The History of Medical Cost Sharing: An Affordable Alternative to Health Insurance
America’s healthcare system is ever-changing and it’s fraught with escalating costs and bureaucratic complexities. Health insurance has become increasingly unaffordable and difficult to navigate.
Medical cost sharing, also known as health sharing, is a viable alternative to health insurance. It’s an innovative solution to the skyrocketing costs associated with paying for medical care via insurance. In addition to being affordable, it provides freedom of choice, price transparency, and the support of a caring Community.
Sedera Medical Cost Sharing was founded in 2014 by Dr. Tony Dale, a British native, who trained at the world-renowned Royal and Ancient Hospital of St. Bartholomew (“St. Bart’s”) in London, England. Dr. Dale’s interest in medical economics began following his experience with the American medical system when he needed knee surgery in 1996. He personally experienced the inconsistencies and staggering costs of a broken healthcare system and became determined to find a way to help people find better access to quality, affordable care.
Dr. Dale’s vision of a better way to pay for healthcare led to the founding of Sedera as well as The Karis Group. The Karis Group’s “navigation and negotiation solutions simplify healthcare with personal, concierge-style guidance that reduces poor choices, frustration, and financial impact.”
Dr. Dale is known for his free-market thought leadership and is also the author of, “The Cure for Healthcare. An Old-World Doctor’s Prescription for the New-World Health System.”
He’s dedicated decades of his life to fixing a broken healthcare system and providing better ways to pay for medical costs. The Sedera Community shares Dr. Dale’s vision to actively pursue the change we all want to see: a simple, transparent alternative to the overly complicated and unaffordable health insurance industry.
During an interview at the 2022 Aspirational Healthcare Virtual Conference, Dr. Dale said, “We need to stop thinking in terms of saving 2% on healthcare costs, or even 20%. We need to think about a healthcare system that can eliminate the approximate 50% of waste in the current system and bring the costs down per person.”
The origins of medical cost sharing
The concept of medical cost sharing, also known as health sharing, can be traced back to the early 1900s. In those early days, close-knit communities came together to support one another in times of need. Those communities knew that they were stronger together than they were apart. There is a long history of these communities successfully helping to share each other’s financial burdens.
Many of these early communities were united by a specific religious faith. While many healthshare communities today still adhere to a religious requirement, some, like Sedera, have become more inclusive.
Sedera welcomes members from all walks of life who share a common faith in certain principles and ethical beliefs. Members also share faith in the power of community to help each other shoulder the burden of large medical costs.
Health sharing: A modern solution for a broken healthcare system
Early medical cost sharing communities set the foundation for the health share model of today. While it might have started with small, local communities, health sharing has grown exponentially for several reasons including:
The need for a better way to pay for medical care has grown due to the high costs of health insurance and a lack of transparency in medical costs.
It’s a viable and affordable alternative to health insurance with a long history of success.
It’s part of the free-market solution to a broken healthcare system that also includes Direct Primary Care and an emphasis on price transparency.
In the United States alone there are more than one million members in health care sharing ministries, health shares, or medical cost sharing communities with common ethical beliefs. These communities will continue to grow as more people seek an alternative to the high costs of health insurance and the freedom to make their own, value-driven healthcare choices.
What are some common problems people have with health insurance?
Many people have the misperception that health insurance is healthcare, but it isn’t. Health insurance is a third-party mechanism for paying for healthcare. It acts as a middleman between patients and their providers. It also adds administrative costs, which are then added to the cost of care and passed on to consumers.
People with health insurance are more likely to seek medical care than those who do not have insurance benefits. However, that care can come at a high cost including:
Unaffordable insurance premiums
High deductibles
High out-of-pocket costs
A lack of price transparency
Inflated medical fees
Network restrictions on the choice of provider and medical options
Healthcare tied to employment
According to the Peter G. Peterson Foundation, “Healthcare experts have estimated that 25 percent of our total healthcare spending goes to unnecessary and wasteful services. Furthermore, healthcare spending is projected to keep rising — faster than inflation, wages, and the overall economy. Not only does the system result in health outcomes that are generally no better for patients, but its inefficiency also creates enormous challenges for the U.S. economy and federal government.”
Medical cost sharing brings peace of mind
People without healthcare coverage are likely to face unaffordable medical bills and they may not seek preventive care which can lead to an increase in health issues. Even if they lead a healthy lifestyle, they worry about what will happen if they have an unexpected medical event. People without insurance generally have no plan for the unexpected and may even be forced into bankruptcy.
People with insurance face a lack of price transparency, high premiums, and overinflated medical costs. This can result in surprise, budget-busting medical bills.
Medical cost sharing is a non-insurance affordable way to pay for large, unexpected medical costs. It can also be paired with Direct Primary Care to provide a comprehensive way to manage primary and preventive healthcare.
Sedera plus Direct Primary Care provides the peace of mind that comes from having a financial plan for the unexpected and the ability to manage everyday and preventive healthcare for a better quality of life.
A recent KFF Survey on health insurance
KFF is an independent source for health policy research, polling, and journalism. In their recent Survey of Consumer Experiences with Health Insurance they found that six in ten insured adults, “had a problem with their health insurance in the past year.” They also reported additional issues including:
Affordability of premiums and out-of-pocket costs are a concern, particularly for those with private health coverage, and for some, contributed to not getting care.
Claims payment issues – About a quarter (27%) of insured adults say there was a time in the past year when their health insurance paid less than they expected for a medical bill.
Provider network issues – About a quarter (26%) of insured adults say there was a time in the past year when an in-network doctor they needed to see did not have available appointments and 14% say there was a time when a particular doctor or hospital they needed was not covered by their insurance.
Pre-authorization issues – About one in six insured adults (16%) say their health insurance denied or delayed prior approval for needed care in the past 12 months.
An overview of Medical Cost Sharing
Medical cost sharing is not health insurance. Instead, healthshare organizations facilitate the sharing of Community funds among Members when they have an eligible medical expense.
How Sedera Medical Cost Sharing works:
Members select options during enrollment including an Initial Unshareable Amount (IUA). This is the amount they feel comfortable paying per injury, illness, or medical event without help from the Community.
Members pay an affordable monthly membership contribution, typically much lower than health insurance premiums.
When a Member experiences an eligible medical event or “Need,” they pay their medical provider directly.
Members first pay their medical providers with their own money, up to the amount of their IUA.
Members then pay the medical bill balance with shared funds from the Community.
Why Sedera is a better way to pay for medical costs
The insurance middleman is eliminated and patients have a direct relationship with their provider.
Because providers do not bill insurance, medical cost sharing Members are considered “cash pay” or “self-pay” patients.
Cash pay patients commonly receive significant discounts on the cost of care.
As cash pay patients, Members are empowered to know the cost of care upfront.
Members are provided with clear Membership Guidelines so that they know what medical care is shareable with the Community before they seek non-emergent care.
Members have the freedom to choose their providers based on personal preference, value, reasonable cost, and convenience.
If you’d like to learn more, here is an in-depth look at how medical cost sharing works.
The benefits of being a member of a healthshare community
Healthcare price transparency
Health insurance is a complicated financial product. The inner decision-making processes are convoluted and opaque. Whether it’s employer-based, private insurance or a government-provided plan such as Medicaid or Medicare, price transparency is generally not front and center.
On the other hand, healthshare communities prioritize price transparency. This allows Members to seek high-quality and value-driven medical care, often at a greatly discounted rate.
Freedom of choice and flexibility
Sedera Medical Cost Sharing Members are not confined by in-network or out-of-network restrictions. Unlike health insurance networks, Member provider choices are not limited by:
Where the Member lives.
Where the Member travels — Sedera goes where Members go, worldwide.
Providers' acceptance of specific insurance plans.
Members are free to choose their physicians and other providers based on best fit, best value, and convenience.
With health-sharing, Members generally have the flexibility to travel for the best value-driven care. For example, if it’s determined that the best medical choice, at the best price, requires travel, Members are empowered to make the decision about where they will receive care.
Member resources
Sedera goes above and beyond to ensure Members have the resources they need to navigate their healthcare including cash-pay-friendly medical resources. Members also have a simple, comprehensive way to shop for affordable medical care because we’ve partnered with Savvos, the nation’s largest cash pay marketplace.
Savvos partners with high-quality healthcare providers across the United States who offer their services at a discounted, cash pay rate.
According to Savvos CEO Lou Morin, “Savvos allows members to compare prices, connect with amazing quality providers all over the country, simplify the process of scheduling care, and engage in affordable solutions. We’re not the solution for primary care but if you’re looking to schedule outpatient surgery, imaging, or diagnostics such as colonoscopies or endoscopies, that’s where Savvos can have a tremendous impact.”
Health sharing is more affordable than health insurance
A significant advantage of medical cost sharing is that it is affordable. Members make a low monthly contribution that is then available for sharing with the medical cost sharing community. The contribution amount is generally much more manageable than a health insurance premium.
Medical cost sharing community support
Interacting with a health insurance entity can feel impersonal, as though you are just a number. Insurance member services may not prioritize your concerns and it may take a long time to get answers to important questions. Even then, the answers may reflect a convoluted healthcare system fraught with administrative pitfalls.
On the other hand, health-sharing communities have intentionally come together to support each other and to share one another’s medical burdens. These communities will have a member services team that is dedicated to serving the best needs of the community members.
Sedera’s Member Services team are medical cost share experts and they help Members every time they have a question, a concern, or need assistance navigating the complex world of medical care. They also foster a personal connection with Members who may be going through a difficult time. Members know that when they reach out, they will almost always connect with their personal advisor who will not only provide assistance but will treat the Member with compassion and respect.
At Sedera, you’re a valued Community Member, not just a number.
Peace of mind
Medical cost sharing is a free-market non-insurance solution for large, unexpected medical expenses. Members have the peace of mind that comes with knowing that if they have a large medical event, they will have the support of their healthshare community. They won’t have to bear the financial burden of a major medical event alone.
Not all medical events are eligible for community sharing. The guidelines for what is, and isn’t shareable vary from healthshare to healthshare. Sedera’s Member Guidelines are deliberately comprehensive and transparent so that Members always know the terms and conditions of their membership.
Is medical cost sharing a good fit for you? Important considerations.
It’s important to understand that medical cost sharing is not health insurance
Insurance arrangements are a contract whereby one party agrees to be legally responsible for and accept another party’s risk of loss in exchange for a payment — a premium.
Medical cost sharing is an arrangement whereby members agree to share medical expenses through an act of voluntary giving.
To put it simply, medical cost sharing is a non-insurance healthcare solution that helps members pay for their medical expenses through voluntary community sharing.*
Membership requirements
While medical cost sharing is an affordable healthcare solution, it may not be the right fit for everyone. All health-sharing organizations have certain requirements for membership. Some health shares have a specific religious requirement while others may require a shared faith in one another and lifestyle commitments.
For example, Sedera is inclusive and welcomes people from all walks of life. The Members of the Sedera Medical Cost Sharing Community:
Are united by a shared faith in certain ethical beliefs and principles as outlined in the Member Guidelines.
Are active and engaged participants in their healthcare decision-making.
Commit to shopping for the best value for their medical care.
Are dedicated to a healthy lifestyle.
State availability
While Sedera operates in most states, there are a few exceptions. Learn more about our state availability.
Pre-existing condition limitations
Medical cost sharing communities have varying policies regarding preexisting conditions. Generally, pre-existing conditions are subject to sharing limitations. This is done to help protect the financial health of the community and its ability to share funds with members.
If you have a significant number of preexisting conditions or serious known health issues, medical cost sharing may not be a good fit for your healthcare.
At Sedera, pre-existing medical conditions are subject to sharing limitations, unless 36 months immediately prior to the membership start date has passed without:
Any signs or symptoms of the condition.
Any treatment needed.
Any medication prescribed or taken.
Any suspicion by the patient or doctors that the condition is resurfacing.
These apply whether or not the cause of the symptoms is unknown or misdiagnosed.
However, no prospective member is turned away for having pre-existing Medical Conditions. Sedera does provide a path to sharing medical expenses associated with a pre-existing medical condition. This path is based on membership tenure and a graduating sharing schedule.
Other specific medical conditions that have an exclusion or waiting period
As Sedera is a Medical Cost Sharing Community that shares large and unexpected medical expenses, some expenses including those related to routine preventative care, prescriptions, cosmetic surgery, and dental care, are generally not shareable. Additionally, medical expenses resulting from using illegal drugs or participating in unlawful activities are not shareable.
Here is a FAQ for more information on some commonly asked questions about Sedera Medical Cost Sharing.
There is a better way to pay for healthcare
One of the key challenges of innovation is public awareness and understanding. Most people are so resigned to navigating a broken healthcare system that they’ve lost hope that there’s a better way. Not enough people are aware that there is a viable and affordable alternative to health insurance.
Our Community Members share their Sedera experience with family, friends, and colleagues which helps the Community grow. We also have free market partners who share our mission to bring affordable and accessible healthcare to all — via health sharing — as a better way to pay for medical costs.
Open enrollment
Unlike health insurance, Sedera Medical Cost Sharing is not restricted to open enrollment periods. You can enroll at any time. And, we’re not tied to employment — we go where you go! Members who originally enrolled via a team option can change their membership to an individual membership as long as it is within 30 days of the team membership cancellation. Now that’s true peace of mind!
Learn more
If you have any questions or would like to learn more about whether Sedera is a good fit for you, Member Services is available to chat or respond via email. If you’re an employer who is looking for a way to facilitate a healthcare option for your team, but not break the bank, contact our sales team. We have innovative and affordable solutions for you!
Sedera Member Service Advisors are not only experts on medical cost sharing, but they also share a commitment to assisting the Community every step of the way and to the vision of our founder, Dr. Tony Dale. They are more than happy to answer any questions, via email or phone and are quick to respond.
*The Sedera Medical Cost Sharing Community is not an insurance company and the Sedera Medical Cost Sharing membership is not issued or offered by an insurance company. Whether any Member chooses to send monetary assistance to you and/or your household to help with your medical expenses will be totally voluntary and neither you nor the Sedera Medical Cost Sharing Community has any right to compel payment of medical cost sharing costs from any Member or household. The Sedera membership is not and should never be considered to be or to be like a group insurance policy or an individual insurance policy. The Sedera Medical Cost Sharing Community is not an employee welfare benefit plan, an employer-sponsored health plan, or multiple employer welfare association (MEWA).
