Are health care sharing ministries a viable option for people with chronic kidney disease?

Health care sharing ministries (HCSMs) are organizations made up of people who share similar ethical or religious beliefs and agree to help each other pay for medical bills. Members of an HCSM will typically pay a monthly fee to be a part of the organization. When a member of an HCSM needs to go to the doctor, for example, they will try to negotiate a lower price with their doctor and then submit the charges to the HCSM for payment. Although this seems similar to health insurance, it is not. HCSMs are not required by law to pay members’ health care bills.

Although many HCSMs have websites that make them look like legitimate health insurance companies, they are not insurance. Thirty states exempt these organizations from insurance laws, meaning they do not need to follow any provisions mandated by the Affordable Care Act, such as covering pre-existing conditions, paying for preventive care or ensuring that members have essential health benefits.

With the rising cost of health insurance, alternative monthly payments to HCSMs can look very appealing to consumers—the difference between the monthly premium for health insurance and an HCSM fee can be hundreds of dollars. With millions of Americans losing their jobs due to the COVID-19 pandemic—and with their jobs, their employer-sponsored health insurance—some consumers are looking to HCSMs to fill a gap in coverage.

Consumers need to understand the risks and the potential financial implications if they have a chronic condition, like kidney disease, or experience a significant health care issue, such as an accident, cancer or a diagnosis of kidney failure—all of which are particularly expensive medical conditions. Without health insurance coverage, a patient can be financially liable for the costs. The press has reported on HCSM members who were left responsible for paying their own bills, which resulted in hundreds of thousands of dollars of medical debt. Some states are also investigating these instances. HCSMs cannot be relied on provide the necessary coverage that many people with kidney disease and especially kidney failure will need.

There are currently 37 million Americans with kidney disease and most of them do not know they have it. Foregoing health insurance is risky and opting into an HCSM does not protect those who may need comprehensive health coverage down the line. Individuals with kidney disease should make sure that they are covered by a health insurance plan that is ACA compliant, so it offers protections for pre-existing conditions and covers high-cost procedures and services, like dialysis or a kidney transplant.

It may be difficult to spot the differences between legitimate health insurance and HCSMs, especially because the IRS released a proposed rule that would allow HCSM payments to be deducted from income tax as a health care expense and be reimbursed with health reimbursement arrangement (HRA) funds. If the proposed rule is finalized, it could make it harder for consumers to see the differences. The best ways to understand your type insurance are to read the fine print on your plan and research the insurance company to make sure they are a legitimate health insurer. One thing to flag is if you are asked to prove that you follow a specific religion or faith—it is illegal for health insurers to ask about your religion. You can also visit healthcare.gov to learn more about health insurance options in your state.

FAQs ACA-compliant Health Insurance HCSMs

Are there doctors in a provider network that have contracted with the company to serve members?

Yes

No

Does the plan usually require members to be a part of a certain faith and follow a code of moral conduct?

No

Yes

Is the plan required by law to cover pre-existing conditions (an illness or illnesses that you had prior to paying your premium or fee)?

Yes

No

Does the plan have an annual out-of-pocket maximum that limits the amount you have to pay in a year?

Yes

No

Is the plan required by law to cover a number of essential health benefits, including for chronic illnesses like diabetes, high blood pressure or kidney disease?

Yes

No

Is there a legally established appeals process if the company does not pay my medical bills?

Yes

No

The American Kidney Fund continues to fight on all fronts to prevent kidney disease and ensure that those living with it have access to the health care that they need. We want to ensure that consumers are armed with the knowledge to make the best health care decisions for themselves and their families. For more information on HCSMs, please see a report on the subject by the Commonwealth Fund.

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About the Author

Deborah Darcy

Deborah Darcy is the director of government relations at the American Kidney Fund

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