Your literal question is,
Have you seen a comparison of Health Sharing Ministry Plans vs. HDHP plans when the health sharing plan is provided by your employer & HDHP is personal?
No, I haven't seen that exact comparison, and it's arguable that it would be very difficult to apply a broad comparison to your exact scenario without diving down into the weeds of your specific options. HSMs are not tightly regulated and have a lot of discretion in how they behave, and your HDHP options may be very different depending on your circumstances (i.e. what state you live in, what your income is, what subsidized options you may have available, and so on) much less the differences from plan to plan (what the deductible is, what network it's on - which is important because that dictates the prices you pay up until your deductible is met) and so on.
Generally, a health sharing ministry operates more like a cost sharing collective than an insurance plan. The insurance industry has standard practices which don't have any direct equivalent for health sharing ministries. The biggest difference in that sense is the concept of a provider network. Consumers usually see a network as a means to dictate which providers they are (or are not) allowed to visit under their plan, but the more important difference on an HDHP is that in network providers will have to follow your insurance plan's negotiated rates.
If a doctor bills you $180 for a simple office visit, your insurance plan may have negotiated that rate down to $60 (Getting two thirds off may seem sensational, but this is a typical example of a discount for a normal office visit to an in network provider). When the insurance plan signed the provider on to their provider network, the provider signed a contract agreeing to a standard rate schedule. That $120 discount is a done deal. It's built into the software the plan uses to communicate with the provider, and the provider will abide by that negotiation automatically.
So, if you haven't met your deductible yet then yes, you have to pay the cost yourself. But - you pay $60, no questions asked. Just by being in the plan you automatically get two thirds off! That's a significant value which is sometimes overlooked. These network discounts are taken for granted so much in our culture that many people don't really understand how they work, or aren't even aware that they exist. People going in to an HDHP plan are often frightened that they will have to pay everything until they meet their sky-high deductible, and they see that as a sign that being on the plan has no benefit. However, even if you never meet your deductible, you're getting the benefit of this negotiation power every time you use an in-network provider.
Compare that to a health sharing ministry, which typically do not have provider networks (in other words, they do not pre-negotiate on your behalf.) That same office visit would cost you $180, and then you'd have to seek reimbursement from the ministry. If you want to negotiate, you certainly can, and many providers will provide discounts if you tell them that you're not insured (after all, they basically expect to get $60 for that office visit, even though they bill it at $180). However, it's basically you "versus" the provider's billing rep - you don't have a multi-billion dollar corporation doing the negotiation for you.
Another major difference is regulation. HSMs aren't covered by the same regulations as commercial health insurance or self-funded health insurance plans. This means that some of the protections built into standard plans aren't extended to those who are members of HSMs. It's hard to discuss this difference in detail, but there can be broad consequences. Laws provide protective guard rails in terms of the types of services that commercial plans must cover and who is eligible for those plans. HSMs aren't required to follow those laws, which means,
- they are allowed to be selective in their benefits (they can choose to not cover some types of healthcare that commercial plans must cover)
- they're allowed to be selective in their eligibility requirements (they can choose who they let on the plan based on factors commercial plans aren't allowed to consider, like pre-existing conditions, chronic disease, or habits like smoking or drinking alcohol).
- they're allowed flexibility for their cost structures (they can make up the "sharing cost" aka premium equivalent you're required to pay based on whatever factors they'd like)
- Commercial plans are carefully regulated in terms of things like lifetime benefit caps and whether they're allowed to limit claim payments under certain conditions, whereas HSMs are not. If you find that you have a catastrophic accident (think: helicoptered out of a remote ski resort with a skull fracture), a "million dollar baby" birth with significant complications, or a very expensive chronic health problem, you may find yourself totally out of luck when your HSM tells you that they're not paying your bill, even though a commercial plan may be required to pay those bills.
For some people, these may actually be benefits. If you don't want to cost share with smokers or people who use birth control, you can choose a health sharing ministry that doesn't allow those things. But if you happen to have characteristics or health needs that HSMs don't want to be involved in, you may find that they don't pay for things you consider to be normal heathcare needs, or that they don't even want you in their group in the first place.
A more obscure and indirect difference from a regulatory perspective comes in the sense of government oversight meant to ensure stable and consistent operation. The government has a lot of operational oversight into commercial insurance plans, which can indirectly impact a consumer's experience with that plan in a positive manner:
- Plans have regulations around how quickly they must pay claims
- Plans are required to operate with certain financial "fail safes" that serve to keep them liquid and able to pay your claims
- Plans are required to follow certain procedures when it comes to handling consumer complaints or disputes of claim decisions
- The underwriting process, by which a plan determines the premiums you pay, is tightly regulated and requires government sign-off to ensure it is legitimate (both from the perspective of ensuring that the plan will collect enough premiums to be able to pay their claims, and from the perspective of ensuring that the plan isn't gouging consumers in order to make extra profit).
Also, being in an HSM means you don't have access to related programs and services which you will get if you're on a commercial HDHP:
- For instance, HDHPs have tax-advantaged savings mechanisms (an HSA) whereas if you're in an HSM and you want to save for healthcare costs, you will have to save post-tax. That alone can be a significant factor, for many people it's equivalent to getting a 20-ish percent discount on all of your out of pocket healthcare costs.
- Commercial plans also typically come with a prescription drug benefit run by a PBM, whereas if you're in an HSM you won't have access to a true PBM-run program and may have to rely on vendor discount programs, which usually aren't as good.
- Commercial plans in general also come with services meant to ensure you have a positive outcome from a health perspective, such as care management or medical management services. This basically means that the plan will have registered nurses on staff helping providers make decisions about your care, in the case that you have significant healthcare needs. These services are regulated to ensure they focus on evidence-based decision making to ensure a good outcome for the patient.
This may all sound very bleak in terms of the outlook for joining an HSM, but if you have personal reasons for wanting to join an HSM (you want to share healthcare costs with other people who have the same beliefs as you), an HSM can be a great option. You just need to go into the decision with your eyes open about the potential financial impact.
Also, it may be worth noting that many consumers who don't have traditional employer-sponsored health insurance available may have lots of competitive options through either ACA state marketplaces or state-run programs targeted at the uninsured or underinsured. If this is your first time trying to find your own insurance, it probably makes sense to talk to a Navigator or whatever resource your state provides for helping people make these decisions. Otherwise, it can be hard to actually even find all your options, much less understand the differences between them.
Also, if you get to the point of trying to compare specific plans, or comparing an HSM to a specific commercial plan, it can be helpful to use your own actual claims experience as a test run. Get the last three years of claims history you had from your prior insurance (if any) and/or any medical bills you've recently paid out of pocket, and talk to representatives from those plan(s) about how your claims would have been handled. This kind of real-world comparison can give you great insight into something that can otherwise be very complicated.
