Medical Coverage and Why We Chose Samaritan Ministries

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A few years ago, this twin mama had one kiddo sitting correctly in the designated seat with the lap belt clasped and another kiddo standing as the figurehead at the prow of the cart.  We were inching along at the local nursery ever so slowly enjoying the season’s blooms.  And BAM.  The cart came to a sudden halt as the front wheels hit a water hose snaking across the aisle.  And my figurehead child did a full flip over the outside of the cart and landed flat on her back on the concrete.

Praise God for our chiropractor telling me to take her to the ER immediately.  Praise God for essential oils that helped calm me enough to remember my child’s name.  And Praise God for a children’s ER close to us who offered excellent, respectful care.  And Praise God our little girl was totally fine.

Part of that story also involves the security we felt by whipping out our handy dandy insurance card when arriving at the ER.  We clung to that blue cross, that blue shield.  Insurance served us well for so many things!  It paid for my transabdominal cerclage so I could carry babies, paid for radiation on my small little brain tumor, paid for my emergency twin csection and lengthy nicu stays for both children.  We definitely used our employer-provided insurance!

However, God moved us to a new place in our lives: my husband gained employment at a small company not offering a group plan and I was able to consider staying home with our children.  But insurance was the main concern.  My pay check went fully for child care and my own insurance policy.  But with my husband and children now in need of coverage, suddenly my check was not enough to cover our family insurance needs.  And neither was hubby’s – he was taking a pay cut to change jobs.

We knew as a family we needed to be prepared for medical events.  But with costs so high, what could we do?

With the option of traditional insurance through our employers off the table, out went the more expensive COBRA option (extending employer healthcare coverage for up to 18 months post employment).  We looked at private plans through the marketplace and our insurance agent, but the costs were well out of reach – high premiums ($1200+/month for our family of 4) and higher deductibles ($6500 – $12500) meant private plans were more expensive than what we already could not afford through my employer.

One might think well, the premium just becomes a cost for security of catastrophic coverage.  But what if we needed a doctor’s visit in the meantime?  We would incur the full cost – and not the cost of the doctor, but the cost negotiated between doctor and insurance.  For example, the optic neurologist I saw had a negotiated rate of $350-450 per appt depending what tests he ran.  I would have to pay that every single time I saw him until I hit that deductible of $6500.  But I also found out his cash price for self-pay patients is $75 flat regardless of what tests he runs.  This was true across the board with every practitioner we may see!  Carrying the insurance policy would actually cost us more!

Still…what if?  What if a car accident happened or somebody needed major surgery or a baby was born and needed a NICU stay?  Suddenly that $6500-12,500 deductible and accompanying max out of pocket wasn’t too bad.

In this blog, I hope to offer a brief overview of various healthcare coverage options along with explanation and experience of our final choice.

Types of coverage

Employer-offered insurance
Just because you work for a company does not mean the company must offer insurance to you.  And, just because the company offers insurance does not mean you must take it!  If it’s available to you, consider the monthly premium (your employer will pay a portion), the deductible (how much you are responsible for before the insurance will pay a portion), the out-of-pocket maximum (how much you would not pay beyond in an insurance year), required co-pays, and your co-insurance portion (for example, insurance may cover 80% of a cost and you are expected to cover the remaining 20%.  That 20% is your co-insurance.)  Know that specific needs may also be handled a bit differently: preventive care like wellness checks, maternity needs, lab work, ER visits, physical therapy, etc. may all be laid out slightly differently than the overall plan.  Also understand who you are allowed to see – some groups require you to stay in a particular group or network of providers – and that network or group can change at any time.  Also understand that service coverage may be limited.  Just because somebody has insurance coverage does NOT mean the insurance will, in fact, cover every necessary treatment.

For example, you know cosmetic or elective procedures would not be covered.  But what about non-frequent procedures like a transabdominal cerclage?  Or genetic testing for things like MTHFR?  Very often, procedures are NOT covered – and people don’t find out until the need arises.  There is no way to get a copy of what is covered prior to signing up, and insurance companies have no obligation to keep covered services the same for the length of your membership.  Hear that again: covered services fluctuate and insurance companies are under no obligation whatsoever to cover anything.  Reassuring, huh?

You are also not eligible to begin/end your membership with the insurance company at any time – you can enroll or decline to re-enroll at the end of the insurance year (called open enrollment) or a qualifying event such as death, divorce, or employment termination can get you into or out of that plan.  IF you have a qualifying event, also know you can look into COBRA to extend coverage.  For example, if you are laid off, you will be allowed to still participate in your existing insurance plan for up to 18 months (you can un-enroll at any time), but you incur the full cost with no employer contribution.

Private insurance secured individually
The required understanding for this is the same as a group plan through your employer.  However, nobody will necessarily be contributing to your monthly premiums (as the employer does).  And obviously COBRA doesn’t apply here, either.  Often the premiums are similar to an employer group plan, but the deductibles and out of pocket maximums may be significantly higher.  Perhaps you make the amount of money that allows for some sort of federal assistance on this, in which case you must secure your plan through the ACA marketplace.  If you are not looking for federal assistance on this, you can still purchase through the ACA marketplace if you want.  Or you can contact individual companies for other plans.  The marketplace plans are still individual plans – they are just plans earmarked by private insurance companies as plans eligible for federal assistance.

I find the best approach for considering this option – federal assistance or not – is to contact a private insurance agent.  We adore Dave Ramsey’s ELP program and found Marvin Greer through him about six years ago.  We don’t pay Marvin anything – not sure how he makes his money! – but he has the heart of an educator and truly wants what’s best for your family and helps you to analyze and decide various options.  Marvin can be contacted at 877-632-6418 or via email at mgreer921@yahoo.com.

Short-term medical plans
These plans can be purchased in 30 day increments through a variety of private companies.  Again, I recommend utilizing an insurance agent like Marvin Greer to help sift through quotes.  These will not satisfy federal guidelines and tax penalties may occur depending on how long you carry it instead of a qualifying plan, but they will work for catastrophic coverage (which is another term for these types of plans).  The key with this approach is to not plan on using it.  The premiums are very reasonable, but the deductibles and out-of-pocket max are incredibly high.  Also, if you get coverage for x during one term, x will then be considered pre-existing for the next term and not covered.  Be sure to ask your insurance agent all the ways these short-term plans are different than the insurance you already know.

For our family, we did end up carrying a short-term plan for a set time period and it worked well for us – probably because we never utilized it.

Medical ministries
Medical ministries are groups of people who unite around sharing the costs of each other’s health care needs.  Several groups exist and each have different ins/outs, but they are well worth exploring.  The commonality between all the medical ministries is a commitment to living in a way that honors Jesus Christ.  A statement of faith is required and some of the ministries require church membership and attendance verification via clergy.

Beyond that, each medical ministry group varies in monthly cost and incident coverage.

Why a healthcare ministry

In the end, our family landed with choosing to participate in a healthcare ministry.  We had considered it for years, but for various reasons, we had not pursued a medical ministry over employee health coverage.  Given the opportunity for me to stay home with our children, exploring the medical ministry world more in depth was a good move.

Here are the top ten benefits we see from joining a medical ministry:

1.  We have learned how to be authorities over our health and any illness.  Diagnosis, treatment, and assessment is actually very possible by everybody if he is willing to put the time in to learn it!  I’m not saying doctors are unnecessary – we love doctors when they are needed.  But common illnesses can be treated at home and don’t require a trip to the doctor’s office for the well-learned person.  (This also includes stocking various supplies and medicines.  Take a look at our home medicine cabinet.)

2.  We get prices up front on doctor visits and medical treatments.  We are able to shop around and compare costs and even negotiate.  Obviously in an emergency, we would attend the nearest ER, but we would still be able to negotiate that.  And, I’ve done my homework on the local ERs and continue to monitor them so I know where I would go for what sort of emergency.  (For example, a pediatric trauma would only go to two of our local ERs.  A pregnancy emergency would only go to one of the ERs where the hospital has a level III + NICU, etc.  I also stay up on the local talk to know what physicians are supportive or assassinating of our particular lifestyle.)

3.  We have learned how to ask for all the parts of a procedure we would be charged for up front, how to read and assess an itemized bill, and how to negotiate medical costs before and after the fact.  These are necessary skills for any medical consumer, but I didn’t realize to what extent when we carried insurance.

4.  We live more in tune with our bodies and are the healthiest we have ever been because we now understand that, truly, we are the ultimate stewards of our health.  Nobody else is responsible for us – just us!

5.  I have developed keen observation skills because I consider myself the primary care provider for my family.  I can properly assess my husband and children and am able to decide when it’s time for another set of eyes to assess and treat.

6.  We are able to be extremely picky about practitioners.  Rather than being at the mercy of a random physician or network, I can research and interview to find somebody competent, respectful, with the heart of an educator, and who views himself as a partner in our treatment.  We are fully in the driver’s seat with practitioner choice.

7.  We get to choose what systems we want to be indoctrinated into.  As part of an employer group insurance plan, we were automatically on the conventional medical conveyer belt.  Part of that is due to my complacency and part of that is due to the way that system works.  With no set path before us now, we have the distinct advantage of a clear overview of all paradigms and how they flush out in belief and practice.  This is true medical freedom.

8.  We are better financial stewards of our money and much more prayerful about our health.

9.  We seek to help others pay for their medical costs and entreat the Great Physician for healing on their behalf.  We literally pray over each medical need presented us and gladly give and pray for somebody’s family every single month.  This is shaping the heart of our whole family in a thrilling way.

10.  Because of the reasonable cost of participating in a healthcare ministry, I am able to be home with our children.  The value our family places on this is extremely high.    If we had known about medical ministries previously, I may actually have been able to stay home with our children from the beginning instead of working the first two years of their lives.

Medical Ministry Options

Many healthcare ministries are available to explore, and I’ll only discuss the biggest players.  Medishare is the oldest on the block.  Christian Healthcare Ministries is one of the most affordable and offers help for pre-existing conditions.  Samaritan Ministries embraces alternative care.  Liberty Healthshare is a new one, and lots of people are loving it.  There are also some specifically Catholic and Mormon medical ministries out there, but I’m less familiar with those.  (Update: CFO Curo is a Catholic medical ministry and I’ve included details below.)

All the ministries have financial limits on each need.  However, most of the ministries also have an additional program one can elect to participate in that would offer a way for more financial coverage if required.  For example, a family signing up with Samaritan’s has a per-need limit of $250k.  But they also offer an additional ministry participation called Save-to-Share.  Families participating in Save-To-Share agree to set aside an additional monthly share for any needs greater than $250k and send in whatever amount is called upon of that each month.  There is still a limit with Samartian’s even for the Save-To-Share members.  Any one need is limited to 50% of the funds on reserve.  Historically, this has meant a limit of $8.5million for one need.

I also believe (though this could have changed), each ministry does not pay for well-visits/preventive care.  So, those visits must be budgeted for.  I’m certain Samaritan’s does not, but please verify that about the other ministries.  (Medishare has limited sharing for well-visits up to age 6 – excludes vaccines. Liberty Healthshare actually does share the cost of most vaccines.)

Some brief notes about each individual ministry:

Medishare functions very much like insurance.  Members choose a plan level with varying monthly costs and co-pays and out of pocket yearly responsibilities.  Medishare prefers providers join a particular network.  Zero consideration for helping support medical needs arising from amoral acts (drug use, drunk driving, out of wedlock pregnancy, etc.).  There looks to be some minimal coverage of pre-existing conditions that are symptom and treatment free on a limited basis.  Alternative care will not be shared ever.  Well-child visits/labs are shared until the age of 6 (excludes vaccinations).  Marvin Greer is a good source of information for Medishare!

Christian Healthcare Ministry: Members choose their level of participation (gold, silver, bronze) varying by monthly share and out of pocket yearly amounts.  No sharing occurs for any alternative care; even physical therapy is not shared.  Medical transportation is only shared if it is from one facility to another – it will not be shared from the scene of an accident/need to a hospital.  (Often local municipalities offer a separate insurance you can purchase).  Zero consideration for helping support medical needs arising from amoral acts (drug use, drunk driving, out of wedlock pregnancy, etc.) CHM does offer financial support for pre-existing conditions on a limited, sliding scale.

Samaritan’s Ministry: Families send money directly to other families.  Monthly cost is a function of a plan chosen (basic vs. classic) and family size (though a family of 3 costs the same as a family of 10).  No sharing of pre-existing conditions (conditions may cease to be pre-existing after a time period.)  Considers needs arising from immoral acts on a case-by-case basis.  Coverage for RX/supplement needs are limited to 120 days (some exceptions for pregnancy).

Liberty Healthshare: At the time I was researching, there was a $1 million/$125k/70% of $125k limit on any need sharing with no recourse if more funds were required.  Alternative care requires pre-approval.

CMF Curo: This is a Catholic extension of Samaritan’s Ministry.  The reason for the link between the two is that when CMF sought to create a group, under ACA guidelines, they could not start something new after 1999.  They chose to link to Samaritan’s because of the same financial abstinence Samaritan’s has (no cost sharing for abortion, ectopic pregnancies, and contraception).  All guidelines are exactly the same as Samaritan’s, including cost + $84/mo.  I contacted CMF Curo to understand the differences between them and Samaritan.  The statement of faith Samaritan’s puts forth may pose challenges for Catholics, though that is addressed by CMF.  The specific differences include:

1. 2 full time lobbyists in Washington

2. ID Card to present (although Samaritans recently made these too)

3. The ID card acts as a preloaded debit card also to pay for pre approved procedures. (Although I just mail in contracts or estimates from providers and have the money sent to me. I’ve already paid the hospital for my csection.)

4. Membership to Formed (described as a Catholic Netflix)

5. Access to Asset Health – a health coaching service.

Check out my Medical Ministries Comparison Chart to view a side-by-side comparison of these medical ministries.

Why Samaritan Ministries

My family chose to partner with Samaritan Ministries for several reasons.

1.  We desired something that looked very different than insurance.  Thinking of co-pays and networks was unappealing.

2.  We wanted to be able to share costs of alternative care.

3.  As we called and spoke with each ministry, Samaritan’s stood out to us as having a heart for wanting people to share costs.  They really encourage members to submit needs.  They were also incredibly prayerful for us and with us even as we were just researching.

4.  We loved Samaritan’s Special Prayer Needs publication.  If a need does not qualify to be shared for members to send their monthly contributions to, the need can be published as a special prayer need.  This gives members a way to know what other needs are out there, lets them pray about it, and the Father can then lead people and direct funds as He sees fit.

Because of the Special Prayer Need ministry at Samaritan’s, we felt incredibly comfortable joining a ministry that would not automatically publish any of my pre-existing needs.  As you all know, I have a small brain tumor that requires annual monitoring.  It also impedes my vision (a symptom).  Until that monitoring and symptom is gone for 5 years, it will continue to be considered a pre-existing condition.  MRIs are expensive ($5k plus).  So our plan is to budget for that and, if needed, we will also submit the cost as a special prayer need for God to lead people to help us or not.

It’s also important to note that Samaritan’s does not make any medical decisions at all.  They rely completely on member physicians.  They do not call my lack of vision a symptom of my brain tumor – I asked my overseeing physician if that is a symptom of the tumor.  He said yes, so that’s what I report to Samaritans.

Our experience with Samaritan Ministries

Giving
Every month, we receive a newsletter from Samaritan’s.  In addition to wonderful articles and testimonies, we receive a daily prayer guide for other members (9/1 pray for John Doe’s back surgery, 9/2 pray for Sally who is expecting a baby, etc.).  In the newsletter is also our monthly share assignment.  We’re told that David had an ER visit and subsequent surgery for a broken femur.  We’re given his address to send him our monthly share of $495.  OR, if his need was over $250k, we might be told a higher amount to share with him like $560 (though thus far we haven’t been called upon to share more than $515.)  Our family prays for David, we draw and decorate a card for him (part of the way our young children participate in ministering to David), and mail him a note of encouragement and prayer along with a check for the assigned amount (or more if God led us to send more!).

Samaritan Letter

We also receive in our newsletter packet the Special Prayer Needs list.  These are needs that do not qualify for automatic publication and sharing (for various reasons).  We read each one and pray over them and ask God to tell us who, if any, He would have us send an amount to.  In over a year of membership with Samaritan’s, He has led us to send money and encouragement to least one need per month.  Some of the special prayer needs we’ve read are due to immoral acts.  Some are from being higher than the $250k need and the family isn’t in the Save-to-Share program.  Some of the needs are pre-existing needs.  No matter to us, we lift them all up to God with an open heart and He allocates His funds.

Receiving
When we have a need arise, we simply call Samaritan’s to start the need.  They ask some very basic questions and then tell us we are good to mail in or upload bills.  (We upload everything, so I don’t know specific details about mailing bills.)  Something else neat about this is that the need is the entire event – not simply one practitioner bill.  For example, if you went to the ER for a broken leg, then to an orthopedist, then had surgery, and had medication for a month, that’s a lot of bills.  But since it is all for the initial event – broken leg – it is all one need.  Members are responsible for the first $300/$1500 (Classic/Basic) of a need.  So if the total need for that broken leg was $7800, the family would pay the first $300/$1500 and Samaritan’s members would mail a total of $7500/$6000 to the family.  (Amounts differ based on either Classic or Basic membership)

Some real examples from our family
One of our daughters had some blood work come back concerning.  We decided which practitioner we wanted to pursue and made the appointment.  We called Samaritan’s for prayer.  We took our daughter to the practitioner and paid cash for the visit requesting an itemized receipt.  The itemized receipt was uploaded to Samaritan’s website and “in review” for a couple of weeks.  The next month, it was published in the newsletter to a few families.  Each family sent us a check with a note of encouragement.  And it was so encouraging knowing other people were praying alongside us – strangers! – for our little girl.

Several months into being members of Samaritans, I became pregnant.  We negotiated a 49% discount off services with my practitioner.  However, the practitioner requires the bill be paid within a certain time frame in order to keep the discount.  This means that publishing the bill and waiting for money to come wouldn’t work for us.  We secured a credit card we call our baby card.  At each visit, I pay the discounted rate on our credit card.  I then upload the bill to Samaritan’s and the next month it is published and people send us money we then use to pay down the baby card.  I also contacted the hospital and negotiated a flat rate of $5800 for facility usage for my c-section.  I uploaded the contract to Samartian’s not yet paying the hospital anything.  Over the following two months, members sent us $5800.  I used that money to then pre-pay the hospital the negotiated amount.  As for the $300 per need incident for which we are responsible, since I negotiated such deep discounts, that $300 is considered part of the very first bill’s negotiated amount, so it wasn’t actually cash out of our pockets.  And, of course, with each check comes a note of encouragement and praise to God for our new little baby.  We love collecting these cards and can’t wait to send them a thank you with her little picture when she is born!

If we had an emergency and needed to make an ER trip, we wouldn’t hesitate to go.  I would explain to the financial person asking for payment that we are members of Samaritan’s and would like to receive an itemized bill.  I would pay them nothing at the time of the visit.  When we receive the itemized bill, I would call the hospital and negotiate it down.  Then, I would submit the newly negotiated itemized bill to Samaritan’s and wait for members to send money to help cover the cost.

A decision of faith

To be sure, choosing a medical ministry is not simply a financial decision.  As believers, we strongly feel that our ultimate provider is the Lord.  We believe He can provide (or not!) through traditional insurance, through the local church, through a medical ministry, or any other means.  We had to truly realize this truth in order to abandon traditional insurance.  It seems silly to write that out now, but it was a genuine challenge and exposure of our deficient faith as we explored medical ministries.

I read a comment on a blog about medical ministries where a member had been in an accident and his leg was amputated.  The wife was furious that the ministry would not pay for the accident or his lifelong prosthetic maintenance needs. (I don’t know details of why not.)  Another person commented asking for a follow-up months later.  The wife responded that it turned out the accident was the other driver’s fault and his insurance had paid.  They also had an out of court settlement that would provide generously for her husband’s lifelong needs well beyond even the anticipated medical cost.  She was still very bitter towards the ministry.

And I remember thinking the lady missed it.  She was wrong to have relied on the ministry in the first place – her reliance should have been on the Lord to provide somehow.  And He did.  He didn’t do it through the ministry, but He did provide.

My friend recently asked me what if a natural disaster completely obliterates an area where a lot of medical ministry members reside – so all of us submit huge, astronomical medical needs well beyond the ministry’s capability to cover.  The answer has to be God would provide.

Even if my husband found himself employed by a company who offered excellent medical insurance, I’m not sure we would jump the medical ministry ship and go back to traditional insurance.  Being a part of Samaritan’s has not only challenged our faith and grown us, but it has been a true family ministry of prayer and provision to others.  That is not something we would easily surrender.

Challenge yourselves.  Ask where your dependence lies.  Who are you truly relying on for provision?  Prayerfully move forward in making your decision.  These are the first steps in making any decision and finding ultimate freedom in the only freedom-giver there ever was, is, or will be.

In Christ,
Kathryn

ps – please research all of this information for yourself and verify it with each separate medical ministry!  Even as I collected information several months ago for this blog, some of the information changed as of this fall.  I’ve done my best to accurately portray each ministry!

pps – you must read the guidelines in full for the ministry you consider pursuing.  There is no way for me to list every single caveat to publication and sharing in a blog post without simply pasting their guidelines.  READ THEM!

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