Transcript Christian Healthcare Co-ops

Storehouse Series
Lesson 3 – Healthcare and Christian Co-ops

This will be on my prayer list today....I would love it if you could add it to yours!! Even with
insurance we end up paying a lot out of pocket for Bobbys treatment and the cost will only go up
as he gets bigger and his dosage gets larger. I think too of the people who's life saving treatment
is unattainable because of the cost. Bobby's health will ALWAYS be more important than money
but this sure would help!! – Sincere Mom

Immune Deficiency Foundation

#IDFAdvocacyDay is today and our advocates are urging Congress to #LimitHealthCosts by
supporting #HR1600, the Patients’ Access to Treatments Act (PATA). The bill seeks to restrain high
out-of-pocket costs for specialty medications and help ensure patients, with chronic, disabling
and life threatening conditions have access to the treatments they need.

FRIDAY MAY 1ST WSJ, Medicare and prescriptions (26% of spending, 1% of claims) go toward MS
and Cancer prescriptions

Samaritan’s Newsletter
Changes to make to presentation

DO NOT stumble over the nature of patents, research, development, etc. Use graphs, speak to examples
(cost of producing pharmaceuticals, name brands, impact on insurance)

Progression – Start with history of healthcare, move into the monster, nature of entitlement programs but
staying power of private industry, and then the nature of healthcare as an investment.


From there, Go into Affordable Care Act and what it is trying to solve and why it’s not working
Answer? It isn’t to trust the system, but to trust God and live in community. Even if you have an employer
sponsored plan, check these out.

Don’t even bother with the slides. Use 2-3 stories of how we interact with the network to begin (relationship, newsletter,
prayer, administration, etc)

Use dehydration example with 1st week of care

Recommend CHM and Medishare for people in their 40’s and 50’s.

This is a way to practice good stewardship with your health and finances related to health. Encouring
consumers to learn, ask questions, break down bills, ask for discounts, and enter into a Christian
commitment with health care overall

Talk about the nature of faith with health. Explain the poem a little bit (5 minutes), talk about ‘the bridge,’
and also talk about having faith but still falling into the trap.’

Talk more about Medicare

Use some strong quotes, and then notes in my notes section.
Cont’d… changes
 Explain how health insurance companies work, demonic!
 “It matters how you own your healthcare coverage!!!!!!”
 Healthcare is one of the single most important decisions you can make, how you
own it, planning for it, how you hope to die, preparations for faith…. It matters!
Housekeeping
 Childcare moving forward
 Invite a friend! Open to community, love the broader discussion
 Going through the whole series vs some lessons
 Storehouse Series – What it is, what’s coming up (show website)
 Mondays are when I have time to meet
 Not a great teacher/preacher. Please pray!
 Going to teach for an hour, then Q&A for 45 minutes or so
 www.StorehouseSeries.com is where I will keep resources, notes, scripture
references, etc.
 Let’s pray together!
I discovered some more facts…
 Read recently that our bodies are still mortal and in a state of decay
 People enjoy having access to good quality healthcare
 Healthcare happens to be one of our most costly household expenses, year
after year
 Most people haven’t thought through a living-will, largely because it’s a
hassle and we don’t really think our life will end in a way other than dying in
our sleep.
 I read the other week of a man who wanted a liver and kidney failure
procedure, guaranteed less than 2 months to live, cost $450,000. Died two
months later. Cost much more than that.
 His response? “Medicare will pay for it, so I will take it.”
A Healthcare Poem
 The “Bridge” that you choose is a choice
 How do we have faith while carrying coverage?
 What are the ethical considerations of healthcare?
 What does Affordable Care Act offer?
 Do we have options outside of the government?
 How do Christian Cooperatives work?
Healthcare Coverage – A Big Problem
 Background with this subject:
 50 page paper in 2007 on Medicare, Medicaid, Long-term Care and their
relationship to federal debt problems
 Studied Comptroller General of US for a few years
 Worked with healthcare coverage for a while in 2009
 Have prepared diagrams of Christian Healthcare Sharing Cooperatives
 Being a planner, end-of-life scenarios are something I will talk with people about.
America is a Healthcare Nightmare
 Presently we spend around 14% of our federal budget on healthcare
 This does NOT include what we as citizens pay ourselves for carrying policies.
 This is $2.5 trillion each year.
 Healthcare typically accounts for around 14-25% of a households monthly
expenses.
 I know people who regularly pay $1000/mo for their premiums.
 Medicare is the program that will sink our federal financial ship of state, not
Social Security. Medicaid will sink the state financial ship of state.
 David Walker in 2007 – Great movie called IOUSA, check it out
 My experience with preparing a paper
Cutting Edge Advancements Cost $
 We pay to have the latest and greatest advancements.
 We pay for the patents, other countries pay for the generics.
 If a pharmaceutical can get a cutting edge drug on an insurance
platform, their profit is immeasurable.
 Money is made from chronic care maintenance and not preventative.
There’s no money to made in prevention.
 Core issue is we as Americans (and Christians) are more interested in
healing than in health. Health is more costly than healing.
 To have healing costs a lot of money, which is why other countries pour
quite a bit more (relatively) into prevention than we do.
Health and Healing
 Our biggest issue as a nation isn’t how medical is provided, but our value
system behind our system of Health.
 “The United States cannot effectively address escalating health care costs
without addressing the problem of chronic diseases.” - Milken Institute
 Heart disease, cancer, diabetes are leading causes of disability and death
in the US. More than 1.7 million Americans die of chronic diseases each
year, 70% of all deaths. 70% of nation’s cost go toward these.
 But, alas, we want to have our cake and eat it, too!
Moral versus Medical
 Our issues with out-of-control spending on healthcare is the belief system we
hold in our hearts, Christians and non-Christians alike.
 Yes, value as people, but rather infinite value because we are infinitely
valuable to God, and thus should respect each other in light of God’s image
and likeness.
 Spirit, soul, body. Healthcare ought to be holistic.
 Human life is from God, a gift, when it is given and when it is taken. We cannot
work against God’s call to rejoin Him in heaven. Christians MUST be able to
make faith-full decisions for the end of life on earth.
 Tony Blair quote from back in 2007.
Enough Already!
 Actually, let’s watch a quick video…
 We the Economy, “Why is Healthcare So Expensive?”
Christian Healthcare Cooperatives
 Health Care Sharing Ministries
 This is NOT Insurance!
 This IS Coverage, though, exempt from Affordable Care Act
 Affordable Care Act was put in place for a reason
 Blue Cross Blue Shield experience… claims denied every time.
 Pre-existing issues, Group Coverage, etc.
 It’s about reducing expenses, but still having problems now because the
buffet is being limited to make that a reality.
 BMW 740i…. Luxury has long-term costs.
Affordable Care Act – Some Benefits!
Coverage

Ends Pre-Existing Condition Exclusions for Children: Health plans can no longer limit or deny benefits to
children under 19 due to a pre-existing condition.

Keeps Young Adults Covered: If you are under 26, you may be eligible to be covered under your parent’s
health plan.

Ends Arbitrary Withdrawals of Insurance Coverage: Insurers can no longer cancel your coverage just
because you made an honest mistake.

Guarantees Your Right to Appeal: You now have the right to ask that your plan reconsider its denial of
payment.
Costs

Ends Lifetime Limits on Coverage: Lifetime limits on most benefits are banned for all new health insurance
plans.

Reviews Premium Increases: Insurance companies must now publicly justify any unreasonable rate hikes.

Helps You Get the Most from Your Premium Dollars: Your premium dollars must be spent primarily on health
care – not administrative costs.
Care

Covers Preventive Care at No Cost to You: You may be eligible for recommended preventive health
services. No copayment.

Protects Your Choice of Doctors: Choose the primary care doctor you want from your plan’s network.

Removes Insurance Company Barriers to Emergency Services: You can seek emergency care at a hospital
outside of your health plan’s network.
Subsidies
 Provide refundable and advanceable premium credits to eligible individuals and families with
incomes between 100-400% FPL to purchase insurance through the Exchanges. The premium
credits will be tied to the second lowest cost silver plan in the area and will be set on a sliding
scale such that the premium contributions are limited to the following percentages of income for
specified income levels:
 Up to 133% FPL: 2% of income
 133-150% FPL: 3 – 4% of income
 150-200% FPL: 4 – 6.3% of income
 200-250% FPL: 6.3 – 8.05% of income
 250-300% FPL: 8.05 – 9.5% of income
 300-400% FPL: 9.5% of income
 Increase the premium contributions for those receiving subsidies annually to reflect the excess of
the premium growth over the rate of income growth for 2014-2018.
 Beginning in 2019, further adjust the premium contributions to reflect the excess of premium
growth over CPI if aggregate premiums and cost sharing subsidies exceed .54% of GDP.
Benefits to Affordable Care Act
 You may be eligible for free preventive screenings, like blood pressure and
cholesterol tests, mammograms, colonoscopies, and more. This includes
coverage for vaccines and new preventive services for women.
 Covers all pre-existing conditions
 No limits to coverage on pre-existing conditions
 Can’t charge more because of gender or previous conditions
AFA Plan Levels
Costs Coverage for Metal Levels

Platinum: the plan must cover 90% of expected costs for the average
individual

Gold: the plan must cover 80% of expected costs for the average
individual

Silver: the plan must cover 70% of expected costs for the average
individual – Subsidies based on % of Silver Level premiums.

Bronze: the plan must cover 60% of expected costs for the average
individual
How They Will Recover Costs
 Increase the threshold for the itemized deduction for unreimbursed medical expenses from 7.5% of
adjusted gross income to 10% of adjusted gross income for regular tax purposes.
 Limit the amount of contributions to a flexible spending account for medical expenses to $2,500 per
year increased annually by the cost of living adjustment. (Effective January 1, 2013)
 Impose new annual fees on the pharmaceutical manufacturing sector, according to the following
schedule:
 $2.8 billion in 2012-2013;
 $3.0 billion in 2014-2016;
 $4.0 billion in 2017;
 $4.1 billion in 2018; and
 2.8 billion in 2019 and later.
 Impose an annual fee on the health insurance sector, according to the following schedule:
 $8 billion in 2014;
 $11.3 billion in 2015-2016;
 $13.9 billion in 2017;
 $14.3 billion in 2018
 For subsequent years, the fee shall be the amount from the previous year increased by the rate of
premium growth.
Coming Trends with Affordable Care Act
 Not enough people enrolling
 The people who are enrolling are in larger number those who couldn’t get coverage, were denied
coverage
 Including those with heart issues, diabetic, major pre-existing conditions
 Cancer, etc.
 HSA’s are how a lot of these get handled now
 Subsidies for families between 100% and 400% of poverty level ($19000 was poverty level in 2014,
approximately). So for family of 3 up to
 Penalty of $695 or up to $2085 (2.5% of income), whichever is higher
 Beginning 2016 penalties begin to increase except for certain hardships
 Not enough young and healthy people enrolling. Also, there are a great deal of subsidies to the
health insurance companies to offset initial premiums, and starting in 2017 there will be significant
rate increases.
 Even though the insurance company needs certified approval of more than a 10% increase, they will
get it. Will probably become very unaffordable, and seek an alternative in the next 5-10 years.
Doug’s Experience
 Technically, I can’t go on the private exchange because I’m offered
coverage from Bethany.
 I applied for my wife to go on an exchange anyway
 Method of reducing costs for chronic conditions
 No way around it
 I chose a Christian co-op instead
The Big Three
 Medishare
 Samaritan Ministries
 Christian Healthcare Ministries
 Download the PDF on the site, click here
Things to Know
 Christian Testimonial
 Levels of Membership
 Provider Network or Open Network
 Routine vs Incident Related
 Deductibles
 Pre-existing conditions
 Maximums
 Major Bills
 Maternity
 Prescriptions
 Not Covered
 How bills are shared
 Timeline for Reimbursement
Christian Testimony
 All require a confession of faith
 Medishare requires documented and signed testimonial
 Samaritan Ministries requires pastoral sign-off and confirmation call
Plan Levels & Deductibles
 Medishare
 AHP (Annual Household Portion)
 $1,250 to $10,000
 After AHP is filled, 100% coverage
 Samaritan Ministries
 $300 per incident, no annual deductible
 Deductible is waved if more than $300 of discounts applied because of ‘self-insured’ status
 Christian Healthcare Ministries
 Bronze, Silver, Gold
 $5000 per incident, $1000 per incident, $500 per year
Provider Network or Open Network
 Medishare is a PPO based program
 20% less payment for outside of network
 Samaritan Ministries and CHM are Open network based on guidelines
Routine Physicals and Checkups
 None cover routine checkups
 Physicals, Mammograms, etc.
 Although, if a routine visit turns into an ‘incident,’ then the cost of the
appointment or test is rolled into the event in all cases
 Colonoscopy for example, $1800… start saving!
Pre-existing Conditions
 Medishare
 36 months of symptom-free or 36 months of regular sharing
 In some chronic cases, 60 months in both
 Will decline coverage based on a couple conditions
 Samaritan Minsitries
 5 years symptom free in most conditions. Different cancers are considered not pre-existing
 7 years for heart issues, Type 1 Diabetes is always pre-existing
 Christian Healthcare Ministries
 $15,000 share the first year
 $10,000 share second year
 $25,000 share third year
 Waived after third year!
Prescriptions
 Medishare
 6 months, incident related
 Samaritan Ministries
 2 months, incident related
 Christian Healthcare Ministries
 Up to 3 months, incident related (Gold plan only)
 All plans offer discount networks which can literally end up costing the patient less than
the co-pays on regular insurance plans.
 Long-term chronic prescription care is far less suitable. MS medications, for example.
This is what will swamp the current healthcare ship of state as it is.
Maximums (Incident, Annual, Life time)
 Medishare
 No maximum
 Samaritan Ministries
 $250,000 per incident
 For $11/month per member up to $33/mo, unlimited (Save to Share program)
 Christian Healthcare Ministries
 $125,000 per incident
 For $7/mo per member extra, up to $1,000,000 per incident
Maternity
 Medishare
 100% after AHP is satisfied
 Samaritan Ministries
 $300 deductible, waved if discounts applied or automatically if home birth is elected
 Pay up front for entire pre-natal, delivery, post-natal if discount offered
 Christian Healthcare Ministries
 Gold Plan – 100% after $500 annual deductible
 Silver and Bronze Plan – 100% after Incident Deductible ($1000 or $5000)
 Prenatal and Postnatal not included
What is Not Covered
 Psychiatric Care (some exceptions)
 Rehabilitation Centers (consider your children)
 Long-term prescription coverage (major discount programs available)
 Claims that take place in blatant sin
 Alternative Care is limited (AMA only with Medishare and CHM, if MD
prescribes it is available with Samaritan Ministries)
 Samaritan Ministries will cover some chiropractic if MD prescribed
How Bills are Paid
 Medishare
 Provider Card
 America’s Christian Credit Union, sign up for account
 Facilitate payments through this account for your monthly sharing
 Samaritan Ministries - (2-3 months)
 Fill out Need Form and submit with Itemized Bill
 Add-on Forms for additional bills after initial event
 Members share directly (you will receive envelopes with checks and prayer notes)
 Pastor or Church Liason to sign off on each Need Form (consider how many events per year)
 Christian Healthcare Ministries - (3-6 months, have been improving in past year)
 Fill out Need Form and submit with Itemized Bill
 CHM reimburses you with a check from an audited bank account
Some Examples
 Doug, Medishare
 Doug, Samaritan Ministries
 1st Week, ER
 Pregnancy
 7 other claims
 Mike, Christian Healthcare Ministries
 Mike, Parkway Family Physicians
Caution!
 This is not insurance
 It is exempt under Affordable Care Act
 Benefits
 Entering into a risk-class a notch above America as a whole
 Not covering claims related to abortion, out-of-wedlock births, but rather
receiving subsidies in some cases related to adoption
 Encourages membership mentality – Benefit of the whole
 Prayer is at every juncture, Network WANTS to share your claim
 Best practices are shared regularly in monthly sharing, health and wellness
 Especially beneficial to young families
General Suggestions
 Medishare for the individual/couple/family who wants the traditional insurance like ‘feel’ to their
coverage and doesn’t mind the annual household portion concept.
 Becomes more expensive with age, so be aware and get a quote before signing up.
 Also, covers pre-existing conditions (in most cases) after either 3 years of 5 years.
 Samaritan Ministries for the younger individual/couple/family that does not have a history with autoimmunity or heart conditions, and people of any age without a long list of pre-existing conditions
that haven’t gone without for 5 years.
 This plan is very similar to carrying CHM’s Gold Plan. There are some positives and negatives to both
CHM and Samaritan’s.
 Christian Healthcare Ministries (Gold Plan) for young couples still planning to have children.
ESPECIALLY for those who have definite pre-existing conditions.
 Ideal for people in 40’s and 50’s, too, who have had some conditions that haven’t completely gone
away, but are in remission… some coverage in first 3 years and then full coverage after 3 years. Mike
uses a silver plan and supplements it with a retainer plan with local doctor office.
 I don’t recommend the Silver Plan for younger couples who are still having families.
 Affordable Care Act – People with heavy health issues, chronic present conditions, or people who
literally cannot afford healthcare coverage and can receive the larger subsidies.
 Before assuming they cover your chronic conditions, look into what is covered first. Much is not
covered, and more reductions may take place.
For Organizations
 Medishare
 I believe they have an option
 Samaritan Ministries
 Will facilitate corporate sharing by an organizational assistant
 I.e, missions organization, can pay for their missionaries coverage directly with 1 check
each month to Samaritan’s and administrate domestically. All bills can be submitted by
administration if needed.
 Christian Healthcare Ministries
 Unknown
Let’s Talk