Such “health care sharing ministries” are conceptually like insurance (“you pay a low monthly fee into a big communal pot of money and get reimbursed for all your care from that pot”). Of course, the details matter, like what medical costs are or are not covered, and whether the organization is managed well enough in a financial sense so that it does not become insolvent, just like any other insurance or similar arrangement.
@ucbalumnus I’ve looked into these but have been too chicken to actually do it. The one I investigated purports to reimburse 100% of health care expenses.
Your mother is mistaken. There is no “three-year flu vaccine.” I suspect she’s referring to the trivalent vaccine, which protects against three strains of influenza.
Yes. We’re specifically with Samaritan Ministries, so I can only speak about them and not the other options as they all differ somewhat.
I am absolutely thankful that we opted to ditch insurance and go with them over a decade ago when H decided to go into business for himself rather than stay with his employer (Civil Engineering - he now owns his own firm). Insurance then was more costly so we needed something less expensive and took what we thought was a gamble.
Since then, we’ve had needs ranging from H blacking out in a horse pasture (still not sure what happened) to my brain tumor (multiple thousands in cost) and it’s all been covered at 100% with no questions asked. Johns Hopkins has been the only hospital that was a pain to deal with, but they eventually came around seeing that it worked. Now we have no problems with them. All other hospital (and doctor) systems we’ve worked with (four) have been awesome. Most thank me because they don’t have to deal with insurance. I just added Geisinger and Hershey to that list - both superb to deal with. I think the groups are large enough now that they aren’t unknown in the medical world. ACA can be thanked for that. Insurance is too costly for many, so alternatives are attractive.
Samaritans has a level one can opt for that has no limit on needs. We’re in that group. It’s optional because it costs more. The normal limit is 250K per incident (I believe). There are several with cancer and even some with organ transplants who have had costs covered.
A quick financial summary for us is that insurance would have cost us at least $500 more per month (a lot more than that now, but $500 makes for easy calcs). That gives me $6000 per year in “basic” costs I can pay before we break even. A lot of flu shots and annual things (like mammograms) can come out of that $6000 and still not reach the total. One would have to beware of prescription meds. We don’t take any at this point.
Then, for covered events, our insurance had a 5K deductible, and only paid 80% until 12.5K OOP. Put three years of brain tumor needs in there and we’re up over 36K OOP vs 0. Many years we’d have never gone past our deductible, so 6K + up to 5K in OOP costs - all for a couple free physicals and vax. With some of my basic (we pay for) appts the staff have told me that the self-pay cost is actually less than some folks have to pay with their “co pay.” She wishes she could tell clients that, but it’s supposedly forbidden. (Makes no sense to me to have it forbidden TBH.) Add the 36K to over a decade of 6K (not even counting the amount into the deductible) and we’d have spent more than 100K on insurance vs health share over the years. That’s a lot of money to us.
Then there are the perks of no networks, worldwide coverage, and no preauthorization needed. No stockholders or high paid executives sharing in the till either.
There’s no way I’d leave health share (specifically Samaritans) now.
BUT, everyone has to do the math based upon their own situation and not everyone qualifies due to pre-existing conditions or some of the things not covered being things they need coverage for (alcohol, self inflicted, etc - we bought insurance when our lads went to college - just in case - it wasn’t needed, but who knows with college younguns?).
Then too, yes, it’s faith based, so that eliminates many. I know some don’t like how personalized it is. They prefer nameless corporations. That’s all personal preference. I love sending my monthly check directly to another family - this month it was to a family who’s son had broken bones in his leg. Other months it could be new babies or cancer or whatever (they’re assigned). Several are sending me checks to pay for my pulmonary and cardiac bills.
Some have told me they don’t like how conservative articles in the Newsletter (monthly) are. Eh - I’m used to reading (or skipping) viewpoints that differ from mine and I absolutely know not everyone in the insurance program we used to be with shared my views either, so that’s no big deal to us.
Personally, I wish more such systems could be formed to allow everyone the option if it appealed to them, but our elected Powers That Be don’t allow that. They’ve only kept the original options available under ACA.
But that’s the basics as I see them of our program. Even if it were to cost more - prescriptions needed or something (cancer meds are covered) - I now like it better to stay with them. I wish all health “insurance” were non-profit and allowed folks to go anywhere without networking, etc.
Perhaps that is why (a) the cost is lower, and (b) such arrangements are not an option for many people.
My daughter and I both got our flu shots earlier this week at Rite-Aid. She just went back to college and I’ll be going to visit my mom, who’s undergoing chemo, in a couple of weeks. I normally wait until October, but decided to go ahead since my mom is immunocompromised. We got lucky with our timing because there was no line and our wait was minimal. And, as an added bonus, we each got a free scoop of ice cream!
@ucbalumnus It’s definitely why it’s not an option for many people at this point - more of these types of groups would need tweaking to make them work for all.
It’s also some of why the cost is lower now, but at the time we joined insurance didn’t have to take folks with pre-existing conditions either so it’s not the total answer. It’s lower partially due to not being for profit and needing less overhead.
At this point, everyone just needs to make the best decision among their choices for them and their family. Going without coverage of some sort is never a good option. Pretty much anyone can pay for a flu shot (ours cost $36 each). Paying for a brain tumor or cancer or cardiac care or _____ is significantly different.
Thanks @Creekland
Not sure they’d take us, as I have high cholesterol and my husband has high cholesterol and high blood pressure. Who in this world does not have pre-existing conditions?
ALL 4 of us in my nuclear family have pre-existing conditions: childhood asthma and allergies. We are fortunate to have excellent insurance and MDs at reasonable costs.
Just to answer your question about getting two, I would never do that (have actually never even heard of that being an option). I also would never get a flu shot if not forced to by my employer, but that is another discussion.
@brantly There wasn’t any medical test when we signed up and there still isn’t as far as I know. By pre-existing I’m pretty sure they mean something cardiac, cancer, pregnancy, broken bones, or something like that. My youngest son developed a type of epilepsy after we had joined (he was a teen). That was fully covered (another money saver for us compared to our deductible and OOP if we’d been on insurance). If he had had it before we joined it wouldn’t have been.
I think I’m not current by saying nothing pre-existing is covered anyway. I seem to recall more recent Guidelines saying there only had to be nothing going on for at least some things during the past 5 years. I have to say I don’t pay the most attention as it doesn’t affect us and I’m not really a spokesperson for them. I’m just relating the basics as I know and have experienced them. I’d brush up quite a bit if I were to promote them a lot.
Well I just got my first flu shot in I don’t know how many years. No particular reason that I haven’t gotten the shot before --just procrastination that ends up getting the better of me every year. (That is, I intend to get the shot and then never get around to it). But this year I’m going to be traveling in the fall-- so flu shot made it onto my to-do list … plus it finally dawned on me that I could make an appointment instead of just showing up at a random time at Walgreens. Plus I got fairly sick last spring with an upper respiratory thing which clearly wasn’t the flu - but was sick enough that it made me realize that I’m not invincible.
No charge for the shot, & barely felt the shot going in. Got the “Fluzone quad” if that means anything to anyone.
Got the note at work today…October 11 for flu shot clinic. Free. I’ll go to that.
@romanigypsyeyes , I’m curious that you can get a flu shot although immune-compromised. I’m on chemo, and AFAIK I can’t get any vaccinations until I’m done, which I HOPE will be on Halloween or the week after. Actually, I should dig out my patient guidebook and check to see if you have to wait for a while after the last cycle.
Luckily, I had the first pneumonia shot last year before I knew I had cancer, and I had the old shingles shot as soon as I turned 60. But Shingrex is going to have to wait, as will a flu shot. H just got his today.
On a related note, I really need to get my teeth cleaned and that is verboten also. Should have had it done before I started chemo, darn it.
@consolation dead vaccines only. Flu and pneumonia are safe. Or more accurately, the benefits outweigh the risks.
For influenza vaccine, the injected flu shot is dead virus, while the nasal spray is live virus. The nasal spray has had some studies questioning its effectiveness, and is not for people age 50+, so it may not be that desirable an option for other reasons anyway.
Got flu shot on Friday afternoon at a CVS Minute Clinic. Usually I wait until October or even November, but had some time so just got it done. Zero discomfort afterward (and I’ve had some surprising pain in the past).
The nurse practitioner who gave me the shot said she had already seen one case of the flu a couple of weeks ago in a man who had been traveling overseas. She hadn’t had her own shot at that time (said she usually waits until early October) so she went straight to the store pharmacy to get vaccinated after finishing with that patient.
I wanted to get the flu shot this week but I have an upper respiratory infection so no. I almost got it last week at my pulmonologist’s office but they didn’t have the hi-test for 65+ so I was going to Target and drag my asthmatic kid but I guess I’ll have to wait.
My daughter tested positive for a type B flu this past week. It started with a sore throat, headache, and fatigue the day after she spent 4 hours on a Greyhound bus from Boston. That night she had a fever of almost 103. The next day I took her to a walk-in clinic and they tested for strep but weren’t going to test for flu until I requested it. When the flu test came back positive, they gave her a prescription for Tamiflu but we decided not to fill it since my daughter wasn’t feeling that bad and I wasn’t sure the benefits outweighed any possible side effects in her case. She was all better in 4 days.
Interestingly, she had already gotten a flu shot when she got sick, but had received it just 3 days prior so she hadn’t developed immunity yet.
It is also possible that she got a strain of flu that the vaccine does not protect against. Most flu vaccines are trivalent and include one of the common B strains; you have to ask for a quadrivalent vaccine if you want it to cover both common B strains. Also, there could be uncommon strains of flu that are not covered by any of the vaccines.