Health Care Costs Making You Sick?

No. MPB plans are not insurance. They are an insurance alternative commonly referred to as health share plans. Similar to health insurance, health share plans spread the risk of medical costs across the member base. MPB collects plan premiums from members into a share pool. When members have medical expenses covered by their plan guidelines, those expensives are paid from the share pool.

This is the biggest concern many have when moving from standard insurance to a health share plan. And for good reason. Insurance of any kind is worthless if it doesn't pay when you need it. And quite frankly, some early health share companies gave the industry a bad name. Let's compare how standard health insurance companies and MPB handle claims:

Standard Health Insurers: They reject on average 20% of in-network claims and 30% of out-of-network claims. Of these, many are due to the subscriber not having applied for prior authorization or going to an out-of-network provider. Subscribers can appeal these rejections and, once exhausting the appeals process with the provider, can appeal to their state insurance commission. The industry average for successfully appealing a rejection is around 50%.

MPB: MPB provides transparent, easy to understand guidelines so you know what is and is not covered. With MPB, there are no network requirements or required pre-authorizations to generate rejections out of hand like with traditional insurance providers. MPB further provides a complimentary concierge service that will validate your coverage prior to a procedure and even help you locate a provider. If a sharing request (claim) is rejected, you can appeal the decision and a committee will review your case.

So while having a state insurance commission to appeal to is admittedly a nice option, MPB's no network, no pre-authorization approach is refreshing. And like any company, MPB must stand on its reputation to be successful. We suggest looking at customer reviews for MPB Health as well as any other insurance or health share provider you are considering. Having done the research, we are confident you won't find a more trustworthy health share provider than MPB Health.

Maybe. MPB Health Plans are a good fit for individuals and families who aren't covered by an employee plan. If you are paying for an ACA plan, with or without subsidies, you may find better coverage at a more affordable rate with MPB. You do, however, need to consider any pre-existing conditions you or a family member may have as coverage for pre-existing conditions is phased in.

Not in the first year. Reimbursement for services related to pre-existing conditions in the 2nd and 3rd year of your membership is capped at $25,000 and $50,000, respectively. Depending on the plan, coverage starting in the 4th year is either uncapped or capped at $125,000. See plan details for more information.

An IUA is similar to a deductible in standard insurance plans. There are some important differences, however. IUAs are the amount you pay before your costs can be paid by the plan. IUAs are specific to an 'incident' that causes you to seek medical treatment (e.g. an auto accident, stroke, etc.). You only pay the IUA once per incident regardless of the number of services received or time frame in which they are rendered. Let's look at an example:

You have an auto accident where you are admitted to the hospital for a broken leg. The hospital charges you $5,000 for x-rays, setting the leg, etc. You then incur $500 for a follow-up visit to the Dr. and $1,500 for physical therapy. Your total bill for this incident is $7,000. If you selected a $1,500 IUA amount when you signed up for you plan, you will pay $1,500 and the remaining $5,500 will be paid by the plan. This is true even if the physical therapy, for example, occurs more than a year later.

You are limited to only paying three IUAs per rolling 12 month period. This is similar to an out-of-pocket maximum in standard health insurance. If you have more than 3 incidents in the 12 month period, they will be covered without you having to pay an IUA.