Thursday, July 11, 2013

Healthcare Sharing Ministries as an Alternative to Health Insurance

We've opted to use Samaritan Ministries, a health insurance alternative, to cover our family's medical needs.

We chose this non-profit organization for several reasons, but in short:

   1.) We don't qualify for employer-sponsored health insurance,
   2.) Private health insurance in Texas does not cover the basic family healthcare of maternity,
   3.) The premium/deductible ratio for private health insurance in Texas is ridiculous.

Here's an overview of the Samaritan Ministries system, and how it's worked for us:

1. We pay $370 a month for our family of four.

If we have another kid, it's still $370 a month. If we have quadruplets, it's still $370 a month. If we adopt more kids, they're covered, and it's still $370 a month. Samaritan Ministries likes kids and understands that families with lots of them don't have spare cash for playing the odds with ER visits.

2. If we have a health issue that costs over $300, Samaritan Ministries covers everything over that $300 out of pocket, up to $250,000.

We could add a plan that covers us higher than $250,000 per claim, but we are playing the risk that we won’t need more than this. When Joshua had his skull/brain surgery, it was about $80,000, so we’re thinking that’s on the higher end of normal claims families might incur.

Once Samaritan Ministries receives our bills, they negotiate with the providers for a self-pay discount. If the total discount received is more than $300, that means we don’t even have to pay the $300 out-of-pocket!
3. Samaritan Ministries doesn’t cover preventative care.

This part sucks. Except there’s a Dallas County pediatric health clinic less than 5 miles from our house, and I can schedule $5 wellness check-ups for the boys with a nurse practitioner. I can also keep all of their vaccinations up-to-date for only $5 each visit.

With our previous pediatrician, we always waited at least 30 – 45 minutes, and then the doctor spent about 5 minutes with us. The nurse practitioners at the Dallas County health clinic are very interactive and have the boys go through play and communication activities to make sure they’re developing at a healthy level.

Wally and I haven’t had any wellness check-ups since being with Samaritan Ministries, but there’s a low-cost clinic in Lewisville that does a women’s wellness exam (including lab/pap smear) for $80. I haven’t tried it out.

4. Samaritan Ministries doesn’t cover sick visits under $300.

This also sucks. So we play a lot of wait-it-out games. For adults and kids over 2, the CVS Minute Clinic works GREAT. For $65, you get a check-up and prescription for all kinds of basic sickness.
5. The paperwork is annoying.

We are collecting all of the bills from my recent ER trip – ambulance (because I thought I was dying), ER, labs, and specialist follow-up – and recording them on the claim page from Samaritan Ministries, which has to be signed by our pastor, before we submit it to Samaritan Ministries.

Our pastor is really supportive, and curious to see how this plays out. He has many parishioners who are struggling with healthcare needs, and we’re the first to try out a Christian healthcare co-op.

6. Samaritan Ministries doesn’t cover eye care or dental care.

We’re looking into a dental discount plan, because those are really cheap. But there are also low-cost clinics for that stuff. And Baylor College of Dentistry in Dallas offers discounted rates.

7. There are over 24,000 households who are members of Samaritan Ministries.

8. Membership in Samaritan Ministries fulfills the individual health insurance mandate included in the Affordable Care Act.

This means we won't have to buy private health insurance through the state exchange, starting in January 2014.

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