Sedera Health Insurance Review [The Ultimate Guide]

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The cost of healthcare in the U.S. is no joke. Premiums increase annually and we have no choice but to participate in it if we wish to have healthcare.

Currently, over 70 million Americans have no health insurance or are underinsured. Additionally, as a country, we pay twice as much per capita for healthcare than the rest of the world. If we are to have any hope of catching up with the rest of the world in healthcare, Medicare would need to negotiate the prices of prescription drugs down by at least 50%, and that’s more than likely a long shot of ever happening in the near future.

At what point do you draw the line? Say health insurance premiums rise to $20k a month to cover your family. Would you pay that much? Even if you’ve got insurance via your work, jobs aren’t always guaranteed. Plus, your company already factors its share of health insurance costs into your wage.

A new type of healthcare coverage is emerging — healthshare plans.

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A health share plan is considered an alternative to traditional insurance but with much lower costs.

Organizations provide these plans to communities that share certain beliefs. As long as everybody’s mission is aligned, it works because everyone’s agreed to cover each other in times of need.

Some have religious belief criteria, but you needn’t worry if you aren’t religious. There are other plans out there and Sedera is one of them.

Penalties For Not Having Health Insurance

Having a health share plan doesn’t qualify for the Minimum Essential Coverage. Federal and state mandates will apply accordingly. It means that in certain states, you’ll still pay a fine if you don’t have traditional health insurance.

Although the tax penalty for not having health insurance was removed at the federal level in 2019, some states continue to penalize residents who lack traditional health insurance coverage. You’ll need to look into your own state’s stance on this. It’s possible you can still save overall with a health share and a penalty, especially if you have a large family.

Sedera is a non-profit medical health share or cost-sharing community that offers a way to manage healthcare costs.

Every member of Sedera contributes funds for other members to use. The contribution costs get charged monthly. The community members share funds through Sedera’s secure platform to pay for medical expenses. All the money that you pay is not paid for by Sedera; it is taken from the communal account.

Sedera Health Pricing

The Sedera Health Access+ pricing, which is aimed at individuals and families, starts at $127 per member and can go as high as $615. The exact price depends on age and the total number of persons per membership type. The older you are (maximum age of 65), the higher it may cost, but if you have more members in a plan, your per-member cost could go down.

There is an additional $75 per month fee for smokers.

Be sure to check out our post on Hospitals That Forgive Your Medical Bill [Find One Near You]!

What is the meaning of IUA?

IUA stands for Initial Unshareable Amount, which is analogous to a deductible. The Access+ plan has an IUA that starts at $500 per medical need and can be as high as $5,000.

You only need to pay your IUA for the first three medical needs of any given year. In order for your medical need to qualify as one, it needs to cost more than your IUA.

This means that if your plan’s deductible is $5,000, you would have to have three separate medical needs of at least $5,001 to be able to have the rest of the year’s medical expenses covered. If your medical needs are always $4,999, you would have to pay for your own expenses always.

This makes it very important for you to know what kind of medical needs you have on a yearly basis.

If you don’t have any pre-existing conditions, your entire medical cost will qualify for full sharing.

What about if you do have pre-existing conditions? Let’s get into that.

Pre-existing Condition Limitations

There are sharing limitations if you have pre-existing conditions. A pre-existing condition is defined as any chronic symptom, treatment, illness, or injury that has been active or requires treatment within 36 months of membership. This includes allergies.

Should you have a pre-condition, the following limitations apply:

In the first 12 months, none of your expenses (related to your pre-existing condition) are eligible for sharing.
Once you start getting into months 13-24, you may then share up to $15,000 of your medical costs.
In months 25-36, the shareable amount increases to $30,000.
Afterward, for the 37th month and on, your entire medical cost will qualify for full sharing.

Maternity Limitations

Your estimated date of delivery must come at least 12 months after initiation of membership (i.e. you cannot get pregnant for roughly three months as a member). Or else, any costs related to your pregnancy will not be shareable. This is the standard of any medical sharing program.

For any medical procedures related to miscarriages, the standard IUA structure applies. Otherwise, the usual IUA structure does not apply. You’ll be required to pay a maternity IUA of $5,000 for standard delivery (this includes emergency C-sections), and $7,500 for elective C-section deliveries. In other words, that would be how much it costs to have a baby with Sedera Health.

Sedera Health Medical Bill Negotiation

Sedera Health has a professional service to help you negotiate your medical bills for you. Since a healthshare plan is essentially paying cash, you are able to get a significant discount on your medical bills. Having a seasoned professional do it for you will help you significantly.

Pros and Cons of Sedera Health: The Pros

Pros

Lower monthly costs for healthcare
Complete freedom to choose your provider or hospital
Experts who step in on your behalf to negotiate medical bills for you
Convenient telehealth services for basic healthcare needs
Medical costs incurred outside of the United States, still qualify for sharing
No maximum lifetime limits per member

Pros and Cons of Sedera Health: The Cons

Cons

Sedera does not count as health insurance, so penalties from your state may apply
There are sharing limitations for pre-existing conditions
Routine preventative care, prescriptions, cosmetic surgery, or dental care are generally unshareable
Costs associated with use of illegal drugs or unlawful activities are unshareable
Sharing turnaround times range from 14 to 60 days from receipt of your bills
Sedera isn’t available in all states
If in any given month, funds run short, they will only be required to cover a pro-rated amount
You need to submit your medical need within 6 months from the date of service

Several organizations in the U.S. provide health share plans, usually involving religious standing. Examples of these organizations include Christian Healthcare Ministries and Medi-Share.

On the other hand, Sedera Health has no specific religious requirements for membership. However, members must still agree to certain outlined ethical beliefs.

Sedera Healthshare vs. Regular Health Insurance

Sedera is not insurance. Their system works differently than traditional health insurance.

Cost-Shifting

Insurance cost-shifting measures can shift thousands of dollars in out-of-pocket costs to its members annually. If you don’t know what cost-shifting is, it’s when health organizations charge their insured patients multiples more than their uninsured counterparts for the same care.

This allows them to compensate for non-payers without digging into their own profits.

Price Transparency

According to a Sedera Health survey of 30 prospective members from 2016 to 2017, applying to the health share program can help members save up to 50% compared to traditional health insurance.

Sedera has the benefit of price transparency, and you will always know your out-of-pocket costs for medication.

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Despite the above benefits, there are still essential features of health insurance that medical cost-sharing programs lack — providing a guarantee and a contract. Health insurance guarantees compensation for a specified injury, illness, or death in return for payment of a premium. The government regulates this, so they can’t just stiff you whenever they feel like it.

Traditional health insurance also involves a legally binding contract between an insurer and the insured. Every scenario is documented and must be executed faithfully.

Sedera Health Reviews (By Real Users)

Here are some real user reviews of Sedera Health. The general consensus is that users are quite happy with the switch from traditional health insurance to Sedera Health Share.

“The staff is great to work with and the coverage is better than what I had with traditional insurance, but for a fraction of the cost.”

“Absolutely amazing staff. I got to spend at least half an hour asking questions and left feeling more proud to be a part of a community. Truly is a special company with a supergroup that is just so knowledgeable. Feels just like family.”

“What great cost savings for my family! Communication is informative and helpful. They make everything easy for their members. Affordable too!”

Should You Be Afraid Of Health Shares?

Still, health shares seem to stay true to their word. As an industry, they haven’t given us any reason to doubt their integrity. Even though they aren’t legally bound to compensate you, they always seem to come through. And it makes sense that any scandal involving non-payment would tear their reputation apart.

They know that to become viable in the long run, they have to work extra hard to convince the public to trust them as a legitimate alternative. After all, the general public hasn’t quite embraced health shares as a completely normal thing as of yet. The question is, will you?

In Conclusion

There are both pros and cons to Sedera Health Share, but in general, the pros outweigh the cons. Here’s a summary of what makes Sedera great:

Lower monthly costs for healthcare
Complete freedom to choose your provider or hospital
Experts who step in on your behalf to negotiate medical bills for you
Convenient telehealth services for basic healthcare needs
Medical costs incurred outside of the United States, still qualify for sharing
No maximum lifetime limits per member