The cost of health insurance has been consistently on the rise over the last few years or more. This has resulted in the search for more cost-effective alternatives to health insurance for individuals and businesses. One alternative that has become quite popular in recent years is a community-based medical cost-sharing memberships.
Here’s how a community-based medical cost-sharing membership works and what elements differentiates this from conventional medical insurance coverage.
Most of the community-based medical cost-sharing memberships tend to be faith-based. They are aimed at facilitating the elective cost-sharing among members for their expensive medical bills. Most of these memberships are registered as either non-profit or benevolence organizations. Members freely make regular monthly contributions that are then allocated to other members with large medical expenses at that time. This idea is based on the time honored premise that people with similar values and beliefs have the ability to help each other in a time of need. This makes medical cost sharing a more personable, relatable and social alternative to conventional medical insurance. One of the unique attributes of Scoop Health is that anyone can join the community, regardless of their beliefs or faith.
Understanding the Difference: Medical Cost Sharing vs Health Insurance
One of the biggest appeals of community-based medical cost-sharing is that it costs significantly less per month than conventional medical insurance. This is partly because cost-sharing members are encouraged to make healthier choices in terms of their lifestyle and when seeking health care. As cash paying patients, cost sharing members have access to the best medical services at a fraction of the monthly cost of health insurance. Furthermore, there are no network restrictions so members always have the option to choose any doctor as opposed to having to see only the insurance network approved doctors as is often the situation with conventional health insurance coverage.
In terms of the costs involved, members contribute a regular monthly amount which is often referred to as a member‘s “share amount” or a “family share”. When a larger medical need comes up, the member is responsible for an ‘initial unshareable amount’, that can be as low as $500 based on the type of membership they have chosen. After that, members are able to submit the remaining medical bills to the community for reimbursement from community funds. From the perspective of a business looking to secure community-based medical cost-sharing for employees, offering this option to employees means both the employee and the employer would pay much less on a monthly basis. In addition employees can access unlimited telemedicine included in the membership for everyday care needs.
The sense of community within medical cost-sharing is a key to the success of these types of health insurance alternatives. These community-based membership programs are based on the premise of like minded people helping each other during times of need, whether the assistance is required as a result of an accident or care due to a serious illness. Members submit their medical bills and after they have met their initial unshareable amount, the community stands ready to share in the rest of the costs according to membership guidelines. Furthermore, some of the community-based medical cost-sharing memberships are not restricted by any preferred provider organizations (PPO) or HMO limitations, meaning that members can see any doctor they like. Cost sharing members know to ask doctors for the cash-price because it almost always leads to a reduction of the physician charges incurred by the member. Additionally, community-based medical cost-sharing encourages patients to pay cash for everyday medical expenses upfront, meaning that the patient is also able to receive cash discounts from service providers for being a cash-pay patient.
Maintaining Your Own Health is in Your Good Hands
Community-based medical cost-sharing organizations are founded on the basis of a mutually aligned community. The people who are the members all share similar beliefs and healthy lifestyles, they all agree to abide by a set of written membership guidelines. Therefore, the premise is, that by encouraging members to maintain healthy lifestyles that do not involve health-compromising activities, they can keep costs lower, since leading a healthy lifestyle can reduce the likelihood of a member developing serious illnesses. This sense of community provides the members with the comfort that they are sharing their medical costs with like-minded individuals instead of counting on a profit hungry insurance company. Members have peace of mind and the confidence of knowing there is a solid community standing behind them, that agrees to sharing their large medical needs too.
Unlike traditional health insurance, community-based medical cost-sharing organizations tend to approach things like the members age and preexisting conditions differently, depending on the membership selected. Most medical cost sharing memberships have rates that increase with the members age as a way to properly allocate each member’s risk in the community. One of the ways in which preexisting conditions are shared in community-driven medical cost-sharing memberships is that during the first year there is no sharing allowed for the preexisting condition. But then members are allowed to share an increasing portion of the cost in subsequent years, like a phase in period. However, it is important to check with the specific membership guidelines to determine if your own personal preexisting conditions are anything that is of concern to you. This is to ensure that your preexisting condition is planned for and you will know the impact and how you need to plan your approach to the costs.
Along the same lines as preexisting conditions medical cost sharing memberships typically charge an extra monthly amount based on members who smoke tobacco. This is because these members are more likely to develop costly medical conditions than members who do not smoke, so they should be required to pay more into the community as a result of that.
The basis of community-based medical cost-sharing is the ability to rely on those fellow members paying their monthly share even when large medical needs arise. Medical expenses that result from an accident or illness are referred to as “Needs”. Needs become shareable after the member first pays for an initial unshareable amount or IUA. There is a comforting assurance in knowing that there is a committed community lending financial support to assist in your time of medical and financial distress. Furthermore, having the freedom to select your own medical practitioner means that you are able to receive care from doctors that you trust without having to worry about any potential restrictive insurance conditions that may limit your ability to pay for their services after your medical needs have been attended to. You won’t need to worry about any hidden red tape when it comes to making choices about your health and the health of your family.
Being a Part of Something Bigger
Scoop Health is part of a community-based medical cost-sharing membership that is powered by Sedera. We encourage our members to pursue healthy lifestyles and, in so doing, are able to provide high-quality healthcare options to our members at a fraction of the cost of health insurance. The community-based medical cost-sharing industry has over two million members nationwide, with over one billion dollars in annual sharing among them. The members of our community can choose to pay a per-need initial unshareable amount (IUA) as low as $500 and are have their remaining costs for the incident shared by the community. After an individual’s third medical need in a year (or fifth in the case of family) then any additional medical needs in that same year are first-dollar shareable, without an IUA. As an employer, you can have peace of mind knowing that your employees will have a medical cost sharing membership at a lower cost to them and you as the employer, and due to their healthier lifestyle choices and medical cost-sharing, you could have a healthier workforce. This could lead to increased productivity for your organization and a happy workforce that doesn’t have to worry about something as basic as large medical expenses. Ask about joining our community and how it can help take care of you, your family and your employees.