As a Direct Primary Care provider, we are here for your primary and preventive needs. But, what do you do when the unexpected happens?
In a nutshell, this is how it works.
- You pay a monthly health share membership fee.
- That fee gets put into a shared bucket or pool to be used for the organization fees and for member needs.
- You also have something called an Individual Unsharable Amount (IUA) or an Annual Unsharable Amount (AUA). This is your responsibility to pay, per incident, before you can ask your community (the health share organization) to share in your medical expenses. Once an incident arises, you pay your IUA and then ask your health share community to help pay the rest of the medical bills.
For example, you have an IUA of $1,000. You fall off a ladder and you break your ankle and fracture your elbow. The cost of the emergency room, radiology, and specialist care was $3,750. You will send in a “need” to your health share community, based on your medical bills. You will be asked to pay your $1,000 IUA and then your community will pay the rest (from the pool you all put your membership and IUA fees into).
Now let’s say you have multiple incidents in yourself or your family. Most health share communities will cut you slack if it’s a bad year, capping the unsharable amounts you have to pay per year (often only 3 or 4), and then everything else is shareable, or they will put a max on the amount you have to pay per year. This ensures that the amount you are responsible for is limited.
These programs started about 25 years ago when a preacher had some health problems and within a few short days, his congregation rallied around him and were able to all cover the cost of his medical bills. This was the birth of health sharing communities. They have evolved over the years, some more robust than others, and some requiring you to live a Christian lifestyle and some not. But in the end, all are working toward the same goal, to support people like they are family, with the motto that we are all in it together.
Health share organizations are not insurance companies. Therefore, they are not regulated the same as insurance companies. But they do work similarly, by allowing members to share unexpected costs.
In January of 2019, the ACA’s individual mandate was repealed, which means individuals and families are no longer penalized for not having a compliant insurance plan in place. Most health share organizations actually met the requirement for the individual mandate so their members were not subject to the rule. Before, during, and after the repeal of the individual mandate, health share organizations have been doing the heavy lifting for their members, giving them financial and health security without the rising cost associated with conventional insurance plans.
Based on our research and experience with members here at Table Health, here are 3 cost-sharing communities we like.
Sedera
Sedera’s Medical Cost Sharing Community is a surprisingly affordable non-insurance solution for managing large healthcare costs. Unlike other options, this approach is centered entirely on people helping people. Members never tackle difficult healthcare decisions alone. The like-minded community is there to share in the burdens of unanticipated medical costs.
Here are a few of the things we love about Sedera:
- Ability to choose your own providers
- No faith statement required
- Pre-existing conditions accepted with caveats
- Prescription marketplace available for an additional fee
- Discount rates for working with a Direct Primary Care practice
- No enrollment date restrictions
- Will cover costs outside of the US
- Employee’s monthly shares can be collected via payroll deduction
- Need sharing with a cap on how many IUA in a 12-month period (3); once this has been met all incidents are sharable
- Fixed monthly membership fees to support the community with a variety of IUA options
Learn more about the membership, guidelines and restrictions here
You can enroll here with the Table Health Affiliate link and receive a discount on your membership if you are a DPC member
Zion Health
Zion Health believes that its Members, in concert with the medical providers of their choosing, have a natural incentive to do what is best for themselves and their families, as well as the primary responsibility for making their own health care decisions. When Members have financial needs due to illness that are greater than they can individually bear, the goal of the Zion Health community, in a corporate sense, is to assist Members in carrying one another’s burdens. The method by which Zion Health seeks to facilitate the sharing of Members’ medical costs is to teach and apply these principles as an integral part of its sharing philosophy.
Here are some things we love about Zion Health:
- Ability to choose your own providers
- No faith statement required
- Pre-existing conditions accepted with caveats
- Prescription program for additional fees
- Discounted rates for working with a Direct Primary Care practice
- Will cover costs outside of the US
- No annual or lifetime caps on what can be shared per incident
- IUA has to be met per incident with 3 IUA’s per 12 months; any incident after has an IUA of $500 then the cost after that is sharable
- Contribute directly with your employer
- No enrollment date restrictions
- Processes “need”, quickly within 5 business days
Learn more about their guidelines and sharable conditions here
Learn more about pricing and membership options here
Liberty
Liberty HealthShare offers health-conscious individuals and families an affordable way to share medical care expenses in a like-minded community. Liberty HealthShare is not insurance, they are a Christian membership-based, non-profit organization where we help facilitate the voluntary sharing between members to pay each other’s medical costs.
Here are some things we like about Liberty Health Shares:
- Ability to choose your own provider
- Will cover costs outside of the US
- Pre-existing conditions are not shareable for the first 12 months
- Medical expenses are met on a per person per incident basis when treated by urgent care facilities, physicians, emergency rooms, clinics, or hospitals
- May share Direct Primary Care membership fees
- Additional packages available for purchase for chiropractic, vision and dental
- Prescription marketplace for an additional fee
- Cap on sharable amounts per year
- 1 annual unshared amount to be paid before sharing can begin
Learn more about Liberty Healthshare here
About their guidelines and restrictions here
Membership options here