『Health Insurance Isn’t Your Only Option — The Health Share Alternative (Bill of Health Ep.7)』のカバーアート

Health Insurance Isn’t Your Only Option — The Health Share Alternative (Bill of Health Ep.7)

Health Insurance Isn’t Your Only Option — The Health Share Alternative (Bill of Health Ep.7)

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Healthcare keeps getting more expensive. Premiums rise, deductibles increase and many families feel like they are paying more every year without getting a better healthcare experience in return. In this episode of the Bill of Health Podcast, presented by Core 360 Benefits Group, I’m joined by Richard Walton, CEBS, of Sedera to talk about an alternative that still flies under the radar for many consumers: medical cost sharing. Richard spent years working in traditional employee benefits before moving into the health share space. We talk about what a health share actually is, how it differs from traditional health insurance and why consumers frustrated with the current system are beginning to look outside the insurance model for other options. We also get into the role of cash-pay healthcare and direct primary care, why health shares are designed primarily around larger and unexpected medical needs, and what families, self-employed individuals and employers should consider before deciding whether the model fits them. Health shares are not insurance, and they are not the right solution for everyone. The goal of this conversation is to understand how the model works so you can make a more informed decision about your healthcare. In This Episode of Bill of Health: Richard and I discuss: • What a health share is and how medical cost sharing works• Why health shares are different from traditional health insurance• Common misconceptions about health sharing and why due diligence matters• How becoming a cash-pay patient can change the way you shop for healthcare• Why direct primary care and health sharing can work well together• How health shares may fit freelancers, families and self-employed individuals• What to consider before deciding whether a health share is right for you What Is a Health Share? A health share is a community of members who voluntarily contribute money to help with eligible medical needs according to established sharing guidelines. Instead of paying premiums to a traditional insurance company, members contribute to a medical cost-sharing community. That community then helps members with eligible larger and unexpected healthcare expenses. The distinction is important: medical cost sharing is not health insurance, and sharing is governed by the organization’s membership guidelines. Healthcare Without the Traditional Insurance Model One of the biggest differences is how consumers interact with healthcare. Traditional health insurance often places a third party between the patient and the provider. Health share members generally operate more like cash-pay patients, which can encourage them to ask what something costs, compare options and make decisions based on value. That does not mean consumers have to navigate everything alone. Health shares can provide tools and support to help members understand pricing and manage medical expenses. Direct Primary Care + Health Sharing Richard describes direct primary care as a natural complement to medical cost sharing. Routine and predictable healthcare can often be handled through a direct relationship with a primary care provider, while the health share is designed to help with larger and less predictable medical expenses. For consumers who are comfortable taking a more active role in their healthcare, combining the two can create a very different experience from a traditional insurance plan. Who Should Consider a Health Share? Health sharing may be worth exploring for self-employed individuals, freelancers, families facing expensive traditional coverage or employees looking at alternatives to their employer plan. It is not automatically the right choice simply because it may cost less. Preexisting conditions, membership guidelines and the way eligible medical needs are shared all need to be understood before making a decision. Richard’s advice is to compare the models side by side and determine what actually makes sense for your family, healthcare needs and budget. Jargon Jar: Initial Unshareable Amount An Initial Unshareable Amount, or IUA, is the amount a health share member is responsible for paying toward an eligible medical need before the community begins sharing expenses. It can sound similar to an insurance deductible, but the two should not be treated as interchangeable. How an IUA applies depends on the health share’s membership guidelines and structure. About Richard Walton Richard Walton, CEBS works with Sedera and has spent more than two decades in the employee benefits industry. His work focuses on medical cost sharing, direct primary care and alternative approaches to paying for healthcare. Connect with Richard: LinkedIn: Richard Walton, CEBSEmail: rwalton@sedera.comPhone: 806-679-0816Sedera: www.sedera.com Learn More Interested in exploring Sedera medical cost sharing through Core360 Benefits Group? Use the Core360 Sedera affiliate link: http://www.1enrollment.com/950517 To learn ...
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