ObamaCare: What you need to know (Part 5): Interested in Samaritan Ministries? I am too...
(Many thanks to Joe Helt for contributing to this post.)
Samaritan Ministries (not to be confused with Samaritan's Purse) is not insurance. If you're going to understand Samaritan Ministries, you must simply put the model of "buying health insurance" out of your mind. In fact, the quickest way to understand the ministry is to understand that signing up for it, instead of signing up for a traditional health insurance plan, makes you a "self-pay" patient.
That's right. The bill for your medical expenses is on you.
That sure sounds scary, right? It does to me. But stick with me. There's good news, too...
There are no medical eligibilty tests to join Samaritan. To sign up for Samaritan, however, you must
- be a professing Christian,
- be in agreement with their statement of faith,
- attend church regularly,
- abstain from any sexual activity outside of a Biblical marriage,
- agree to practice good health measures,
- keep your membership active by promptly sending out your monthly share,
- agree not to sue other Christians in the program,
- sign a continuation form each year, and
- have your pastor sign a confirmation that you meet the above requirements.
Once you've signed up, you make a payment based on your family size every month. Once a year, that payment goes directly to the Samaritan headquarters to cover the costs of running the program. For the other 11 months in the year, you send your contribution directly to another member of the program. Samaritan coordinates all of this each month with a Christian Healthcare Newsletter that is sent to each household in the program. The monthly newsletter contains a share notice, which lists the amount that you need to send, the name and address of the person to whom you are sending the money, and a little note about how to pray for that family. (Here's a sample of the monthly share notice.)
So, the key to having your medical expenses paid for by other member's of Samaritan is having your medical needs published in the newsletter. The next question is obvious: "How can I have my needs published in the Samaritan Ministries Newsletter?"
Samaritan Ministries assumes that their members can budget for medical expenses under $300, and so any expense under $300 cannot be shared in the newsletter. That $300 is not exactly a deductible as a traditional health insurance plan would define the term, but it works in a similar fashion. If you have a medical expense that is eligible to include in the newsletter, you cover the first $300, and remainder of the expense is shared among Samaritan members. If a member household has more than three shareable needs in any 12-month period, the first $300 is also shared for the fourth, and any subsequent needs in that period.
Samaritan Ministries strongly encourages it's members to save money on their medical bills as best as they can. One way they do that is by waiving the initial $300 when the member family saves $300 or more on their medical bill. Any self-pay discounts you receive on your bills can be put towards your initial $300, potentially lowering the amount you pay for a medical expense to zero. This review by a member of Samaritan after a year of use states that they never had to pay the initial $300 for multiple medical bills that year because of those self-pay discounts. As mentioned in a previous post, self-pay patients who pay with cash generally pay 40-60% less than the sticker price for their medical expenses. Finally, Samaritan waives the initial $300 for home births.
With Samaritan's, there are no co-pays and no co-insurance. If the medical bill is eligible to share in the newsletter, the initial $300 is the only part of the bill that you have to pay. In order for your need to be eligible, it must conform to the Samaritan guidelines (PDF). I cannot emphasize enough how important it is for you to read and understand these guidelines well before you jump in. I don't think it's valuable for me to go through the guidelines in detail here, but I think it's fair to say that, in general, pre-existing conditions and routine procedures and check-ups, including routine drug prescriptions, cannot be shared. Generally, everything else that conforms to a Christian lifestyle can be shared (read: no abortions).
There are no lifetime maximums on needs that are shareable with Samaritan Ministries. There is, however, a $250,000 limit per need. A recent commenter mentioned that the cost of having a premature baby could easily exceed that amount. To address the problem of medical needs in excess of $250,000, Samaritan has a "Save to Share" program. To be included in the program, members are asked to set aside an additional amount in the case of a large need. If the money is needed that year, they are asked to send that money to the needy family or individual.
Finally, Samaritan also has a "Special Needs Prayer Requests" section in their newsletter. Members can send in prayer requests and even requests for financial assistance regarding needs that are not eligible under the guidelines. Unlike the regular sharing, members are under no obligation to give towards the special needs requests.
It's easy to figure out your costs for joining Samaritan, but here's a nice summary on yearly costs:
- Single person: $1,980 (maximum out of pocket $2,880)
- Married couple: $3,780 (maximum out of pocket $4,680)
- Single parent family: $2,760 (maximum out of pocket $3,660)
- Two parent family: $4,440 (maximum out of pocket $5,340)
If one adult in your household is 25 years old or less, then you qualify for a discount on these prices.
As I mentioned above, Samaritan members must think about all their medical expenses from the mindset of a self-pay patient. This has many advantages, but one significant disadvantage is that you must pay very close attention to your family's cash flow. The reports I have read and heard testify that the program works well, and that you will be reimbursed for eligible expenses. However, it takes roughly 30-60 days to have your needs published, and then another month for all the funds to come in. That's a 3-month process. As long as you're in regular conversation with your medical providers, they may be willing to work out a payment plan of sorts so that you won't have to pay out of pocket initially for your expenses. But having the money on hand to pay up front always helps with your negotiating power.
Speaking of negotiation, Samaritan Ministries encourages its members to negotiate prices, but it's not a requirement. If Samaritan believes a bill is higher than it should be, they will call you and ask if they can negotiate it down on your behalf. If you prefer, Samaritan can do all of your negotiating for you. Samaritan contracts with the Karis Group to actually perform these negotiations.
If you're interested in pursuing Samaritan Ministries, there is another program that is a division of the Karis Group: The Health Co-Op. The Health Co-Op is a program you can join in addition to Samaritan. For a family of three or more, the cost is an additional $73 on top of your monthly contribution to Samaritan. You can see their prices here. Member benefits include, among other things, 24/7/365 phone access to a board-certified and state licensed physician and discounts on important medical services (including eye and dental). Click here for more information about member benefits.
For a side-by-side comparison of Samaritan Ministries with Medi-Share, click here.