But some critics say these ministries don’t do enough to protect consumers.
Sherri Myers was at a dance class in 2009 when she felt something tear in her leg. The Bolingbrook woman went to the hospital, and soon learned her leg was bleeding internally, and she needed surgery. Her bills started mounting. Myers was worried, her family had switched from traditional insurance to a new way to pay health care costs just months before.
“It was cheaper, truthfully,” Myers said. “We didn’t need a lot of the bells and whistles of insurance, and with our insurance it didn’t take care of that anyway, and it felt like instead of just sending for your insurance, it seemed like such a way to minister to other people.”
Myers had signed up for a cost-sharing ministry, and this was the first big test. People from all over the country sent her checks to cover her medical bills, and cards to encourage her.
“It’s like a gift in a way,” she said. “You’re praying for them, they’re praying for you, at different times. And that God in all of it gets glorified.”
Myers is a customer of Samaritan Ministries, based in Peoria. As is her pastor, the Rev. Timothy Greene, at Living Word Bible Church in Morris. He said Samaritan’s health care plan is based on the Biblical principle of carrying your own load, and helping others bear their burdens too.
“Our bodies are created by God, we need to take care of them,” he said. “There is a real sense of responsibility that we feel. We don’t just want to rush off to the doctor for everything.”
The pastor estimates nearly 20 percent of his 150-member congregation is part of Samaritan.
Earlier this year, thousands of people joined them during the rush to sign up for traditional health insurance under the Affordable Care Act. While millions bought private plans on the new health exchanges, others opted to join a Christian health-care sharing ministry. With about 37,000 families enrolled, Samaritan is one of the three largest cost-sharing programs in the U.S.
“Health care sharing ministries are a mechanism for people of faith to band together to share medical bills without using insurance,” said Executive Vice President James Lansberry.
Many didn’t want to buy insurance that covered abortion or some types of contraception.
“I wouldn’t say people were attracted to us because they wanted a way (out) from the Affordable Care Act,” Lansberry said. “I think there were particular facets in plans in the Affordable Care Act that caused them to have some moral concerns that drove them toward health care sharing.”
In fact, members are required to lead an evangelical Christian lifestyle and share certain religious beliefs.
“The members all agree to attend church, they agree to abstain from illegal drugs, they agree not to abuse tobacco or alcohol,” Lansberry said, adding they also agree to abstain from sex outside of “traditional marriage.” (The plan won’t cover pregnancies or sexually transmitted diseases if they happen outside of marriage.)
Members sign a pledge each year, and their pastors sign off that they’re following the tenets of the plan. At Samaritan, the monthly cost ranges from $180 for a single person to $405 for a family. Members pay for routine care like doctor’s visits out of pocket. When big things happen, like baby deliveries or broken legs, customers help repay each other’s bills. Samaritan coordinates who pays whom.
“Every month we send our check in, but we’re not just sending it to a big company somewhere in Omaha or Providence, we’re sending it to an actual person,” Lansberry said. Once a year, members send their checks directly to the company to help with administrative costs.
But not everyone thinks this system works. Some consumer advocates like Kevin Lucia have misgivings.
“I have concerns in part because some of the important consumer protections that apply to the individual market do not apply to health care sharing ministries,” said Lucia, a senior research fellow at Georgetown University’s Center on Health Insurance Reforms.
These companies don’t have to meet protections provided by the Affordable Care Act because they’re exempted as religious ministries. That’s why people who sign up for them don’t pay a penalty for not having traditional insurance. The ministries are also exempt from many state and federal laws, Lucia said. For instance, the ministries can cap reimbursements; and they don’t have to cover pre-existing conditions.
Both of these things are true of Samaritan, which caps reimbursements for a single need at $250,000, and qualifies how it covers pre-existing conditions. Some members are in an additional program to save up money and share higher costs for expensive things like cancer treatment that can easily top $250,000.
“In most states, there are reserve requirements because if a plan takes on too much risk and they can’t pay out the claims for their members, there is this possibility the insurance company will go under,” Lucia said. Ministries don’t have to hold such reserves in case health needs outpace contributions.
When that happens at Samaritan, the company prorates how much people get paid back for their bills. After three months of this, it asks members to vote on increasing their monthly contributions.
“Because they’re not covered in many states under insurance law, (members) don’t have this kind of army of consumer regulators that are available to protect them in case something goes wrong,” Lucia said.
If there’s a problem, Lucia said, the only remedy is the Attorney General’s Office or the courts. The Illinois Attorney General’s Office reports one complaint back in 2000, and no lawsuits show up in federal or Cook County court records.
Samaritan’s James Lansberry said members regulate themselves: “There’s no direct regulation from any state or federal agency because there’s no need for it. If we make our members upset, we won’t have an organization.”
20 years after it started, Lansberry’s organization is still here and growing stronger because of people like John Appleton. The West Chicago man’s been a member of Samaritan Ministries for 15 years. He likens it to an Amish barn raising, where everyone voluntarily helps each other. But he acknowledges not everyone will be comfortable with health care sharing ministries.
“It’s all about where you put your faith,” he said. “If some people would rather put their faith in the government or an insurance company, for us, we put our faith in Christ and his people.”