For people losing coverage or priced out
Insurance feels unaffordable? See how the math actually works.
Premiums jumped again in 2026 and more people are losing coverage through work. Here is a plain comparison of four ways to get your everyday healthcare met in Mequon and Milwaukee, using real 2026 numbers, so you can see what fits your life.
First, what each option actually is
Traditional insurance
A marketplace or employer plan. You pay a monthly premium, then a deductible before most care is covered. Primary care visits usually still carry a copay and a short appointment.
Direct primary care (DPC)
One flat monthly fee for unlimited primary care with your own doctor. No copays, no claims. It is not insurance and does not cover hospitals or specialists.
DPC + a health share
DPC for everyday care, plus a medical cost-sharing community for big, unexpected bills. Members share each other’s eligible costs above an amount you choose. Not insurance.
DPC + Medicare
For people 65 and up, or past health-share age limits. Medicare handles hospitals and specialists; DPC gives you a doctor who has time for you.
The side-by-side, for one adult in 2026
Insurance figures are for a 40-year-old on the Wisconsin marketplace with no subsidy. Health-share figures span the plans' published age bands. Your numbers will differ by age, income, and health. Sources are listed at the bottom.
| What you pay | Traditional insuranceMarketplace Bronze / Silver | DPC aloneLotus Direct Care | DPC + health shareLotus + Zion, Sedera, etc. | DPC + MedicareAge 65+ |
|---|---|---|---|---|
| Monthly cost | $353 to $616+ premiumBronze from about $353. Silver benchmark $616. | $150Standard membership. $200 for a couple. Kids $20 each. | $150 + $88 to $320DPC plus a share contribution that depends on your age and the amount you keep. | $150 + $202.90Part B premium is $202.90 in 2026, more at higher incomes. |
| Before big bills are covered | $5,000 to $7,500 deductibleAverage Silver about $5,000. Average Bronze about $7,476. | Not applicableDPC covers primary care only. Big bills need a second layer. | $500 to $5,000, you chooseCalled the Initial Unshareable Amount. Zion: $1,250, $2,500, or $5,000. Sedera: $500 to $5,000. | $283 Part B deductiblePlus the Part A hospital deductible and 20% coinsurance unless you add a supplement. |
| Seeing your doctor | Copay each visit. Often 15 minutes. Weeks to get in. | Unlimited visits, no copay. Same or next day. Visits run as long as they need to. Text and phone access to Dr. Rosenberg. | Same as DPC alone. | Same as DPC alone. Medicare still covers specialists. |
| Hospitals and specialists | Covered after the deductible, in network. | Not covered. Keep insurance or add a health share for this. | Shared by the community after your chosen amount, for eligible needs. Read the guidelines carefully. | Covered by Medicare. |
| Pre-existing conditions | Covered by law. | Welcome. Primary care is for everyone. | Usually waiting periods or limits in the early years. Varies by share. This is the biggest difference from insurance. | Covered by Medicare. |
| Pay with HSA or FSA | Yes, for eligible expenses. | Yes, for the $150 Standard membership. How that works · legal framework | DPC portion yes. Share contributions generally no. | DPC yes. Not for Part B premiums in most cases. |
| Is it insurance? | Yes. | No. Not minimum essential coverage. | No. A health share is a voluntary sharing community, not a guarantee of payment. | Medicare is federal coverage. DPC is not insurance. |
| Rough yearly total, healthy year | $4,200 to $7,400Premiums only, before any visits. | $1,650 to $1,800$1,650 if you pay 11 months up front. | $2,700 to $5,600DPC plus share contributions. | $4,200DPC plus Part B, before supplements. |
The pattern most people notice: the money in traditional insurance goes to the premium and the deductible, and the doctor visit is the afterthought. DPC flips that. Your everyday care is the thing you actually get, at a price you can see, and you decide separately how to protect against the rare big bill.
Please read this part. Direct primary care and health shares are not health insurance. They do not satisfy the Affordable Care Act's minimum essential coverage. A health share is a community that shares eligible medical costs; it is not a contract that guarantees payment, and each one has its own rules, waiting periods, and limits, especially for pre-existing conditions and certain treatments. If you have a serious ongoing condition, are pregnant or planning to be, or need expensive medications, talk with us before leaving an insurance plan. We are your doctors, not your financial advisors. Prices above are published rates as of September 2026 and change with age, family size, and location.
Health shares that pair well with DPC
These are the communities our patients ask about most. We do not sell or receive money from any of them. Listing here is not an endorsement of any specific plan; read their member guidelines before joining.
Zion HealthShare
Individuals about $114 to $320 a month by age. You choose $1,250, $2,500, or $5,000 as the amount you cover first, and no household pays more than three of those in a rolling year. Dr. Rosenberg’s own family uses Zion.
Sedera
Individuals about $88 to $413 a month. Five choices for the amount you cover first, from $500 to $5,000. Based in Austin, founded by a physician, no religious requirement.
Knew Health
Individuals about $142 to $379 a month, families from $400. Designed to sit on top of a DPC membership. Pre-existing conditions phase in over several years.
Christian Healthcare Ministries
Individuals about $115 to $299 a month. Requires a statement of Christian faith and church attendance. One of the oldest and largest programs. Pre-existing rules differ; cancer has a five-year lookback.
Which one fits you?
“I lost coverage or the premium is out of reach.”
Start with DPC today for $150. Add a health share for big-bill protection. Many patients land under $300 a month total.
“I have a high-deductible plan through work.”
Keep it for hospitals. Add DPC so the care you actually use stops costing copays and waiting. Your HSA can pay the membership.
“I am on Medicare.”
Medicare covers the big things. DPC gives you a doctor with time, same-day access, and no rushed visits.
“I have a serious ongoing condition.”
Talk with us first. DPC still helps a lot, but a health share may not be the right big-bill layer for you, and we will tell you that honestly.
Sources, September 2026. Wisconsin marketplace premiums and deductibles: healthinsurance.org, forhealthinsurance.com, plainhealthplan.com. Zion HealthShare: zionhealthshare.org. Sedera: sedera.com. Knew Health and CHM: whichhealthshare.com, chministries.org. Medicare 2026: cms.gov. Lotus pricing and HSA rules: membership, HSA FAQ.
Lotus Direct Care, SC. Membership is not health insurance and does not meet minimum essential coverage. This page is general information, not medical, legal, or financial advice.