Health Sharing in Idaho: How It Works and How Programs Compare

What health sharing is

A health care sharing program is a group of members who agree to share each other's eligible medical bills under written guidelines. Each member pays a monthly share. When a member has a large eligible bill, money from the group helps pay it.

It isn't insurance. Nobody is legally required to pay your bills, so sharing is voluntary and not guaranteed. It isn't Minimum Essential Coverage under the ACA, and you can't get a tax credit for it. In exchange, monthly amounts are often well below the full price of an individual plan, and there's no provider network.

Health sharing and Idaho law

Idaho Code § 41-121 says a qualifying health care sharing ministry isn't in the business of insurance. It also requires a specific notice on the ministry's applications and guidelines. That notice says the organization isn't an insurance company, that help from other members is voluntary, and that you're always personally responsible for your own medical bills. We repeat the full notice at the bottom of this page. Idaho has no state penalty for going without insurance.

How a big bill is handled

Here's how it works with the program we most often recommend (Sedera, under its current Membership Guidelines):

1. Call first. Contact a Member Advisor as soon as you know about planned care. For emergencies, notify the program within 48 hours.
2. Pay your Initial Unshareable Amount (IUA). You pay the provider up to your IUA for that Need, as a self-pay patient. The IUA applies per Need, not per year, and no more than three apply in a membership year.
3. Open a Needs case. Upload itemized bills within six months.
4. Bills are negotiated. The program negotiates bills over $1,000 on your behalf.
5. Shared money is paid to you, and you pay the provider.

What isn't shared

• Routine and preventive care, apart from some screenings. That's the job of direct primary care.
• Ongoing prescriptions beyond the first 120 days after a new diagnosis.
• Pre-existing conditions in year one. Conditions from the 36 months before joining are phased in: nothing in year one, up to $25,000 in year two, up to $50,000 in year three, then fully shareable.
• Maternity unless the due date is at least nine months after you join. The maternity IUA is twice your normal IUA, up to $5,000.
• Counseling above $750 a year, routine dental, glasses and contacts, and alternative medicine.

This list is why we pair sharing with a virtual primary care membership and a dental savings plan.