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

  1. be a professing Christian,
  2. be in agreement with their statement of faith,
  3. attend church regularly,
  4. abstain from any sexual activity outside of a Biblical marriage,
  5. agree to practice good health measures,
  6. keep your membership active by promptly sending out your monthly share,
  7. agree not to sue other Christians in the program,
  8. sign a continuation form each year, and
  9. 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.

Lucas Weeks

Lucas serves as an assistant pastor at Clearnote Church in Bloomington, Indiana. Although he pines for the warm, tropical weather that was familiar to him growing up in west and central Africa, he has since made peace with the harsher climates of North America.

Want to get in touch? Send Lucas an email!

Comments

No, thank You, Lucas. You have put a lot of work into these posts and have a much more robust view than I gave to you.

And, I would add, Samaritan has been great so far. And several of our friends have had amazing experiences over the years of prayer, support, and giving for the saints. Truly a great example of the body of Christ working together to share the need among the many.

Thanks brother for doing this hard work so the body of Christ may be like the men of Issachar. Thank you!

I want to see if I understand this correctly: you receive a customized monthly share notice with just one specific recipient that you send a check to? Or is it that there are multiple names on it and you pick one of them?

It is interesting how this all works; the risk pool is impacted by the faith and lifestyle factor. I am leaning toward joining.

@Denver,

You are correct. Each month, you receive a customized monthly share notice with just one specific recipient that you send a check to.

As someone who has had a six-figure need processed by Samaritan, I can vouch for the legitimacy of the organization and their operations. They help members shuffle millions of dollars around to each other every month. My wife and I have received hundreds of checks and notes of encouragement from fellow members, and on the flipside it's been comforting to know that our monthly share is directly going to a family. It's a breath of fresh air compared to "traditional" insurance.

Just familiarize yourself with all the details before pulling the trigger.

Maybe someone could discuss the downside. I see that that pre-existing conditions are exluded. And there is a $300 "deductible" per event. And you have to be willing to have your issues disclosed to outsiders, which could be hard on privacy.

The $300 personal responsibility per event applies only to the 1st three per year. 4th and beyond that is waived. If you get discounts on your bills, those count toward the $300, so it's fairly common to have that wiped to zero (I don't know a single insurance company who does that).

Medical issues disclosed to outsiders isn't as bad as you think. As the patient you get to write the blurb about your need, so you can disclose as much or as little as you like. It really isn't anything more than I would see in a church bulletin requesting prayers for congregational members. Since Samaritan members pray for each other, it's also very helpful to know exactly what to pray for. Members control the amount of information, it's not setup to be threatening, merely supportive.

Pre-existing conditions are another issue. Before the ACA it was common for these to be excluded by everyone. Samaritan went a bit farther and says that any condition which has gone 12 months without symptoms or needing treatment, and the doc says it's gone, those are no longer pre-existing. Something like a cancer has to be 7 years without treatment. A couple of things are always considered pre-existing (diabetes, heart issues). Of course it would be nice to have everything covered right away, but financially this isn't possible. The monthly cost required would be too large a burden. Samaritan probably isn't a good fit for someone with a lot of pre-existing conditions, although that person would not be turned away for membership. Prior to the ACA many people were denied coverage, or charged a lot more, for conditions which weren't even an issue anymore. Samaritan is a great solution for them. They are also a great fit people who have well managed conditions, either through diet or inexpensive medications. But anyone with a condition currently would want to evaluate if this is a good fit. Samaritan doesn't try to be the answer for everything, but what they are doing, they are doing very very well. 

One downside that I can see relates to prescription drugs. It doesn't appear that there is coverage for long-term prescriptions, say for  an allergy med. If one or more family members need long-term meds, this could get expensive.  On the other hand, maybe prescription discount cards or the low-cost generic drugs offered by many pharmacies associated with department/grocery store chains could help with these costs.

For prescription drugs we use goodrx.com  It saves us a fortune over retail cost, sometimes costing us even less than what our former insurance copay was. I highly recommend it. Easy to use, and free. It will quickly outline the wide price variations in the same drug in the same town, across multiple pharmacies. of course some drugs are just plain expensive no matter what.

http://samaritanministries.info/my-trip-to-the-pharmacy-using-goodrx/

http://samaritanministries.info/prescription-drug-savings/

Don't want to be a broken record on this topic, but for many families with multiple children, the prices for traditional health insurance on the new healthcare.gov site are lower than you might expect. A quicker way to find out is healthsherpa.org or kaiser calculator.org...for example, a family of 4 with an income of $60,000 would pay about $400 a month for the Silver plan, $300 a month for the Bronze plan. I'm just say'in.

Yes, and that “Bronze” plan would have a family deductible of over $10,000 and only pay 60% of your medical costs, leaving 40% up to you. Maximum out of pocket for the family over $12,000. Yikes!

I’ve got nothing against high deductibles per se. I’ve got a high deductible plan right now. But I’m just going to let those numbers sink in now.

All Obamacare plans are catastrophic plans. If you add up the costs for premiums and out of pocket, they are all the same for the most part. Who has $12,000 each year? Woe to the one who gets really sick on December 31, and then has to meet his deductible all over again on January 1.

I'm not sure I understand the idea that all ACA/Obamacare plans are only catastrophic health insurance plans.

I went to the HealthSherpa website and used the following  scenario:

  • family of 6 - adults 40 & 38; children 13, 11, 8, & 8
  • my personal central Ohio zip code
  • family income of $53,000 (because I think recently read that the US median income is about this much

Here is what I found:

This family would be eligible for a monthly subsidy of approximately $165/month.

There were several silver PPO plans with individual deductibles in the $2000 range and total out-of-pocket limits in the $5000-$6000 range.

With the subsidy, these plans would cost approximately $400/month for this hypothetical family.

From what I've read in our local paper, the insurance carriers offering these plans have our local children's hospital in-network. One carrier includes its entire provider network in its plan.

Obviously, there's no way to apply this information to anyone's specific situation.  I just wanted to point out that the ACA does offer more than catastrophic health care without breaking the bank in central Ohio.

I think it is very important for people to understand Sue's point. For some people, the subsidies and cost-sharing will mean that their health insurance will be much cheaper with ObamaCare.

Denver, I don't think you're right that all the plans are catastrophic plans. Some of the plans are catastrophic plans only, but some of the plans really are more like health insurance. The ones that are more like health insurance aren't affordable at all... until you consider the subsidies.

Lucas,

Thanks for confirming what I tried to say.

The plans were definitely like traditional insurance. They varied from plan to plan, but all had co-pays for primary care and specialist doctors, ER, and prescription drugs, for example. I saw one where you had to meet the deductible before the insurance would kick in for the above. But the others offered the office visits and prescription drugs for co-pays varying from $0 to $35 or so.

I re-read this post because I'm going about to tell a friend to check out the Christian health-care ministries because the deadline for obtaining ACA coverage by April 1 ends this week.

Then I saw this:

>I Generally, everything else that conforms to a Christian lifestyle can be shared (read: no abortions).

With all due respect, neither of the Christian health sharing ministries cover any mental health conditions. Why do mental illnesses like serious clinical depression, PTSD, bipolar disorder, and schizophrenia not conform to a Christian lifestyle?

I'm not dissing Lucas, but this raises a huge flag to me. Like "there for the grace of God go I."

Thanks for posting back, Sue. What you've said there about mental health conditions is very important. Can you tell me where you found that information?

Hi Lucas,

This is the first time I could get online tonight. I don't have time to look where I saw that there was no mental health coverage now, but I'll try tomorrow. It might not be tomorrow evening, though.

Oops! I meant "not be able to check until tomorrow evening."

Here is the information I could find about mental health/behavioral health coverage from Samaritan Ministries (http://www.samaritanministries.org) and Medi-share Christian Health Care (http://mychristiancare.org/medi-share/)

Samaritan Ministries Member Guidelines (downloadable .pdf file from their web site dated 11/13), p. 28

Section VIII. Needs Shared by Members -> B. Medical Expenses for Which Sharing Is Limited

23. Psychiatric Care—Inpatient psychiatric care due to involuntary commitment and the treatment for injuries and detectable organic agents causing cognitive disabilities are publishable up to $50,000 per condition. Psychotropic medication to treat chemical imbalances not demonstrable by lab tests is not publishable except as a part of involuntary commitment. No other type of psychiatric care or services is publishable.

Medi-share Christian Health Care

Medi-Share 2.0 Guidelines, as posted on http://mychristiancare.org/guidelines.aspx on 3/12/2014, 12:39 am

Section VI, Details of Sharing -> J. Medical Conditions Not Eligible for Sharing

Behavioral/Mental Health care – including, but not limited to:
--Psychiatric or psychological care
--Alzheimer’s disease and other dementias
--Special education charges
--Counseling or care for learning deficiencies or behavioral problems, whether or not associated with a manifest mental disorder or other disturbance (e.g. Attention Deficit Disorders or Autism)

They have to draw the lines somewhere, but it's a little disappointing in my opinion.

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