Health Care Sharing is a little known and less costly alternative to conventional health insurance that was legally enabled by §5000 of the Patient Protection and Affordable Care Act of 2010, commonly known as the ACA or Obamacare, and referred to throughout as “Traditional Insurance.” Health Care Sharing organizations (HCSs) derive from the ancient practice of religious group members pooling their funds to aid fellow members with their healthcare costs “from those who have to those who need,” although the religious component has faded into the background. Today, Health Care Sharing (HCS) has evolved into true healthcare coverage that is virtually indistinguishable from Traditional Insurance and seamlessly pays for members eligible medical claims, costs, and expenses of members. As Shakespeare famously said in Romeo and Juliet, “a rose by any other name would smell as sweet.” To paraphrase Shakespeare, HCS “smells as sweet” as Traditional Insurance for up to 60% less monthly cost, while offering great, customizable coverage and far smaller deductibles – up to 68% less for hospitalizations! 

Records show Amish and Mennonite communities practicing this concept over 100 years ago. The technological advances of the 1970s and early 1980s enabled some religious groups to expand this concept beyond their local communities, forming the first of today’s HCSs. HCS works like traditional insurance but can charge far less money because, in part, it does not accept people with significant pre-existing medical conditions (PreEx). This is a huge cost saving, because healthy people no longer must pay for the claims of sick people each and every month.

Today, almost two million people are saving significant money while enjoying great healthcare coverage by being HCS members. HCS plans are an effective, legitimate, 100% legal, and far less expensive alternative to Traditional Health Insurance. HCS proves to be equal to or better than Traditional Insurance in nearly every way for those who do not have PreEx, and if you have PreEX, you can of course stay with Obamacare, which takes all comers, even those with PreEx. If you don’t have significant PreEX, remember what Shakespeare said. But if you do have PreEx, we offer both HCS and Traditional all over the United States.  

When the ACA was passed, HCSs were granted an exemption from the ACA’s central requirement that insurers must accept everyone at the same premium rate, even those with PreEx - a huge cost saver for HCS. Not having to insure people with PreEx, along with being able to set reasonable and customizable incident, usage, and coverage limitations so that members can choose annual membership costs and coverage benefit that works for them, results in monthly HCS costs that are as much as 60% less than Traditional Insurance while taking care of preventative medicine, telemedicine, specialists, and hospitalization. 

The benefit of being customizable is a great advantage of HCS over Traditional Insurance, which is not customizable but is rather “take it or leave it.” These differences result in HCSs not only having much lower costs than Traditional Insurance but also much lower maximum out of pocket costs (“MOOP”) – up to 80% lower (a $17,500 Traditional MOOP can become $3,500 with our HCS) while offering good plan design and coverage that is customizable by each member. And there’s no need to wait for open enrollment - you can sign up any time you want.

At their core, HCSs, Traditional Healthcare, and in fact, all forms of insurance, collect funds from policyholders that are sufficient to both pay their claims and make a profit, or in the case of HCSs, since they are all by law 501(c)(3) nonprofit corporations, to create a reserve to pay large claims. All insurance is based on the theory of shared risk pools, the law of large numbers, and actuarial science to ensure that the business model works for everyone, as it does here. HCSs pay their claims just like Traditional Insurance - in fact, HCSs have paid billions of dollars in claims to date! 

Both HCSs and Traditional Insurance employ methods to manage and control the costs of claims, but the HCS method is far more efficient and favors the member in order to reduce the monthly cost of your coverage. Traditional healthcare is bound by the 15% rule – actually a law - that says that insurers may only make a 15% profit on operations. Although it sounds as if this might be a good thing, it actually provides a huge disincentive for Traditional Insurers to save money, because if they spend more on claims they can earn a higher profit given that 15% of a higher number is, obviously, a higher number and more profit. In case you are wondering, the 15% rule was bought and paid for by lobbyists working for the major insurers and was adopted by both political parties in order to keep costs high and their campaign chests full.  

The result of this 15% rule is that Traditional Insurance normally reimburses hospitals, the biggest component of healthcare costs, at a minimum of 247% of the Medicare reimbursement rate based on negotiated discounts from Chargemaster, the hospitals’ full list price for everything they can bill. On the other hand, many HCS reimburse hospitals at 125% of Medicare, almost 50% less than Traditional Insurers pay, because Healthcare Sharers use something called Reference Base Pricing (“RBP”). Federal case law says that hospitals must accept Community Pricing, which is the Medicare reimbursement rate plus 25% - the Reference Base Pricing Rate - which is much less than Traditional Insurers pay hospitals - almost 50% less, a substantial savings that Healthcare Sharers pass on to their members. 

Hospitals list all of the procedures, tests, services, drugs, and actually every single thing they can bill a patient for, along with a code number, in Chargemaster. The Chargemaster prices are very inflated. They are “list” prices, which they then discount, often arbitrarily. Then the major insurance companies enter into contracts with the hospitals, specifying discounts from the ridiculously inflated Chargemaster prices such as $30 for an aspirin. This results in the major insurers reimbursing hospitals based on a discount from inflated retail, rather than a cost plus analysis based on what things actually cost them, which is the way Medicare reimburses. Reference Based Pricing, which was just a fringe movement when it first appeared over twenty years ago, has become much more mainstream today. Some hospitals are even starting to base their insurer contracts on RBP to provide more realistic and competitive price structures. Importantly, it is well settled federal law that has been upheld in multiple court cases that hospitals must accept Reference Based Pricing for all medical procedures and services they provide. Our Healthcare Sharers have retained lawyers to guarantee that their members are protected from any hospital balance bills in excess of the Member Responsibility Amount (think “Deductible”) that was clearly set out in the plan they selected. The fact that hospitals cannot contact patients directly about a balance bill once the Healthcare Sharer becomes involved provides great comfort to HCS members, so being free from the nuisance and expense of balance bills is a great advantage of Healthcare Sharing.

The insurance lobby also accomplished another huge protection for insurers’ high retail pricing by paying billions to both Republicans and Democrats to actually make it illegal for any non-employer association to obtain group healthcare, forcing people who are not employees to pay much higher individual rates. 

If this feels like we’re being tough on the lobbyists, and if this sounds like corruption to you, it’s because that’s exactly what’s going on. Here’s another example of how the lobbyists have paid Congress off to help special interest groups and hurt you. You’ve already heard that you can’t get a bunch of your friends together to form an association to buy group health insurance, saving everyone a lot of money and get better plan design. Actually, that’s how AlumniCare started – trying to help the former CEO of the National Football League Alumni Association, the famous Beasley Reece, get healthcare insurance for his former players. It drove us all crazy to find that this would be illegal because they did not have a common employer. Here’s another one just like that. It’s also illegal for health care insurers to try to negotiate lower drug prices with the major pharmaceutical companies! That’s why U.S. drugs, the same drugs you can buy here, are around 80% cheaper in New Zealand than they are here. These three things, the 15% Rule, the law that says that you cannot buy group health care unless everyone in the plan has a common employer, and the law that says that insurers cannot negotiate price with major pharma – what else can you call them but corruption?

There are many other things wrong with U.S. healthcare that open the door for and make HCS a necessity in addition to the high prices and deductibles of Traditional Insurance, such an obesity, diabetes, elder care, lack of tort reform, and the fact that healthy people have to pay much higher rates just to make it affordable for those with PreEx, and we will talk more about this later. For now, we will just focus on the rose that smells just as sweet and saves you money – healthcare sharing.  

Membership across all HCSs grew from fewer than 200,000 members in 2010 to an estimated 2,000,000 members today. From a member-perceived quality of service standpoint, HCS service matches and exceeds that of traditional health insurers.

How It Works

• Community-Based Approach: AlumniCare operates on the principle of healthcare sharing, where members pool their resources to assist each other with eligible medical expenses.

• Monthly Contributions: Members contribute a monthly amount, similar to a traditional insurance premium, to a shared fund in an escrow account.

• Sharing of Expenses: When a member incurs eligible medical expenses, the cost is covered by the shared fund, helping to cover those expenses.

• Eligibility Criteria:

  • Age: Typically, there are no age restrictions.

  • Residency: Must live within the United Sates of America. Confirm with Larry

  • Pre-existing Conditions: Crucial: AlumniCare likely does not cover pre-existing conditions. This exclusion is a key factor in keeping costs lower for members.

• Sharing Guidelines:

  • Eligible Medical Expenses:

    • Typically cover a wide range of medical expenses, including doctor visits, hospital stays, surgeries, and prescription medications.

    • Specific guidelines may vary, so it's essential to review the detailed list of eligible expenses.

  • Ineligible Expenses:

    • May exclude certain expenses, such as cosmetic procedures, elective surgeries, and expenses related to pre-existing conditions.

  • Unshared Amount: Members typically have an "unshared amount" (similar to a deductible) that they are responsible for paying before sharing begins. Need to confirm if the max out-of-pocket is the same for all tiers of HCS

• Claims Process:

  • Members submit medical bills to AlumniCare for review.

  • AlumniCare verifies the eligibility of the expenses.

  • Once approved, the sharing process begins, and other members contribute to cover the eligible expenses.

• Member Responsibilities:

  • Make monthly contributions.

  • Adhere to the program guidelines and eligibility criteria.

  • Submit medical bills for review and reimbursement.

  • Maintain open communication with AlumniCare regarding any changes in health status.