Healthcare cost sharing cooperatives are a relatively unknown and certainly underutilized resource for most patients. They have many advantages and some drawbacks but are valuable tools for patients willing to be responsible for their own healthcare and cost decisions. While not technically insurance, members of these cooperatives are exempt from the ACA requirements and exempt from the tax penalty for not having ACA qualified insurance. However, since it isn’t insurance, coverage of claims is limited to the members fulfilling their responsibility to care for one another. Practically speaking, most claims are covered and members are very satisfied with the process. Likewise, most patients have experienced being told ‘no’ by their insurance company so having health insurance doesn’t guarantee you’ll have your healthcare covered.
Cooperatives are built on the premise of sharing the cost of healthcare much the same way that the early Christian church shared with one another. Each member or family has a ‘share’ in which they are expected to pay each month. This is akin to the monthly insurance premium although is substantially less expensive. This share is paid each month directly to another cooperative member with an expressed need. When Sally in Nebraska has appendicitis her hospital bill might be shared with a section of the cooperative members who then write Sally a check equal to their monthly share. If you have a medical expense that qualifies, then you can submit your bill to the group for help paying it. The programs often help coach members on how to negotiate with medical organizations for lower cost therapy and reduction in charges.
Generally, small medical bills are expected to be paid individually. This is what makes cost sharing cooperatives such a nice pairing with a DPC membership. The DPC membership covers the day to day routine healthcare costs while the cooperative is on standby for the major medical expense.
Here’s a list of some of the programs our patients have used. Again, this is not an endorsement of any particular program and, in particular, is not a blanket statement advising patients not to have appropriate health insurance.
Check out this blog post by fellow DPC physicians for a good summary too: http://ochnahealth.com/health-cost-sharing-2019/