At Embody Health and Performance, we believe in helping people make informed choices about their care. The information shared here reflects what we’ve found through our own research, education, and experience working within and alongside the healthcare system. We’re not insurance brokers or financial advisors, and this isn’t legal or financial advice—it’s intended to help you better understand your options so you can do your own research and make decisions that fit your life, values, and health goals.
If you missed it, Blog 2: Why the “Sick-Care” Model Fails (and What Whole-Human Care Gets Right) explores how our healthcare system became reactive instead of restorative—and why it’s time to rebuild it around people, not policies.
Why It’s Time to Look Beyond “Just-in-Case” Insurance
Most of us keep health insurance because, well, what if something catastrophic happens? It’s a valid concern—but the numbers tell a sobering story.
- Family premiums have more than doubled since 2010 (KFF Employer Health Benefits Survey 2024).
- Average deductibles now exceed $8 K.
- Out-of-pocket maximums often add another $9–12 K.
Millions are now “functionally uninsured”—covered on paper, unable to afford care in practice.
The good news: transparent, ethical, direct-care alternatives exist for nearly everyone.
1. Direct Primary Care (DPC): Your Doctor, Your Terms
A membership-based relationship where you pay a flat monthly fee—typically $75–$150—directly to your physician.
No middlemen, no claims, no CPT codes.
Why it matters:
- Same-day or unlimited visits
- 30–60 minute appointments
- Wholesale labs and imaging
- Transparent monthly pricing
DPC restores prevention, continuity, and trust—and coordinates seamlessly with out-of-network specialists like PTs or naturopaths.
📎 Learn more: Direct Primary Care Alliance.
2. Health Sharing Communities: Coverage Built on Cooperation
Voluntary, nonprofit cost-sharing groups where members’ monthly “shares” pay each other’s medical bills.
Examples: Zion Health Share, CrowdHealth, Sedera, Samaritan Ministries.
Why it matters:
- 30–60 % lower monthly costs
- Catastrophic protection without network restrictions
- Transparent fund tracking
- Wellness credits for preventive care
📎 Explore: Zion Health Share | CrowdHealth.
3. Reference-Based Pricing (RBP): Restoring Market Value
Instead of accepting “network discounts,” RBP ties payments to fair-market benchmarks—often 120–150 % of Medicare rates.
Example: Hospital bills $38 K for knee surgery; payer offers $16 K cash based on local averages.
Why it matters:
- True price discovery and competition
- 30–50 % lower overall spend
- Freedom to see any provider
- Fewer surprise bills
4. Catastrophic and Out-of-Network Options: The Safety Net You Actually Use
Even many physicians carry only catastrophic coverage—protecting against rare, life-threatening events while paying cash for everyday care.
Pairing catastrophic insurance with direct care or functional wellness is often cheaper and more effective than all-inclusive plans few can afford to use.
At Embody Health and Performance, out-of-network physical therapy follows that same principle: a transparent exchange of time for service, where your care plan is guided by need, not a billing code.
5. What About Medicare? Understanding Your Options After 65
One of the most common questions we hear is, “I’m on Medicare—do I have to use it?”
The short answer: No one is legally required to accept Medicare coverage, but there are important rules to understand before making that choice.
Medicare Basics
- Part A (Hospital Insurance): Generally premium-free if you paid Medicare taxes for ≥ 10 years. Opting out means you must repay any Social Security benefits already received.
- Part B (Medical Insurance): Voluntary with a monthly premium ($174.70 in 2025). You can decline or drop Part B, but you’ll owe a lifetime late-enrollment penalty if you re-enroll later (Medicare.gov).
- Part C (Medicare Advantage): Private plans that replace original Medicare and often restrict provider choice—functionally mirroring traditional HMO/PPO networks.
Your Alternatives and Flexibility
- Stay on Original Medicare but choose out-of-network or cash-pay providers who opt out of Medicare. These providers must file a formal opt-out agreement with CMS and have you sign a private contract acknowledging that Medicare won’t reimburse you. This is 100 % legal (CMS Opt-Out Affidavit Process).
- Pair Medicare Part A (only) with cash-pay care for everything else. You’ll retain catastrophic hospital coverage but avoid Part B premiums if you rarely use traditional providers.
- Join a Health-Sharing Community that accepts members 65 and older. Some (such as Zion Health Share) offer Senior plans for those with Medicare A/B to supplement catastrophic gaps or cover alternative care.
- Use Direct-Care Memberships. Many DPC and integrative clinics welcome Medicare-aged patients on a membership basis; you simply pay a flat fee for services not billed to Medicare. This is fully compliant as long as the clinic has opted out of Medicare.
Why This Matters
Seniors often believe they “must” use Medicare because it’s automatically linked to Social Security retirement benefits. In reality, you can decline or limit your participation—though it requires clear documentation and accepting financial responsibility for care. For many, a hybrid approach makes the most sense: keep Part A for hospital coverage while using direct-care or cash-pay options for everyday wellness and therapy.
In short: You have choices—even after 65. The goal is not to reject Medicare, but to use it wisely while reclaiming control of your everyday care.
Choosing Your Best Fit
Ask these questions each open enrollment season:
- Does this plan restrict which providers I can see?
- Can I get a price estimate before care?
- Does it reward prevention and wellness?
- For Medicare: Does my provider opt out, and if so, have I signed a private contract?
If you can answer those honestly, you can compare on value instead of fear.
Conclusion
Healthcare should be simple—a fair price for trusted expertise. These five alternatives prove it’s possible to get quality care without bureaucratic obstacles. Some might call it radical. We simply believe it’s how healthcare should be done—for your well-being, your family’s security, and your freedom to choose what’s best for you.
As always, we encourage you to explore these ideas further, ask questions, and seek professional guidance where needed. The more you understand the system, the more freedom you have within it.
