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For people priced out of insurance

Health share + direct primary care vs. insurance

Marketplace premiums in Ozaukee County rose about 29% for 2026, and many people who buy their own coverage feel priced out. For some people, a different setup can cost less: a direct primary care membership for everyday care, plus a health care sharing ministry (a “health share”) or a low-cost catastrophic plan for big, unexpected bills. For others, it is a bad idea. This page shows both sides, with real 2026 numbers.

Health care sharing ministries are not insurance. They are not offered by an insurance company, they do not guarantee that any medical bill will be paid, and they do not meet the Affordable Care Act's minimum essential coverage. You remain responsible for your own medical bills. Direct primary care is not insurance either. This page is general information, not insurance, legal, tax, or financial advice.

How the pieces fit together

1. Everyday care

Lotus Direct Care membership

$150 a month for unlimited primary care visits, same or next-day appointments, and direct access to your doctor. No copays. It does not pay for hospitals, specialists, or pharmacy prescriptions.

2. Big, unexpected bills

A health share

You pay a monthly contribution. After you pay a set amount yourself, other members may share eligible bills such as a hospital stay or surgery. Sharing is voluntary and follows each share's own rules.

Or: real insurance for the big things

A bronze or catastrophic plan

Lower premiums, high deductible, but it is insurance with legal protections. Since 2026 these HealthCare.gov plans count as HSA plans, and an HSA can pay your membership. HSA details

Who this might fit, and who it doesn't

Might fit if

  • You are generally healthy and under 65
  • You buy your own coverage and do not qualify for much subsidy
  • You can afford to pay a few thousand dollars yourself if something big happens
  • You want a doctor you can actually reach for everyday care
  • You have read a share's guidelines and are comfortable with them

Probably not for you if

  • You have Medicare, Medicaid or BadgerCare. Keep it.
  • You have a serious ongoing condition, need expensive medications, or expect surgery
  • You are pregnant or planning to be. Maternity rules and waiting periods vary.
  • You qualify for a large premium tax credit. Insurance may cost you less.
  • You need coverage that is guaranteed to pay

Not sure? Check what you would really pay on HealthCare.gov (opens in a new tab) first. Many people qualify for a premium tax credit, and then insurance can cost less than any alternative.

The numbers, for one example person

Illustrative example only. One 40-year-old non-smoker in Ozaukee County, buying their own coverage with no subsidy, using published 2026 prices retrieved September 28, 2026. Your situation will differ by age, income, family size, and health. Subsidies may make insurance cheaper for you. Sources are at the bottom of this page.

Insurance only

2026 benchmark silver plan

Monthly cost
$576Benchmark silver premium, no subsidy.
Cost for the year, if you stay healthy
$6,917Plus copays or deductible for any visits you use.
A very bad year
Up to $17,517Premiums plus the $10,600 legal out-of-pocket cap, in network.
Pre-existing conditions
Covered from day one, by law.
Guaranteed to pay?
Yes, for covered services under the policy.
Premium tax credit can lower it?
Yes, depending on income.
Can you use an HSA?
Silver plans usually are not HSA plans.

Lotus Direct Care + insurance

Same silver plan

Monthly cost
$726$150 membership plus the same silver plan.
Cost for the year, if you stay healthy
$8,717Primary care visits included, no copays.
A very bad year
Up to $19,317Same cap. You pay the membership on top.
Pre-existing conditions
Covered from day one, by law.
Guaranteed to pay?
Yes, for covered services under the policy.
Premium tax credit can lower it?
Yes, for the insurance part.
Can you use an HSA?
Same. A bronze or catastrophic plan would be.

Lotus Direct Care + a health share

Zion HealthShare example

Monthly cost
$364$150 membership plus a $214 share contribution (Zion HealthShare, $2,500 amount you pay first).
Cost for the year, if you stay healthy
$4,368Primary care visits included, no copays.
A very bad year
$11,868 or moreContributions plus up to 3 of the $2,500 amounts, only if every bill is eligible and shared. There is no legal cap.
Pre-existing conditions
Limited or excluded for the first years. Varies by share.
Guaranteed to pay?
No. Sharing is voluntary. You stay responsible for your bills.
Premium tax credit can lower it?
No.
Can you use an HSA?
The share alone does not let you contribute to an HSA.

How to read this. In a healthy year, the health share setup costs less. In a bad year, insurance has a legal cap and a legal duty to pay; a health share has neither. Paying for Lotus Direct Care annually lowers the membership to $1,650 a year. Other shares and other amounts you pay first change these numbers.

What you give up by leaving insurance

  • A legal promise to pay covered claims
  • Coverage of pre-existing conditions from day one
  • A yearly out-of-pocket cap set by law ($10,600 in 2026)
  • No annual or lifetime dollar limits on essential benefits
  • Premium tax credits and cost-sharing reductions
  • A state regulator and a formal appeal process
  • Easy re-entry: dropping a Marketplace plan usually does not let you rejoin until the next open enrollment

Wisconsin's Office of the Commissioner of Insurance has warned consumers to be careful with health care sharing organizations and other alternatives, and to get every plan detail in writing. Read the state's advice (opens in a new tab).

Some well-known health shares

Listed alphabetically, not ranked. Lotus Direct Care has no financial relationship with any of them. We receive no fees, commissions, or discounts, and we do not enroll anyone. A listing here is not a recommendation. Read each one's member guidelines before you join, and ask them your questions directly.

Christian Healthcare Ministries

Faith-basedHealth care sharing ministry

$115, $169, or $299 per unit per month (Bronze, Silver, Gold), not age-based. Published.

Requires a statement of Christian faith. $125,000 limit per illness unless you add CHM Plus ($42 a month). Operating since 1981.

Visit Christian Healthcare Ministries (opens in a new tab)

CrowdHealth

No faith requirementCrowdfunding membership

Priced by quote on their website.

Not a sharing ministry. Members fund each other's bills through the platform. Not insurance, and payment is not guaranteed.

Visit CrowdHealth (opens in a new tab)

Medi-Share

Faith-basedHealth care sharing ministry

Priced by quote on their website.

Requires a Christian statement of faith. You choose an Annual Household Portion that you pay before sharing begins.

Visit Medi-Share (opens in a new tab)

Samaritan Ministries

Faith-basedHealth care sharing ministry

Priced by quote on their website.

Requires a Christian statement of faith and regular church attendance. Members send shares directly to each other.

Visit Samaritan Ministries (opens in a new tab)

Sedera

No faith requirementMedical cost sharing

About $269 a month for one 40 to 49-year-old at a $2,500 amount you pay first ($231.95 on their rate for members with DPC). Published rate sheet, effective March 2026.

Members agree to Sedera's ethical beliefs and guidelines. Pre-existing conditions are limited in the first years of membership.

Visit Sedera (opens in a new tab)

Zion HealthShare

No faith requirementMedical cost sharing

About $254, $214, or $188 a month for one 40 to 49-year-old, at a $1,250, $2,500, or $5,000 amount you pay first. Published.

Members agree to Zion's principles of membership. Pre-existing conditions: nothing shared in year one, then limits of $25,000, $50,000, and $125,000 in years two to four. Members must be under 65.

Visit Zion HealthShare (opens in a new tab)

Common questions

Is a health share the same as health insurance?

No. A health care sharing ministry is a group whose members agree to share each other's eligible medical bills. It is not insurance, is not offered by an insurance company, does not guarantee that any bill will be paid, and does not count as minimum essential coverage under the Affordable Care Act. Wisconsin's insurance regulator has cautioned consumers to read these programs carefully.

Is it legal to go without insurance in Wisconsin?

Yes. The federal tax penalty for not having insurance has been $0 since 2019, and Wisconsin has no state penalty. That does not make it safe for everyone. If you have ongoing health problems, are pregnant, or rely on Medicare, Medicaid or BadgerCare, keep your coverage.

Can I use my HSA with direct primary care and a health share?

From 2026, a direct primary care membership up to $150 a month for one person no longer stops you from contributing to an HSA, and you can pay the membership from your HSA. But you still need a high-deductible health plan to make new HSA contributions. A health share is not one. Bronze and catastrophic plans from HealthCare.gov now count as HSA plans. Ask a tax professional about your situation.

Does Lotus Direct Care get paid by any health share?

No. Lotus Direct Care has no financial relationship with any health share or insurance company. We receive no fees, commissions, or discounts, and we do not sell or enroll anyone in any plan. We list several options so you can compare them yourself.

Will a health share pay for my visits at Lotus Direct Care?

Generally no. Shares are built for large, unexpected bills that meet their guidelines. Some include limited preventive sharing; ask the share. Your Lotus Direct Care membership is paid by you, and it covers your primary care visits with no copays.

Health care sharing ministries are not insurance. They are not offered by an insurance company, they do not guarantee that any medical bill will be paid, and they do not meet the Affordable Care Act's minimum essential coverage. You remain responsible for your own medical bills. Direct primary care is not insurance either. This page is general information, not insurance, legal, tax, or financial advice.

Wisconsin's required notice for religious sharing organizations

Wisconsin law (Wis. Stat. § 600.01(1)(b)9.) requires this notice on materials from religious sharing organizations. We repeat it here because it explains plainly what a share is:

ATTENTION. This publication is not issued by an insurance company, nor is it offered through an insurance company. This publication does not guarantee or promise that your medical bills will be published or assigned to others for payment. Whether anyone chooses to pay your medical bills is entirely voluntary. This publication should never be considered a substitute for an insurance policy. Whether or not you receive any payments for medical expenses, and whether or not this publication continues to operate, you are responsible for the payment of your own medical bills.

Sources (retrieved September 28, 2026)

The age-40 insurance premium is the Ozaukee County age-21 benchmark multiplied by the federal age factor for 40 (1.278). Share prices are the shares' own published rates and can change at any time. Lotus Direct Care, SC is a medical practice, not an insurance agency. Nothing on this page is insurance, legal, tax, or financial advice.

Healthcare that puts you first

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