Questions We hear every day answered honestly
From the difference between cost sharing and insurance to Medicare Advantage vs Medigap — these are the real answers from an independent broker with no incentive to steer you wrong.
Philosophically, both come from the same older ideas: community pooling, neighborly protection, mutual aid, and collective stewardship.
Historically, many early insurance systems actually grew out of mutual aid societies, guilds, churches, and community support groups — similar in spirit to some modern healthshares. There is nothing new here. We have simply cut out the middleman, the contracts, which can be more of a hindrance than a benefit when it comes to care anywhere.
- Community pooling of resources
- Neighborly protection in times of need
- Mutual aid — members helping members
- Collective stewardship of shared funds
Both models work on the same core principle: many people contribute regularly, funds are pooled together, and the group helps cover members’ losses or medical expenses. The core principle is collective support.
| Feature | Mutual Insurance | Healthshare |
|---|---|---|
| Legal status | Regulated insurance | Not insurance |
| Claim obligation | Legal claim obligations | Voluntary sharing |
| Ownership | Policyholder-owned | Membership / community-based |
| Regulation | State regulated | Often lightly regulated |
| Coverage rules | Contract guarantees | No guaranteed payment |
| Model | Risk pooling | Cost sharing |
A healthshare is:
- Not insurance — it is a membership-based voluntary sharing arrangement
- Usually faith-based or values-based
- Covers medically necessary expenses — illness, injury, accident, and diagnosis
There is generally:
- No legal guarantee that claims will be paid
- Less state regulation than insurance
- Member guidelines instead of policy contracts
- No middleman pre-determining cost and care
Because monthly contributions tend to remain stable for years — and family sizes are grouped by banding rather than individual age — healthshares are often dramatically easier to budget than traditional insurance where premiums rise every year.
Most health share programs share costs for medically necessary events — unexpected illness, injury, accident, or new diagnosis. Some include:
- Major medical events and hospitalization
- Specialist visits (through the sharing guidelines)
- Telemedicine and virtual care
- Prescription discounts
- Worldwide coverage for emergencies
⚠️ Pre-existing conditions typically have waiting periods or may not be shareable. Always read the member guidelines carefully or ask us to walk you through them before you enroll.
A healthshare works well for people who:
- Are generally healthy and rarely visit the doctor
- Want lower monthly costs in exchange for understanding the guidelines
- Don’t qualify for ACA subsidies or prefer not to use the marketplace
- Are self-employed, 1099, or between jobs
- Want the freedom to see any doctor — no network restrictions for major events
✓ Best strategy: Pair a health share with a Direct Primary Care (DPC) membership for day-to-day care, and a MEC plan for ACA-compliant preventive benefits. This gives you comprehensive coverage at a fraction of traditional insurance cost.
Money Driven or Care Driven?
The healthcare system requires sick people paying premiums. A care-driven approach flips this entirely.
💰 Money Driven
Needs sick people paying premiums, deductibles, medicines, durable medical, office visits, surgery, specialists, imaging, diagnostics, and treatments.
Without you — without your illness — there is no industry.
- Profits depend on high utilization
- Middlemen determine your care
- Contracted treatment agreements
- Annual premium increases
- Network restrictions limit your choices
🌿 Care Driven
You pay as you go. You know where to go because you have a real relationship with a doctor or clinic. Present as a cash payer and get more than 60% off providers and services.
A real patient-practitioner relationship — regardless of coverage.
- Cash-pay discounts of 60%+ on care
- No middleman between you and your doctor
- Direct Primary Care for daily needs
- Cost sharing for major events
- Take back your health
| Feature | Mutual Insurance | Medical Healthshare | Large For-Profit Insurance |
|---|---|---|---|
| Primary structure | Member-owned insurance | Community cost-sharing | Shareholder-owned corporation |
| Purpose | Benefit policyholders | Share medical costs among members | Generate profit for shareholders |
| Claim obligation | Legally required to pay | Voluntary sharing | Legally required to pay |
| Ownership | Policyholders | Membership community | Investors / shareholders |
| Financial goal | Stability & member benefit | Shared support & affordability | Profit growth & market expansion |
| Profit distribution | May return dividends to members | No shareholder profits | Profits to shareholders |
| Admin structure | Moderate, member-focused | Leaner operations | Large corporate systems |
| Consumer protections | Strong legal protections | Limited legal guarantees | Strong legal protections |
| Typical philosophy | Mutual protection | Shared responsibility & community | Corporate risk management & profitability |
Both mutual insurance and membership health shares encourage members to:
- Avoid unnecessary claims and procedures
- Maintain healthier habits and lifestyles
- Reduce wasteful spending on low-value care
Members often pay less for medical intervention than holders of for-profit “Medical Express” insurance plans — because the incentives are aligned with your wellbeing, not a corporation’s quarterly earnings.
Medical Express is a term used to identify for-profit medical insurance plans that process people based on contracted treatment agreements. Health shares especially emphasize personal responsibility and lifestyle choices as a condition of membership.
From a broker point of view: Advantage plans have many of the same medical benefits, network limitations, and ancillary characteristics of group health insurance. Medigap supplements, on the other hand, are more like life insurance in how they work.
Both options require you to pay Medicare Part B (and Part A if you have missing credits or other circumstances).
| Feature | Medicare Advantage (Part C) | Medigap Supplement |
|---|---|---|
| Relationship to Medicare | Replaces Medicare with a carrier-branded plan | Works with Medicare original — not a replacement |
| Extras included | Often includes dental, vision, fitness benefits | Usually no extras — just the gap coverage |
| Provider access | Network restrictions apply (PPO/HMO) | Any provider that accepts Medicare — no network |
| Monthly premium | Often $0 or very low | Higher monthly premium |
| Medical questions to join | No — guaranteed acceptance at 65 | Yes — health questions, possible denial or rating |
| Out-of-pocket risk | Copays and MOOP to consider | Predictable — covers the 20% Medicare doesn’t pay |
💡 Our recommendation: Always review a Medigap supplement first then the Advantage plan. The best fit is the one that matches your lifestyle and expectations. If you have any health conditions, Medigap underwriting becomes a critical factor.
⚠️ If you are nearing 65, most of what you receive in the mail is Advantage plan solicitations. That does not mean they are the right fit — it means they have the highest marketing budgets. Get an independent comparison.
Your Initial Enrollment Period (IEP) is a 7-month window: 3 months before your birth month, your birth month, and 3 months after. Missing this window without qualifying coverage triggers lifetime penalties.
- Part B late penalty: 10% per 12-month period — permanent
- Part D late penalty: 1% per month without credible coverage — permanent
- Still working with employer coverage? You may be able to delay — but get it in writing from HR
→ See the full Medicare enrollment guide and Scope of Appointment
No — never. Broker fees are paid by the insurance carrier, not by you. You pay the exact same premium whether you enroll through us or directly with the carrier. The difference is you get honest, personalized comparison and ongoing support at no extra charge.
✓ As licensed independent brokers we are not captive to any single carrier. We will compare what’s available and tell you what actually fits your situation. Some products are not available to brokers to sell because the carrier only offers coverage through their employee agents.
A Special Enrollment Period allows you to enroll in or change health coverage outside of the standard enrollment window when a qualifying life event occurs:
- Losing employer-sponsored health coverage
- Getting married or divorced
- Having or adopting a baby
- Moving to a new area
- Change in household income
- Losing Medicaid or CHIP eligibility
Most SEPs give you 60 days from the qualifying event. Medicare-specific SEPs have different rules, call Us to confirm your window.
The APTC is a federal subsidy that lowers your monthly health insurance premium — paid directly to your insurer on your behalf. Eligibility is based on:
- Household income between 100–400% of the federal poverty level
- Not eligible for Medicaid or Medicare
- No affordable employer-sponsored coverage available
- Must enroll through the marketplace (MNSure or HealthSherpa)
As a MNSure Certified Assister (ID #5503492), Amy can check your eligibility and help you apply — at no cost to you.
Ask Us, no question is too small
A 15-minute call can clarify what coverage type, plan, and enrollment path gives you the best protection at the lowest total cost. No fee, no obligation, ever.