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Please enable Javascript to view the comments powered by Disqus.In July, abortion rights advocates marched in Austin, Texas, to protest legislation that could shut down all but five abortion clinics and restrict abortion rights throughout the state.
Tamir Kalifa/APIn July, abortion rights advocates marched in Austin, Texas, to protest legislation that could shut down all but five abortion clinics and restrict abortion rights throughout the state.
Tamir Kalifa/APThe fight over abortion in Texas is being played out in federal court, where abortion rights activists are challenging a new state law.
The measure bans abortions at 20 weeks, adds building requirements for clinics and places more rules on doctors who perform abortions. Some clinics have shut down, saying they can't comply with the law set to go into effect Oct. 29.
Abortion rights activists call the new law a dramatic change that will affect all clinics across the state, including a huge Planned Parenthood facility in Fort Worth that opened in June.
It's a $6.5 million center with three surgical suites and 19,000 square feet of space, built specifically to meet the building standards that activists saw coming.
"You know, we did not think the laws would come as quickly as they did," says Ken Lambrecht, president and CEO of Planned Parenthood of Greater Texas.
He says three nurses are required to be in the clinic when abortions are performed. The law also mandates the size of operating rooms, the type of ventilation systems and the width of the hallways.
"You could fit at least two gurneys in this hallway, and it's the size of many hospital corridors," he says. "And it's certainly not necessary for the procedure."
Related Stories The Two-Way Women's Health Groups Sue Texas Over Its New Abortion Law Shots - Health News State Laws Limiting Abortion May Face Challenges On 20-Week Limit U.S. New Regulations Could Treat Virginia Abortion Clinics Like HospitalsLambrecht says there's no medical basis for the new law. He thinks the law is intended to increase costs and shut down clinics, most of which do not meet the new building codes.
Abortion rights groups are challenging the law. At a hearing this week, the state's attorney argued that Texas has the right to regulate clinics and has an interest in protecting the rights of the unborn.
"If the woman chooses to proceed with the abortion, she should have the best care and best environment possible," says state Rep. Jodie Laubenberg, who sponsored the measure.
She says the law is designed to make abortions safer.
"Why would anyone argue against making it a better place and a better environment?" she asks. "If a clinic closes, that is their choice. We're not forcing anyone to close."
Laws like the one in Texas have passed in more than a dozen states. As a result, clinics have closed in states from Virginia to Ohio, and in Texas.
Another provision threatening to close clinics requires doctors to have admitting privileges at a hospital within 30 miles of a facility.
But hospitals do not have to grant admitting privileges. Some say doctors must live in the local community. Others require them to admit a certain number of patients. Some don't approve of abortion.
The doctor in Fort Worth does have privileges, but the hospital is too far from the clinic. That means the brand new Planned Parenthood center there would also have to stop performing abortions.
Across the vast Texas plains, more than 300 miles from Fort Worth, is the city of Lubbock, in the northwest part of the state. It's just an hour from the New Mexico border, and it's home to a much smaller Planned Parenthood clinic. The facility recently stopped scheduling appointments.
Annie Jones recently had an abortion. She's a single mother working and going to school in Lubbock, and she has a 2-year-old daughter, Molly.
Jones, who is 28, says she decided to have an abortion because it was best for her family.
"I knew that if I decided to have the second child, I would be doing it a disservice," she says. "I'd be doing my daughter a disservice because I wouldn't be able to care for them in the way that they deserved."
At least three Texas clinics have closed since the law passed, and Jones is worried that this center could close, too.
"I think that the people who are passing the bills ... are trying to legislate morality, and they see abortion as wrong," she says.
For abortion opponents, passing the measure after a filibuster was a big victory. When Republican Gov. Rick Perry signed the bill, he said it would further what he called "the culture of life in Texas."
"It is our responsibility and duty to give voice to the unborn � the individuals whose survival is at stake," Perry said.
But abortion rights activists say the right to an abortion was decided 40 years ago.
Angela Martinez, director of the Lubbock clinic, says if her facility closes, women seeking abortions would have to travel more than 300 miles.
"We are the only clinic in West Texas who sees patients and performs abortions," Martinez says. "It's frustrating for me. It's frustrating for my staff, just because ... we want to be available."
Just outside the clinic on a recent crisp morning, a few protesters stand holding signs. Krysten Haga says she sees the law as a first step, not as the end of this debate.
"I'd like to see abortion completely banned in the United States," Haga says. "That's ideally what we're looking for � is for abortion to not be an option at all."
A federal judge is expected to rule soon whether part of the new Texas law will go into effect next week.
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Please enable Javascript to view the comments powered by Disqus.HealthCare.gov was meant to create a simple, easy way for millions of Americans to shop for subsidized health care.
Instead, in a little two more than weeks, it has become the poster child for the federal government's technical ineptitude.
A dysfunctional contracting system clearly bears some of the blame. But entrepreneurs in Silicon Valley likely would have approached the project differently from the start.
A week after the site launched, NPR spoke to Suzanne Cloud, a jazz musician based in Philadelphia. At that point, Cloud had spent hours on the site, trying to sign up for coverage. "Something went wrong, and it just went to a page with all kinds of html stuff," she said.
This week, Cloud says she gave up on the website and ended up registering by phone. The folks on the phone took all of her information � then asked if she'd like to pick out her plan online or receive information about her health care options via snail mail.
Cloud chose snail mail. "Once I signed up with the telephone, I didn't go back and try the site again," she said.
At 17 days old, HealthCare.gov has become a bit of a joke � even to folks like Cloud, who were eagerly awaiting its rollout.
So how could a roughly $400 million software project that had been in the works for years have so many problems at its launch? One bit of advice from Silicon Valley: Start small.
"It's not as if Facebook says, 'OK, here is our six-year plan for how we're going to make Facebook.com,' " says entrepreneur Ben Balter. "They build one feature at a time, and take a step back, look at how the feature is be used, before they go on to the next feature."
Balter says you build something small, you test it, and when it works for your users, then you take the next step. Right now, Balter works for GitHub.
"GitHub is a social code-sharing service," he says. "Think of it like Facebook for code. So instead of posting pictures of your kids or posting ... on Twitter what you had for lunch, you are showing what projects you're working on."
By sharing the code you are writing, lots of people can critique it, find the bugs, offer ideas and make sure it works. It's called open source, and Balter believes HealthCare.gov should have been written that way from the start.
"Why would you make that code private?" Balter asks.
But often when things don't work in government, the impulse is to duck and cover and clamp down on information.
"I think the key reason is the way projects get funded," says Michael Cockrill, who used to work in startups and is now the chief information officer for Washington state.
He says to get a software project funded in the public sector, typically you have say exactly what it is going to do, spell how much it will cost and when you will finish.
"As a result, you end up creating this culture that is all about doing what you said you were gonna do," Cockrill says.
It's a culture that is risk-adverse and terrified of public failure. You can't learn from little failures or adjust course midstream. And instead of taking big jobs, breaking them down into small tasks and testing for success at each step, a project like HealthCare.gov becomes a giant all-or-nothing gamble.
Cockrill says too often it's a gamble taxpayers loose.
"You've made all these commitments about what you are going to build. What is it going to look like upfront," Cockrill says. "And even if the market changes underneath you, and even if your customers need something different � which you know always happens � you made a commitment a big public commitment, and they've written it into budgets and law."
Cockrill and many others around the country are trying to help governments become more flexible and agile as they embark on software development projects.
"It's really hard to convince people to kind of trust you," he says. "Especially when you are saying, 'Look I don't know exactly what is going to look like � but we are going to do what matters most first.' "
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Please enable Javascript to view the comments powered by Disqus.This is one of several explainers to help consumers navigate their health insurance choices under the Affordable Care Act, or as some call it, Obamacare. Click here for answers to other common questions. Have a question we missed? Send it to health@npr.org. We may use it in a future on-air or online segment.
About The ExchangesWhat is a health insurance exchange?
It's an online marketplace where individuals and small employers can shop for insurance coverage. Enrollment began Oct. 1 for policies that will go into effect on Jan. 1. The exchanges will also help people find out if they are eligible for federal subsidies to help cover the cost of coverage or if they are eligible for Medicaid, the federal-state health insurance program for the poor.
When can I shop at my exchange?
You can enroll until March 31, 2014, though you'll need to sign up and pay your first premium by Dec. 15 of this year if you want to be covered when the mandate to carry health insurance kicks in on Jan. 1. If you sign up and pay premium between Dec. 16 and Jan. 15, 2014 - coverage starts on February 1.
Jan. 16 - Feb. 15: coverage begins March 1.
Feb. 16 - March 15: coverage begins April 1
March 16 - 31: coverage begins May 1.
Generally, people will be able to enroll in or change plans once a year during an annual open enrollment period. This first year, that period is unusually longer in subsequent years the time period will be shorter, running from Oct. 15 to Dec. 7.
Do all states have exchanges?
Yes. Sixteen states and the District of Columbia are running their own exchanges and the federal government is setting them up in 27 states. In seven states, federal and state officials are partnering to run the exchanges. You can get information about the exchange at healthcare.gov, which has details on the federal exchanges and links to state-run exchanges.
Do I have to buy insurance on an exchange?
Some people do, but definitely not everyone. These exchanges are for two major groups of people: Those who don't have insurance now, and those who currently purchase their own insurance, meaning they don't get it through an employer.
If you have insurance at your job or through a public program like Medicare, Medicaid or the VA, you don't need to pay attention to the exchanges unless you lose that coverage for some reason. If you have insurance through your employer, you can shop for and buy insurance on an exchange if you like, but you probably won't qualify for a subsidy or tax credit. And you would lose the contribution your employer makes toward health insurance.
How does it work to shop for insurance from an exchange?
In theory, you can do it all or most of it online. You go to healthcare.gov or to your state-run exchange, if there is one, and create an account. You provide some basic information, like where you live and how old you are and you'll get a list of plans available in your area. If you provide income information, you'll be able to get an estimate of whether you'll eligible for federal help paying for insurance or whether you might qualify for Medicaid.
The exchange will offer a list of health plans and their premiums and out-of-pocket costs, including deductibles and co-payments. If you decide to buy one of those plans, in most cases, you will be directed to the insurer's Web site to make the payment. Some plans or insurance companies may require a phone call to set up payment. In some jurisdictions, consumers will make their first premium payment to the exchange and then further monthly payments to the insurer.
If your income makes you eligible for a tax credit subsidy, it will be applied upfront to the monthly premium payment. You won't have to wait until you file your taxes in 2015 to get the credit.
You can also fill out paper applications or apply over the phone.
What if I need help with signing up?
The federal government has set up call centers to answer questions from people in states with federal exchanges. That phone number is 1-800-318-2596. States running their own exchanges also have individual call centers.
Most states have also trained people called assisters and navigators who can walk people through the process, although in some states the training for them has been delayed. Contact information can be found on the exchange websites.
Who Shops At ExchangesIf my employer (or former employer, if I'm retired) offers me insurance, can I shop on the exchange to get a better deal?
Even if your employer offers coverage, you can opt to buy a plan on the exchange. However, you may not be eligible for a subsidy.
If I am buying coverage on my own, do I have to buy it on the exchange?
Consumers can shop for coverage on or off the exchange. However, subsidies for those who are eligible are generally available only for plans sold on the exchange.
Can I wait until I get sick to sign up for insurance?
No. You can't just sign up when you're sick and facing big medical bills. Otherwise that's what everyone would do. The exchanges under the Affordable Care Act have been designed pretty much the same way most employer insurance plans are: There's an open season every year when you can buy or change plans, and that's generally the only time you can buy or change plans.
I am on Medicare. Do I need to use an exchange?
No. Medicare is not part of the health insurance exchanges and Medigap policies are not being sold or subsidized through the exchanges. As a Medicare beneficiary, you can enroll at Medicare.gov to get the program's traditional drug coverage or a Medicare Advantage plan, where Medicare enrollees get coverage through private health insurance plans. The Medicare open season begins Oct. 15.
What about federal workers?
Most federal workers will continue to get their health coverage through the Federal Employees Health Benefits Programand not be required to purchase coverage through the health law's marketplaces. Members of Congress and their personal staffs, however, will be required to buy health insurance through the exchanges.
I'm a U.S. citizen living abroad. Do I need to buy health insurance on an exchange?
No, you need to find insurance that will cover you in the country where you live.
What if I am an immigrant in the U.S. legally?
Legal immigrants are permitted to use the marketplaces � and may qualify for subsidies if their income is less than about $46,000 for an individual and $94,200 for a family of four. Legal immigrants may qualify for Medicaid if their income is low enough. The laws governing benefits to lawful immigrants are quite complex. The federal Department of Health and Human Services has a guide to Medicaid and other benefits for immigrants.
What if I am an undocumented immigrant?
Immigrants who are in the country illegally are barred from buying insurance on the exchanges.
Do small businesses have to shop at the exchanges to cover employees?
There are no requirements for employers with fewer than 50 workers to buy health insurance for their employees. Many small business do offer health care as a benefit, however, and for them, the insurance exchanges represent a new option for them in terms of where to shop.
Certain employers with fewer than 25 workers are eligible for federal tax credits. To qualify, the company has to cover at least half of the premium for all of its employees, and also have average wages of less than $50,000. For details on these tax credits, see this answer sheet from the IRS.
Costs And SubsidiesHow much will insurance cost me on the exchange?
It depends on several factors, including your income, the state in which you live, your age, whether you smoke or not and your family size, among other factors. You could end up paying very little or nothing at all if your income falls within a certain range. If you do not qualify for a subsidy, coverage could be quite expensive � well over $1,000 a month in some cases. But this may still be lower than what you are paying now, if you have an individual policy.
There are caveats. One is that the cheaper plans come with big deductibles and lots of other out-of-pocket costs. Now, if you don't think you're going to have much in the way of medical expenses, that may be fine. But people should be aware that if they buy a plan that only costs $40 or $50 a month, they may have a $5,000 or $10,000 deductible before the plan starts paying benefits.
The other is that some of these less expensive plans come with very limited lists of doctors and hospitals. So if you have a particular doctor or hospital you know you want to use, you should check that before you sign up.
What if I can't afford the premiums?
The health law provides fairly generous subsidies for many people, effectively lowering their monthly premiums. The subsidies are on a sliding-scale, though, so they become less generous as your income grows. If your income is income between 100 percent of the federal poverty level ($11,490 for an individual) and 400 percent ($45,960), you can get some help paying for premiums. A family of four can get a subsidy, although just a small one, with income up to $94,200.
Some people also can get help with deductibles and co-payments. To qualify, your income has to be less than 2.5 times the poverty level ($28,725 for an individual or $58,875 for a family of four). You also have to choose a so-called silver plan. That's the second lowest cost of the four levels of coverage that will be available � bronze, silver, gold and platinum.
Subsidy amounts are calculated based on your modified adjusted gross income, a figure you can find on your annual tax return by adding lines 8b and 37 on IRS form 1040. That includes things like wages and interest, less deductions like tuition and alimony, and additional payroll taxes paid by the self-employed. it does not include assets such as the value of your house, stocks or retirement accounts. You'll be asked to estimate what your income will be for next year; if you're wrong, you'll have to reconcile with the IRS come tax time the following year.
What if I guess wrong on what my income will be for next year?
If your income increases during the year, notify the exchange promptly so that you can avoid having to pay back the subsidy. On the other hand, if your income goes down, you could be eligible for a bigger subsidy. Either way it's important to notify the exchange if your income changes.
How do I claim the subsidy?
If you qualify for a subsidy to pay your premiums, you can choose to either have the credit sent directly to the insurer or pay the whole premium up front and claim the credit later on your taxes.
If you qualify for help with deductibles and co-payments, that subsidy will be sent directly to the insurer, and you won't have to pay as much out of pocket.
Will everyone pay the same price?
You won't have to pay more for insurance if you have a medical condition and that condition will be covered when your policy begins. But older people can be charged more than younger people and smokers face a surcharge.
About The Plans And BenefitsDo the exchanges have a good selection of plans to choose from?
The number of plans that you can choose from varies widely. In some states, only a couple of insurers are offering policies though the marketplace, while in others there may be a dozen or more. Even within a state, there will be differences in the number of plans available in different areas. Insurers generally offer a variety of types of plans, including familiar models like PPOs and HMOs.
What health services are covered?
Each plan offered has to cover 10 "essential health benefits." These include prescription drugs, emergency and hospital care, doctor visits, maternity and mental health services, rehabilitation and lab services, among others. In addition, recommended preventive services, such as preventive mammograms, must be covered without any out-of-pocket costs to you. It's important to keep in mind that the insurer does have some discretion about which specific therapies they'll cover within each category of benefit. So it's very important to study the plans carefully to make sure it is offering any specific benefits you may need.
There's a cap on how much you pay out-of-pocket for medical services each year. That cap is $6,350 for individual policies and $12,700 for family plans in 2014. Your regular monthly premiums do not count toward the cap.
What's this about Bronze, Silver, Gold and Platinum plans?
Plans are divided into four different types � bronze, silver, gold and platinum � varying based on the size of their deductibles, copayments and other consumer cost-sharing. The bronze play pays for 60 percent of medical costs; the platinum, 90 percent. Premiums are highest and deductibles the lowest for platinum plans. Bronze plans generally have deductibles in the thousands of dollars; $5,000 and $10,000 deductibles are not unusual for bronze plans. Within each tier, the amount you pay for deductibles, copayments and co-insurance may vary from company to company and even from plan to plan within companies.
No matter which plan you choose, the 10 essential benefits remain the same. There is also the option to purchase catastrophic insurance � low cost plans that cover minimal services but provide a safety net in the event of an accident or serious illness. But those plans do not come with subsidies.
People up to age 30 will have the option of buying a catastrophic plan that will cover only minimal services until they meet a deductible of roughly $6,400. The premium is usually much lower than the other plans. After the deductible is met, the plan covers the 10 essential health benefits � a kind of "safety net" coverage in case you have an accident or serious illness, according to the Healthcare.gov website. Catastrophic plans usually do not provide coverage for services like prescription drugs or shots. And there are other limits.
How do I know which health plan is best for me?
You should carefully weigh the state of your health with your financial situation. For example, a person who's 27 and in excellent health may decide that the low premium and high deductibles of a Bronze or Silver plan are their best bet. Of course, an illness or accident can arise at any time, so you'll need to take that into consideration. That's why they call it insurance.
For older adults with a chronic health condition or regular prescription expenses, it may be best to consider a Gold or Platinum plan with a higher premium that gives you a policy with lower out-of-pocket expenses for doctors visits and hospital stays.
Can I keep my doctor?
If you're shopping for a new policy on the insurance exchanges or are eligible for Medicaid, the answer is "Maybe." For private policies purchased through the exchange, it all depends on the list of doctors that the health plan considers 'in network.' If your doctor isn't in the plan's network, you'll likely pay a higher amount for co-insurance or copayment. The number of doctors who take Medicaid is growing in states where the program is being expanded, but the number of doctors who take Medicaid is still limited in most areas.
Can my insurer drop me?
Your insurer generally can't drop you, as long as you keep up with your insurance premiums and don't lie on your application.
Do all insurance companies have to offer policies through the exchange?
No. Insurers are not required to sell through the exchanges. In several states, for example, the largest insurers decided not to offer insurance this year, while they wait to see what happens. Some were concerned about the negative publicity that might result if the exchanges got off to a shaky start. Others wanted to wait to see if this market would be profitable.
Can insurers deny me coverage because I have an existing medical condition?
No. The Affordable Care Act prohibits discrimination on the basis of prior or existing health conditions.
Other Questions Related To ExchangesCan I change insurance plans?
Generally, you are only able to enroll in or change plans once a year during an open enrollment period. This first year, that period runs from Oct. 1, 2013 to Mar. 31, 2014. In subsequent years the time period will be shorter, running from Oct. 15 to Dec. 7.
There are certain circumstances when you will be able to change plans or add or drop someone from coverage outside the regular annual enrollment period. This could happen if you lose your job; get married or divorced; give birth to or adopt a child; or move to a different state. Any of those life events triggers a special 60-day enrollment period where you can change or buy health insurance on an exchange. Otherwise, you'll have to wait until the next open enrollment.
What personal information will I have to give the exchange?
You'll need to set up an account with your name, address and social security number. If you have an email address, you can provide that, too. The exchange will want to know about your marital status; the number of children under 18, birthdays of anyone who'll be covered; whether you smoke; financial information and citizenship status. The financial and citizenship information will be checked against records at the Internal Revenue Service and other government agencies.
See other Frequently Asked Questions on the Affordable Care Act:
Understanding The Health Insurance Mandate And Penalties For Going Uninsured A Young Adult's Guide To New Health Insurance Choices What Retirees And Seniors Need To Know About The Affordable Care Act How Obamacare Affects Employers And How They're Responding Where Medicaid's Reach Has Expanded � And Where It Hasn'tAdditional coverage from NPR Member Stations:
California (KQED, San Francisco) California (KPCC) California (KXJZ Capital Public Radio, Sacramento) Colorado (Colorado Public Radio) Massachusetts (WBUR, Boston) Minnesota (Minnesota Public Radio) Georgia (WABE, Atlanta) New York (WNYC) Oregon (Oregon Public Broadcasting) Pennsylvania (WHYY newsworks.org) Texas (KUHF) Texas (KUT, San Antonio)This FAQ was produced through a collaboration between NPR and Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health-care policy research organization. The Kaiser Family Foundation is not affiliated with Kaiser Permanente.
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Please enable Javascript to view the comments powered by Disqus.No matter what happens in Congress, the Affordable Care Act deadlines are still in effect. On Tuesday, public exchanges will open for business. Already, several companies are making changes to how they provide health care to their employees.
Host Arun Rath speaks with NPR's Julie Rovner about those changes and the difference between public and private options. You can hear their conversation � and the full story on the health care sharing ministries � at the audio at the top of the page.
The Affordable Care Act requires nearly every American to have health insurance or pay a penalty, beginning Jan. 1. The so-called "individual mandate" has been controversial ever since the law was passed.
But for people who fall into a few select categories, the mandate doesn't apply. Like Native Americans who get health coverage through the Indian Health Service, or people who are incarcerated.
Another exception is for members of "health care sharing ministries," a way for individuals with a "common set of ethical or religious beliefs" to share medical bills.
Sharing Health Burdens
The sharing ministries are not insurance: there's no guarantee that a given bill will be covered. Instead, it's like a co-op, where members decide what procedures to cover, and then all pitch in to cover the cost as group.
"It's a group of people, in this case Christians, who band together and agree that they want to share one another's burdens," says Andrea Miller, medical director for the largest Christian health-insurance alternative, Medi-Share.
She says members put aside a certain amount of money every month, which then goes to other Christians who need help paying their medical bills. Medi-Share's monthly fees vary, but its website advertises that family options "average less than $300 a month."
There are a few requirements to fulfill before participating, Miller says. The first is that you have to be Christian. "Second, you need to agree to living a Christian lifestyle, including no smoking, including not abusing alcohol or drugs," she says.
To constitute as a health care sharing ministry � and therefore be exempt from the Affordable Care Act requirements � the nonprofit has to have been in existence since 1999 (Medi-Share has existed since '93). The ministries also have an independent accounting firm conduct a publicly available annual audit.
Footing The Bill
Tens of thousands of Americans belong to Christian health sharing ministries, including Fred Bennett of Chattanooga, Tenn.
Bennett and his wife, Beth, have belonged to a health care sharing ministry for 19 years. They've always been healthy, but in the last few years, as they've entered their 60s, they started to have medical trouble.
"In '04, my wife was rushed to the hospital with E.coli in her kidneys and, actually, it spread to all of her body," he says.
She recovered, but the hospital bill was staggering. After six days in the hospital, most of which was spent in intensive care, the cost came to about $70,000.
Shots - Health News 'How Much Will Obamacare Cost Me?' Try Our CalculatorAnd that bill was just the beginning for the Bennetts.
"She hasn't had many claims, but unfortunately, I had a stretch of five or six years there that things were pretty rough," Bennett says, including multiple surgeries and a heart attack.
The medical bills reached tens of thousands of dollars, but for each incident, the Bennetts paid only their $250 deductible. The rest was paid by fellow Christians through Medi-Share.
Of course, the same would have been true if they had normal health insurance. But Bennett says he prefers the health sharing ministry because the ministry doesn't pay for procedures he thinks are immoral, like abortions.
"The part I liked about it was that I wouldn't have to be having some of my premiums spent to take care of someone who wasn't taking of themself, physically or spiritually, either one," he says.
What's Not Covered
While the federal health law includes an exemption for health sharing ministries, some states have sued to try to keep them out. The concern is that consumers shopping for insurance will be confused about what ministries really guarantee in the way of coverage.
"We do not share in every medical need that a person has," Miller of Medi-Share says. "Some of the things we don't share in are related to lifestyle issues, such as an abortion. But others of them are related to things that the members have agreed that they would rather pay for themselves."
For example, she says, members tend to pay for their own preventative care (with the exception of very young children). There are also some restrictions on pre-existing conditions.
At Medi-Share, Miller works with a steering committee of health share members who discuss what kind of care is covered by the guidelines. "Any significant change in the guidelines is something that has to be passed by all the members," she says.
In August, CNBC reported that members whose claims are rejected have the right to file an appeal. In the current fiscal year, 76 percent of the bills submitted to Medi-Share were considered eligible, and all of those were covered, Medi-Share told CNBC.
Spiritual Support
Bennett of Tennessee points out that because all the members decide what to share the cost of, health ministries often cover things insurance rarely does, like adoption fees and funeral costs. Plus, he says, his health sharing ministry gives him a service he could never get from an insurance company.
"The night before my surgery, the lady who'd helped me locate the right providers and everything called me back and said, 'Would it be OK if I prayed with you for your surgery tomorrow?'"
Three days later, she called back to ask how the surgery went.
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