Health Care Costs Making You Sick?

No. Health share 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 expenses are paid from the share pool. See our health sharing vs traditional insurance guide for more details.

For the most part, yes. There are no federal laws outlawing health share plans nor is there a federal tax penalty for not having traditional insurance (the Obamacare individual mandate penalty was eliminated in January 2019). Most states also do not prevent health shares from being sold or impose tax penalties with a few exceptions. See our is health sharing legal guide for more details.

No. There are no religious affiliations or beliefs required.

This is the biggest concern many have when moving from standard insurance to a health share plan. And for good reason. An insurance policy or health share plan 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 health shares handle claims:

Standard Health Insurers: According to a recent American Hospital Association report, standard health insurance providers reject 15% of claims. Of these, many are due to the member not having applied for prior authorization or going to an out-of-network provider. Members can appeal these rejections and, once exhausting the appeals process with the insurance provider, can appeal to their state insurance commission. According to the same report, 54.3% of rejections are successfully overturned after an appeal.

Health Shares: Health shares provide transparent guidelines so you know what is and is not covered. There are generally no network requirements or required pre-authorizations to cause out of hand rejections like with traditional insurance providers. The health share's concierge service is available to validate your coverage prior to a procedure and even help you locate a provider in some cases. If a sharing request is rejected, you can appeal the decision and a committee appointed by the health share, generally consisting of board members as well as ordinary members, will review your case.

So while having a state insurance commission to appeal to is admittedly a nice option, a health share's no network, no pre-authorization approach is refreshing. And like any company, health shares must stand on their reputation in order to be successful. We suggest looking at customer reviews for the health share provider you are considering. Having done the research, Smart Share recommends Zion and Sedera based health shares as well as MPB's add-on services such as HSA compatibility and MEC preventive coverage. All have a strong track record of paying elgibile sharing requests.

Maybe. Health share plans are a good fit for individuals and families who aren't covered by an employee health plan. If you are paying for an ACA (Obamacare) plan and don't qualify for subsidies, you will likely find better similar benefits at a more affordable rate with a health share. 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.

It depends on the underlying health share provider. Zion and Sedera do not have coverage in the first year. Reimbursement for services related to pre-existing conditions in the 2nd and 3rd year of your membership will be capped at $25,000 and $50,000, respectively. Coverage starting in the 4th year is either uncapped (Sedera backed plans) or capped at $125,000 (Zion backed plans). EverTrust is a bit different. They cover pre-existing conditions in the 1st year capped at $5000 and then have the following progression: 2nd year $30,000, 3rd Year $75,000, 4th year $150,000, 5th year and beyond is unlimited. See the plan guidelines, however, as additional restrictions apply.

Pre-existing conditions are defined as any health issue you were diagnosed with, or for which you had symptoms, during the 'lookback period'. The lookback period is 2 years for Zion backed plans, 3 years for Sedera. and 1 year for EverTrust (although EverTrust has a 3 year lookback for any cancer related conditions). For example, if you went to the ER with chest pains during the lookback period and you later have a heart attack, it will likely be considered a pre-existing condition and covered based on the phased-in approach discussed in the FAQ above. What is considered pre-existing varies between the Zion, Sedera, and EverTrust backed plans. For example, Zion and EverTrust do not consider high blood pressure, high cholesterol, and diabetes as pre-existing as long as they are managed (i.e. you are taking your medications) and you have not been hospitalized for the condition in the prior 12 months. It is important that you read the plan guidelines found under the Details section of each plan for specifics if you believe you may have a pre-existing condition. See our pre-existing conditions guide for a general overview.

Simply tell the provider that you are a cash pay (uninsured) patient and pay the bill directly. Usually this will be at a discounted rate since the provider does not have the overhead of dealing with an insurance company. You will then open a sharing request with the health share through their web portal or mobile app for reimbursement once you meet your IUA requirement.

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 shared (paid) by the plan. IUAs are specific to an 'incident' that causes you to seek medical treatment (e.g. an auto accident). 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 shared (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 for Zion and Sedera based plans, and 2 for EverTrust. This is similar to an out-of-pocket maximum in standard health insurance. If you have additional incidents in the 12 month period, they will be covered without you having to pay an additional IUA (although EverTrust plans charge $1000 per incident in lieu of an IUA). EverTrust plans further require that all expenses that make up an IUA are incurred within a 6 month window and if 6 months elapse between treatments once the IUA is met, the incident is considered over and any further bills associated with the incident will require an additional IUA.

A sharing request is similar to making a claim against traditional insurance plans. If you have an eligible medical expense and you've fulfilled your IUA obligation, you submit a sharing request to the health share and they will reimburse your expense.

Eligible prescription expenses may be shared when they are part of a larger, eligible medical need. Additionally, certain memberships include access to prescription benefits via RX Valet which provides deeply discounted pricing on thousands of prescriptions.

Similar to traditional insurance's out of pocket maximum, MPB health share plans limit the total amount you have to pay to three IUAs per rolling 12 month period. If you have more than 3 incidents in the 12 month period, each additional incident will be covered without you having to pay an additional IUA. This applies regardless of household size (e.g. you are limited to 3 IUAs even when the medical incidents occur across individuals covered by a family plan).

Generally no. There is no limit, either yearly or lifetime, on the amount you can submit and receive payment for via sharing requests for most medical services. Some plans, do however set caps for certain named procedures (e.g. EverTrust caps sleep apnea treatment at $2,000 per sharing request). Please read plan guidelines for specifics.

MPB leverages three of the leading health share providers, Zion, Sedera, and EverTrust, to provide the medical cost protection portion of their plans. While similar, certain details such as IUA options, pre-existing condition coverage, mental health coverage, etc. differ based on the underling provider. It is therefore important to review the guidelines for each plan to see which best fits your needs. You can also review our Zion vs Sedera guide for information on how those two providers differ.

Unplanned (emergency) medical procedures are covered as long as proper documentation is provided. Preventive and/or scheduled services are generally not covered.

For plans that include dental benefits, the dental savings plan is provided by the Careington Dental Network. This is a savings plan rather than insurance. To utilize, you will locate a participating dentist via the MPB portal or mobile app and then provide your dental ID card when scheduling an appointment with the provider. The savings plan covers routine, basic, and major procedures.

For plans that include dental benefits, you will use the MPB portal or mobile app to connect with a dentist via an audio or video call just like you would for virtual primary care. This service is designed for non-emergency needs.