Although health sharing is not the same as health insurance, sometimes its structure looks very similar. Today, we thought it would be a good idea to review some of the most common, insurance-like terms used by health sharing ministries. Knowing this vocabulary will make it easier to interpret medical cost sharing membership plans when you come across them. It will also save time because you won’t need to look these terms up!
What is a coshare?
If you’ve used traditional insurance before, you may be familiar with the term “coinsurance.” Many insurance companies ask their members to pay a coinsurance. In other words, the insurance pays a percentage of a medical bill (usually 60-90%), and the insurance member pays what’s left over. Insurance plans with coinsurance cost less per month than plans where the insurance takes responsibility for 100% of the medical bill.
The good news is that “cosharing” works almost entirely the same way! If you see a health share membership that mentions a coshare, you can expect that your cost, per incident, will be higher in exchange for lower monthly membership fees. There’s more good news, too: memberships that use cosharing pay a relatively high percentage of the bill. We’ve seen 10% coshares, and 20% coshares, but nothing worse. In fact, those rates are really good!
There’s no extra downside to health share coshares, aside from the standard “health shares only help pay for eligible medical costs”—not all bills are shareable, so in some cases members will be responsible for 100% of their medical cost. This should not be unexpected for any member of a health share, however, so we can’t count that as a negative. Occasionally paying full costs for medical services is part of the health share model and a key reason why monthly costs are so much more affordable.
What is a copay?
Copays are vanishingly rare in the world of health sharing, but they do sometimes happen. Essentially, a copay is the amount paid directly to a provider during an office visit. Depending on the health plan, this may happen only after the member meets their deductible, or it may be a fixed, set fee (e.g. a primary care visit costs $20).
In the world of health shares, “copays” usually only happen with lower-cost services such as annual wellness checks or sick visits. So far, we haven’t seen any company that requires the member responsibility to be met before paying a copay. If your health share membership uses copays, the fee structure will be listed in your membership information or the member guidelines, so just double-check.
What is member responsibility?
With insurance, there are two types of member responsibility: the annual deductible (how much someone must pay before the insurance steps in to start paying for part of their care), and the annual out-of-pocket maximum (how much someone must pay before the insurance pays for 100% of their care). Health share responsibilities work a bit differently.
For one thing, companies all call the member responsibility by different names. Some actually use the name “member responsibility.” Others might say “Annual Unshareable Amount” or “Initial Unshareable Amount.” This is where things get slightly complicated, because aside from using different names, companies also have different policies about the member responsibility. You’ll want to read the program and membership guidelines very carefully before deciding to enroll in any particular membership plan; it’s always a good idea to understand what you’re signing up for. Possible member responsibility options include:
An annual unshareable amount
- Similar to a deductible, the amount a member/household must pay before the health share begins helping with medical costs. However, instead of resetting every January, the year resets with the membership anniversary (rolling calendar year). This type of responsibility is often called an Annual Shareable Amount (AUA).
A per-incident member responsibility amount
- A per-incident cost that members must pay before the health share steps in to help pay bills. This is less common than an annual amount, and is often called “Initial Unshareable Amount” (IUA) or “Member Responsibility.” This model also typically uses a rolling calendar year.
A coshare structure
- In some cases the health share will only help pay for part of the cost (see “coshare” above). In other memberships, once the member responsibility is met, the health share helps with eligible costs at 100%.
Before choosing a membership type, read carefully! You don’t want to go in expecting you’ll have a $1,000/year responsibility, only to realize it’s actually $3,000/year because it’s actually per-incident, max of three in a rolling calendar year. And, similar to insurance, if you select a plan with a lower member responsibility, you’ll have higher monthly costs to make up for it.
We hope this vocabulary review proves helpful! Thanks for reading!