A proven alternative to managing healthcare costs.
Health insurance costs are getting higher, making it hard for many people to afford. It can be tough to keep paying for a system focused more on treating sickness than promoting health. If you want to take charge of your health, medical cost sharing may be a better option. This alternative is cheaper than health insurance and gives you more control over your healthcare spending. When you switch to this innovative alternative, however, you don’t just save money. You also get to decide how to use those savings for your healthcare, giving you more independence in your health choices.
The rising costs of health care.
Health insurance can sometimes be hard to understand. Each year, costs and premiums rise. At the same time, coverage for services appears to decrease. Some programs, like the Affordable Care Act (ACA), can help. So can subsidies and plans from employers. But these aren’t always options for everyone. And if they are, they might not be the best choice.
Medical cost sharing is an affordable and comprehensive alternative to traditional health insurance plans. Benefits 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 employer-sponsored health insurance premiums have been increasing steadily. In 2019, individual premiums were 227% higher compared to 1999, while family premiums rose by 255%. These numbers have continued to rise. Since 2010, family premiums have increased at twice the rate of wages and inflation. The average deductible is now almost double what it was ten years ago.
Over 40% of insured adults in the US don’t have sufficient coverage, resulting in potential out-of-pocket costs consuming a significant portion of their household income. Over 12% of adults don’t have any coverage at all.
What is medical cost sharing?
This comprehensive alternative to traditional health plans, designed for health-conscious individuals committed to personal health responsibility, costs less than health insurance. It lets members keep more of their money in their pockets while giving them the freedom to choose the providers of their choice.
Members can save up to 50% over traditional health insurance. There are no provider networks, and they are free to choose the medical providers they want.
Membership isn’t denied to anyone due to a pre-existing condition, and members are provided with the tools and support they need to actively participate in their healthcare.
What makes medical cost-sharing unique?
People often associate medical cost-sharing programs with faith-based foundations, but some programs don’t follow this model. Instead of a religious foundation, these alternatives establish themselves on the concept of a healthy community.
They believe that making smart choices when it comes to diet, exercise, and lifestyle can greatly improve the quality of life for each member while reducing costs for everyone.
When 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 have the freedom to choose their preferred medical providers, not just the ones that are “in-network”.
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 within 24 months of becoming a cost-sharing member. Many 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. In medical cost-sharing plans, a member must pay an initial unshareable amount (IUA) for each medical need before the community can share the expenses. 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 healthcare 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 on individual health insurance.