In our practice, we aren’t just about selling memberships for our services. We want our members to have access to “best in breed” programs and providers to improve health. That’s why we hand-pick specialty referrals, offer a CSA discount (coming next season!), and more.
So since you need coverage for medical needs beyond primary care, we researched the best options for our members. Avicenna members receive DPC member pricing for Sedera Health’s medical cost-sharing solution, appropriately entitled ACCESS.
At a lower monthly cost, (usually 20-60% depending on the “deductible” you select), this program can replace high-deductible plans that would otherwise be purchased through your employer or the federal Exchange. It is also an affordable way for people who do not have health insurance at all to obtain coverage for unexpected medical expenses.
In short, Avicenna membership addresses your routine, primary care needs, while Sedera or other medical cost-sharing (including high-deductible insurance plans) address other medical expenses, such as hospital stays or surgery.
Sedera works differently than insurance, e.g. most active pre-existing conditions are not covered in full for three years, and lifestyle choices such as smoking limit coverage for certain conditions. Sedera also has systems in place to negotiate with providers to reduce member costs.
In other words, costs are examined more carefully for members than in a traditional plan, helping to keep monthly fees low. Thus, Sedera would not be appropriate for someone who has several complex conditions.
However, for members who enjoy relatively good health, Sedera offers more freedom of choice. For example, there is no “in-network” restriction since members are considered self-pay patients. So if you need surgery and there is one surgeon around who is considered the best, you have access to that expertise.
There is also a large choice of “Initial Unshareable Amounts (ISAs)” (deductibles), from $500 to $5000.
If Sedera might be right for you, and you currently have insurance through an employer, you may wish to consider all your options before faced with Open Enrollment this fall or next year. Sedera enrollment can take place year-round.
Note — if chronic conditions prevent you from enrolling in Sedera, that could change. Since an Avicenna membership should help you better control such conditions, that may provide more medical cost-sharing options in the future.