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Health Care Open Enrollment Season Options

Health insurance open enrollment is upon us again and it is time to familiarize yourself with pricing and options.


I want you to know that you don’t have to settle for ridiculously high premiums you can not afford that don’t really cover anything you need anyway. You don’t need a plan with a deductible so high that it makes your mortgage seem cheap. You don’t have to have a plan that traps you into a “network”. You can do better.


There is exciting news for health care mandates too: beginning January 1, 2019 the individual mandate penalty for NOT having health insurance will be zero.


This is exciting because you can finally go without health “insurance” and pursue other options.

Health Shares are becoming a more popular option for many people. I like the idea that you are paying into a risk share pool and your money is going towards other members health care needs (think of a co-op). With traditional insurance, about 20% of your premium goes towards profits, operating costs and compliance with government regulations. Another 20% go to prescription drug costs which means profits for PBMs (Pharmacy Benefit Managers) such as CVS Caremark, Express Scripts, United Health care and Walgreens is working on launching one as well with Blue Cross Blue Shield. PBMs are probably the biggest racket in healthcare in terms of price manipulation. Finally, another 20% go toward “outpatient services” which is largely labs and imaging. This means that roughly 60% of your premiums go towards goods, services, profits and administrative costs. Of those costs for goods and services, you can do about 70-90% better. Of the administrative costs, you can do 50-60% better.


In other words, you are most likely vastly overpaying for health care goods and services if you have traditional insurance exclusively.

What are the alternatives?

For individuals:

A DPC (Direct Primary Care) + a catastrophic coverage plan or a DPC + health share plan

Health shares include Medishare, Christian Sharing Ministries and Liberty Health Share. Liberty Health share will reimburse you a portion of your membership fee if you are a MedLogic DPC member.


Another option is Sedara Health which offers various levels of deductibles (called the unshared amount in health sharing terms).

Joining a Primary Care DPC such as MedLogic Primary Care plus a Health Share is a total healthcare solution. This combination is a financially savvy way to have full comprehensive coverage: You are covered for outpatient primary care through your MedLogic monthly premium and you have a cost sharing plan for any services that are required outside this scope such as an ER visit, major or minor surgery, childbirth and pregnancy care, cancer treatments and more. Check out our website today for all our services that are included for free in your membership. We offer deep discounts (70-90%) on labs, imaging and medications to our members as well. In many cases, membership pays for itself in terms of cost savings on medications, imaging and labs. If our care can help you to avoid an ER visit, you could save an entire year worth of membership fees.

For example, a 35-year-old would have a total monthly cost of $194 per month for individual coverage ($72 per month for MedLogic + $122 per month for Sedara Health).


Learn more about MedLogic DPC here: www.MedLogicMD.com

Learn more about Sedara Health + DPC here:

https://sedera.com/dpc/

Try out different pricing combinations here:

https://sedera.com/dpc2/

Learn more about Liberty Health Share here:

https://www.libertyhealthshare.org/3-program-options **

(** Liberty Health Share will reimburse you up to $40/mo individuals, $60/mo couples, $75/mo families if you are MedLogic Member)

For Small Businesses with 5-150 employees:

Please contact us directly to learn how you can cap your business’s health care premium expenditure, having a fixed cost that does not increase year over year and a cap on total health care cost liability. We can show you how!

Call or email us today at MedLogic Primary care: office@MedLogicMD.com or 847-881-6858

Happy saving everyone!

Jill Green MD

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