Personal Solutions to the Healthcare Crisis

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In the United States healthcare has gone from crisis to tragedy. Double digit increases in insurance premiums for many years on one hand and a tax code that forces you to pay up on the other is a painful experience for many family budgets.

The current tax code contains a health insurance mandate; have health insurance or pay a tax penalty. Congress has unsuccessfully tried to end the mandate, but the current tax bill might contain language ending required health insurance coverage.

Even if the health insurance mandate ends there is the problem of affordable insurance. If you are fortunate enough to have an employer paying most or all of your health insurance premiums you are lucky. Small employers are far and few between who can shoulder the cost of healthcare. And large corporations are scaling back the employer paid portion of healthcare benefits.

An anomaly of the current economic expansion is the lack of wage increases. For employers covering health insurance the cost of each employee is exploding due to rapidly rising health insurance premiums even when they offer modest wage increases at best. It might be a good idea to have a Plan B.

Then we come to you, dear readers. Many of you are either running your own small business/side gig or are planning on early retirement. The FIRE (financial independence/retire early) community has one vital flaw! Saving and investing a large portion of your income creates a large net worth fast. Unfortunately, healthcare is probably your single biggest expense, even more than housing if you retire early before you qualify for Medicare!

The Right Man in the Right Place

A few months ago I was in Dallas at FinCon 17. I was busy with demands from readers and other bloggers keeping me from the sessions (now available on YouTube). That doesn’t mean I didn’t learn anything. No matter where I go I always pick up several tidbits of information I can use personally or for clients.

On Day 2 I decided to walk the vendors. Before long I was interrupted by adoring fans. I asked Mrs. Accountant to run the obstacle course of vendors and clue me into the ones I might be most interested in. It was a good strategy.

Mrs. Accountant knows the dire straights my clients are in (not to mention our own escalating health insurance issues). She had a list ready for me when I had a break.

I formulated a plan with my research. I was aware of most of the companies involved. What I needed to do was connect the dots. No one company provided a comprehensive solution. Like a jigsaw puzzle, I assembled the pieces into what is a working program to cut health insurance costs in half while reducing out-of-pocket expenses at the same time.

Connecting the Dots

My strategy uses a three legged chair. Each leg provides benefits, but if you are lucky enough to be able to use all three legs you are golden.

Medi-Share was the first stop. Medi-Share is NOT insurance, but satisfies the tax mandate requiring insurance. If the mandate is lifted Medi-Share is a powerful consideration for handling your healthcare needs regardless.

There is one very serious drawback to Medi-Share. Medi-Share is faith based and therefore is only available to Christians. Many readers will have no problem with this requirement; however, people of other faiths or no faith will probably not be accepted into the program.

Medi-Share looks and feels a lot like health insurance. You pay a monthly Share amount similar to a premium. The money is deposited into YOUR separate bank account which is completely different from insurance. There is an annual amount you pay first which feels like a deductible.

But it is different. As other members have medical bills come in the medical bill are matched to other members with excess funds in their account. The bills are matched until all medical bills of members are paid. Medi-Share uses technology to handle the management of member accounts.

The best part of Medi-Share is the dedication to wellness. Insurance companies have an incentive to keep costs high! Health insurance carriers can only have a certain percentage of premiums as profit so they are incentivized to waste as much as possible to keep premiums as high as possible as 20% of two billion dollars is more than 20% of one billion dollars. The more expenses the more profit the insurance company can keep.

Medi-Share is focused on quality of life and provides support to keep medical costs down while providing maximum health and wellness. Medi-Share is non-profit so they are service based versus profit driven.

The Second Leg

Medi-Share’s program cuts medical costs be half or more for most people. The U.S. has outrageous medical costs, but when common sense is added the cost become more reasonable.

If you don’t qualify for Medi-Share due to faith issues you can still use Leg 2 of The Wealthy Accountant program.

The way Medi-Share keeps medical costs down is by utilizing technology and preventative care. You can use the same tools to reduce your medical bills.

Leg 2 is a company called amino (they don’t capitalize their name).

Have you ever tried to get a hospital or doctor’s office to give you a firm number on the cost prior to a procedure? It’s impossible. You get every excuse and runaround imaginable! They act like they have no idea what it costs and have no way of finding out until they got you by the throat! Amino fixes that.

Amino tracks virtually every medical service provider in the country for cost and quality. Doctors and hospitals are not allowed to advertise or buy their way to the top of the list. You get an unbiased view of your medical choices based on price.

With amino you can track you insurance deductible (or Medi-Share share amounts) and even set medical appointments right through their portal. Finally, they analyze your bill.

Anyone with high deductible insurance (that should be all of us), paying their own medical costs and those using Medi-Share and other similar faith based healthcare management systems can’t afford not to include amino in their health management mix.

The Final Leg

Now that you have Medi-Share to manage medical bills and amino to get the best price on medical care, you need a tax deduction!

What I’m about to share is a down and dirty outline of an incredible tax advantage. As time permits I’ll roll up the sleeves and give this one topic an entire post. From the providers of this third leg it seems even accountants have a lot of questions on this. I’ll give you the details to get started so you can maximize your tax benefits.

The third leg is a Qualified Small Employer Health Reimbursement Account (QSEHRA). This only works if you have your own business or side gig. If you have an employer you will need them to engage this leg of my program as a traditional HRA or QSEHRA.

The first thing to remember is QSEHRAs only arrives recently (December 2016) with what is known as the CURES Act. There are still some issues needing clarification. I will share generally accepted interpretations.

QSEHRAs are only for small employers WITHOUT a group medical plan and with fewer than 50 full-time equivalent (FTE) employees. A FTE is defined as an employee working 30 or more hours per week or 130 hours per month for 120 consecutive days.

Section 213(d) of the Internal Revenue Code (IRC) states a QSEHRA can cover any DOCUMENTED healthcare expense, including health insurance premiums. As I understand it, Medi-Share payments would qualify. If I discover different I will update this post so check back if you plan on using this tax strategy in the future.

The employer funds 100% of the QSEHRA! There is a limit to how much an employer can fund: $4,950 for an individual and $10,000 for a family annually.

Caution: If employees receive a subsidy from a policy the subsidy is reduced by the amount of the QSEHRA provided by the employer. Talk to your tax professional on your specific situation and the tax consequences if you receive a federal subsidy.

The most important part of this leg is DOCUMENTED. You will need someone to manage your QSEHRA. Your accountant isn’t the person to do it!

I recommend Take Command Health. I was impressed by the depth of their knowledge when I met them at FinCon and through follow-up encounters. If you are planning on a tax break you may as well make sure it sticks.

The Triune Healthcare Solution

Healthcare and medical insurance are causing more gray hair than old age. No one solution solves the problem for everyone. Many readers should find value in all three legs. Others can benefit from only one or two legs. Regardless, containing and managing medical costs is a primary concern in most households.

To recap, there are three steps to taking control of your healthcare needs and costs:

  • Use this link to review and join Medi-Share.
  • Review amino and determine if their service will save you time, money and hassle.
  • Have the government give you a juicy tax break with a QSEHRS managed by Take Command Health.

You will have lots of questions, I know. Leave your questions in the comments section below versus sending me an email. Many questions are repeats and it helps me manage time better. Some questions might take some research as the CURES Act is still being interpreted. Check back often to see if I found an answer for you.

Here is to clean living.

Personal Capital: You can't manage what you don't know.

Keith Taxguy


  1. wcrn on December 11, 2017 at 8:06 am

    An interesting proposed solution to a horrible morass of an industry (or a poor wounded lamb at a wolf tea party).
    Average cost (payments) of medical services are 40% of charges (initial bill). With nobody watching the store costs have gotten completely absurd. I think market forces could fix a lot of it with price transparency. I am particularly excited about ‘amino’.
    Interesting observation with respect to 20% profits kept of (amount wasted).
    Hard to find great articles on healthcare! passing it along to my buddies ‘in the biz’.

    • Keith Schroeder on December 11, 2017 at 8:53 am

      wcrn, it’s my opinion healthcare premiums climb 30% every year due to a law with good intentions. Insurers complained when they were required to pay out 85% of premiums and benefits so the number was dropped to 80%.IMO insurers discovered the more they waste the more profit they enjoy. The Law of Unintended Consequences bites hard at times. I think my idea is workable for a percentage of the population. Wish I had more answers for the rest of the crowd.

      • Mick on December 13, 2017 at 7:57 pm

        Haven’t we dealt with the”gold plating”issue in other industries? I think when AT&T was a regulated monopoly the cost-plus approach was tried and resulted in higher costs to get higher profits.
        Telephone costs did not really drop until the government forced competition (free market capitalism) by breaking up Ma Bell and fostering an environment that would help competitive local exchange carriers compete with the entrenched incumbents.

        You think if the government allowed the competitive free market to work, that the insurance companies could better focus on outcomes and have incentive to reduce costs AND premiums via innovation? Competition has a way of naturally limiting profits way better than any law.

        Why is LASIK eye surgery so cheap and so much better than it was 30 years ago? An industry that gets minimal benefit from insurance coverage, many providers and highly competitive market.

        • Keith Schroeder on December 13, 2017 at 10:06 pm

          It works great in theory, Mick, but application is a real problem. A phone line was $10 or so and we complained about big bad Ma Bell. Now we pay up to $70 or more a month for a cell phone without a whimper and we have more competition. Alan Greenspan worked hard to convince Congress to deregulate the airlines. Airfare is MORE expensive now and the quality is magnitudes of order worse. Many airlines went broke so there is LESS competition. Certain industries must be regulated more and were 100 years ago and people back then were smart enough to know it. Utilities are an example of a natural monopoly. Without regulation prices would be unconscionable. Internet is another example. Do you really think ending net neutrality will benefit consumers? Companies don’t lobby hard to have their prices cut. They do it to legally screw the masses.

          Healthcare is another natural monopoly. When I’m sick I don’t shop around for a better price. If you take the profit motive out of medicine you reduce costs, but stifle innovation. The real trick is to dance on the head of a needle and not get pricked! My program of Medi-Share mixed with amino and Take Command Heath works because the program cherry picks the healthiest people. There are exclusions. Healthcare is broken in the U.S., but other countries around the world also struggle with the same issues. The U.S. is broken the worst gauging by cost and quality of service.

          So back to your question: Do I think the free market would improve the situation, especially with insurance companies and premiums? No. Insurance companies cried when their profits were capped at 15% of premiums so it was changed to 20%. To counter the profit problem they waste like crazy to keep premiums growing 20% or more per year. The higher the premium, the higher that 20% is they can toss to the bottom line. You pay the price while the U.S. has some of the worse healthcare in the industrialized world.

          Medicare pays back 98% of premiums as benefits and insurance companies have Americans hoodwinked (and politicians) this is the worst thing EVER! It will not be long before Medicare is scaled back and then gone. Then we will enjoy higher free market prices to fund overpaid insurance company executives and get worse service. At least we will not live long in old age to complain about it.

          Pure capitalism and pure communism do NOT work! The answer is somewhere in the middle and it’s not an easy answer. Europe thinks the answer is further to the left; I think (and most economists think) the answer is somewhere to the right. Of course, if we knew the exact place for maximum benefit we wouldn’t need this discussion. The answers are not easy. And just when we think we figured it out a wheel falls off and back to work we go.

          At least it makes for an interesting life.

          • Mick on December 14, 2017 at 2:25 pm

            I have to respectfully disagree with your analysis of phone costs.
            A phone line in say 1975 would have been a landline, voice only. Maybe a party line if you wanted to save money. And $10 in 1975 is close to$50 today.
            My Ooma VOIP line costs $5 per month (that is just taxes) and it has features that no 1975 landline had (call waiting, blocking, caller ID, ability to use with my Android phone over WiFi) I don’t even use a contract mobile carrier. I will admit my phone handset costs a bit more, even adjusted for inflation, but it could probably get an Apollo mission to the Moon-something no handset from 1975 could do. And my cheaper plan includes U.S. and Canada. Sure, you can pay lots more for phone service, but you get much more product for your dollar.
            Remember having to wait until evening for LD rates to go down? Most people reading this probably have no idea what long distance even means.
            I could probably make a similar argument for sure travel, especially if you factor in safety.

          • Mick on December 14, 2017 at 6:27 pm

            But I totally agree that pure capitalism –completely unrestrained markets–does not work. The Telecom revolution was enabled by some pretty heavy handed govt regs which IMO served to incentivize small start ups and enable them to compete against the entrenched incumbents. So govt regulation resulted in better free and open competition and served the compelling interest of fostering innovation in the industry.
            I don’t know how to replicate that in healthcare, but I think regulations that would require transparency and upfront pricing, maybe allow innovators to make better profit if they provide a better product for the money, and maybe allowing competition across state lines.
            I would also take a look at some of the success in elective medical procedures like LASIK and cosmetic.

  2. Dan Wick on December 11, 2017 at 8:11 am

    Nice article and timely considering the recent developments in the tax plan. The only downside would be those with pre-existing conditions that would be exempted from Medi-share plans. I am not sure of the waiting period for coverage for pre-existing conditions. amino is a great tool to educate people purchasing health services.

    • Keith Schroeder on December 11, 2017 at 8:49 am

      I didn’t mention the pre-existing condition issue because I didn’t want readers to exclude themselves before they start, Dan. Medi-Share is a good option for some, but not all.

    • Steven Sullivan on December 11, 2017 at 9:59 am

      there is a 3 yr waiting from the last episode of the condition before it is covered by medi- share . I just signed up and my coverage begins in Jan, 2018.

  3. Michael on December 11, 2017 at 9:33 am

    FWIW, I preferred Samaritan Ministries to Medi-Share when I researched several years back so that is another option to consider. I can’t recall why now, but found fewer negative reviews. We were only on it for 6 months before getting employer sponsored again.

    • Keith Schroeder on December 11, 2017 at 9:37 am

      There are three or four out there, Michael. What I liked mos about Medi-Share is the amount of time they took with me. Liberty is another similar program for those looking to research the field.

  4. Megan on December 11, 2017 at 9:51 am

    I have heard it rumored that Liberty holds good morals as a requirement but not participation in a certain religion. Unfortunately every time I think I find their site I wind up with someone trying to sell me insurance that hasn’t ever heard of it. I am both non-Christian and have a pre-existing condition, so if you ever happen to find something that would still work, I at least would love to know.

    • Keith Schroeder on December 11, 2017 at 10:25 am

      That’s a tough one, Megan. Pre-existing issues have an extended waiting period and I wasn’t 100% comfortable with Liberty. These faith-based plans need to be careful. The ACA considers them an acceptable alternative to avoid the mandate penalty, however, they need to be faith-based. I know of no non-Christian plans. If any reader knows of one, Megan and I both will be pleased.

      As a side note, your favorite accountant had a plan. I wanted to start our own plan with our religion FIRE of Wealthy Accountants. All that would work, but the medical faith-based programs had to be in existence since 1990. I hate it when a good idea goes down in flames. I don’t share every idea I have when it fails, but I’m always working on ideas.

  5. Steven Sullivan on December 11, 2017 at 10:09 am

    Thanks for the this post is has really made me feel more comfortable joining Medi-share. I just signed up and my coverage starts this Jan. I will definitely try to use the other legs you mentioned as well. Knowing that I can see how much it will cost is a life saver. My insurance premiums were $1200 a month and now they will be down in the $300- 400 range for my whole family. we looked into the other companies as well and have felt medi share is the best option for my family. thanks again

    • Keith Schroeder on December 11, 2017 at 10:26 am

      Keep us informed, Steven. I like to use this blog as a funnel for experiences. It helps everyone in the decision-making process.

  6. Michael Crosby on December 11, 2017 at 10:52 am

    Last night I watched a 5 part documentary on diabetes in New Zealand (Youtube). One guy who had diabetes was on dialysis and spent over 5 months in the hospital. The doctors just kept cutting off his legs higher and higher as the disease progressed. One health practitioner wisely said that we’re on the crest of the wave of this healthcare epidemic. Then he said no, we’re actually at the bottom of the wave, and this wave is a tsunami.

    What I also found interesting about this documentary as in many others about obesity, is that many of the health professionals saying how bad obesity is, are in fact as obese or even more than their patients.

    With health care, (an oxymoron), an aging population, and diabetes exploding even within our youth, it will only get worse. When the WIC program denies potatoes because of being unhealthy, but oil, butter, white bread is healthy, we even further don’t have a chance.

    The good news though, if you buy individual stocks, look at dialysis companies.

    • Keith Schroeder on December 11, 2017 at 11:01 am

      I’d give you a high-five for hitting the nail so straight, Michael, but it’s too depressing. If we eat better many medical issues would also go away. Much of what afflicts society are self-inflicted wounds. Unfortunately I can only douse one fire at a time and I’m not sure I’m doing anything more than using a squirt gun on a forest fire.

  7. Jim on December 11, 2017 at 11:36 am

    I encourage people who live in a state with Medicaid expansion to look into the possibility of getting on Medicaid for multiple reasons. First it’s totally free (for the beneficiaries) saving you hundreds or thousands of dollars in premiums a month, not even counting when you actually use the services. Second lord Obama eliminated the asset check, so you can literally be a millionaire and be on Medicaid now. Third children are usually around 200 percent of magi to cover, so even if you don’t qualify your children may. And last and maybe most importantly, qualification is entirely dependent on magi as a percentage of the federal poverty level and 401k contributions do not count towards magi so a married couple can save 36k in long term savings before Obama considers them to have made one dollar as far as Medicaid expansion is concerned. Sure this screws the tax payer, but hey you’re being screwed by the insurance companies and government at the same time so why not reduce your expenses ??

    • Christopher Hipskind on December 12, 2017 at 12:06 am

      Thank you for sharing that important info!

  8. Kourtney on December 11, 2017 at 3:39 pm

    Our family joined Medi-Share in January. They have paid all the claims after our annual household portion/deductible was met. The discounts are better at our kids’ peds office with Medi-Share’s PPO than what we were receiving with Medica/UnitedHealthcare. That being said one of our kids has an immune deficiency requiring expensive infusions every 3-4 weeks and a metabolic disorder so we had to keep him on a traditional plan. Thanks for sharing this info. I am excited to learn more about amino.

    • Keith Schroeder on December 11, 2017 at 4:34 pm

      Kourtney, serious medical issues are an incredible challenge. That is why I added the two additional legs to my program. Fingers crossed amino helps reduce the out-of-pocket a bit. Let me know how it works for you.

      • Kourtney on December 11, 2017 at 8:09 pm

        We were lucky to learn this past year that the drug companies offer copay assist programs. They offer up to $5k in copay assistance for you using their expensive $3500 biologic 17 times a year. $61k less $5k copay assist/disc = $55k in revenue. Genius for them. My son’s deductible was paid by the drug company. The one nice thing I can share about Big Pharma. I will keep you updated on amino but hoping the rest of us on Medi-Share will not have any major health needs this year.

  9. Jeff on December 11, 2017 at 7:51 pm

    Great post. I’m currently a resident and know all too well the cost of healthcare. I will likely be taking an independent contractor position upon graduation so all my medical expenses will be on me. Because I’m an independent contractor (no other employees) and paid on a 1099, will I be eligible for QSEHRAs?

    I also thought this post from another blogger was helpful (he is also a physician):

    • Keith Schroeder on December 11, 2017 at 9:14 pm

      Yes, Jeff, if you are married and your wife is a W-2 employee which is easy enough to do. Otherwise a C corp might do the trick.

  10. Margin of Saving on December 12, 2017 at 10:10 pm

    I’ve been reading more about doctors that charge a monthly fee instead of taking insurance. I think it’s a great idea because with more regular, preventative care, we should ideally have better outcomes instead of waiting until the issue becomes too serious to treat easily. The downside is that this doesn’t obviate the need for catastrophic insurance, like in cases where you need surgery, since it only covers routine care.

    This is why I’m hyper-focused on staying healthy (except when it comes to chocolate). I know billionaires that would trade all their wealth just to be healthy again. You can easily make money. You can’t easily get your health back.

    • Keith Schroeder on December 12, 2017 at 11:45 pm

      For the record, Margin, chocolate is good for you; it’s the sugar they add that kills you.

      And I agree. Good health is worth more than all the money in the world. Thanks you for sharing.

      • Margin of Saving on December 13, 2017 at 9:06 pm

        Good to know. Please let me there’s something healthy about bacon or ribeye steaks!

  11. John on December 13, 2017 at 8:13 am

    Keith, does Medishare have a lifetime cap on medical expenses that can be paid? I had looked at Samaritan Ministries and others and this was a hangup for me. If anyoe in my family was diagnosed with a severe medical condition = bankruptcy with a lifetime maximum limit.

    • Keith Schroeder on December 13, 2017 at 8:29 am

      Medi-Share has no lifetime limits, John, according to their Program Guidelines and FAQ.

  12. Mick on December 14, 2017 at 6:41 pm

    Really great post!
    My main obstacles to RE now is my concerns of potential medical costs and coverage–and if I work about 4 more years I will be able to keep my employer subsidized plan for life. Second concern is long term care (I am hoping for AI and robots to help in this area, but still looking at LTC insurance).
    And we are very healthy, don’t have any”life style” (i.e avoidable) diseases and live a very healthy lifestyle.
    Thank you Kieth! This post gives me a lot of other options to consider.

  13. Brad on January 11, 2018 at 9:42 am

    Great Post. At the time this came out, I was also in the throes of getting my plan selected by the 12/15 deadline on the ACA website. Our 2017 plan which we also got on the ACA exchange would be going up from $1795 a month to $3400 a month for a family of four in Virginia! I’m 56 and have been financially independent for seven years. One thing I’ve noticed, once you turn 55 premiums begin to skyrocket. For 2018 we decided to switch to a high deductible plan from Cigna that comes in at $1603 per month. Our plan is to stay under the 98K subsidy cliff by maxing out an HSA and a SE 401K through an S-Corp that I put all of my self-employed income through. ( just saying that is a mouthful) If I can do that, the premium would drop all the way down to $237 per month, and I can apply any paid premiums along with HSA expenses against my income. I was able to do something similar in 2015 but the last two years we went over the cliff. I find it fascinating how complex all of this is, so it really helps to read about it and write about it! Thanks for a great article and the extremely helpful links.

    Wondering what your thoughts are on my max pretax HSA contributions, reducing income, while at the same time running the premiums through my S-Corp vs. QSEHRS.


  14. DaniS on January 15, 2018 at 1:39 pm

    Thanks for the informative article. It is especially timely as I have already started on this path and have found little information so it was great to come across this article! I’m curious if there are any further updates regarding if the monthly health share amount can be used with QSEHRS. I just saw something that contradicted but wanted to check in to see. Also, it appears that the documented health costs incurred (medical costs obtained while reaching the so called out of pocket/deductible) can be used with QSEHRS. Is that correct?

    • Keith Schroeder on January 15, 2018 at 1:49 pm

      You are correct, Dani, with limits. The money the employer provides in the QSEHRA can be used for premiums and/or out-of-pocket expenses.

      Also consider contacting Take Command Heath.

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