The reason Ali Margo stumbled upon Zion Healthshare was because her husband’s company took away the option to add spouses to insurance coverage. The company’s decision was prompted by high premiums and set Margo, a self-employed writer, on a search for individual plans. But the most affordable plan that met her needs included a $700 monthly premium. 

Through Zion Healthshare, she seeks out treatment, lets the provider know she does not have health insurance and submits the bill to Zion to be reimbursed.

“I pay around $250 a month and am covered after the first $1,000,” Margo told The Sopris Sun. “So far, this has worked well for routine screenings. The first time I used it was for a mammogram [and] I was reimbursed relatively quickly.”

Margo was enthusiastic to share her experience with Zion and said the company provided a solution.

“The fact remains that health insurance is insanely expensive and ultimately doesn’t provide much coverage,” said Margo. “I’d rather take on the risk of going with this alternative than pay through the nose for nothing — a high deductible means that I’m paying out of pocket anyway.”

On the other hand, Doctor George Bohmfalk, a retired neurosurgeon and active member of Charlotte, North Carolina’s chapter of Physicians for a National Health Program, said that while Zion’s offerings may seem appealing, there are risks associated with the nonprofit’s “community-based alternative” compared to standard insurance.

“I’m completely opposed to them because … people don’t realize what they’re getting into,” said Bohmfalk. “It’s all fine if all you do is break a leg or something like that. But if you had obstructive lung disease and they found out you smoked … they might just not hand over any kind of reimbursement.”

Bohmfalk said he believes in universal healthcare but, practically speaking, getting there is not so simple. 

“On the one hand, solving our healthcare problem is a simple thing. If we had Medicare, improved it … and then spread it to everybody we’d save money [and] everybody would be happy,” said Bohmfalk. “But then, when you start looking at the details of it, it’s horrendously complicated.” 

“If the Democrats swept congress and enough pressure was made … we could get it,” he added. “On the other hand, we might slog along for another 30 years with everybody suffering unnecessarily and wasting so much money on the healthcare system.”

Concierge and DPC 
Concierge medicine and direct primary care (DPC) are two forms of healthcare coverage that Bohmfalk considers to be “elite entities.” Both are subscription-based coverage options in which a patient pays an annual fee to a clinic. However, concierge patients are required to pay for individual office visits on top of their fee, whereas those visits are generally included under a DPC membership. 

Doctor Tim Kruse of Premier Medical Center in Basalt operates his clinic with the DPC model and claims it’s a better setup for providers and patients alike. He added that he first heard about DPC at a medical conference.

“I decided then that I wanted to try that type of practice where I had more time to spend with patients and to focus on them,” said Kruse. “That was something that was really important to me.” 

On Premier Medical Center’s website, the cost for monthly fees ranges from $49 a month for children (under 25) and up to $230 a month for adult members over the age of 50. Patients can pay the clinic monthly, quarterly, semi-annually or annually depending on their preference. Kruse added that the reason new patients tend to be hesitant of the DPC setup is because of a lack of understanding. 

“It took a while to explain it to folks and for them to really see the value. Because, for a long time, it’s just been, ‘How much is my healthcare going to cost, and how can I minimize that cost?’” said Kruse. The efficient nature of DPC makes for happier patients who end up being seen sooner than they would at a standard doctor’s office, he added. 

“Several businesses in the Valley have been able to offer this to their employees as part of their benefits package,” added Kruse. “It saves the business a little bit of money and improves employee satisfaction.”

Being able to afford healthcare is an obstacle that continues to grow for many Americans.
The consideration for alternatives to standard health insurance payments will only increase as premiums keep going up.