Say what you will about the Affordable Care Act (ACA), one thing is certain: it is significantly changing how health-care is paid for. One example of this can be found in the small, but fast-growing, segment of the healthcare world known as healthcare-sharing ministries.

Such ministries, the first of which began more than 30 years ago, don't provide "insurance." Instead, inspired by the biblical instruction to "carry each other's burdens" (Galatians 6:2), all members of a healthcare-sharing ministry pay a monthly "share" amount (similar to an insurance premium). Those members with eligible health-related expenses receive money from other members' shares.

Players in this space include Samaritan Ministries, Christian Care Ministry (more commonly known as Medi-Share, the name of its healthcare-sharing program), and Christian Healthcare Ministries. We'll focus on the first two to demonstrate how healthcare-sharing ministries work, but anyone considering this type of service is encouraged to gather information from all three.

Impact of the Affordable Care Act

The ACA requires most U.S. citizens to carry health insurance. It also makes it easier to do so by eliminating pre-existing conditions as a factor in qualifying for coverage and by lowering the cost of insurance through subsidies for those with low incomes.

While healthcare-sharing is not insurance, a provision within the ACA makes members of healthcare-sharing ministries exempt from the mandate to either purchase insurance or face fines. In fact, healthcare-sharing ministries credit the new law for recent spikes in their growth, whether for faith-related reasons, financial reasons, or both.

Faith factors

To join a healthcare-sharing ministry, you must agree in writing to its statement of faith. In Samaritan's case, your pastor also must sign your application, verifying your regular church attendance and Christian lifestyle.

Each healthcare-sharing ministry makes clear that certain costs are not eligible for sharing, including abortion-related expenses and treatment related to substance abuse. For some, knowing their "share" money will help provide for the needs of other Christians and will not support practices contrary to their faith, are important draws.

Dr. Andrea Miller, Christian Care Ministry's Medical Director and VP of Sharing, said, "We really want people who understand the concept of a sharing ministry. We want people who want to pray for others and are interested in sharing each other's burdens. This isn't just another way to pay for healthcare."

Cost factors

Still, cost is a key consideration for most people, and healthcare sharing has long been viewed as a less expensive alternative to health insurance.

At Samaritan Ministries, a family's monthly share price is currently $405 ($355 if both heads of household are 25 or younger). There is no added cost based on the number of children a family has, nor does the cost go up any further after age 25.

Shared funds are not available for needs under $300. Further, the first $300 of the first three eligible medical expenses that exceed $300 in a year are not covered — similar to a deductible in an insurance plan. Also, there is a $250,000 cap per eligible need unless the member pays extra to take part in Samaritan's Save to Share program.

In contrast, with Medi-Share, you choose among seven annual household portion (AHP) options. For a family in which the oldest adult is 25, a plan with a $1,250 AHP (think of that as the family deductible) costs $610 per month. At age 45, the same plan would cost $637. After meeting the AHP, there are no caps, except in the case of pre-existing conditions (discussed below). Medi-Share also offers monthly share-price reductions if you meet certain good health standards.

Costs are kept low at both ministries, in part because certain procedures that might be covered by some traditional insurance policies are not eligible for sharing. These include routine physicals and screenings, such as mammograms and colonoscopies.

There are also limits as to what costs related to pre-existing conditions are eligible for sharing. At Samaritan, pre-existing conditions are not eligible unless there have been no symptoms or treatments for 12 months, or five years for heart disease and cancer.

At Medi-Share, pre-existing conditions are not eligible for sharing unless there have been no symptoms or treatments for 36 months. Even then, there is a $100,000 per-member annual cap, rising to $500,000 for members who have been with Medi-Share for five years and have been symptom- and treatment-free for that long. Cancer cost eligibility requires that a member be cancer-free for 84 months.

Medi-Share does help pay for certain expenses insurance doesn't cover, such as adoptions and funerals.

Samaritan's process

Samaritan Ministries' members have no restrictions as to which doctors they can see. But as self-pay patients, they do not receive the lower rates many insurance companies have arranged for their members. When a Samaritan member incurs a medical expense, he or she submits the bill for review. If it's an eligible expense, Samaritan attempts to negotiate a lower price. The ministry then notifies certain other members to send their next monthly share amount directly to the member who had the expense.

Samaritan sends a checklist to those who are due to receive money from others so they know who is supposed to send money and can keep track as the money comes in.

If there are more needs than money available for sharing at any given time, those with needs may end up receiving a lesser pro-rated amount. Samaritan Ministries' Anthony Hopp, Director of Membership Development, says that's happened 10-12 times in the past four years, and in every case the full needs were eventually shared.

The direct-sharing process may sound unusual to someone accustomed to insurance, but Craig, who has been a Samaritan member for a little over a year, likes writing checks to other families. "It's a greater blessing than saying, 'Here, insurance company, here's another $400.' I feel like I'm doing something a Christian should be doing, sharing in the needs and burdens of others."

Medi-Share's process

Medi-Share members are part of a preferred provider organization (PPO), which means they receive pre-negotiated rates (which are often significantly lower) if they use providers that are in its network. Members are responsible for a $35 provider fee, similar to the typical office co-pay. Then medical service providers bill Medi-Share, just as they would a traditional insurance company. Once a member household has met its AHP, all other eligible costs are available to be shared.

Each member deposits the required monthly share amount in a checking account set up with America's Christian Credit Union, and gives Medi-Share limited power-of-attorney to access the account. This enables Medi-Share to move money in and out of the account, depending on whether the member is receiving money from, or sending money to, other members. Ultimately, Medi-Share pays a member's bill directly from that member's account.

To make sure there's enough money to meet its members' needs, Dr. Miller says Medi-Share constantly evaluates how much is coming in, how much is needed, and what their past experience has been. When needs run high, the ministry slows the bill-pay process while trying to stay within a 30-day time frame, or it may increase members' monthly share prices. She points out that since the ministry was founded over 20 years ago, every eligible need has been fully met.

Is healthcare sharing for you?

Healthcare-sharing ministries have traditionally appealed on the basis of their low cost and faith-friendly policies. While the Affordable Care Act has driven renewed interest in the ministries, lower-income families may find that significant government subsidies (where available) on policies available through the health-insurance exchanges make those policies a less expensive option than healthcare sharing. Still, anyone comparing insurance with healthcare sharing should consider their total out-of-pocket costs, including deductibles and co-pays.

Samaritan's Anthony Hopp points out that their value proposition has never been solely based on price. "There's a lot of 'one-anothering' that went on with the early church. This is similar in that it's a way for like-minded believers to bear one another's burdens—not only financially, but emotionally and spiritually."