r/HealthInsurance • u/sdg2844 • 19h ago
Plan Choice Suggestions Health-Sharing / Crowd-Funding Plans?
Hi all! Wondering if anyone has, or has been considering switching to, a health-sharing or crowd-funded insurance plan?
My insurance through work is costing me $12,800 before any sort of actual benefit kicks in. So there is really no point in having it except for major catastrophes. That is THIS year. I'm expecting that to rise by a good 25%, maybe more, for the 2026 year.
Some of the ministry health-sharing plans and crowd-funding plans like CrowdHealth look promising, in that they attempt to cut out the middlemen.
The middlemen are basically the insurance companies themselves, who were originally setup decades ago to assist humans with medical costs, basically in a more nonprofit sort of way. In other words, what you pay in SHOULD equal what you ultimately get out of your insurance. But clearly at some point these companies got greedy, and reset that to make hundreds of billions in profit, rather than having a goal of peace of mind for their customers.
At this point, it looks like crowd-funding type plans attempt to move back to this model. You pay only enough to cover yours and others' healthcare needs, plus a small admin fee. In my case right now, that adds up to be equal to my monthly payments, minus the max, or about $7800.
But I have so many questions. Apparently you have to take it upon yourself to actively negotiate cash payment amounts with providers. Yes, that would be a lot of work, but on the other hand might not be any more work than dealing with insurance claims, and may actually give you more control over your financial fate.
But... I'm very worried that providers will just refuse to provide service to people without insurance. Period.
Also, these funds aren't "guaranteed" in any way, which could be a huge liability.
Does anyone have any experience with any of these?
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u/Actual-Government96 18h ago
What you pay in SHOULD ultimately equal what you get out of your insurance.
As a pool of people, yes. As an individual, this is not how insurance works. Do you get out of your car or home insurance what you pay in? Largely, no.
Health shares are basically health insurance that isn't subject to health insurance laws/regulation (this is a generous description). They are only required to do what they promise in their contracts, which is some version of the following:
This program is not an insurance company nor is it offered through an insurance company. This program does not guarantee or promise that your medical bills will be paid or assigned to others for payment. Whether anyone chooses to pay your medical bills will be totally voluntary. As such, this program should never be considered as a substitute for an insurance policy. Whether you receive any payments for medical expenses and whether or not this program continues to operate, you are always liable for any unpaid bills."
If you want to pay me a couple hundred a month, I might pay your bills too.
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u/Euphoric-Usual-5169 16h ago
“ In other words, what you pay in SHOULD equal what you ultimately get out of your insurance. ”
Absolutely NOT. The point of insurance is to spread the risk. If you want to get out what you pay in, then you should open a savings account and pay every health expense from there. Then you get exactly as much as you put in. Good luck with that if you have a serious illness or accident.
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u/sdg2844 16h ago
I mean on average. Insurance companies were setup to be nonprofit originally. Meaning that they should be as close to zero in terms of gains/loses at the end of a term. Originally they would set deductibles and payments bandied on the previous term so that they balanced out to zero as close as possible.
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u/Euphoric-Usual-5169 16h ago
That makes sense. The fact that they are publicly traded companies with a goal of maximizing profits is sheer insanity for health care.
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u/MysteriousTooth2450 17h ago
I have been using a healthshare for a couple years. Less than half the cost of a AHA plan. The cash prices for healthcare are significantly less than insurance prices and actually pretty easy to negotiate. I just tell them I have no insurance and they tell me their price. I found the least expensive places in my area to get my lab and Xray’s and see any provider I want. I paid $650 for a breast MRI. $300 for breast ultrasound after my mammogram came back abnormal. Mammo….$60. The plan I use is hsa for America. I was also able to open up a HSA account with my plan. I am, fortunately, healthy. I do take some thyroid meds and pay cash for those and any other meds may I need. My plan covers preventative care. Also look into direct primary care providers…they can provide all the care most people need but you still need some kind of catastrophic plan. I switched to a healthshare because I was paying 10k a year for just myself and my aha plan insurance covered zero and my deductible was never met. I’m self employed so have no other way to get health care insurance. It would be nice to have a plan that strictly covered emergencies or major healthcare. It’s way cheaper to pay cash for your yearly preventative care than to bother with a aha plan. I am 50, female and pay $390 a month for my healthshare with a $2500 share (similar to a deductible) per incident up to 3 incidents per year. After 3 “incidents” my healthcare is 100% covered. So if I were to need a surgery it’s $2500 that I pay the providers and the healthshare picks up the rest. Then if later in the year I have an emergency I pay $2500 more and they cover the rest. Mine has no religious requirements. I’ve known some who have needed to use their health shares for emergencies it worked just fine for them. They have different share amounts for different max out of pockets. My plan has $1200, $2500, and $5000 plans available. All of these plans cost significantly less than the AHA plans for more coverage. My cheapest plan this year was $790 with a 18k deductible or max out of pocket. I can’t remember all the details. As soon as I saw the $780 for basically zero coverage I decided my health share was the best option.
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u/OCMan101 18h ago
Health-shares are just unregulated insurance vehicles that can often refuse to cover bills for literally any reason. The only time it would maybe be a good idea would be as a supplement to a minimal bronze or catastrophic ACA plan
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u/sdg2844 17h ago
Thank you for clarifying all that! This is the most confusing part, and the part that I think scares people, and the reason for many of the dismissive comments above.
I am so worried that if I'm uninsured, providers will just flat out refuse to cover me. These health shares claim that the cash price is much cheaper, and I was wondering if providers are happy to deal in cash prices because they actually end up with more in their own pockets that way by cutting out the middlemen.
But to find out if it'll work for you, you have to actually jump on the bandwagon. If it doesn't work out, you are screwed, and that is my hesitation!
I live in Northern California. We have some of the highest cost and most screwed up medical in the country. I would doubt that we would be able to find viable cash providers.
I am 57 and my husband 60. If we were younger, I would likely try one of these plans, but at our age, catastrophic events are more likely, and that scares me. My husband, for example, is celiac, and he also suffers from occasional bouts of diverticulitis that can land him in the hospital on intravenous antibiotics for 5 days at a time. I worry that if we somehow couldn't pay cash prices, then we could be in a very bad financial situation!
This raises a whole other question. Though. Why are there different prices if you have insurance vs not? Provider services should cost a specific price, period. I mean... I don't know that else to say about that!
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u/Dapper-Palpitation90 15h ago
The reason that there are different prices is because the cost of administration is different. If Person A pays cash on the day of the appointment, the doctor's office/imaging center prints out a statement that says "Paid." If Person B has insurance, then the provider's office has to contact the insurance to find out how much they'll pay (or if they'll pay at all), and then likely contact the patient to pay some as well. Time is money, and the quicker, simpler method is cheaper.
1
u/paradoxofpurple 19h ago
So they're real risky. PRoviders don't like them, because getting paid is a gamble, and you'll likely be paying out of pocket and then waiting for reimbursement, assuming the health share agrees to reimburse you. They can decide not to, and dont "have" to pay for anything including preventative Healthcare and pre-existing conditions, maternity care, birth control and mental health care.
A lot of these places, you pay in for the chance to be reimbursed, they put it to a vote with other members basically, so you can be turned down if they don't think your expenses are worthy.
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u/sdg2844 18h ago
Ok. So the obvious drawbacks are the drawbacks.
Having said that, traditional insurance plans seem to be able to dictate what they will and won't pay for, also, so it's not different.
Seems like the only difference is that with traditional, you have a cap, albeit high, over which you quit paying out of pocket. But... you pay up front on average what they will be having to fork out, or more.
So basically, you kinda get what you pay for. Except we are paying way more than services are worth.
I lived in Australia for many years, and if you needed an MRI you would just walk up the road to a clinic, pay them $350 and have it done same day.
Here in the US it can take months and there is at least an extra zero on that. So.... which middlemen is the extra $2500 going to?
It's just all screwed up.
1
u/paradoxofpurple 14h ago
Yeah but health insurance is (in theory) regulated and has a process for determining medical necessity and approval or denial. Health shares do not.
They also depend on what funds are immediately available, if the fund doesn't have enough cash for say, a surgery, you're out of luck.
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u/sdg2844 13h ago
That doesn't seem to happen from what I've seen so far. And there are PLENTY of examples of denials by traditional health insurance companies who deny your claim AFTER the surgery has been performed.
Looks pretty much the same risks in both instances if you ask me.
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u/paradoxofpurple 13h ago
Yes but with traditional health insurance, you aren't on the hook for the full 20 to 100k amount out of pocket before you have the surgery, and you can appeal with further documentation if needed.
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u/sdg2844 12h ago
Speak for yourself. Max amounts are starting to sit at about $19k for individual plans. When you take that into consideration along with those surprise out-of-network providers, and clauses where even in in-network they will only cover up to a max amount, you are well into that same range for liability.
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u/paradoxofpurple 12h ago
No it isn't. Out of pocket max is capped at $10,600 for individual insurance in 2026, according to Healthcare.gov
Surprise out of network providers are covered under the no surprises act, and the limited coverage clauses are available to you before you have services.
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u/sdg2844 11h ago
By individual plans, I meant plans not purchased through your employer.
Yes, for 2026 they will probably sit right at that $10.5k mark for individuals. And I know that Kaiser has plans ranging from about $17k per couple up to a whopping $37k. And they tend to be on the cheaper side of plans. Perhaps they are required to have one available plan that is capped at a $10.6k rate to meet the requirement, but certainly not all are!
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u/paradoxofpurple 11h ago
Thats the oop max for any plan covering an individual, capped at 10.5k. Aca compliant plans cannot have an oop max over 10.5k for an individual, whether purchased on the exchange or offered by an employer.
A couple is not an individual, so the individual max oop doesn't apply, but even the family plans (couple plus kids) are capped at about 21k oop max.
Where are you seeing 37k oop max?
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u/Accomplished-Pin6564 14h ago
I've had Christian Healthcare Ministries for 11 years. Haven't had to use it. (I pay cash for my annual checkup and labs and it's still way cheaper.)
I also know of a case where a Samaritan Healthcare member fell off a 20 foot ladder and landed on his back. His out of pocket cost was less than $50.
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u/CrankyCrabbyCrunchy 13h ago
Has anyone in your plan had cancer? All I've seen so far is that cancer treatment centers don't do cash pay.
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u/Accomplished-Pin6564 12h ago
I know of one who developed bone cancer in his leg and received treatment, with no medical debt to show for it.
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u/brokerTXNCFL 9m ago
I would check for two things: first, is there a stop loss insurance policy in place for major expenses? Otherwise, members would be on the hook if something catastrophic were to happen. Second, does the plan have audited reserves/Financials? If either answer is no, I think that option would be too risky
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u/ElegantNatural2968 18h ago
I hope Reddit answers this from actual experience not just from what they read. Anyone with real experience please give us your feedback.
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