A proven alternative to managing healthcare costs.
Health insurance premiums continue to rise and can be out of reach for a growing number of people. It can be disheartening for anyone who focuses on a healthy lifestyle to continue to pay into a system that incentivizes sick care and is at the breaking point.
Medical cost sharing can be an effective alternative that costs less than health insurance, is designed for health-conscious folks who are committed to taking personal responsibility for their health, and puts money back in their pocket to spend on the care of their choice.
The rising costs of health care.
Health insurance can be a frustrating system to navigate. Each year, out-of-pocket costs, premiums—or both—go up, while the coverage for services seems to get weaker and weaker. Programs such as the Affordable Care Act (ACA), subsidies, and employer-sponsored plans can help mitigate your costs, but all of these options aren’t available to everyone. And even if they are, they may still not be the best option.
Medical cost sharing can be an affordable and comprehensive alternative to traditional health insurance plans. Benefits of these plans include:
- Savings of 30%-50% or more over traditional health insurance (yes, even ACA-subsidized plans).
- 24/7/365 access to telemedicine.
- Second opinions from some of the nation’s top doctors.
- Help navigating the complex world of medical care from expert advisors.
- Resources and tools to become a savvy healthcare shopper.
- Access to shop the best price for prescription drugs.
When coupled with a Health Access membership, this can be an even more comprehensive alternative. Benefits of a Health Access membership include:
- Unlimited access to primary care physicians with no co-pays or hidden fees.
- Reimbursement for dozens of eligible preventive labs and screenings, including dental cleaning and/or vision exams.
- Access to discount prescription drugs.
- Out-of-pocket assistance on Sedera’s 3rd Initial Unshareable Amount.
The expense of traditional health insurance
Annual premiums for employer-sponsored health insurance continue to rise, with average 2019 individual premiums a staggering 227% higher than they were in 1999, and family premiums are up 255%. These numbers just continue to rise. Since 2010, average family premiums have increased twice as fast as wages and inflation. The average deductible is almost double what it was a decade ago.
Over 40% of adults in the US who are insured don’t have adequate coverage—meaning their potential out-of-pocket costs eat up too much of their household income. Over 12% of adults don’t have any coverage at all.
Thankfully, medical cost sharing can be an excellent alternative to traditional health insurance, providing coverage for large, unexpected medical bills while also costing a whole lot less.
What is medical cost sharing?
Medical cost sharing can be an effective alternative that costs less than health insurance, is designed for health-conscious folks who are committed to taking personal responsibility for their health, and puts money back in the member’s pocket to spend on the care of their choice.
Medical cost-sharing members can save up to 50% over traditional health insurance. There are no provider networks, and members are free to choose the medical providers they want.
No one is denied membership due to a pre-existing condition. And members are given the tools and support they need to take an active role in their own health care.
What makes medical cost-sharing unique?
Medical cost-sharing programs are a proven alternative to the health insurance status quo and are available to both businesses and individuals. These programs can offer savings of up to 50% over traditional health insurance. Depending on the plan, members can have access to 24/7/365 telemedicine, second opinions from the nation’s top doctors via 2nd.MD, and access to a member services advisor to help them navigate medical cost-sharing and manage their healthcare choices.
While medical cost-sharing programs are known for being faith-based, there are programs that aren’t. Rather than having a foundation that’s guided by religion, these alternatives are built on the idea of a healthy community. These medical cost-sharing communities believe that making smart choices with diet, exercise, and lifestyle can greatly improve one’s quality of life. They recognize that when a community of like-minded people agrees to strive for a healthy lifestyle and share one another’s healthcare expenses, everyone wins.
When medical cost-sharing members incur medical expenses, some of these costs are shareable with the larger community, where other members contribute funds to help partially offset these costs. Unlike health insurance, it truly is a program where members directly help other members.
There are no provider networks. No one is denied membership due to pre-existing conditions. Members are free to choose the medical providers they want, not just those they are told they can choose from. Members are given the tools and support they need to take an active role in their own health care. This helps improve the lives of each member, as well as the community as a whole.
Medical cost sharing for individuals
Medical cost-sharing plans are becoming an increasingly popular alternative to costly health insurance plans for individuals and families. These plans are particularly attractive to individuals who prioritize living a healthy lifestyle. Medical cost sharing can be extremely powerful, especially when combined with programs like the Health Access membership, which provides access to free preventive services, low-cost prescription drugs, unlimited access to direct primary care (with no copays!), and more.
Is medical cost sharing a form of insurance?
Medical cost sharing is not insurance. Instead, it’s an alternative model where individuals share the cost of their medical expenses with a group of like-minded individuals who also want to share in the cost of their healthcare. Because they are not insurance plans and don’t fall under the same set of regulations, the monthly costs can be considerably lower.
What types of expenses are covered under a medical cost-sharing plan?
A wide range of medical expenses are shareable with medical cost-sharing plans. These include expenses incurred from medically necessary treatment from licensed practitioners and facilities including, but not limited to, physicians, emergency rooms, and hospitals. Limitations and restrictions can vary between cost-sharing plans.
Are pre-existing conditions covered under medical cost sharing?
Most medical cost-sharing plans have a waiting period for the sharing of pre-existing medical conditions for new members. A pre-existing condition is generally defined as any illness or injury that an individual has been examined, diagnosed, taken medication, had symptoms, or received medical treatment for within 24 months of becoming a cost sharing member. Many cost sharing plans have a “phase-in” period that phases in the sharing of pre-existing conditions. For example, any medical expenses related to a pre-existing condition may not be shareable during the first year, then limited to $25,000 the second year, and $50,000 the third year. This “phase-in” period and any associated limitations can vary from plan to plan.
Are there any out-of-pocket maximums or deductibles?
Because medical cost sharing plans are not insurance, they do not have out-of-pocket maximums or deductibles. Medical cost sharing plans include an initial unshareable amount (IUA), which is the amount a member is responsible for paying per medical need before expenses can be shared with the community. You can choose between multiple IUAs when enrolling. Members are also usually only responsible for three IUAs each year.
Is there a network of providers that members can use?
No. Medical cost sharing members are considered cash-pay patients.
Does medical cost sharing meet the requirements of the Affordable Care Act (ACA)?
Recognized healthcare sharing ministries that were continuously in existence prior to 2000 are exempt from the individual ACA mandate. Plans from Sedera and Zion HealthShare are not considered minimum essential coverage (MEC) and do not meet the requirements of the ACA or any state-level individual mandate that requires folks to purchase health insurance. However, since 2019, individuals are no longer penalized for failing to purchase health insurance.
Are there any religious or lifestyle restrictions that apply to medical cost sharing?
Traditionally, healthshares have been faith-based, requiring members to live by a set of religious standards to join. There are currently two medical cost sharing plans that don’t require religious affiliations to join—Sedera and Zion HealthShare. These two plans do, however, include lifestyle requirements they ask members to commit to which generally include being ethical, health-conscious, and embracing an active role in maintaining good overall health.
Are medical cost sharing plans available in all 50 states?
Medical cost sharing plans from Sedera are currently available in every state except Illinois, New York, Pennsylvania, Vermont, and Washington state. Zion Health is available in every state except Washington state.
What makes this program different?
This innovative program combines a medical cost-sharing plan from Zion with an employee assistance program from Health Access to form a comprehensive plan that supports access to preventive services while providing affordable coverage for large, unexpected health care needs.
Got more questions?
Book a free 15-minute call with me so I can answer any questions you have. At the end of this quick call, you could save as much as 50% on what you’re currently spending for individual health insurance.
2 replies on “Medical cost sharing”
[…] Medical cost sharing […]
[…] Medical cost sharing […]