Alternative to health insurance

A few years ago, we opted out of the standard health insurance available to us through Jeremy’s employer, and joined a health share called Samaritan Ministries. It is hands-down one of the best decisions we’ve made for our family. Gone are my days of stressing over the financial impact of a theoretical major medical event, gone are my days of not fully understanding medical bills, gone are my days of being cared for by medical professionals I cannot choose myself. I feel so much freedom in leaving the world of health insurance. Here is how it works.

Up front, know that Samaritan is a Christian health share. So there are requirements for being a member, including church attendance, limitations on alcohol and smoking as they pertain to health, and others. This is already in line with our values, so Samaritan is a great fit for us. There are other health shares with less/different requirements, they all work slightly differently, and I imagine Google has some answers. Being a member of Samaritan satisfies the Affordable Care Act’s requirement to have health insurance, so there is no penalty tax on your yearly returns. Samartian sends out clear instructions about how to fill out the health insurance portion of your tax paperwork, and it is a very simple process.

So, as part of Samaritan, each month we are told via our online account who we should send our monthly share to, and a short synopsis on their medical need so we can pray for them as we feel led. Once per year our share goes straight to Samaritan for upkeep costs. As a family with a child, our monthly share is $495 (I’m transparent about that because it’s listed on the website.) This is standard month-to-month. On occasion the amount will actually be lower because the amount of money for all of the member’s collective needs is less that month. Samaritan doesn’t keep any excess.

Any medical event (called a “need” in Samaritan terms) over $300 is able to be covered (shared). The handbook lists the types of needs that are not able to be covered, with consideration for Samaritan’s values. $300 is the deductible, but there is a way to get some or all of that covered as well, more on that later. This means that standard checkups, sick visits to the doctor, etc, are not covered. As a family, we budget for those as needed, and we are a generally healthy family who looks to western medicine rarely anyway, so those costs do not happen frequently for us. We pay out of pocket for chiropractor visits once a month and that’s generally it.

When you are at the doctor’s/hospital/etc, you fill out the insurance paperwork as self-pay. And you ask for discounts for self-pay/cash patients. Typically there are discounts, even up to 60%. These discounts are important because they lower the collective amount of money that members are sharing month-to-month. Additionally, receiving a discount helps to lower your $300 deductible. So say you are billed for $500, but because you are self-pay, you are discounted down to $300 and that is what you pay. When you file paperwork with Samaritan, the $200 discount is then taken off the initial $300 deductible, leaving you with only $100 paid out of pocket once all the expenses are recouped.

My pregnancy was covered 100%. All my prenatal appointments, any supplements recommended by my care providers, up to 40 therapy visits (chiropractor, massage, acupuncture, physical therapy, some require a doctor’s note to be covered). My birth tub rental was even covered. I planned to give birth at home, and since the cost of home-birth is generally much lower than hospital birth, the $300 deductible was automatically waived. However, I ended up transferring to the hospital while I was in the throes of labor, and my $6000 birth turned in to a $25,000+ birth. I was and am still so thankful that I didn’t need to worry about the financial impact of my necessary hospital transfer. A few weeks after giving birth, I went through allllllll the paperwork, called care providers for discounts as needed, and paid everything off or set up payment plans. I kept all the paperwork organized and submitted it to Samaritan. Two months later I received dozens of cards in the mail with checks totaling the exact amount of money I needed to cover all of the medical bills. These cards came from people all over the USA with notes and prayers written in them. It was such a beautiful example of community.

So clearly submitting a medical need takes some legwork and organization, and you need to be active in your medical bills in a different way than you are with typical insurance. This is something I like- I have such a stronger understanding of where my money is going and what bill is for what. If I misunderstand what I am being charged for, I don’t just passively sign off on it. I make phone calls, wait on hold, and speak to people to learn why this or that is being billed to me. I take ownership of every medical bill that comes through our mailbox.

There are more often than not up-front costs before you submit your need to Samaritan. Some care providers will not let you pay on a payment plan if you ask for a discount, so you need to pay in full at the time of service. This was a bit of an issue for us after our hospital transfer, since we hadn’t planned for it. We ended up splitting the hospital bill over two credit cards, and then applying for a new credit card with 0% APR for 12 months and we did a balance transfer to the new card before being charged interest. We paid the new card off once we received everyone’s shares toward our need. I do NOT recommend doing that, it was very nerve-wracking, but it worked for us in a pinch and we are better prepared these days. Pregnancy needs can be shared in advance if you know generally how much everything is going to cost. Our midwives charged us $6000 on a payment plan throughout my pregnancy, and I was able to have that need shared long before Harrison was born- which was ideal because everything was paid for before giving birth and I theoretically wouldn’t be drowning in paperwork after the birth. But hah, such is life when plans change and you enter a hospital.

There is no “in-network” or “out-of-network” with Samaritan. You have freedom to research and decide who the best care providers are for your specific need. Western medicine and alternative medicine are equally recognized and respected. You can go to someone down the street, or in a different state, or in a different country- you determine where you can get the best care, and submit the paperwork the same way for any provider. I LOVE this freedom.

So for an example to make some sense out of it all (in general numbers, I don’t remember the specifics)- Jeremy went to Urgent Care for a broken toe not too long ago. The initial cost of the urgent care visit was $700. We asked for a discount and paid $500 up front that day. We retained all the paperwork that showed the initial cost and the discounted cost that we paid. We received a bill a week later for the x-rays they took at the visit- $300. We called the billing company to ask for a discount and paid $220 over the phone. Jeremy also went to the chiropractor a few times to help his body out as it was adjusting for his uneven walk as his toe was healing. $450 total for all that, no discount. So the initial total was $700 + $300 + $450 = $1450
The discounted total was $500 + $220 + $450 = $1170
That is a $280 difference. Upon submitting the paperwork, that $280 got put towards our $300 deductible, leaving us with a $20 deductible and we received every penny after that in the mail two months later.

I love being part of Samaritan and the active role it allows me to take in my healthcare. For more information you can check out their website or feel free to reach out to me!