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  1. Do these medical sharing plans have dental coverage as well?

    • Leslie Nicole – Not that we’re aware of, unfortunately. For dental plans, I recommend a dental savings plan that lets you save income tax-free and hold onto funds that you don’t spend so you can use them later.

  2. Hi there Steve, thanks for commenting! I’d love to friendly share some more information for you to consider.

    First before you read, please take off your insurance hat and set it on the table. Health insurance has trained us all so well to believe it’s the only viable option to have access to healthcare. That’s not the case anymore. Medical cost sharing has a proven track record of over 30 years. Starting first with the ministry based organizations back in the 80’s, they have continued to grow. In 2010 there were around 100k members industry wide and have since grown to over 1 million members industry wide today. To my knowledge none of these organizations have gone under for going bankrupt and not being able to pay their members’ invoices. All have some type of excess needs fund in place for the times the monthly shares don’t cover the needs for the month.

    Please keep in mind that medical cost sharing doesn’t offer “benefits”, so they can’t offer “poorer” benefits over insurance. You are a self pay patient when you belong to a medical cost sharing organization. Self pay patients are eligible for significant savings, most far surpass any price based on an insurance relationship. Sedera on average saves 45% in total billed services they receive from their members.

    You mention, healthcare costs what it costs. That’s simply not true today. Transparency is not something that exists in today’s health insurance market. If you call 5 surrounding hospitals looking for a price for a hernia surgery with your BCBS insurance I guarantee it will be nearly impossible to get a price over the phone. If you are able to get a price or two it will vary greatly in cost. How does your insurance have your back if they are not negotiating the best care and price for you? There are free market surgery centers popping up across the country that post their surgery costs online for all to see in defiance of this very situation. Unlike insurance companies, medical cost sharing organizations don’t profit from not paying their members’ invoices.

    Aaron already commented on how Sedera handles pre-existing conditions. I will add that if well controlled the following conditions do not have sharing restrictions; non-insulin diabetes, high blood pressure, high cholesterol, and sleep apnea. Sedera does not limit what they will pay on an invoice, there is no cap on a need. Since you are part of a community you are required to commit to no use of illegal narcotics and to not drive while intoxicated. If you do get in a wreck and your blood alcohol limit is over the legal limit than your need would not be eligible for sharing in the community. Furthermore, if you are breaking the law while injured those bills would not be eligible. So you are correct if you aren’t wearing your seatbelt and are injured in an accident, those bills would not be shared. On the flipside, your child not wearing a bike helmet is not against the law, so your child’s bills would be shareable in this instance. It’s all about doing your part and making responsible choices. You’re part of a community that has agreed to pay your medical costs so we’re all looking out for one another’s best interests.

    You are very lucky that 16k per year doesn’t break your bank, but the vast majority of people aren’t in your boat. You have it all backwards when you say medical cost sharing “makes routine medical costs more affordable but it can leave you exposed if you have a really serious health event.” Routine/preventative care would be provided by the base layer MEC plan. And it’s the big medical costs where medical costs sharing actually becomes effective for you and your family. Any need over your IUA is fully shared with the community. And one final way we help limit our members’ out of pocket exposure is we cap how many IUAs an individual or family has per membership year. If you have a really horrible year as an individual where you have 3 car wrecks all incurring their own medical costs; the fourth accident would not require you to pay an IUA before it becomes shareable, it would become shareable on dollar one. We limit it to 5 needs per family per membership year. We are all working together to help keep the out of pocket costs down.

    It’s not your status quo option, however for times like these where insurance rates continue to rise 15-50% per year, many of us need a better solution.

    • I read Juliet’s article and thought I had finally found the answer for our little company. But, like Juliet, I read the fine print!
      This is probably great for younger folks like her, but I don’t know ANYONE over 40 who doesn’t have a pre-existing condition-& lots of kids do, too. Sedera won’t pay on any pre-existing condition for THREE YEARS. All of my employees are over 40, all have had what can be considered pre-existing conditions.
      Our insurance guy, who told us about Sendera yesterday, failed to mention this.
      Sadly, this won’t work for us-or millions of others.

      • Good points Julia – You may want to check into Medi-Sharetoo. Best.

    • I agree about finding a better solution, however, I just got the run around from a case with Sedera. What I am frustrated with is the agent I received who is not customer service friendly just basically blew me off. My case of going to emergency was a necessity. I had a chronic condition in the past but the condition was reversed and this is way before Sedera became involved.

      They don’t help like you claim. I got a 25 % discount on a bill way over $1500. Whoopie. I paid $285 per month for the entire year into this cost sharing plan and I just paid double. I paid over $3,000 for the entire bill which Sedera did not help with. I know it’s not an insurance company but here is the thing. You sure know how to collect the money and say anything to potential customers just to take their money. Not any better than a health insurance company. Medicaid expansion was really good. No hassles and having to deal with unfriendly reps.

      The problem with Sedera is that they feel that people have to be perfect. I still got a surprise. A $2,000 bill that was due within 5 days. Now with all the other bills to pay, how does one expect others to pay that fast??? Sorry but certain people are going to get sick since they are going to be surrounded by sick people on a job. I guess it’s a crime to get sick at all but not a crime to try to entice people to buy your service only to make empty promises.

      Oh and Sedera does not cover alternative medicine which does by the way work. They will use any excuse not to have to provide your needs.

  3. I do not have a dog in the fight since I have more than enough resources to pay for conventional health insurance. If I couldn’t afford my $16K annual premiums with Blue Cross then I might be tempted to try something like Sedera. The problem is I’m a math guy as an engineer and the fact is that the math does not support health sharing as a sustainable business model. Health care costs what it costs and while slight discounts can result from negotiating it still costs what it costs so in the long run health sharing can only offer lower costs by offering lower benefits, it is just math. And the benefits from regular insurance, as you pointed out, are not anything special so choosing even poorer benefits doesn’t appeal to me.

    The way they reduce benefits is by screening out most pre-existing conditions, limiting the amount they will pay per claim and by having per event deductibles so that each new illness has to repay the deductible again. They also expose you to risks like refusing to cover your child’s bicycle accident if he wasn’t wearing a helmet or car injury if he wasn’t wearing a seat belt meaning you never know if your kids are really covered or not. It is surely better than nothing but it is not a robust substitute for insurance unless you have no kids and no chance of an expensive claim in the future.

    For me insurance is to save me from health care costs that I can’t afford without wrecking my finances, conventional insurance does that even if it is expensive. Health care sharing does not do that, it makes routine medical costs more affordable but it can leave you exposed if you have a really serious health event in the family.

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