Whether you are new to non-insurance health coverage models or considering it, here is some help on how it works, and the important considerations and common concerns I come across as people review more options for a health plan and sick care help.

Before I go in to the detail on how medical bills are shared, please remember that YOU are the best doctor and preventative medicine for yourself. The best health care investment is not a monthly premium but what you do every day to feed your amazing body that is ALWAYS working to keep you well, even when you don’t think about it. It wants to survive! Your body wants to move, it needs activity and resistance to be remain strong. Do not think you can avoid this with much success. See below what important nutrients your body needs to support essential organs, knowing this you can help yourself better and ask the right questions with your doctor. No pharmacy drug can do what good food does. yum.

Membership Health Sharing PROGRAMS.

There are quite a number of health shares popping up lately, it is hard to keep up, but the good news is more people are turning to alternatives for medical coverage. It is a BIG STEP to take when you are older and used to the convenience of group health insurance, showing a card and paying the bills up to your deductible and then a max-out-of-pocket. The alternative coverage does not have a medical card for hospitalization, you present yourself as ‘self-pay’. It can be scary and exhilarating at the same time, especially if the doctor wants cash up front for an expensive medically necessary procedure. Most long standing health share communities will give you the money up front to pay the provider before the procedure takes place, non-emergency.

IMPORTANT: Health Share Memberships do not share in primary care visits, that is what you pay for out of pocket, unless it is part of a major medical need. Most Health shares work similar but have different Membership Guidelines that you will agree to, so be sure to review each community’s guidelines for the pre-existing limitations, and how sharing is done and if it is right for you.

Navigating Care

In an emergency, present yourself as a ‘cash payer’, the hospital will send you an adjusted ‘self pay’ bill for services. If the bill exceeds your initial unshared amount (like a deductible) the community will share the remaining bills for that medical need. Either by debit card, or pay through a patient portal or deposit the funds in to your account so you can pay the outstanding bills. It works much like CAR INSURANCE. Your car gets in a wreck, you pay the deductible or initial amount, and you get the funds to fix it. You can go where you want and choose how to get your repairs. Health sharing works like that, and the unshared amount does not reset in January.

Benefits Include:

Freedom to choose your provider and remedy, as long as the practitioner is licensed. World-wide coverage as a cash payer. Catastrophic only coverage. Usually includes telemedicine and pharmacy discounts for an extra fee. Reference Based Pricing (medicare allowed amount plus 40-50%) is much usually less than the insurance paid amount.

Drawbacks

People love to have a physical card to present to a clinic or hospital, health shares have no card because YOU get the bills and pay them using community funds. You manage the expenses and bill paying. In this way we save on our monthly contributions thereby have lowering overall out-of-pocket costs. It is not convenient. BUT when you compare the monthly expense, it can be very worth while, especially when there is no medical needs.

Typical costs for options:

Plan Type	Monthly Cost	What is Covers	Best for
Traditional Insurance	$300 – $1400	In-Network treatment	Insurance companies
Direct Primary Care	$75 – $100	Primary Care Visits	Frequent use
TeleMedicine	$10 – $40	Virtual Urgent Care	All
Health Share	$150 – $220	Major Medical event	Catastrophic / Small business
MEC Plan	$60 – $200	Preventative Care	Compliance coverage
Concierge Medicine	$100 – $200	Primary Care Doctor	Chronic conditions

Membership health plans comparison worksheet, you can use this to help you better understand each community you research.

Compare health sharing to traditional insurance budget Worksheet.

What are biggest the Differences. In-and out-of-Network providers vs no network(freedom to choose care) | Covered/Not-covered Treatments vs Treatment from any licensed provider | Carrier Negotiated pricing vs Reference Based Pricing | Deductible $6000 vs Unshared Amount starting $1250 for a medical need.

What is Reference Based Pricing? that is the medicare allowed amount plus up to 50%, paid directly to the provider or clinic by you. *Works a lot like ‘paying a deductible’ first, but once you reach your max out of pocket ($1250 – $3000) for a major medical need you are given the funds by debit card, or deposited into your account so you can pay the submitted bills. See member guidelines for Needs sharing, usually a member or family is responsible for two unshared amounts, after two the member/family does not pay another unshared amount due to bad luck….it is a benevolent membership.

Primary Care Solution.

A great pairing with health share plans is a MEC plan, minimum essential coverage. This is actually compliant insurance that covers an annual exam at no cost, discounts for medicine, and access to PPO primary care providers, specialists, urgent care, and imaging for a discount or co-pay, you choose your primary care experience. MEC plans serve primary care and acute illness, not hospitalization, that is what the health share does for you. So you can ADD a MEC plan to a health share and create your own strategy for more comprehensive coverage that has a medical card for primary care. The best of both worlds. Instead of MEC you could pay a DPC, direct primary care subscription service to a clinic or doctor for local unlimited care. You can design your own care experience or pay as you go.

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