Health Care Costs Making You Sick?

No. MPB plans are not insurance. They are an insurance alternative commonly referred to as health share plans. Similar to health insurance, health share plans spread the risk of medical costs across the member base. MPB collects plan premiums from members into a share pool. When members have medical expenses covered by their plan guidelines, those expensives are paid from the share pool.

Yes. Health sharing plans are legal in all 50 states. They operate as 501(c)(3) non profits and are recognized under ACA section 1402(d). There are currently no federal penalties for not having traditional insurance. There are, however, some states (CA, MA, NJ, RI, DC, VT) with individual mandates that may not consider health share plans as qualifying coverage.

No. There are no religious affiliations or beliefs required.

This is the biggest concern many have when moving from standard insurance to a health share plan. And for good reason. An insurance policy or health share plan is worthless if it doesn't pay when you need it. And quite frankly, some early health share companies gave the industry a bad name. Let's compare how standard health insurance companies and MPB handle claims:

Standard Health Insurers: They reject on average 20% of in-network claims and 30% of out-of-network claims. Of these, many are due to the subscriber not having applied for prior authorization or going to an out-of-network provider. Subscribers can appeal these rejections and, once exhausting the appeals process with the insurance provider, can appeal to their state insurance commission. The industry average for successfully appealing a rejection is around 50%.

MPB Health: MPB provides transparent, easy to understand guidelines so you know what is and is not covered. With MPB, there are generally no network requirements or required pre-authorizations to cause out of hand rejections like with traditional insurance providers. MPB further provides a complimentary concierge service that will validate your coverage prior to a procedure and even help you locate a provider. If a sharing request is rejected, you can appeal the decision and a committee will review your case.

So while having a state insurance commission to appeal to is admittedly a nice option, MPB's no network, no pre-authorization approach is refreshing. And like any company, MPB must stand on its reputation in order to be successful. We suggest looking at customer reviews for MPB Health (and Zion Health and/or Sedera for plans leveraging those providers) as well as any other insurance or health share provider you are considering. Having done the research, we are confident you won't find a health share provider with a better track record than MPB Health.

Maybe. MPB Health Plans are a good fit for individuals and families who aren't covered by an employee insurance plan. If you are paying for an ACA plan, with or without subsidies, you may find better coverage at a more affordable rate with MPB. You do, however, need to consider any pre-existing conditions you or a family member may have as coverage for pre-existing conditions is phased in.

Not in the first year. Reimbursement for services related to pre-existing conditions in the 2nd and 3rd year of your membership will be capped at $25,000 and $50,000, respectively. Depending on the plan, coverage starting in the 4th year is either uncapped (Sedera backed plans) or capped at $125,000 (Zion backed plans).

Pre-existing conditions are defined as any health issue you were diagnosed with, or for which you had symptoms, during the 'lookback period'. The lookback period is 2 years for Zion backed plans and 3 years for Sedera backed plans. For example, if you went to the ER with chest pains during the lookback period and you later had a heart attack, it will likely be considered a pre-existing condition and covered based on the phase-in approach discussed in the FAQ above. What is considered pre-existing varies between the Zion and Sedera backed plans. For example, the Zion backed plans do not consider high blood pressure, high cholesterol, and diabetes as pre-existing as long as they are managed (i.e. you are taking your medications) and you have not been hospitalized for the condition in the prior 12 months. It is important that you read the plan guidelines found under the Details section of each plan for specifics if you believe you may have a pre-existing condition.

Simply tell the provider that you are a cash pay (uninsured) patient and pay the bill directly. Usually this will be at a discounted rate since the provider does not have the overhead of dealing with an insurance company. You will then open a sharing request with MPB through their web portal or mobile app for reimbursement once you meet your IUA requirement.

An IUA is similar to a deductible in standard insurance plans. There are some important differences, however. IUAs are the amount you pay before your costs can be shared (paid) by the plan. IUAs are specific to an 'incident' that causes you to seek medical treatment (e.g. an auto accident). You only pay the IUA once per incident regardless of the number of services received or time frame in which they are rendered. Let's look at an example:

You have an auto accident where you are admitted to the hospital for a broken leg. The hospital charges you $5,000 for x-rays, setting the leg, etc. You then incur $500 for a follow-up visit to the Dr. and $1,500 for physical therapy. Your total bill for this incident is $7,000. If you selected a $1,500 IUA amount when you signed up for you plan, you will pay $1,500 and the remaining $5,500 will be shared (paid) by the plan. This is true even if the physical therapy, for example, occurs more than a year later.

You are limited to only paying three IUAs per rolling 12 month period. This is similar to an out-of-pocket maximum in standard health insurance. If you have more than 3 incidents in the 12 month period, they will be covered without you having to pay an additional IUA.

A sharing request is similar to making a claim against traditional insurance plans. If you have an eligible medical expense and you've fulfilled your IUA obligation, you submit a sharing request to MPB and they will reimburse your expense.

Eligible prescription expenses may be shared when they are part of a larger, eligible medical need. Additionally, certain memberships include access to prescription benefits via RX Valet which provides deeply discounted pricing on thousands of prescriptions.

Similar to a traditional insurance's out of pocket maximum, health share plans limit the total amount you have to pay to three IUAs per rolling 12 month period. If you have more than 3 incidents in the 12 month period, each additional incident will be covered without you having to pay an additional IUA.

No. There is no limit, either yearly or lifetime, on the amount you can submit and receive payment for via sharing requests.

MPB leverages two of the leading health share providers, Zion and Sedera, to provide medical cost protection and various other services that come with MPB plans. While similar, coverage specifics for Zion and Sedera differ in some areas such as IUA options, pre-existing condition coverage, mental health coverage, etc. It is therefore important to review the guidelines for each plan to see which best fits your needs.

Unplanned (emergency) medical procedures are covered as long as proper documentation is provided. Preventive and/or scheduled services are generally not covered.