How Health Sharing + Direct Primary Care Works
A health share is a community of members who contribute monthly and share each other's eligible large medical bills under written guidelines; it isn't insurance and doesn't guarantee payment. We pair it with Direct Primary Care—a flat-fee membership for everyday doctor visits—because health sharing deliberately does not share routine care.
Written and reviewed by Graham Kerswell, Founder of Beacon Health Benefits.
The Three Pieces
A modular approach that separates routine care, unexpected major bills, and optional dental savings.
Direct Primary Care (DPC)
Everyday health: sick visits, routine wellness checkups, chronic condition management, and wholesale-priced labs and medications with zero copays.
Sedera Medical Cost Sharing
Catastrophic and major medical: emergency room visits, hospitalizations, surgeries, and serious illnesses shared by the community after your IUA is satisfied.
Dental Savings Plan
Access to pre-negotiated provider discounts for routine cleanings, x-rays, fillings, crowns, plus vision and prescription medications.
What Happens When You Need Care? Three Scenarios
Illustrative figures for a single member, age 35, with a $1,000 IUA at $226.86/month (rates as of October 2026).
A Sinus Infection
You message or book a same-day virtual visit with your primary care provider. You speak with a doctor, discuss symptoms, and have a treatment plan created.
A Broken Wrist
An ER visit, x-rays, stabilization, and a cast total a $4,800 hospital bill. You pay your Initial Unshareable Amount. Sedera negotiates the line items, and eligible remaining costs are shared by the community.
A Hard Year
Three distinct Needs in 12 months: appendix surgery, a car accident, and a kidney stone. You pay three IUAs ($3,000). A fourth Need occurring that year has an effective $0 IUA.
*Sharing in scenarios 2 and 3 depends on Sedera's published guidelines: pre-existing conditions phase in over three years, and certain services are limited or excluded.
What Doesn't This Cover? The Honest Gaps
We never conceal limitations. If any of the following apply to your immediate medical needs, traditional insurance is likely the better choice.
Conditions treated within 36 months before joining phase in: $0 shared in Year 1, up to $25k in Year 2, up to $50k in Year 3, and fully shareable from Month 37.
Counseling is limited to $750 per year. Long-term, continuous outpatient psychiatric care is not shareable through Sedera.
Maternity is only eligible for sharing if your estimated due date is at least 9 months after your effective membership start date.
Prescription sharing is limited to 120 days for new diagnoses. Ongoing chronic maintenance medications must be sourced via wholesale cash programs.
Careington ancillary plans provide negotiated network discounts, not indemnified claim payment or insurance coverage.
Health sharing is not minimum essential coverage under the ACA and will not exempt residents of MA, NJ, RI, or DC from state tax penalties.
Health Share + DPC vs ACA Marketplace Insurance
Understanding how the core mechanics and legal guarantees differ.
| Comparison Point | Health Share + DPC | ACA Marketplace Plan |
|---|---|---|
| Payment of Big Bills | Eligible costs shared under guidelines; not legally guaranteed | Covered under binding legal contract (after deductible) |
| Price Based on Income? | No; set by household size, age, and IUA tier | Yes; premium tax credits determined by household income |
| Pre-Existing Conditions | Phased in over 3 years (not covered Year 1) | Covered immediately without pre-existing limitations |
| Provider Network | None; see any doctor, surgical center, or hospital | Restricted PPO/HMO network tiers and out-of-network penalties |
| Enrollment Timing | Enroll any month (memberships begin on the 1st) | Restricted to Open Enrollment (Nov 1–Jan 15) or Qualifying Life Events |
If your household qualifies for substantial ACA income subsidies, requires active treatment for a serious condition this year, is already expecting a child, or requires contractually guaranteed claim reimbursement—we will advise you to choose an ACA plan.
Common Questions
What is a health share?▼
Is a health share cheaper than insurance?
Can I join at any time of the year?
Statutory Legal Notices & Disclaimers:
Health care sharing ministries and medical cost-sharing communities are not insurance and are not regulated as insurance. Sharing of medical expenses is voluntary and not guaranteed. Review each organization's guidelines for details, limitations, and state-specific notices.
We may receive compensation from some organizations we recommend. This does not change our evaluation of how they work.
THIS PLAN IS NOT INSURANCE and is not intended to replace health insurance.
This page provides general information and does not constitute medical, legal, or tax advice. Prices are set directly by the programs and can change.