To many, a health care sharing industry is a rather unfamiliar term, but as a New Hampshire reporter shows, they’ve been around for decades, and two in particular are drawing some attention in his state.
According to Bookman, health care ministries have been around for several decades and are rooted in Christian communities of faith with a central idea that people should help each other in times of need.
“Members of health care sharing ministries essentially pay monthly premiums, with the expectation that that money will be shared amongst all the members when a medical bill arises,” he said.
Ministries function in different ways, Bookman explained. In some, members mail their monthly premium check to other members who have had healthcare bills. Others function like a clearinghouse, so when a patient gets a medical bill, they request payment from the central clearinghouse.
This is in contract to traditional health insurance in one key area, he said.
“There’s really no guarantee of coverage,” Bookman said. “These entities are exempt from regulations that apply to other health insurance companies, including the no ban on pre-existing conditions.”
In addition, the religious nature of these ministries often means that patients have to follow Christian rules.
“They really adhere to a Christian set of beliefs,” Bookman said. “To join, members often have to pledge to live a moral lifestyle … and these entities, also, generally speaking, won’t cover abortion services.”
Health care sharing ministries generally attract people with deep-faith traditions. The “sticker prices” for the ministries are generally much lower than traditional insurance plans, sometimes as low as one third of the cost, Bookman said. Some are also attracted to the idea of helping like-minded people in their time of need.
“There’s also a feeling of community that can be created with these ministries,” he said.
Health care ministries are growing in popularity, though it is difficult to get exact figures due to the lack of regulation on them. An industry group Bookman has worked from has released statistics estimating that there are roughly 100 different ministries nationwide, covering 1 million members. And the digital age has made learning more far easier, he said.
“There’s just more information available about these ministries,” Bookman said. “It used to be, perhaps, hard to research them, but now, they all have websites.”
Since the signing of the Affordable Care Act, those numbers have only increased.
“When the Affordable Care Act was signed, there was an exemption carved out – the individual mandate did not apply to people who received coverage through a health care sharing ministry,” he said.
But there can be downsides to these plans, Bookman cautioned. One health care sharing ministry customer he spoke with said people have to go into it knowing what will and won’t be covered. For example, the man knew he could not have a mammogram covered and would have to pay for that out of pocket. To some, the savings from joining a ministry balances out that added cost.
“You really just need to be an astute user of the healthcare system. You have to be able to negotiate with your healthcare provider,” he said. “You have to be willing to reject certain charges and take, say, a hospital to task for certain bills. … This is not insurance, but it is a program and it is a way for people to have their medical bills covered.”
Some of these health care sharing ministries are being banned from doing business in several states, including New Hampshire. Bookman said this applies to two ministries in particular: Aliera Group and Trinity. Aliera is a for-profit company founded in 2015, and Trinity is a nonprofit founded in 2018.
“These two entities, they are legally distinct entities, though we should note there appears to be some clear relation between them,” Bookman said.
The two companies rent office space from each other and are both based in Georgia. Trinity functions as a healthcare sharing ministry, and it has commandeered scrutiny along with Aliera, which does the marketing and administrative work on Trinity’s behalf.
As Bookman has reported on, regulators in New Hampshire argued that Aliera and Trinity weren’t following regulations. In May of this year, regulators in Texas filed an action to stop Aliera and Trinity from offering products in that state. This was followed by moves in Washington state and Colorado. In New Hampshire, in late October, his state’s insurance department filed a cease and desist order.
Bookman said New Hampshire had three main allegations.
“One is that, under New Hampshire state law, for these healthcare sharing ministries to operate, they must’ve been formed before Dec. 31, 1999,” he said. “Another allegation is that these ministries, they need to clearly establish that they’re faith-based organizations, and the state insurance department is alleging that Trinity and Aliera, that their marketing materials don’t make that clear enough. And then, there’s a third point … which has to do with offering the coverage to groups instead of just an individual market.”
Bookman stressed that there are some health care sharing ministries that are operating without problems, and many in the industry are thus saying that Trinity and Aliera are casting all health care ministries in a bad light.
“There are healthcare sharing ministries with little or no complaints or scrutiny, … and then there’s this Aliera/Trinity institution, which has generated dozens of complaints to the New Hampshire insurance department about their practices from consumers here in the state,” he said.
The Aliera/Trinity cases show that state insurance departments seem to have some ability to take action when a healthcare sharing ministry is violating certain regulations, Bookman said. There are some regulations, as the ministries do have to meet certain requirements to function in the state, requirements several states say Aliera and Trinity violated.
“It does appear as though consumers do have an option to contact their local regulators if they feel as though their rights have been violated,” Bookman said.
So far, though, there haven’t been any nationwide regulations on these ministries, and state governments don’t seem to be increasing regulations in response to the Aliera/Trinity cases.
Based on the news he’s seen and covered, Bookman said the future of these ministries is rather uncertain. As for the Aliera/Trinity legal battle, the two are requesting an appeal in New Hampshire, and despite the frequent coverage, the two companies are still not household names. As such, for now, Bookman cautions everyone to do their homework before signing up for any health care ministry.
Correction: A previous version of this article referred to one of the health care sharing ministries as "Alera." The correct name of the company is "Aliera."