Under Obamacare, nearly every American has to have health insurance or pay a penalty. One of the few exceptions is for people who are members of what’s called “health care sharing ministries.” The two largest sharing ministries – Samaritan and Medi-Share – have both nearly doubled their membership in Texas since the Affordable Care Act.

The KERA radio story.

Diane Cozart has strong beliefs. Among them, that there should be freshly-baked cinnamon bread around the holidays, and a fully-decorated Christmas tree in the living room.

Lauren Silverman/KERA News

Diane Cozart and her family chose Medi-Share as their health care alternative. Texas is Medi-Share’s largest market, with more than 7,500 members.

She also believes the body is the temple of the Holy Spirit, and in between home-schooling her six kids, she taught each of them to make healthy choices. So when Cozart and her husband found out about the Christian health sharing ministry called Medi-Share fifteen years ago, they signed up the whole family.

“It’s a lot more than insurance, it’s a great piece of mind and it really feels like ministry too,” she says.

Every month Cozart contributes $590 – that’s for her husband and two youngest kids – to a Member Share Exchange run by a credit union. That credit union transfers funds from one member’s bank account to another’s when there’s a medical need that’s covered.

A graphic illustrating how Medi-Share works.

Christian Care Ministry

A graphic illustrating how Medi-Share works.

Faith, And Contributions Required

Sharing Ministries aren’t insurance – there’s no guarantee a bill will be covered — they’re a collection of like-minded individuals who agree to share in each other’s medical bills. Think about it like passing the collection plate at church on Sundays, only at a much larger scale.

There are some additional requirements under the biblical model of sharing, among them: members have to attend church, abstain from extramarital sex and avoid alcohol and drug abuse.

“I like knowing there’s an organization that sees how important it is that I first make healthy choices. Then I like that my insurance dollars are not going to folks who live alternate lifestyles and maybe they do things that are not healthful,” Cozart says. “I feel confident I’m not paying for another person’s bad choices. So my premiums stay down.”

Medi-Share participants do pay less on average than they might for traditional insurance — 30 percent less for according to a 2009 study by the industry trade group the Association of Health Insurance Providers.

Obamacare Fueling Growth

The two largest health care sharing ministries are Medi-Share and Samaritan Ministries, with about 68,000 members and 93,000 members respectively as of Dec, 2013.

Tony Meggs, president of the Ministry which facilitates Medi-Share, says membership has almost doubled in Texas from 4,000 to 7,578 members since 2010 – the same year President Obama signed the Affordable Care Act into law. Meggs says that’s not a coincidence.

“Since the passage of the Affordable Care Act in 2010,” Meggs says, “and where health care sharing ministries have been made an acceptable alternative to the individual mandate, we have seen significant growth.”

There are some provisions of the Affordable Care Act Meggs says insurance industries have to cover that some people in the Christian community would find objections to – for example the morning after pill, abortions, or drug rehab. None of those are covered by Medi-Share.

“It’s not something that is for everyone,” Meggs says.

Regulation Concerns

Under the Affordable Care Act, insurance plans have to cover a set of essential health benefits – things like lab tests, prescription drugs and mental health services. You can’t be can’t be turned down because of a pre-existing condition or because you’re gay, for example.

[More from KERA News: Obamacare 101: Essential Health Benefits]

Kevin Lucia, a Senior Research fellow at the Center on Health Insurance Reforms at Georgetown University, explains these consumer protections don’t apply to health care sharing ministries because they’re not regulated as insurance.

“You don’t have a team of regulators watching them closely to make sure that they’re financially solvent, that they’re not going to go bankrupt if they get a huge claim,” Lucia says.

He also worries that these cost-sharing ministries won’t be held accountable if they refuse to reimburse benefits expressed in their contracts.

Bob Singleton, 60, is a composer and music producer who lives with his wife in Collin County, TX. They are members of the health care cost-sharing group Samaritan Ministries.

Bob Singleton

Bob Singleton, 60, is a composer and music producer who lives with his wife in Collin County, TX. They are members of the health care cost-sharing group Samaritan Ministries.

One Satisfied Customer 

Bob Singleton is a music composer and producer in rural Collin County. His family has used the second largest Christian health insurance alternative – Samaritan Ministries – since 2005 – and says it’s fine by him that there’s no coverage for preventative care. Under Samaritan’s model, contributions are sent directly to the member in need.

“There’s a lot of personal responsibility in this,” Singleton says. “I feel a certain amount of responsibility when I’m submitting a claim that I’m not submitting a claim for something totally superfluous.”

Every month, the Singletons receive a letter from Samaritan Ministries with the name of a person, several sentences about their medical condition, a call for prayer, and for a check.

A few years ago Singleton had to have surgery on his finger that cost over $10,000. Afterwards, he called Samaritan, sent in the receipts, and a month later checks and greeting cards from across the country began arriving in the mail. He says within a few months, he was completely reimbursed for the procedure.

“A lot of people think it is some sort of a Ponzi scheme or multi-level marketing or something like that and it’s not,” Singleton says.

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