Question 1

Is Beacon Health traditional health insurance?

Accepted Answer

No. Beacon Health Benefits is not an insurance agency and doesn't sell insurance. We pair a direct primary care (DPC) membership for everyday care with Sedera medical cost sharing for large, unexpected bills. Neither is insurance.

Question 2

Who is eligible to join?

Accepted Answer

Adults 18 to 64 and their families in most states. As of October 2026, Sedera isn't accepting new members in California, New Mexico, Pennsylvania, Vermont or Washington. Anyone can join regardless of health, but pre-existing conditions have a phase-in period. Members agree to Sedera's 10 ethical principles; there's no religious requirement.

Question 3

What is direct primary care and how does it work?

Accepted Answer

A membership with a primary care practice: you pay a flat monthly fee for a defined set of services, usually unlimited visits and direct access to your doctor, with no copays or insurance billing for those services. It doesn't cover hospital, ER or specialist care.

Question 4

Does DPC membership require a specific network?

Accepted Answer

Your DPC is the practice you join (for example Akos MD's virtual care). For everything else, Sedera has no network: you can use any doctor or hospital.

Question 5

Is Sedera an insurer?

Accepted Answer

No. Sedera's guidelines state it 'is not an insurance company nor is it insurance.' Sharing is voluntary and not guaranteed.

Question 6

What is a “Need”?

Accepted Answer

A Need is the medical expenses for one illness or injury. Related bills for the same condition stay on one Need until you've had 12 symptom-free months.

Question 7

How is the IUA different from a deductible?

Accepted Answer

The Initial Unshareable Amount applies to each Need, not once a year, and you choose it ($500, $1,000, $1,500, $2,500 or $5,000). A deductible is a yearly amount under an insurance contract. After your IUA, eligible bills may be shared under the guidelines; that isn't guaranteed.

Question 8

Is there a yearly limit on IUAs?

Accepted Answer

Yes. No more than three IUAs apply per household per membership year. A fourth Need in that year has no IUA.

Question 9

Are there annual or lifetime limits?

Accepted Answer

There is no lifetime maximum. Some services have their own limits (for example counseling, therapy and high-cost gene or cell therapies), and no single Need may use more than a third of available shares in a month.

Question 10

Can I choose my own doctors and hospitals?

Accepted Answer

Yes. There is no network. You pay as a self-pay patient and Sedera negotiates bills over $1,000.

Question 11

How are pre-existing conditions handled?

Accepted Answer

Conditions with symptoms, treatment or medication in the 36 months before you join phase in: nothing shared in months 1–12, up to $25,000 in months 13–24, up to $50,000 in months 25–36, and fully shareable from month 37. If you need treatment for an ongoing condition this year, an ACA plan is likely the better fit.

Question 12

Is maternity shared?

Accepted Answer

Yes, if your due date is at least 9 months after your membership starts. The maternity IUA is twice your standard IUA (max $5,000); an elective C-section has a $5,000 IUA. If you are already pregnant when you join, sharing is very limited. Add your newborn within 30 days of birth.

Question 13

Are emergencies and hospital stays shared?

Accepted Answer

Eligible emergency and hospital bills above your IUA can be shared. In an emergency, get care first and notify Sedera within 48 hours.

Question 14

How do I open a Need and submit bills?

Accepted Answer

Open a Needs Case in Sedera's Member Portal and upload itemized bills within 6 months of the service.

Question 15

Is routine preventive care shared?

Accepted Answer

No. Routine checkups, physicals and adult vaccines aren't shared. That's what your DPC membership is for. Screening colonoscopies and mammograms can be shared without an IUA after 6 months of membership, within set limits.

Question 16

Are prescriptions shared?

Accepted Answer

Medications for a new diagnosis are shared for the first 120 days. Ongoing maintenance medications aren't, which is another reason to have a DPC that offers wholesale-priced medications.

Question 17

What if I use tobacco or nicotine?

Accepted Answer

Your monthly amount is higher. Members 50 and older who use tobacco have a $25,000 limit on certain tobacco-related conditions until 12 months after quitting.

Question 18

Does Sedera negotiate bills for me?

Accepted Answer

Yes. Sedera negotiates bills over $1,000 and offers patient advocacy. Members must allow negotiation; refusing can reduce sharing.

Question 19

Is mental health shared?

Accepted Answer

Counseling is limited to $750 per year. Psychiatric care has separate per-Need limits. If you need ongoing therapy, health sharing alone won't cover much of it.

Question 20

Does Sedera satisfy the ACA individual mandate?

Accepted Answer

No. Sedera isn't minimum essential coverage. There is no federal penalty, but Massachusetts, New Jersey, Rhode Island and Washington, DC have their own mandates.

Question 21

Can I use or contribute to an HSA?

Accepted Answer

Sedera isn't a high-deductible health plan, so it doesn't make you eligible to contribute to an HSA on its own. HSA rules for DPC fees have also changed recently. Please consult a qualified tax professional.

Question 22

What do routine blood work and imaging cost?

Accepted Answer

Many DPC practices offer labs at wholesale prices, often far below retail; imaging is usually extra but discounted. Lab and imaging bills that are part of an eligible Need can be shared after the IUA. Ask us for current prices for your specific DPC option.

Question 23

Do you offer employer plans?

Accepted Answer

Yes. Beacon structures customized benefit solutions for small employer groups, business owners, and 1099 contractor teams to sponsor paired DPC and Sedera memberships. Employers can also request an independent evaluation or referral.

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