Health Share vs. Health Insurance: A New Option You Need to Know About

Over the years, I’ve had many conversations with clients who use health share plans. Health shares can be appealing because they often have lower monthly costs and align with faith-based values. However, many people don’t fully understand how health shares work until they actually need to use them.

That’s why I’m excited to share a new option that may be worth considering.

The Difference Between a Health Share and Health Insurance

First, let’s talk about one very important distinction:

Health shares are not health insurance.

Because health shares are not insurance, they do not operate under the same rules as traditional health insurance companies.

This means:

• Claims may be reviewed on a case-by-case basis.
• There is no insurance contract guaranteeing payment.
• Some expenses may not be eligible for sharing.
• Coverage decisions can vary depending on the organization’s guidelines.

Many health share organizations work very well for their members, but it’s important to understand that reimbursement is not guaranteed in the same way it is with traditional health insurance.

How Many Health Shares Work

Depending on the program, members may be required to:

• Pay cash for medical services upfront
• Submit receipts for reimbursement
• Meet a sharing amount before expenses are eligible
• Follow certain membership guidelines

Many health shares also have limitations involving:

• Preventive care
• Prescription coverage
• Pre-existing conditions
• Services that conflict with the organization’s faith-based principles

Some programs do offer wellness benefits and additional services, but benefits vary significantly from one organization to another.

Pre-Existing Conditions Can Be Challenging

One area that often surprises people is pre-existing conditions.

Some health shares:

• Do not cover pre-existing conditions at all.
• Require lengthy waiting periods.
• Limit what conditions may be eligible for sharing.

Understanding these rules before enrolling is extremely important.

A New Option: Faith-Based Health Insurance

I’m excited to share a newer option called Presidio Healthcare.

What makes this option different?

It is a faith-based plan, but it is also actual health insurance.

That means members receive the protections and structure that come with an insurance plan while still participating in a faith-based healthcare model.

How the Plan Works

One of the unique features of this plan is that it does not use a traditional deductible structure.

Instead, members choose a sharing amount that ranges from:

• $2,500
• Up to $10,000

The plan then shares expenses with you, generally on a 50/50 basis until you reach your selected out-of-pocket maximum.

Once your maximum responsibility is reached, eligible services may be covered at 100%.

Rollover Credits

Another feature that makes this plan unique is its rollover credit.

For example: If you select a $10,000 sharing level and only spend $8,000 during the year, a portion of your expenses can carry forward into the following year as credit toward future costs.

This can provide meaningful savings and additional peace of mind.

Nationwide Network Access

The plan utilizes the First Health network, which offers access to providers nationwide.

You may also choose to receive care outside the network.

While out-of-network costs may be higher because there are no network discounts, you are not automatically excluded from coverage.

Could This Be a Good Fit?

This type of plan may be worth exploring if you:

• Currently use a health share
• Want actual insurance protection
• Need a nationwide network
• Are self-employed
• Want an alternative to traditional ACA coverage
• Are looking for a faith-based healthcare solution

There are health questions and eligibility requirements, so the plan won’t be the right fit for everyone.

However, for the right family, it could be a game changer.

Final Thoughts

Healthcare options continue to evolve, and there are more choices available today than many people realize.

If you’re currently participating in a health share and feel frustrated by limited reimbursements or uncertain coverage, it may be worth exploring whether a faith-based insurance option could better meet your needs.

If you’d like to learn more, schedule an appointment and let’s talk through your options.

Visit jkappconsulting.com to schedule a consultation.