Is Health Insurance the only solution?

Is there a way to accomplish the job of health insurance for less?

The solution would need to provide help and hope:

Help: Provide access to care for ordinary situations.  This means your health team will care for you today, and that you can afford to be cared for.

Hope: Be there to help in extraordinary, unpredictable situations.

 

At Big Tree, we like solutions.

For individuals and small groups, that means getting “ordinary care” through direct primary care (such as Big Tree) and using a health sharing membership to help pay for extraordinary needs.

 

Ordinary Care: Minimal or no cost.

Relational Care from a medical home

  • A personal relationship with your care team.
  • 24-7 access to your care team via video and text message.
  • Unlimited visits at no additional cost (virtual visits or in person visits, depending on plan).
  • Same day visits (no need for urgent care and little need for ER)
  • Management of most acute conditions (such as as UTIs and sinus infections), chronic conditions (such as diabetes and PCOS) and mental health conditions (depression and anxiety).

Affordable medications, labs and supplies.

  • Most plans include over 100 free medications including most generic medications.
  • Labs and supplies at over 90% off of retail.

Extraordinary Care: high deductible “insurance” or a health sharing membership.

Hospital Care and Emergency Care

  • Though most ER and hospital utilization is avoided, Big Tree pairs well with high deductible insurance plans or with alternatives such as a membership in a health sharing community.
  • For groups larger than 50 employees, we partner with a TPA to create a level funded or self funded health plan.
  • For small groups and individuals, we partner with insurance companies providing short term health plans or with health share groups.
  • Our partner insurance agency is able to help anyone set up a comprehensive solution for 50%-70% cheaper than a comparable solution in the insurance market.
  • For example, compare the Big Tree-Sedera health share membership for a family ($603/month) to a HealthCare.gov plan at $2,942/month (visit these links, input your own data for custom quotes, or to get more info).

Case examples:

The following examples compare prices alone. They do not compare the value provided by the personalized care in a direct primary care-based system. They also do not include the psychological costs of trying something new (such as our programs) or the stress caused by being uninsured. This particular system was designed combining the Big Tree Unlimited plan with a health sharing membership through Sedera (we work with other programs too, check them out at our partner agency, linked below). Similar solutions could be achieved by combining a short term health plan with Big Tree or a group self funded health plan with Big Tree.  Of note, a marketplace sliver plan would have around a $5,000 deductible, while the health share membership would have a $500 per “episode” out-of-pocket cost, hardly comparable.  In none of these cases does the patient qualify for a subsidy to defray part of the cost of health insurance.  You can calculate your actual cost for a health care insurance plan through the ACA exchange, including checking to see if you qualify for a subsidy, here.

34 year old female on birth control and an antidepressant.  During the year she has an acute care visits for sinusitis and a UTI.

Costs Big Tree/Health Share Without Insurance Marketplace Cigna Silver Plan
Monthly cost/premiums $246.00 $0.00 $460.00
Annual Medication cost $0.00 $204.00 $350.00
Annual Doctor visits/copays $0.00 $975.00 $150.00
Total Annual Cost $2,952.00 $1,179.00 $6,020.00

55 year old female with heart attack in month 6.  Requires 3 day hospital stay, a stent and then is discharged on 4 medications.  Was only on a high blood pressure medication prior to the heart attack. The patient has a $500 per episode initial unsharable amount with the health share plan or an $8,150 deductible silver plan from the ACA marketplace. The patient’s hospital provides a 60% discount for uninsured patients.

Costs Big Tree/Health Share Without Insurance Marketplace Cigna Silver Plan
Monthly cost/premiums $366.00 $0.00 $854.00
Annual Medication cost $0.00 $1,764.00 $750.00
Annual Doctor visits/copays/hospital fees $500.00 $10,036.00 $7,400.00
$4,892.00 $11,800.00 $18,398.00

One of the weaknesses of health share memberships is how they treat pre-existing conditions.  However, even paying out-of-pocket for pre-existing conditions, the below patient saves over $16,000 by using a health share membership rather than buying an insurance plan, despite having a very unlucky year.  This patient is a 62 year old early retiree with diabetes, high blood pressure and high cholesterol.  They take, or are supposed to take, 2 oral diabetes medications, 2 blood pressure medications and one medication for high cholesterol.  They are hospitalized for 2 days for high blood sugar, which is not eligible for sharing in the health sharing arraignment, as it is a pre-existing condition.  The patient has a $500 per episode initial unsharable amount with the health share plan or an $6,750 deductible silver plan from the ACA marketplace. The patient’s hospital provides a 60% discount for uninsured patients.

Costs Big Tree/Health Share  Without Insurance Marketplace Cigna Silver Plan
Monthly cost/premiums $582.00 $0.00 $1,421.00
Annual Medication cost $0.00 $2,340 $600.00
Annual Doctor visits/copays/hospital fees $1,828 $3,528 $7,950.00
$8,812.00 $5,868 $25,602.00

These calculations include retail prices for medications, 4 doctor visits per year with HgbA1c and other appropriate diabetes labs.  They are hospitalized for 2 days for high blood sugar.  The hospitalization only costs $1,828 for both the uninsured case and the health share case as the hospital offers a 60% cash pay discount, which the patient is not eligible for if they have insurance.  Of course, in the uninsured case, the patient is at risk for a catastrophic claim, and their diabetes hospitalization could have easily been a $1million hospital bill had they caught it a day later, a situation that either the case with the share membership or the Cigna plan would be protected against.

For more information, including video content on the ins and outs of health sharing, visit our partner agency here.

Simple. Easy. Affordable Health Care

With Big Tree Medical Home