry they are considering since they know their guidelines and procedures the best. 🙂
I have a question:
I have a family member who is uninsured (not a part of a Health Care Sharing Ministry, just uninsured). Within the past week, they attempted to go to two different doctors (one a OB/GYN and the other their GP) and both offices told her they would not see her because she has no insurance.
In other words, they refuse to treat those who are cash-pay. I think this is because they fear they won’t pay.
Have you ever had or heard of a medical provider refusing care because of a lack of insurance?
I haven’t heard of that problem around here, but we’re also not approaching it from the same unprotected standpoint so the situation is different. We have the backing of the ministry. Most clinics have plans in place for cash pay and if they don’t they come up with one. Emergency care must be treated regardless. I encourage people to contact their providers to see what their cash pay options are, to find out the discounts available, payment timelines, and policies. The vast majority of the time it’s a nonissue. Communication and ability to pay is the key. considering their bad debt loads it’s understandable that the billing department could assume no-pay if you are cash-pay, but as ministry members we can easily have the conversation to show them otherwise. It hasn’t been an issue at all for us and I made pre-emptive calls to all my area providers before joining Samaritan. It was no big deal to them.
So yes, it can happen (her story proves it), but that situation is fairly rare now and being a member of an HCSM changes that conversation because a lot of providers really just want to be sure we have the ability to pay. Membership in a health care ministry gives us that ability. Yes we are technically uninsured, but we are not unprotected and that makes all the difference. So I wonder if she would have had the same answer if she was a member? Maybe, but much less likely.
Ironically, it’s actually now far more common for providers to refuse patients because they have certain ACA insurance plans or are on medicaid, or medicare (happened to a relative of mine) because the reimbursement rate is so low. The tide is turning in fact, as some doctors are now going to cash only/direct pay practices to avoid the expensive burden of processing insurance (now at 7% as of 2013). I did a quick bit of research and by 1000 to 1 the stories I found were people not complaining about cash problems, but instead complaining their providers wouldn’t take their insurance plan, or their medicaid, or encouraged them to pay cash instead of using their insurance option. Doing a quick search I found only one forum thread about cash pay problems and its dated 2010 and they were also not ministry members either. One of the big headaches of the ACA is that people have the insurance, but many doctors are declining ACA insurance participation because the reimbursement rates are too low. So patients have insurance but can’t use it. Frustrating, huh? Some doctors are opting out of medicaid and medicare because of low reimbursement rates. Now the ACA is giving them the same problem.
Thank you so much for your answers.
We are joining Samaritan beginning January 1st.
And we are very excited. Your website has answered a ton of questions for us.
You’re very welcome. While you wait for Jan 1, I recommend watching all the videos on mysamaritanstory.org, I enjoy them so much and it’s so nice to hear how Samaritan has impacted the lives of these people with sometimes very big medical issues. Welcome to Samaritan! 🙂
And one more question:
Normally, a portion of medical expenses is tax deductible (the amount over 7.5% of your AGI). Is this true even though your expenses are being paid by others?
For example, let’s say you have a medical event that costs $10,000. You get shares from others for the whole $10,000 amount, and that pays the bill.
When tax time comes, can you use whatever of that $10,000 is over 7.5% of your AGI and deduct it?
I’m pretty sure the answer is no, but confirm with your tax professional. The IRS ruled that if we are reimbursed for our medical expenses, we can only claim the unreimbursed amount, and if that puts the total under the 7.5% level then nothing can be deducted. ref: http://finance.zacks.com/tax-deductions-medical-expenses-paid-fundraisers-8533.html It’s a good thing I suppose, since the ministry is covering the bills, we aren’t left with big expenses so there’s no need for a deduction.
How about screenings (colonoscopy etc.) are they covered? How about regular Dr. appointments?
Also, when you go to your doctor and report that you are self pay, do you pay the bill up front and then send the bill to Samaritan or does the doctor bill us then we send the bill to Samaritan?
Preventative and routine visits are not shared, so a screening colonoscopy is not publishable, although if you are having symptoms which started after you began membership and one is ordered by your doc then it is publishable. A screening colonoscopy can also be submitted as a Special Prayer Need. Costs vary depending on where you live and which facility you go to, use the healthcarebluebook.com as a reference point. We are just saving up for ours.
For general checkups (or going in for a sinus infection for example) we tell them we’re self pay, ask for their cash discount and pay on the spot. But that’s because we know it’s a stand alone checkup visit or something that would be under $300 and those aren’t published anyway. Most clinics want payment at time of service for things like that. If we had a bigger need, like an injury which could have lab, xray, ER visit, etc, the doctor usually has to bill us later because hospitals often don’t bill that quickly, then we would ask for the self pay discount, pay the minimum allowed, submit the bills to Samaritan and pay the rest when the shares came in. It really depends on whether the total after discounts is something you can carry or not. $1000 I may put on a credit card or pull from my medical savings (then reimburse myself later from shares), but $12,000 is obviously much harder. It will vary for everyone and will also depend on what your doctors request as a minimum. The problem with paying it all in full right away is that Samaritan no longer can help us get bigger discounts. The larger the bills, the better the chance for a reduction so I would pay the minimum in case another discount was possible. I’ve read of people paying $10/month until the shares came in, but each hospital will be different. We also look for ways to shop smarter. So skip the ER and use urgent care more, or a clinic if during office hours. Ask about buying our own splint for $20 at CVS (if not broken) instead of the $400 hospital issue one…things like that.
Do you have an opinion on Christian Healthcare Ministries. They have the Gold, Silver and Bronze plan. Interested in your thoughts.
Regards,
Mark
Yes, I wrote a page similar to this one about CHM. They were my second choice ministry after Samaritan. Here’s the link to that comparison. http://samaritanministriesreview.com/samaritan-ministries-vs-christian-healthcare-ministries/
I have a couple of questions:
I see you say that we can receive discounts that can make that $300 OOP be less. How do you get those discounts?
Re: OOP what if you have several different DR. appts that total $124 for each visit…When that reaches $900 is that when Samaritan’s would kick in…or does it have to be $300 per incident?
My wife has restless leg syndrome? She has a monthly perscription that she gets but has to go to the Dr. every 3 months to get it re-approved. Would this be covered since it is something she has dealt with since she was 17…she’s 56 now.
Our monthly share…is it tax deductible?
I’m sure I have many more questions but this will at least get us started.
1. Discounts are obtained by asking for their “self pay or quick pay discount” at the hospital/clinic. You can ask at time of service or after receiving the bill, depending on the situation. If you are unable to get discounts or just don’t want to ask, Samaritan has a service that asks for us, which is used whenever they think bigger discounts could be obtained. Most of the time members are able to get big discounts on their own just by asking.
2. Each event/medical issue counts as an incident. So if you see 5 docs at $124 each to deal with the same issue/event (eg: shortness of breath, lets say that takes 6 weeks), and the total is $620, and you get zero discounts, then you cover $300 of it yourself, and Samaritan shares the remaining $320. If you get $200 in discounts then you cover $100 yourself (300-200 discount) and Samaritan shares $320, with the doctor reducing the bill by $200 (200 discount +100 your share +320 samaritan published = 620). If the problem comes back a month later the bills get tacked on to that same need, the $300 doesn’t start over until you go in for a new need.
3. Her long term meds are not shared as part of the membership guidelines. Her doctor visits for the med renewal also wouldn’t be shared because of pre-existing condition and could maybe also be seen as a “checkup” which also aren’t shared, but Samaritan would have to determine that. Stand alone doctor visits generally don’t get above $300 so most in that case aren’t shared anyway. However, if the total of those 4 visits a year are a burden, you can group them as a special prayer need and get some donations toward it. SPNs must be less than a year old to be shared, so maybe group them 3 at a time if they are expensive enough. Don’t forget, those visits would be under self pay status and may be quite a bit cheaper than you think. Some clinics have a very nice self pay discount so an SPN on those may not even be needed.
4. Monthly shares are not tax deductible. Missouri lets you deduct them on your state taxes, but they are the only one I know of. Donations to Special Prayer Needs ARE deductible if you send them to Samaritan to distribute.
Thanks so much. And than you for replying so quickly…wow…impressive!!
You said that discounts are when you ask for self-pay at the hospital, but according to new insurance laws, the self-pay is far higher than the insurance deductible. So with Samaritan I would pay over $5000 for a MRI of which if I was on a PPO my cost would be $569 and even if it were put to the deductible, the deductible would be covered first test of the year.
For example: last jan. I knew something was wrong with me but my insurance wasnt allowing me to get test run without a doctor talking with them first, since I looked healthy my doctor wasnt about to call my insurance so I went to a diagnostics center and paid out of pocket for an MRI, once they discovered I had multiple sclerosis then although I still hadn’t reached the deductible, my cost for the MRI was only $569 yet the self-pay was over $5000.
So I dont see that as getting a bigger discount. It seem to me that having a insurance company negotiate the cost of the test is best because I have to get an MRI every six months and so far, PPO was the best route.
Another question though, are test and meds for MS covered under Samertian?
Hi Ella. If one MRI maxes your deductible then you probably have a $500 deductible with insurance and that is really good. A lot of people are unable to find that now, or cannot afford it because of the high premiums required. A benefit Samaritan members have is that our members know their doctors are free to order whatever tests they feel we need without asking permission from anyone other than the patient. It sounds like you were smart to get checked. I would suggest shopping around on price though, $5000 is crazy high for one MRI. And they could easily say, “this is $5000 without insurance” and neglect to mention they give a huge discount because they want you to ask for it first. WIthout being there it’s hard for me to know.
Treatment pricing and insurance rates vary considerably across towns, states and regions. And not all policies and insurance companies are the same. Imaging centers and outpatient facilities tend to be cheaper than hospital chargemaster rates, but not always. Self pay patients tend to get pretty good at finding the best deals when they have options available, because we are typically more cost conscious. Insurance does negotiate some good prices, but not on everything, and not every plan does. As self pay patients, we ask for discounts and negotiate prices also, sometimes very well, sometimes not. Usually the places with the highest chargemaster rates also give the biggest discounts. It varies everywhere. Samaritan also has a 3rd party group that gets discounts for us if we are unable. Self pay doesn’t always get better rates than insurance, and insurance doesn’t always get better rates than self pay. I haven’t seen anything in Obamacare that mandates self pay should cost more; some providers try, others cut their costs significantly for self pay. My local hospital reduces self pay costs to match the discounts they typically offer insurance plans, but patients generally have to ask for it (so even though I’m self pay if that was the insurance negotiated rate here then I would pay the same $569 you did because of my hospital’s discount policy). It sounds like you have a policy that is treating you well financially for your needs. Companies want us to think that insurance always gets you the better deal, but it’s not true, and I’ve seen it personally. As members we get the discounts we can (sometimes with the help of Samaritan if necessary) and then Samaritan members share in the remainder. In some cases we pay less than we would with insurance, sometimes the same, sometimes more. It tends to average out. And the net result means our out of pocket costs are usually much less. If I had symptoms and got a diagnostic $5000 MRI discounted to $569, it would leave me with $0 out of pocket because the discount I got wiped out my $300 responsibility. Samaritan would share the entire cost. A 90% discount is incredible.
Long term medications are not shared, but 4 months worth for each incident are shared. You could check goodrx.com to see how the med costs compare to your co-pays now. SInce you already have a diagnosis your MS would be considered pre-existing and costs would be shared as Special Prayer Needs. Members who have developed symptoms after membership started and get checked for MS, yes, those tests are shareable. Once a condition is in maintenance status then generally those tests are are considered routine and are not shareable (routine/checkups/preventative costs aren’t shared as part of the guidelines). MS is a unique disease that will affect people in multiple ways and specific questions should be asked of Samaritan directly as your situation will be different than another person’s. Ask those same questions of CHM and Medi-share, too, as all 3 operate a little differently. If you are happy with your insurance I’m not sure a health care sharing ministry is a good fit for you at this point, but I don’t know your full situation, costs, etc. I’m glad to hear you have something working for you now, I hope that continues.
Hello, My question is who would be first insurance provider responsible if I were in a car accident? Would my health coverage through Samaritan(or Medishare) covering me, come in first and car insurance 2nd or vice versa? All hypothetical…. no accidents on this end, and hoping never, but just checking who is primary on vehicle accidents. Lots of great info here! Thanks!
Health care sharing ministries are always 2nd payer if an insurance claim is involved, so car insurance is first. I was told by Samaritan that if it happened and there was some kind of long drawn out legal battle between the insurance companies where the providers weren’t being paid, then Samaritan would share the costs and any payment I got from insurance would need to be sent on to Samaritan for distribution to members. That is always case by case, but they are open to it if insurance gets messy. Samaritan doesn’t want our providers to wait too long. I don’t know how medi-share handles those, but they are officially 2nd payer also. Great question! 🙂
As a 60 year old male with a history of 2 different cancers, rheumatoid arthritis and being on 8 different prescription meds I’m guessing that Samaritan would not accept me since I see a couple of specialists 3-4 times a year each.
I am a believer in Jesus and am happily married for 32 years and otherwise healthy. Almost every thing I see a doctor for is follow up because of a pre-existing condition.
Any insights?
Congrats on being a survivor of 2 cancers! You would be welcome to join Samaritan, but expenses related to your current conditions could only be shared as Special Prayer Needs. Cancers that are 5 years old, with no treatments, medications or symptoms, no longer count as pre-existing, but I don’t know if that fits your situation or not. Long term meds aren’t shared as part of the regular membership anyway and what they are treating would probably be pre-existing. Depending on how expensive your meds and 3-4 office visits are, combined with the monthly share price vs what you would pay with an insurance company a health care sharing ministry may still be a good option. The cancers would be the bigger concern to me personally, depending on their status. I would suggest presenting your needs to Samaritan and to the other HCSMs to see which one could serve you best in the time between now and Medicare. Medi-share and CHM both have different step up plans for pre-existing issues that may suit you better if the other ministry differences are of no concern. I wish I had a more direct answer for you. You may find that regular insurance is a good option, too, but I know that comes with its own expensive pitfalls. I wish you the best in your search for a good fit.
Hi, Thank you for such a great blog with lots of information as I am all new to this, but have friends on both Medi-share and Samaritan. I have a question that I cannot seem to find the answer to. Do you know with Medi-share if the preventative appointments go towards the AHP? thanks!
I am not an expert on Medi-share, but I found a PDF Medishare released dated 9/1/14 which indicates that well visits, routine care and preventative care are not eligible for sharing, and only eligible bills count toward the AHP. Joining those two statements would indicate that those routine visits do not count toward the AHP. However, they do negotiate for some discounts on those visits whereas Samaritan members obtain their own discounts.
Thank you so much for sharing this website!! It seems that most doctors just want us to have insurance. Have you had this problem being self paid?
No, I haven’t had problems yet. Doctors and hospitals are used to insurance, they understand it, but they don’t love it. My job has just been to explain how Samaritan works and they’ve all been really open to it, they just wanted to hear me say that I had a way to pay. I’ve found it pretty easy to get discounts. Our bills so far have all just been check-up/preventative related, so nothing has been submitted to Samaritan, but knowing that could happen someday I talked to my local providers about how they handle cash pay patients. They clearly told me their discount policy, their payment timeframes, and that minimum payments would be needed until the bulk of my shares arrived. Some had longer interest free payment periods than others, but all were open to it as long as I was going to pay the bill. Some people are asked to prepay for non-emergency services, I find this ok as long as the prepay amount is reasonable and doable. Healthcare is a business just like any other with their own bills to pay.
And don’t be fooled, I know many doctors personally, and they hate insurance regulations. They hate the expense, they hate the bureaucracy. Most of them are thrilled to learn they don’t have to answer to an insurance company. Billing departments don’t know much other than insurance arrangements, and may assume you’re a nonpay if you’re self pay. It doesn’t take long to get them to see that we are paying customers. That was a long explanation, but in a nutshell, it hasn’t been an issue for me at this point. I encourage anyone thinking of a healthcare ministry to call their hospitals/clinics and ask about their self pay policies. It’s really not scary, just something we haven’t been used to for 60 years. 🙂 In fact, when I discussed my Samaritan membership with our local clinic, the billing lady was so excited about it she took the information for her own family! People are looking for something affordable and reasonable. Insurance has quickly become neither for millions of Americans.
Medishare is not as Christ-like as they advertise themselves to be. About two years ago, I went through a miscarriage. For the next year and a half, it seems as though I was not able to get pregnant. Finally, I paid out of pocket to have some fertility testing done, knowing that Medishare would probably not pay a dime to help me find out what was wrong or if there was medicine that might help. We discovered a couple of minor things that led to an inexpensive medicine and some vitamins. We were thrilled to discover that we were pregnant soon after, but our joy was cut short as we went through another miscarriage.
I went to a local obgyn to ask some questions about what to do for recurring miscarriages. She explained that she did not have the expertise to diagnose or treat me and referred me to a Reproductive Endocrinologist at one of the top clinics in the country. I started to feel hope after this terrible loss, but when I called Medishare, they very firmly told me that they would not cover a doctor who does fertility treatment. I tried and tried to explain that I was able to get pregnant, but my babies died, and this was an effort to save the life of my little baby. I was put on hold. I thought I would have the opportunity to speak to the supervisor, but the supervisor could not be bothered to speak to me. I want the world to know that “Christian” Medi-share does not care about the life of my unborn child.
How does Samaritan keep track of shares being paid or not paid?
Members who are receiving payments are given a checklist of what to expect and who those shares are coming from. At the end of the month they report back to the main office what they got. It can be done through mail or through our online accounts. The sender can also report through their online account the date the share was sent and check number. But verification comes from the receiving member.
In Samaritan’s program when shares are set to other members how is that money treated? Income,gift taxable?
If you receive shares they are not taxable, it is considered a gift for tax purposes.
I am 60 and my wife is soon to turn 62. How does Samaritan or MediShare work when she becomes Medicare eligible and I will still need to find a way to cover/share my expenses for an additional year and a half?
With Samaritan you would both be on a regular Samaritan plan at $360/month for a couple, being on medicare isn’t required by Samaritan but if she does join it then she would switch to having Medicare as first payer, then Samaritan would share the qualified needs that Medicare didn’t. You being younger would still have Samaritan for all need sharing until you reached the Medicare age (if you chose to join). Nothing would change in your membership other than she would have something else (medicare) covering their stuff first.
I don’t know full details about how Medishare handles it but it looks like they have a reduced rate for seniors, medicare is required, and I did find this link to their senior section on their website. http://mychristiancare.org/Medi-Share/Public_Content/Senior_Assist_Guidelines.aspx Looks like they all have required AHP’s of $1250 per year, which cycles over at the anniversary date. So then medicare would pay, she’d have her $$1250 AHP, then medishare would kick in after that. You would be on your own individual membership at that point. I ran through their share calculator, and someone who is close to medicare but not there yet would pay a significant amount more each month… their regular rate for someone born in 1950 is over $400/month for just ONE person. that is quite a bit more than Samaritan’s $180 rate.
The comparison of cost is between the monthly share amounts and AHP. With Samaritan the member pays a monthly amount but then you report that the members send contributions to the other members to meet their authorized expenses. It sounds like a double payment – I’m probably misreading the description. Where is the monthly amount sent and how does this relate to shared expenses sent directly to other members? Are total costs higher than published monthly amounts?
I’m a 7 year Medishare member and in Feruary I was diagnosed with cancer. My bills to date are over $15,000 and Medishare hasn’t paid anything toward them. Fortunately, Medicare is picking up the lion’s share. I haven’t aggressively pursued an explanation from Medishare but for those thinking they are getting an autopay insurance type plan with Medishare: it ain’t necessarily so.
In the chart I’m comparing both monthly amounts and AHP type info on different lines. Samaritan doesn’t have an AHP like Medi-share does, but as members we are responsible for the first $300 of needs. Since we can also get discounts to reduce that to zero $$, sometimes members have no out of pocket (AHP) at all. Samaritan members only send shares direct to other members, that’s their monthly contribution. There’s not another payment that goes to the main office. Once a year our monthly share goes to the office for admin costs instead of to another member. Still no double payment. 11 months we send to members, 1 month we send to the main office. A customized newsletter tells us which member to send our share to, and what it’s for.
I’m sorry to hear about your cancer diagnosis, I pray that all goes smoothly for you. It’s unfortunate to hear that Medi-share hasn’t come through for you yet, although Medicare is supposed to be first payer so maybe it’s just a matter of time. Thank you for your input about your experience, and I hope your cancer treatments are successful! 🙂
I called MediShare to inquire about my account and I want to clarify in this blog that I have not reached my AHP which is $1250 / household member (me and my spouse). Medicare has covered the bulk of my expenses and will continue to do so. After the AHP has been met (another $120) Medishare will pick up remaining amounts due to my health providers.
MediShare has a program for seniors called Senior Assist which covers my wife and I for $142/mo. That includes a discount for our good physical condition. My comparison of cost indicates it’s about a push between Samaritan and MediShare.
We are not the best examples for cost comparison because of Medicare and our good health (except for this cancer of mine) but for seniors on Medicare and in good condition due to exercise and diet it is worth considering Medishare.
Each family will have different issues to consider.
Amin ps: I have finished my treatments and the Dr says I have an excellent chance of being in remission. We are thanking and praising God for His mercy and grace.
Thank you for the update and your pricing info. I’m glad to know you could soon be in remission!
Hi there, this site is truly helpful. Thank you!
I am wondering though about the route of alternative medicine and what are the specifics. What would qualify as alternative (chiropractic, herbalism, homeopathy, acupuncture) under Samaritan? Does Samaritan need to see a referral from a physician?
Hi Daniella. I am not well versed in the alternative medicine sharing, that is an area of medicine we haven’t ventured into much yet. I like knowing that options are available, though they are more restrictive than traditional medicine, they are at least shared in some cases. My best suggestion is to contact Samaritan directly as they can give you more specific examples and can answer specific questions. However, I can quote the guidelines which references alterative options in a few places: “An “alternative medical practice” or “treatment” is a treatment proposed for a condition diagnosed by a licensed, medical doctor, but not prescribed by the member’s doctor and not otherwise listed in the Guidelines as a publishable need. Alternative treatments are published with prior written approval from Samaritan Ministries. Approval is based upon factors such as the less invasive nature of the proposed treatment, demonstration that such treatment will prevent more costly conventional treatments, 6/14 25 consistency of the treatment with what a medical doctor would prescribe for illness or injury, and the member’s acceptance of appropriate preconditions for publishing the expenses. An example of a treatment that may be an alternative, but which has been published with prior written approval by SMI: The use of vitamin B-17 for the treatment of cancer.”
……and “Naturopathic procedures, adjustments, manipulations, ultrasound, and similar treatments will be treated as “Alternative Medical Practices” (Section VIII.B.1). However, medical treatments and prescriptions provided by a licensed Doctor of Naturopathy that meet all other requirements will be publishable.”
….and “Services of nutritionists, dietary consultants or herbalists, and nutritional products are not eligible for sharing unless prescribed by a doctor or, if the member is hospitalized, prescribed by a member of the hospital staff. Prescribed nutritional products are publishable for the customary cost of a 120-day supply, not including inpatient hospital stays. The Guidelines for “Alternative Medical Practices” may also apply in some cases (Section VIII.B.1).”
…and Osteopathic—Adjustments and manipulations, etc., are subject to the same specific musculoskeletal injury or musculoskeletal disease and 25 office visit limits as chiropractic care. Other medical treatments that a medical doctor would prescribe and that meet all other requirements will be publishable.
I didn’t see acupuncture listed anywhere in the guidelines. I’m sure that doesn’t fully answer your questions, but I do think talking directly to their support staff would be advisable in this case.
Is there a waiting period once you sign up? Or once you get accepted.
For Samaritan membership it’s just waiting for the mail to get the application there. you can have it set to start the day it arrives, or on a specific date of your choosing. There is currently no waiting period for a need to be shared either. Cannot be pre-existing of course.
What about my being 66 years old and on Medicare A & B with Medicare paying 80% of my medical cost and the shares only needing to cover the other 20% – is there a lower share cost for me since there will be a much lower need for using shares from others?
Hi Jim. There isn’t a lower share price for medicare participants. My friends with medicare tell me that the Samaritan share is still less per month than what their secondary insurance options are. You are correct that medicare would pay out first and Samaritan would be sharing in the remainder. It may be that the 20% you are left with after medicare pays is within your budget and there isn’t a need for HCSM membership. if not, you may find that the $180 monthly share cost is still less than the other options available to you, while providing better “coverage” for that 20%. For specifics I would recommend that you speak directly with someone at Samaritan as they can give you better scenarios to decide of Samaritan membership is helpful for your situation.
Are these plans HSA compatible?
Not at the moment. There is a bill in congress to make them work with HSAs, with about 70 or senators co-sponsoring it, the problem is that in our current political environment not much is getting done. I expect that in the next year or two (maybe as soon as the next elections), then things could happen. For now we wait on that getting approved. My understanding is that you can use money in your HSA now, but cannot add more to it tax free. Check with your tax advisor to be sure.
Do you know what the senate bill number is? I would like to check if my two Ohio senators are sponsors. My guess is Portman yes Brown no.
Yes, it’s H.R. 207. If your senators are not on the list you can fill out this form: click link here and get a quick letter sent to those House Members who haven’t sponsored yet, or you can take the body of it and send separately to your own representatives.
Is there any update on this question? This is one of our barriers to a sharing ministry, as we have an HSA under our current plan and would like to be able to keep adding to it.
Hi Tricia. No updates yet. With a new administration I am hopeful about this going through, but there’s been no official change. Samaritan is great about notifying us of major updates so I’m sure we’ll be told as soon as it happens. However, I also know that government doesn’t move rapidly, so while I’m hopeful for 2017, I know it could still be a while.
I have a question for both plans…trying to understand these?
If you go to the doctor for say strep throat and your office visit/throat culture/medication comes to $250.00….do you have to pay this at this time and then submit your bill to Samaritan or MediShare and then they basically pay you back?
How do you explain these plans to your doctor office?
Are you considered self pay? Are you responsible to have the money upfront to pay any doctors bills and get reimbursed later if Samaritan or MediShare approve your bills?
Sorry….I am just confused how this works and need to know before I pick one. Thanks Carolyn
You will probably get better, more detailed answers if you call each one directly, but I would like to try to address them as best I can. 🙂
WITH SAMARITAN
1. a $250 office visit for strep would be our responsibility and isn’t shared with others because it’s under $300. Each incident has a $300 minimum, which can be reduced to $0 through discounts. Preventative checkups and small visits we pay ourselves. Samaritan helps us cover the bigger needs that go over $300. If the bill was over $300 before discounts (you would ask for a self pay discount) then you pay the minimum required and submit the total to Samaritan. you pay it all off when the shares come in. You do not have to pay everything up front, although some places may want you to for small things (like on a credit card or from savings). Bigger things generally don’t get paid all up front (not many have lots of cash lying around or cc limits that high), so you ask what their minimum is (which should be fair and reasonable) and then you will pay off the remaining (after discounts) about 2 months after you are billed. For the ability to avoid messing with insurance companies providers are pretty happy to give a discount (often a big one), take your minimum good faith payment, and then get paid in full by you often faster than insurance ever would have paid them.
2. To the doctors office I told them I am self pay (no insurance), and a member of a healthcare sharing ministry that will help me pay the bills. I would like the courtesy of their self pay discount, hopefully it’s at least the same as what they discount for insurance companies. I’ve never had a problem saying I’m self pay. They offer their discount with a smile, I pay it on the spot (because they’ve always been small bills so far). The main office can give you better wording guidance on the rest of an explanation if it becomes necessary. A friend of mine had much bigger bills and he paid the stated minimum (hospital calculated it easily as a very small percentage of total due), and then paid off the rest when shares came in. Most clinics/hospitals have a grace period of “interest free” time, sometimes 90 days, others are 18 months or more. Just make a small payment for a couple months then pay it off in one big chunk with member shares.
WITH MEDISHARE
Members have an insurance type membership card that they submit. So the $250 strep visit would probably cost $220 (guessing) after the preset discount, you pay the rest. Medishare operates very much like insurance so it’s the same familiar process. you get pre-arranged discounts on your services (no good chance for bigger discounts since the deal has already been made), and I think they pay the provider themselves once there is enough share money in your “account” to cover it. I don’t think members are considered self pay.
On the surface Medishare’s plan seems easier because it’s so much more like insurance companies. But the final cost to the member is higher because of their higher AHP limits (like a higher deductible). As a result you also have more of the insurance type headaches with enrollment and coverage hoops to jump through, high likelihood of a denied claim (based on reviews), higher costs for going out of network.
The tradeoff to keep our costs lower requires us to be more involved in the billing/payment process with Samaritan, but we also have complete freedom to choose any licensed doctor, anywhere. Things are much more hands off with Medishare, but it ends up costing people more. Which one you choose will depend on your own personal preferences and budget requirements. I hope this helps a little. 🙂
Thank you :0
Is age a factor in joining?
No, you can join at any age. Children can stay on the parents plan until age 26. Also if one or both of the heads of household are age 25 or younger then the monthly share is reduced. Age 26 and up all pay the same monthly rate.
Medi-share is indeed a unique program for providing assistance with medical care, but unlike health insurance programs this route uses blatant discrimination to prevent certain individuals from benefiting from its service. Mychristiancare.org specifically points out that only those engaging in sexual intercourse within a “Christian” marriage are allowed to join. This immediately eliminates gay, lesbian, and transgender individuals from enrolling in Medi-share. The program also places limits on services it covers based upon religious beliefs and states specifically that abortions will not be covered under any circumstance.
To be clear, Medi-share is not an insurance program. Medi-share operates as a non-profit group and while members pay into a group fund each month, the money is never Medi-share’s money. Furthermore, Medi-share is not required to pay any bill, nor keep cash reserves on hand.:REF http://www.newsonhealthcare.com/how-does-medishare-work/
You are correct. I don’t believe any of the 3 Christian healthcare sharing programs would allow members to have a non-traditional marriage, nor do any of them cover abortions. That would be considered living an unbiblical lifestyle outside their belief system, and living biblically is a requirement for membership. None of these healthcare sharing ministries (Samaritan, Medishare or CHMinistries) are insurance companies, and they operate under a different set of rules and procedures. The guidelines and rules are clearly stated so members are not surprised by the rules or conditions for joining. Membership in these ministries is not for everyone. Personally I hope everyone is able to find coverage that fits their family well and is affordable. I know what works for me may not work for all my friends, and vice versa. That’s ok.