Health care sharing ministries are not health insurance, do not have to cover pre-existing conditions, and have no legal obligation to pay your medical bills. Because you are moving to the US legally, you qualify for official, guaranteed health insurance through the government Marketplace.
“I'm moving to the US from Canada in a few months and have never had to pay for health insurance out of pocket. How do health share programs work, and are they too good to be true compared to traditional insurance?”
Summary
You can cross this worry off your list. You do not have to gamble on unregulated plans to afford care in the US. Because you will be lawfully present, you can buy the same guaranteed health insurance that protects US citizens from medical bankruptcy.
The US has official health insurance that guarantees your coverage, and unregulated alternatives that do not. Here is how they compare for your move.
Official health insurance that must pay your covered claims, cover pre-existing conditions, and protect you financially.
Unregulated programs that pool money but are not legally required to pay your medical bills.
Clinics that provide primary care based on what you can afford, if you cannot get insurance right away.
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The truth about health share programs
How health share programs work: In a health care sharing ministry, members pay a monthly amount to share the costs of health care with other members. The organization either matches paying members with those who need funds or pools the money to pay members directly. They often attract people because they charge lower up-front costs than traditional insurance.
Are they too good to be true? Yes. State insurance regulators warn that these programs are not insurance products. They often provide very limited benefits and usually do not have provider networks, meaning doctors and hospitals can charge you full price.
No legal protection for pre-existing conditions: Because health share programs are not legally classified as health insurance, they do not have to follow the consumer protection rules of the federal Affordable Care Act. The federal Affordable Care Act is the law that requires real insurance plans to cover treatments for pre-existing conditions and cap your out-of-pocket costs. Health share programs are exempt from these rules.
No legal obligation to pay claims: Health share programs cannot guarantee they will pay your claims. While they might share funds when you have a health need, they are not legally required to do so. If you have a massive medical bill, the program can simply choose not to pay it, leaving you entirely responsible.
Next steps
To avoid the risks of health share programs, you can enroll in official health insurance through the government Marketplace.
Establish your lawful presence
To buy Marketplace insurance, you must live in the US and be lawfully present. Valid non-immigrant visas and Lawful Permanent Resident status both count as lawfully present.
Apply during an enrollment window
You can enroll during the yearly Open Enrollment period, which runs from November 1 to January 15. If you need to enroll outside of those dates, you must qualify for a Special Enrollment Period due to a life change. There is no official rule stating if moving to the US qualifies as this life change, but it is often worth checking Healthcare.gov or calling their contact center when you arrive to see if your move opens a window.
Apply for cost savings
You might qualify for a premium tax credit to lower your monthly payment and extra savings on out-of-pocket costs. This depends on your income compared to the Federal Poverty Level. The Federal Poverty Level is a measure of income the government uses to decide if you qualify for benefits. You can get these savings if your expected annual household income is between 100% and 400% of the Federal Poverty Level.
Use a community health center if you have a gap
If you cannot get Marketplace coverage immediately, you can get primary care at a community health center. They charge on a sliding fee scale based on your income.
Legal sources
The rules for US health insurance eligibility and the legal status of health share programs come from the US government and state insurance regulators.
NAIC Consumer Insight
Health care sharing ministries are not insurance and are not legally obligated to pay your medical claims.
HCSMs are not insurance and can't guarantee the payment of claims; i.e., while they may share funds with members who have health needs, they are not legally required to do so.
NAIC Consumer Insight
Health share programs are exempt from the Affordable Care Act rules that require covering pre-existing conditions.
HCSMs do not have to comply with the consumer protections of the federal Affordable Care Act (ACA), like covering treatments for pre-existing conditions or capping out-of-pocket costs.
NAIC Consumer Insight
Health share programs work by having members pay a monthly amount that the organization uses to pay for other members' medical expenses.
A member will typically contribute a monthly payment to cover the qualifying medical expenses of other members. The HCSM will match paying members who need the health care funds or pool all the monthly shares and administer payments to members directly.
Healthcare.gov Marketplace Basics
You must live in the US and be lawfully present to buy official Marketplace health insurance.
To be eligible to enroll in Marketplace health coverage , you must live in the United States, be a U.S. citizen or national (or be lawfully present), and not be incarcerated.
Healthcare.gov Lawfully Present Immigrants
Having a valid non-immigrant visa makes you lawfully present for health insurance purposes.
The term “lawfully present” includes immigrants who have: ... Valid non-immigrant visas
Healthcare.gov Marketplace Basics
The standard time to sign up for health insurance is between November 1 and January 15.
Open Enrollment is November 1 - January 15
Healthcare.gov Marketplace Basics
To sign up outside of the standard window, you must have a life change that qualifies you for a Special Enrollment Period.
Outside the yearly Open Enrollment, you can get coverage or change plans only if you: - Have a life change that qualifies for a Special Enrollment Period
Healthcare.gov Lawfully Present Immigrants
You can get discounts on your monthly insurance payments if your income is between 100% and 400% of the Federal Poverty Level.
If your annual income is between 100% and 400% of the FPL, you may qualify for the premium tax credit and extra savings on Marketplace health coverage.
Healthcare.gov Immigration Status
If you cannot get Marketplace insurance, community health centers offer primary care based on what you can afford.
If you aren't eligible for Marketplace coverage you may be able to get health care at a lower cost through a community health center. They provide primary care services on a sliding fee scale based on your income.
SettleKit is not a law firm and this is general information, not legal advice. Confirm your specific situation with a licensed immigration attorney.
SettleKit is not a law firm. This is general information, not legal advice.
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