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Given the escalating cost of health insurance premiums, Medical Cost Sharing is a true alternative to health insurance. For a monthly fee that is 40-60% lower than most insurance premiums, it can help with larger medical expenses such as hospitalization, emergency room visits while a Direct Primary Care membership will take care of 80-90% of your routine health care needs. And with the insurance mandate penalty reduced to $0 in 2019, there are no longer any need to purchase insurance just to avoid the penalty.
We compile this table below for the major medical cost sharing organizations currently operating. It is not meant to be comprehensive, so please review the Sharing Guidelines of the respective plans for full details regarding sharing requirements.
Best efforts were given to ensure the most accurate information, but typo errors and details might be missed. Please consult the full sharing guidelines of the respective programs for complete information.
Plans are ACA-exempt with regards to the insurance mandate penalty except for Sedera Access. Starting in 2019, the penalty is reduced to $0, but subject to change from future governmental rules and regulations
(1) Liberty Healthshare
Most sharing requests have restrictions, and may require pre-approval. Enrollment requires completion of a health questionnaire. Pre-existing conditions: Eligible for sharing at up to $50,000 for in the 2nd and 3rd year of membership combined; No restrictions afterwards, subject to Guideline.
- Exemption with HealthTrac Program (additional $80/month): Diabetes, Hypertension, Heart disease, Cholesterol, Obesity, and Tobacco Use.
Maternity: Conception has to be after joining.
Direct Primary Care (DPC) Membership often include office visits in the monthly membership fee at no additional cost.
DPC Membership fees can be reimbursed at up to 75%, to max of $40/month for individual, $60/month for couple, and $75/month for families, subject to change by Liberty.
(2) Sedera Health Access
Pre-existing conditions: Eligible for sharing at up to $15,000 in the 2nd year, $30,000 in the 3rd year of membership; No restrictions afterwards, subject to Guideline.
- Exemptions from Pre-existing conditions limitations: Hypertension, Cholesterol, Hemorrhoids, and Sleep Apnea.
- Limits on Tobacco users: $25,000 each for Cancer, Heart conditions, COPD, and Stroke (until confirmed tobacco free for 12 months).
Maternity: shareable up to $5,000 normal or $7,500 C-section deliveries with IUA waived (IUA $500 for home births) for delivery date beyond first 12 months of membership Sedera Health Access requires membership in an association to be eligible. If Sedera Access is sponsored by a DPC practice, membership in the practice may be required.
Monthly Amount depends on age, family size, and selection of AHP amount.
Cost might be higher when not using MultiPlan, such as a co-liability of 20% at non-PPO hospitals.
The $35 and $135 co-payments are required even after the member has met the AHP amount.
Pre-existing conditions: shareable only after 36 months of membership, up to $100,000/year if no symptoms in the last 36 months, or $500,000/year if in the last 60 months.
Maternity: Conception has to be after joining, with maximum amount shared at $125,000.
(4) Christian Healthcare Ministries
A unit can be an adult, or all dependent children of an adult: One unit: 1 adult | Two units: 2 adults, or 1 adult + children | Three units: 2 adults + children.
Extended Coverage with Brothers’ Keeper Program: Annual fee $40 per year, plus $25 per quarter per unit.
- For Bronze and Silver, amount is increased by $100,000 per year of renewal up to $1 million maximum. For Gold, it is unlimited.
(5) Samaritan Ministries
Pre-existing conditions: shareable after 1 year without symptoms or treatment, or 5 years for genetic defects, hereditary diseases, cases of related cancers, or heart conditions.
- Exemptions from Pre-existing conditions limitations: Diabetes, Hypertension, Cholesterol.
Rate of $200-250/month for single-parent (divorced/widowed) household for Samaritan Basic, $305/month for Samaritan Classic.
DPC Membership are eligible for sharing at up to $100 for the month in which a physician is consulted, makes a referral, or charges for services related to a shareable need.
Sharing after IUA is 90% for Samaritan Basic, 100% for Samaritan Classic. Max shared expenses for Medical Equipment up to $4,950.
Maternity: Due date must be 260 days or more from membership start date; Individual Membership not eligible; Up to $5,000 until $13,500 has been spent, then max per plan.
(6) Altrua Healthshare
Doctor’s Office Visits: Maximum $300/visit can be counted towards 1st MRA, then 2nd MRA.
Maternity: max $4,000 normal delivery, $6,000 non-elective C-section, and after 10 months of a Couple Membership.
Colonoscopy: Not shareable in the first year; Maximum 3 per lifetime, unless having genetic diseases.