John Oliver skewered health care sharing ministries Sunday night, but New Jersey has been trying to ban the faith-based scams since last year.
Health care sharing ministries (HCSM) are organizations in which health care costs are shared among members who have common ethical or religious beliefs.
These plans are not prohibited in New Jersey, but Garden State residents should know that these plans are typically limited in coverage, exclude pre-existing conditions and often do not provide comprehensive benefits.
Since they do not meet the federal definition for health insurance, HCSMs are not subject to the consumer protections of the Affordable Care Act and are not regulated.
Residents shopping for health insurance should also be mindful of hospital indemnity plans, which offer limited benefits and are meant to supplement a more traditional insurance plan. Additionally, short-term limited duration plans, also known as “skimpy plans,” are prohibited in New Jersey.
There were 1,712 New Jersey consumers enrolled in plans from Trinity HealthShare as of November 2019, and 1,227 active New Jersey members enrolled in the Trinity Plans as of February 2020.
More than a million people nationally are enrolled in about 100 nonprofit organizations that are masquerading as an alternative to insurance, but are in fact a religious-based scam.
The Boston Globe recently reported on the plight of Betsy Hargreaves, who wanted to save a few bucks on health insurance a couple of years ago and decided to switch to a religious-based plan.
For a while it worked, cutting her monthly premium by hundreds of dollars.
Then, she had double hip-replacement surgery to relieve acute pain, followed by a four-day stay in the hospital and extensive physical therapy.
The surgery was successful, but Hargreaves’s “insurer” refused to cover any of the costs and she was saddled with nearly $75,000 in medical bills.
They told her the day before the surgery that it would not be covered, she said.
Hargreaves’s financial crisis is rooted in her decision to opt out of a traditional health insurance plan, which she says she did without understanding all the ramifications.
Under the Affordable Care Act, traditional health insurers are prohibited from denying coverage to members due to a preexisting condition. It was one of the biggest selling points of Obamacare.
But Hargreaves’s plan, OneShare Health, is not traditional insurance. It is a nonprofit “health care sharing ministry,” and like all such ministries, exempt from the ACA, and therefore not legally mandated to cover preexisting conditions.
Some health care ministries have come under sharp criticism from state regulators who say their aggressive marketing efforts have misled some consumers into the false belief their coverage is the equivalent of traditional insurance, only cheaper.
At the bottom of its website homepage, OneShare says it is not an insurer. In an e-mail, a spokeswoman for the nonprofit told me it’s different from a traditional insurer because it does not assume the risk of medical expenses incurred by its members, does not promise to pay expenses, and makes no guarantee of coverage.
Instead, it collects monthly “contributions” — the equivalent of premiums paid to insurers — from members and coordinates the payment of eligible medical expenses among members according to its own established rules.
Still, the nonprofit shares some of the look and feel of an insurer with its offerings of various coverage packages with names like “Catastrophic,” “Classic,” and “Complete,“ each with a schedule of per-visit payments (looking a lot like copayments) and different in- or out-of-network rates. (Hargreaves has the “Complete” plan, which is the most comprehensive.)
Health care sharing ministry members have “a common set of ethical or religious beliefs and share medical expenses in accordance with those beliefs,” according to the exemption in the ACA. Many of them are aligned with Christian ideals or principles.
The OneShare website displays biblical quotations, including one about carrying “each other’s burdens.”
The spokeswoman for OneShare said it currently has about 180 members in Massachusetts. Those ministries are not licensed by the Division of Insurance because they are not insurers.
About a dozen states, including Massachusetts, have issued warnings to consumers about joining a health care sharing ministry.
“Consumers should use caution when considering alternatives to traditional insurance plans . . . such as health care sharing ministries,” the Massachusetts Division of Insurance says. “These plans, while legal, do not offer the same consumer protections.”
That state’s health care exchange, similarly says health care sharing ministries “do not necessarily cover expenses for the same kinds of services that health insurance covers.”
In 2020, the Bat State added a regulation that now effectively blocks brokers or agents from selling health care sharing ministry plans in the state, but Massachusetts residents are still able to enroll if they approach the scam artists.
Hargreaves, 58, a self-employed real estate agent, said the religious aspect of the plan was not the primary reason she chose it. She was shopping for savings.
Hargreaves said she had purchased traditional health insurance through a broker since 2015, but switched to a health sharing ministry plan in March 2019.
On Dec. 23, 2020, Aliera Companies (Aliera) and its subsidiary, Trinity Healthshare (Trinity), were ordered to stop transacting business in New Jersey because the companies were found to be operating illegally in the state and issued an Order to Show Cause.
Aliera administered and marketed health coverage in New Jersey on behalf of Trinity, which represented itself as a health care sharing ministry, which would have made it exempt from state regulation if true.
However, the Banking and Insurance Department found that Trinity does not meet the statutory requirements that health care sharing ministries must meet. To qualify as a HCSM, an organization must have been in operation and continuously sharing member healthcare costs since Dec. 31, 1999.
Trinity was established in 2018.
Christian Care Ministry (CCM), a not-for-profit 501(c)(3) corporation, based in Melbourne, FL, operates the Medi-Share program, a Christian health care sharing program.
Founded in 1993, Medi-Share claims it has over 400,000 members across America who were convinced it provides "an affordable alternative to health insurance for faith-based consumers" but on fact may gave been sold a bill of goods.
New Jersey residents who believe they may have purchased a noncompliant plan to call the state’s Consumer Hotline at 1-800-446-7467 (8:30 a.m. to 5:00 p.m. EST Monday through Friday).
New Jersey residents may file a complaint by clicking on Consumer Assistance – Inquiries/Complaints, online at https://www.state.nj.us/dobi/index.html.
To report the marketing of plans that are banned in the state, visit https://www.state.nj.us/dobi/consumer.htm
For more information about health plans and financial help available, visit GetCovered.NJ.gov.
A total of 788 amendments were submitted during the Affordable Care Act’s markup in the Senate Committee for Health, Education, Labor and Pensions committee before Obama’s reform proposal became law.
Three quarters of those changes were filed by the committee’s Republican members, and of them, 161 were adopted in whole or revised form.
Among them was the one that allows health care sharing ministries yo rob and kill people who misplace their faith in the scam operations.
Although the Republicans made a firm impact on the eventual law, only one GOP member of Congress voted for the final product.
The House passed the bill on November 7, 2009, with the votes of 219 Democrats and one Republican (Rep. Joseph Cao (R-La.)). Thirty-nine Democrats and 176 Republicans voted against the bill.
On December 24, 2009, the Senate passed its version of the bill 60-39, with all Democrats voting in favor of the bill and all Republicans but one voting against it (Sen. Jim Bunning (R-Ky.) was not present for the vote).
The Order to Cease and Desist may be found here: https://www.state.nj.us/dobi/division_insurance/enforcement/E20_31.pdf
The Order to Show Cause may be found here: https://www.state.nj.us/dobi/division_insurance/enforcement/E20_32.pdf