>> There is an updated edition of this blog available <<
The very concept for and purpose of insurance is to protect one against unpredictable and large expenses, such as damage to your vehicle from an accident, or to your home from a hurricane. In health care where there is no transparency, most health care costs are unknown. Health insurance gradually morphed to provide “coverage” for everything, from the routine care such as doctor’s visits, ancillary services (laboratory and radiology) and prescriptions to the catastrophic needs when one gets hospitalized or requires emergency surgeries.
Direct Primary Care solves the routine care dilemma by making the cost of health care and ancillary services all transparent, affordable and predictable with the all-inclusive monthly membership. In so doing, Direct Primary Care renders health insurance irrelevant for most routine needs. Then by removing the routine care from traditional health insurance, the cost for such is dramatically lower, as in the case of most health cost sharing plans. These plans perfectly pair with a Direct Primary Care membership to deliver you a health care solution that is better than most traditional insurance offerings, yet cost half as much.
Unless you have chronic medical conditions that truly require the care of a specialist physician and expensive medications, these health cost sharing plans will be just what you need. Most medical conditions that are currently managed by specialist physicians can be cared for by a Direct Primary Care physician who is not spending time running from room to room seeing 25-30 patients a day as in a traditional medical practice. That practice setting favors referrals for almost everything due to time constraints and network referral pressure.
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. However, starting in 2019, the penalty was reduced to $0, but subject to change from future governmental rules and regulations.
(1) Sedera Health
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.
(2) Zion Health
Pre-existing conditions: Shareable in 1st year if considered cured, symptom- and treatment-free within prior 12-month period, subject to a maximum equal to year-to-date contributions
Insulin for diabetes: not shareable regardless
Exemptions from Pre-existing conditions limitations: Hypertension, Cholesterol, Hemorrhoids, and Sleep Apnea
Sharing for colonoscopies and other preventive services requires 1yr of Direct Membership or in Connect Health program with a DPC practice.
Maternity: IUA may be waived for home births | Pregnancy prior to start of membership shareable up to max contributions made to date
Death benefits require 2 years of uninterrupted membership: $10,000 primary member or spouse, $2,500 dependent child
(3) 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 Memberships 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
(4) Medi-Share
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.
(5) 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.
(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
(7) 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.
Previous editions of this blog:
0
0
