Healthcare for Ministers in Texas

A few years ago, I was on an insurance plan for Church of Christ ministers. That plan went away, which left me scrambling. I wrote up an article about other options for ministers, and I decided to share it here in case anyone else could use it:

If you, like me, are scrambling to find an alternative to CLBA (Churchwide Healthcare), here are some items to help you in your search. Please note that most of my research applies to Texas residents only, and please verify the following information before making any final decisions.

UPDATE: We were looking at switching plans at the end of the year, when most insurances are available to sign up. If you're trying to switch in the middle of the year, your options are more limited. If you've lost your job, or you're moving to a different county, you may qualify to switch. Also, most of the health-sharing groups allow you to switch in the middle of the year!

1. Every county's coverage is different. There are considerably more plans in metro areas, and each metro area (DFW, Houston, Austin, etc.) has different plans.
   
   The Texas Department of Insurance has a list of which insurance companies in Texas offer which types of plans (HMO, PPO, etc.). They also have a list sorted by county.
   
2. You can find different plans on different "marketplaces" or healthcare guides. There are a lot of different guides, and some have access to additional plans. The actual term "marketplace" is supposed to refer to plans available on the federal marketplace at healthcare.gov. All marketplace plans are eligible for a federal tax credit (see #3), while private (off-marketplace) plans do not qualify for the discount.
   
   I've looked at a few healthcare guides, including HealthCare.gov, GoHealth, Take Command Health, Gravie, and USAA (membership required).
   
   Based on design and usability, I recommend Take Command Health as the best healthcare guide I've seen so far. Some guides let you select doctors (to make sure they're covered in potential plans), but TCH is the best at showing you doctor availability when comparing plans against each other. (They also include Medi-Share in their search parameters...more on that in #4.)
   
3. As a minister, you can subtract your housing allowance from your healthcare-related income, which may qualify you for a (bigger) tax credit. Again, these tax credits are only available on "marketplace" plans. When entering your current income, enter your housing allowance-adjusted income (technically speaking, your MAGI).
   
   This lower income level may possibly qualify you for Medicaid, and your children may qualify for Medicaid or CHIP. Your child can only be on one plan, CHIP/Medicaid or a healthcare.gov plan. (Otherwise you'll lose the healthcare-related tax credits.) I've heard horror stories about CHIP/Medicaid, but I've also heard plenty of stories of regular insurance providers.
   
4. It may be time to consider a health-sharing group like Medi-Share. In the past, I've chosen CLBA over Medi-Share because I felt more comfortable with a traditional insurance plan, even with the significantly higher monthly premiums. But since CLBA is going away...
   
   There are four major health-sharing groups I've found so far: Medi-Share, Samaritan Ministries, Christian Healthcare Ministries, and Liberty HealthShare.
   
   These groups are different, but they essentially offer a collaborative approach to medical bills, and most view themselves as a ministry. All four of the above groups are exempt from the "no insurance" tax-penalty. However, none of the four are considered an "insurer" so they are also exempt from certain regulations. For example:
• Under all insurance plans, "wellness checks" and most birth control are fully covered at no cost to you. That's not always the case with medical sharing plans.
• If your medical sharing group refuses to cover a particular expense, you have no legal recourse.
• These groups can also deny coverage of conditions based on an "immoral" lifestyle. For example, the groups may require no extramarital sex or drunkenness, so if you have sex and get an STD (or get in a car wreck while under the influence), your medical expenses will not be covered. (Also, abortions and treatment for drug addictions are usually not covered.)

We're probably going with Medi-Share, because they are the most similar to the (CLBA) PPO plan we used previously...but that doesn't necessarily mean you should do it too. Below I've listed some areas to think about. (Please note that these groups don't use the terms "deductible" and "premium", but they function in similar ways.)

• Negotiated Prices - Medi-Share and Liberty have pre-negotiated prices, as with most insurers. That means you'll probably pay less than if you walked in off the street. Of course, some medical providers charge less for uninsured clients, but I prefer the simplicity of negotiated prices. (Medi-Share uses the PHCS PPO list of providers, which includes our three primary doctors, and our preferred hospital.)
  Side note: most medical providers will negotiate prices with cash clients, particularly if you can pay upfront.
• Lifestyle Restrictions - I haven't looked at every group's restrictions in-depth, but from what I've read so far, Medi-Share doesn't require us to do anything we don't already believe is important.
• Wellness Visits - Medi-Share does NOT cover "expected" medical expenses, such as wellness visits. (Children under 6 are covered, however.) They ask you to budget appropriately for those. Even with these costs, I think we'll come out ahead compared to other options.
• Alternative Healthcare - Medi-Share doesn't cover "alternative treatments". Liberty and Samaritan do. We're fine with only using standard treatments.
• Payment Methods - Your bill is sent to Medi-Share, which then approves and covers a certain amount, and the remainder of the bill is then mailed to you, similar to regular insurance. (Samaritan Ministries has its members send money directly to each other, which is appealing for some people but not for me.)
• Maternity - We're not done having kids, so this was important to research. Medi-Share covers routine maternity costs, and life-threatening complications, as long as you become pregnant after joining the program. (I'm still unclear on whether epidurals are covered.)
• Pre-Existing Conditions - Treatment for these conditions is only covered if you haven't had any sign/symptoms of the pre-exisiting condition for 36 months, or if you've been paying for 36 months. In other words, if you start Medi-Share in January of 2017, you can't get coverage for that pre-existing condition until January 2020. (Coverage is limited to $100,000, or $500,000 if you've been symptom-free or a member for 60+ months.) We don't have any major pre-exisiting conditions, but if you do, Medi-Share may not be a wise option.
• Healthy Bonuses and Unhealthy Penalties - depending on your weight, blood pressure, etc. you may qualify for a discount or penalty. Check these requirements before signing up.

UPDATE: Not every hospital accepts these plans. We recently moved and discovered that our primary hospital doesn't accept "healthcare sharing" plans. Even though Medi-Share has a PPO (which pre-negotiates prices), because Medi-Share wasn't technically insurance, our hospital didn't honor those PPO prices. Instead, they would treat us as cash patients, and then we would have to do the work of getting reimbursed by Medi-Share.

You should verify that these plans will work with all of your preferred medical providers—doctors, specialists you know you may visit, your children's pediatrician, your local hospital—before you sign up. Good luck!