This post may contain affiliate links, which means if you enroll through my link, I’ll receive a small commission at no extra cost to you.
If you or someone in your household has a pre-existing condition, this might be one of the most important things you read before deciding to join a health share or switch to a different one. Health shares can be a great way to save money on healthcare, but when it comes to pre-existing conditions, there are some crucial details you need to understand upfront. Let’s break it all down so you can make the best decision for your situation.
What Is a Pre-Existing Condition in a Health Share?
Health shares are not health insurance, and they operate under different guidelines—especially when it comes to pre-existing conditions. A pre-existing condition in the context of a health share is any medical issue, symptom, or diagnosis you had before joining. This includes:
- Any diagnosis you’ve received from a doctor
- Any treatments you’ve undergone
- Any signs or symptoms you’ve experienced, even if you never sought medical attention for them
Essentially, if there were any indications of a medical condition before you became a member, a health share will likely consider it pre-existing.
Why Does This Matter?
Unlike health insurance, which may be required to cover pre-existing conditions due to regulations, health shares have specific sharing limitations when it comes to these conditions. However, that doesn’t mean you can’t join a health share if you have a pre-existing condition—it just means there’s typically a phased-in approach to sharing.
How Health Shares Handle Pre-Existing Conditions
Most health shares follow a phased-in approach, meaning that as time passes, your pre-existing condition may become eligible for more sharing. While specifics vary by health share, a general guideline looks like this:
- Year 1: No sharing for medical expenses related to pre-existing conditions.
- Year 2: Limited sharing (e.g., up to $15,000–$25,000 after meeting your Initial Unshareable Amount [IUA] or Member Responsibility Amount [MRA]).
- Year 3: Increased sharing limit.
- Year 4: Some health shares stop considering it a pre-existing condition entirely or have a higher cap for sharing.
Exceptions to the Pre-Existing Condition Rules
Some health shares make exceptions for specific conditions, particularly those that are well-managed. For example:
- High blood pressure, high cholesterol, or diabetes may not be considered pre-existing if controlled through lifestyle or medication.
- Cancer, heart disease, or recent major surgery will always be classified as pre-existing and subject to phase-in rules.
Should You Join a Health Share if You Have a Pre-Existing Condition?
This ultimately depends on your medical situation and healthcare needs. Consider the following:
- If you require ongoing, immediate care for a condition (such as pregnancy or active cancer treatment), a health share may not be the right fit.
- If you have a well-managed condition and mostly need financial protection for unexpected medical events, a health share could be a great way to save money.
How to Make the Right Decision
If you have a pre-existing condition and are considering joining a health share, one of the best things you can do is read the member guidelines of the health share you’re interested in. These guidelines spell out exactly how pre-existing conditions are handled, including specific waiting periods and sharing limits.
Understanding these details upfront will help you set realistic expectations and ensure you choose the best health share for your needs.
Final Thoughts
Health shares can be an excellent alternative to traditional health insurance, offering significant savings and a community-based approach to healthcare. However, if you have a pre-existing condition, it’s essential to know how sharing works so you can make an informed decision.
If you’re considering joining a health share, be sure to do your research, read the member guidelines, and choose a plan that fits your needs. I want you to have a great health share experience, and being informed is the best way to make that happen!
Health shares are not insurance and do not offer insurance coverage. Membership in a health share does not guarantee the payment or reimbursement of medical expenses. Each organization operates under its own membership guidelines, which determine what expenses may be eligible for sharing. This publication is for informational purposes only and is not provided by an insurance company. For state-specific notices and full program details, please visit the respective health share’s official website.
Leave a Reply