The One Valley Healthcare Program is a Medical Cost Sharing Model combined with a preventative care program. Medical cost sharing is an alternative to health insurance in which like-minded people come together and choose to share health care costs. By definition, medical cost sharing is not health insurance. Instead of paying monthly premiums to an insurance company, members share a set amount on a monthly basis and are provided community funds as medical needs arise. As a result, there is every incentive to keep medical costs to a minimum.
Through this model, members can see healthcare savings up to 60% less than the comparable costs (monthly premium, deductible, and maximum-out-of-pocket) of employee sponsored group health insurance.
The elimination of the Individual Mandate Penalty to enforce the requirement to have health insurance with Minimum Essential Coverage (MEC) provides an opportunity to for consumers research alternative solutions for affordable healthcare. The recently launched One Valley Healthcare Program. brings a MEC preventative plan and cost sharing program to Eagle County individuals and businesses.
Today, there are almost one million members of medical cost sharing plans throughout the United States. Unlike health insurance, where premiums can vary widely within a state (as those in Eagle County well know), the monthly share for medical cost sharing plans is the same for all fifty states.
How does it work?
Cost sharing eliminates traditional insurance marketing expenses; the Affordable Care Act mandated that health insurance companies use a minimum of 60% of health insurance premiums for healthcare costs, or a maximum of 40% of health insurance premiums for marketing and administrative costs. Conversely, health sharing plans are, by definition, benevolent organizations structured for the benefit of their members: For example, Sedera Health deducts 9.9% for administrative costs.
When a member of a medical cost sharing group has a major medical emergency expense, the member pays the Initial Unshareable Amount (IUA) that they selected ($500, $1,000, $1,500, etc.) to the provider with their credit card and requests an invoice for a cash payment for the balance. Simply Google “pay cash for medical bills”. You will find countless articles from numerous reputable publications on how providers will discount their scheduled charges for cash payment. Cash payers pay less according to varied sources including HappyMD, Kiplinger, Consumer Reports, and Wall Street Journal.
In layman’s terms, medical cost sharing plans provide members with the practical means to manage their maximum out-of-pocket expenses for a major medical expense at a fraction of the cost of a group high deductible insurance policy.
Healthcare sharing is not insurance where a premium is paid and the risk of major medical expenses are assumed by the insurance company. In healthcare sharing the patient deals directly with the doctor or hospital (with assistance from the cost-sharing program sponsor) without the interference of an insurance company actuary.
A new model is necessary as health insurance costs in Eagle County and across the mountain region continue to escalate and create increased cost burdens on individuals and businesses. Our recent workforce study indicates the increased impact of health care costs is negatively impacting businesses, and many business do not offer medical benefits to employees. The One Valley Healthcare Program helps change that dynamic – giving businesses and individuals access to a model that is gaining popularity across the country.
Learn more about our local model at OneValleyHealthcareProgram.com.
Chris Romer is president & CEO of Vail Valley Partnership, the regional chamber of commerce. Learn more at VailValleyPartnership.com