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I wanted to share a recent experience I had with healthcare costs and healthshares. I hope it might help others when navigating choices around health insurance and healthcare costs.
The TLDR summary is that I am very impressed by Zion Healthshare, and to never pay the first hospital bill.
I am self-employed and for many years purchased ACA insurance, but in the last few years costs have just kept rising, and I found that many providers in my area didn’t accept the insurance.
I also ended up switching doctors all the time because providers would stop taking it, or in one case the insurance company went bankrupt and I had to switch plans.
I was pretty unhappy with paying large premiums and then not being able to access care.
I decided to take another look at healthshares as an alternative.
I had always been afraid of the risk of them not paying out, but after several experiences where insurance also refused to pay what should have been qualified expenses, I decided I might as well save money on the premiums.
We were already using a direct primary care practice for our primary care needs (and love it so much!!!), and we’re self-pay anyway for many smaller medical expenses (physical therapy, mental health, allergy treatments, lab work, prescriptions) since the ACA deductible was $9,500
(not HSA available either since our deductible was TOO high).
After a lot of research, I chose Zion Healthshare since it was one of the few non-religious options and had good reviews.
I unfortunately had to put the healthshare to the test last month after an ER visit.
The bill from the hospital was $28,000, plus bills from individual providers (so frustrating that each provider also bills you!)
Zion quickly approved my sharing request and assigned me a case manager who called me to talk me through the process.
She gave me her direct line and email, and always responded promptly to my questions.
She was also genuinely kind, and it was really nice to be treated like a human.
She assured me that all I would need to pay was my “initial unshared amount” of $2500 (this is like a deductible, but its per medical event, not calendar year, they cap them at three per rolling 12 month period).
She did encourage me though to ask for any self-pay discounts.
Healthshares are not insurance, so as far as providers are concerned, you are self-pay.
I filled out the financial aid assistance form that the hospital sent me, thinking I wouldn’t get anything since we aren’t low income.
I was shocked when the hospital then dropped the bill down to around $2,500! I also called each provider and just simply asked for a self-pay discount and all of them gave one, some up to 90% off.
Zion has paid all bills that I sent them within a day or two.
In the end, after the massive self-pay discount, they are only paying out around $1,000, which explains how they can keep costs fairly low, but they seemed perfectly ready to pay the $28k bill too if I didn’t get a discount.
Healthshares are definitely not for everyone, and not a perfect solution.
They have many restrictions on coverage, and are not insurance.
However, I found the whole experience to be much better than my previous experiences with health insurance.
It seems like people’s experience also varies a lot by company, and I can only speak to my personal experience with Zion.
So do your research carefully, and make sure to read all the fine print.
Also, never pay the first hospital bill, always fill out their financial aid paperwork, and ask for discounts! It is so frustrating that our healthcare system works (or doesn’t work) like this, but I guess we just all need to figure out how to best navigate it.