Anyone can afford health benefits that don’t suck, but before we get into that, let’s talk about why health insurance is so broken and why it’s so expensive. For starters, health insurance premiums cost more than your monthly food budget. It’s a big problem for independent contractors and their families. It’s nerve wracking to have to choose between health insurance and groceries. On top of that, health insurance is so confusing!  Most people have no idea what’s covered until they actually get really sick or injured. That’s not the best time to figure out you’re on the hook for the $6,000 deductible and an $18,000 out of pocket max. Until you hit your deductible, you’re totally on your own. You don’t think they’d make health insurance confusing on purpose, do you?

You have to understand that health Insurance is just a business. You also need to be crystal clear: health insurance should never be mistaken for healthcare.  Health insurance companies are in the business of collecting money and paying medical bills, for a profit.  So why do health insurance premiums continue to go up every year?

After all, if big insurance companies like Blue Cross were getting the lowest rates for healthcare, wouldn’t the premiums be going down?  No, you can’t judge this book by its cover.  These big companies are making a profit every time they spend another dollar on healthcare.  In other words, health insurance companies like Blue Cross, Aetna, and United grow profits when they pay more for health care.  No wonder premiums keep on rising.

The key to unlocking affordable health benefits comes down to understanding a few basic facts about people and their health.  It’s a well-known fact that most people identify as generally healthy. This commonly overlooked fact is the foundation for building great health benefits that work best for real people.  Now even though most people are healthy most of the time, everyone still has routine health needs. That means great health benefits must include low cost, super easy access to routine primary and preventative care. 

Fortunately, there is a whole new care delivery model that sells primary care memberships instead of the traditional fee-for-service approach.  By charging a simple monthly fee, members get no cost, yet unlimited access to their care team for all their routine needs.  By limiting the number of patients assigned to a care team, doctors and patients are both motivated by keeping all their members healthy.

Virtual Medicine is one of the biggest positives to emerge from the pandemic.  Virtual care became a best practice during the lockdown by moving from the occasional, episodic prescription to a wide range of routine and preventive care as well as coordination of chronic and higher-level care.  It’s quick, easy, and the only cost to you is your low-cost, monthly membership.  There are no more long scheduling delays for a 3-minute visit with your doctor. Drive time, traffic jams, and sickly waiting rooms are a thing of the past.   

Of course, there are instances when a virtual visit with your doctor isn’t enough.  Sometimes routine care means a drive to urgent care.  But when you have affordable health benefits, you will be saving a ton of money compared to health insurance.  Your savings will be more than enough to cover the cash price for an urgent care visit, or even two. 

But let’s not forget how this whole health insurance game began in the first place.  Catastrophic coverage is what health insurance was initially designed for.  Everyone wants to know they have a reliable way to pay for the “big” unexpected health bills. They’re the ones that always pop up at the worst possible times. 

While big health insurance has been dominating the market as a profit driven business, nonprofit medical cost sharing has been quietly growing its membership too, by performing the same basic functions as health insurance for a substantially lower cost.  Perhaps the most significant difference between medical cost sharing and health insurance is the fact that only one has shareholders who expect to make a profit.  The other is a nonprofit community of like-minded people who simply want to be sure their medical bills will be paid.  By eliminating the overhead and profit incentives of traditional health insurance, medical cost sharing ends up costing 30-60% less than a typical health insurance plan. 

While it appears to work exactly like health insurance, some important differences make medical cost sharing a better alternative for most generally healthy people.  The low monthly cost and out of pocket maximum are the most apparent differences between medical cost sharing and traditional health insurance.  But let’s not overlook the fact that medical cost sharing doesn’t tell you which doctor to see. It doesn’t force members to stay in the network, meaning cost sharing members can get healthcare they want from the providers that fit their needs.  And if you find yourself across the country and in need of care, that is not a problem.  You’re not going to get stuck paying ridiculously high out-of-network rates like you would with health insurance. Because with most medical cost sharing plans, you are never “out-of-network,” no matter where a significant medical event might pop up.

Just like membership based primary care, medical cost sharing incentivizes healthy lifestyle choices for its members.  It’s not hard to understand how when a community of people strive together to live healthy lifestyles, everyone reaps the benefits.

Lastly, with medical cost sharing, you’re not just another patient with an insurance card.  When you have a medical event in life, you have a community there behind you to support you, help you navigate the complex healthcare system, and help with the bills.