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Started By
Message
Has anyone here joined Sedera Medical Cost Sharing, or anything similar? I have questions.
Posted on 11/21/24 at 12:45 pm
Posted on 11/21/24 at 12:45 pm
I am looking to get away from standard health insurance. I am a 1099 independent contractor (I'm a management consultant) so I obviously don't have access to job offered insurance.
I was researching options and found a medical practice in Houston that offers monthly membership for standard checkups, sick visits, etc. In addition to that, they partner with a company called Sedera that offers a way of paying for major medical issues through "cost sharing" from its members.
It's interesting to say the least. You pay a monthly fee, which is less than most insurance plans, and if your "need" qualifies they pay it after a deductible they call "Initial Unsharable Amount". You have to pay cash for your medical care and than get reimbursed.
If you have pre-existing conditions it's definitely not a good option. I don't have any. I can't find any real negatives and they've been around for years and actually do pay the claims. Here is the website for the doctor's office in Houston that partners with Sedera:
First Primary Care
Here is the website for Sedera:
Sedera
Opinions? Thoughts? I'm seriously considering doing this. BTW I'm 48 years old and in excellent health as is my wife.
I was researching options and found a medical practice in Houston that offers monthly membership for standard checkups, sick visits, etc. In addition to that, they partner with a company called Sedera that offers a way of paying for major medical issues through "cost sharing" from its members.
It's interesting to say the least. You pay a monthly fee, which is less than most insurance plans, and if your "need" qualifies they pay it after a deductible they call "Initial Unsharable Amount". You have to pay cash for your medical care and than get reimbursed.
If you have pre-existing conditions it's definitely not a good option. I don't have any. I can't find any real negatives and they've been around for years and actually do pay the claims. Here is the website for the doctor's office in Houston that partners with Sedera:
First Primary Care
Here is the website for Sedera:
Sedera
Opinions? Thoughts? I'm seriously considering doing this. BTW I'm 48 years old and in excellent health as is my wife.
6
Posted on 11/21/24 at 12:52 pm to Boondock Saint
I would be open to a conceirge type medical provider. As far as medical cost sharing, two of my concerns, which are related, would be actuarial soundness of the plan and what happens if you have a catastrophic, long term hospital stay with multiple surgeries, etc. It's one thing to medical cost share an appendix operation. It's another thing entirely to cost share a lung transplant.
Posted on 11/21/24 at 12:59 pm to Jim Rockford
quote:
It's one thing to medical cost share an appendix operation. It's another thing entirely to cost share a lung transplant.
Exactly. I keep reading there are no maximums and they will share any cost, but I feel like at some point that can't be true. It seems like a bit of a risk, but I know insurance companies are notorious for denying claims as well. What's the better risk???
Posted on 11/21/24 at 1:17 pm to Boondock Saint
Haven’t heard of Sedera but there are established Christian health sharing ministries that do the same thing. I think the largest one has hundreds of thousands of members.
Posted on 11/21/24 at 1:20 pm to Boondock Saint
I have been part of a Shareplan for years. Called CHM. It's a great thing to be a part of. Very cost effective and helps tremendously. I wound up being diagnosed with cancer in 2022 and had a couple hundred thousand dollars of bills. They negotiate with the hospitals and clinics to bring the cost down, and paid for all of it. Any one issue, once it goes over $1k, they kick in. And they reimburse that original $1k. Now you have to stay on top of things a bit more and submit your bills, but so worth it. I pay so much less than I used to with regular insurance. By the way, the cancer is gone now, so I'm good. ??
Posted on 11/21/24 at 1:22 pm to Fletch1985
quote:
Haven’t heard of Sedera but there are established Christian health sharing ministries that do the same thing. I think the largest one has hundreds of thousands of members.
This is definitely similar which is honestly one of the things that gives me pause. I'm not a religious person, I'm just looking for better options than standard health insurance.
They do make you sign something that says you won't do illegal drugs or break the law (drunk driving, etc.). If you do these things and get hurt they won't pay. That's not an issue for me, but it all seems a little strange. Can't decide what to do....
Posted on 11/21/24 at 1:26 pm to Boondock Saint
quote:
In addition to that, they partner with a company called Sedera that offers a way of paying for major medical issues through "cost sharing" from its members.
It's interesting to say the least. You pay a monthly fee, which is less than most insurance plans, and if your "need" qualifies they pay it after a deductible they call "Initial Unsharable Amount". You have to pay cash for your medical care and than get reimbursed.
Isn’t that just insurance, but without direct billing from the provider?
I’d be curious why they choose to market it as “cost sharing” and not as insurance. Is it because of regulatory requirements they don’t have to meet if they aren’t selling “health insurance?” If so, what are those requirements and how do they impact you?
At least, those are the questions I would be asking.
Posted on 11/21/24 at 1:39 pm to Boondock Saint
Check the fine print for pre-existing conditions and no matter what they say there are no guarantees that they will pay all or part of the medical expenses. Also, with the Christian Share plans they can refuse to pay medical expenses if you aren't "Christian enough."
Posted on 11/21/24 at 1:40 pm to lostinbr
quote:
Isn’t that just insurance
Medi-Share plans are not insurance. They are not regulated the same way and do not need approval through the DOI.
Posted on 11/21/24 at 2:06 pm to La Place Mike
quote:
Also, with the Christian Share plans they can refuse to pay medical expenses if you aren't "Christian enough."
That would definitely be a problem for me considering I'm not a Christian. How could they possibly know this or determine this anyway?
Posted on 11/21/24 at 2:28 pm to Boondock Saint
quote:
That would definitely be a problem for me considering I'm not a Christian. How could they possibly know this or determine this anyway?
Some plans require a verification from a Pastor. Other plans are on the honor system, but if they find out you drink or smoke etc... they will drop you.
It doesn't appear Sedera is Christian organization but pre-existing conditions look like they aren't covered.
This post was edited on 11/21/24 at 2:33 pm
Posted on 11/21/24 at 2:34 pm to Boondock Saint
I've had Medi Share for 6-7 years. It is very affordable ($130 a month for me with a high $10k "deductible"). It is capped at $1 million I think.
They don't cover prescriptions and I've never needed it, so can't comment on its usefulness. There are tons of people that use it and pay into it and it has been around for decades. I know a bunch of people that go this route.
My strategy is to stay on it unless, God forbid, I have some major illness/disease/issue. In that case, with no exclusions/denials for preexisting conditions for standard health insurance policies, I will buy a policy if needed. Rolling the dice every year, but as a 1099 worker with no benefits and my kids on my ex's health plan, it works for me. Alternative is another mortgage sized monthly payment. Crazy and infuriating system.
They don't cover prescriptions and I've never needed it, so can't comment on its usefulness. There are tons of people that use it and pay into it and it has been around for decades. I know a bunch of people that go this route.
My strategy is to stay on it unless, God forbid, I have some major illness/disease/issue. In that case, with no exclusions/denials for preexisting conditions for standard health insurance policies, I will buy a policy if needed. Rolling the dice every year, but as a 1099 worker with no benefits and my kids on my ex's health plan, it works for me. Alternative is another mortgage sized monthly payment. Crazy and infuriating system.
This post was edited on 11/21/24 at 2:36 pm
Posted on 11/21/24 at 2:34 pm to La Place Mike
quote:
It doesn't appear Sedera is Christian organization but pre-existing conditions look like they aren't covered.
Pre-existing conditions are definitely not covered. They make that pretty clear. I think if you go three years without an issue they will start to cover them. I am healthy and don't have any so that is not a concern for me.
Posted on 11/21/24 at 2:42 pm to Jim Rockford
quote:
you have a catastrophic, long term hospital stay with multiple surgeries, etc.
I used to see patients in the hospital like this often and they were totally screwed
Posted on 11/21/24 at 3:05 pm to BeachDude022
quote:
I used to see patients in the hospital like this often and they were totally screwed
Give me more details on why they were totally screwed. Supposedly they will pay for anything and there is no maximum. Do you have any specific examples?
Posted on 11/21/24 at 3:17 pm to G Khan
Double post
This post was edited on 11/21/24 at 3:19 pm
Posted on 11/21/24 at 3:18 pm to G Khan
quote:
with no exclusions/denials for preexisting conditions for standard health insurance policies,
That, along with a lot of other things, may be changing in the next couple of years.
Posted on 11/21/24 at 3:40 pm to Boondock Saint
If it sounds too good to be true, probably is. I stick with Blue Cross, UHC, etc…
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