MPB Health Plans, Pricing & Comparisons

Once you understand what health sharing is and how it differs from insurance, the next question is usually the practical one: what does a plan actually look like, what does it cost, and which tier fits my situation? This page provides you with a description of MPB Health’s plans, what they cover and don’t cover, and how you interact with the plan (e.g. get medical services, file sharing requests, etc.). You can also view plans and see pricing online via our comparison tool. Please reach out to Smart Share if you have any remaining questions after reading this guide.

The Plan Tiers

MPB Health offers a few distinct membership tiers, and the right one depends on how much you want routine costs handled versus how much you’re using the plan mainly for larger, unpredictable medical needs:

• Essentials is the lightest tier and does not include medical cost sharing. It’s built around low-cost, everyday health support — things like virtual care, mental health care, and pet telehealth — rather than sharing the cost of major medical events. It’s often selected by individuals/families with existing medical cost sharing through another health share plan.
• MEC+ Essentials adds MEC Compliant preventive services and HSA eligibility on top of Essentials. As with Essentials, it’s often selected by individuals/families with existing medical cost sharing through another health share plan.
• Care+ adds medical cost sharing on top of Essentials. It’s designed for people who are comfortable paying out of pocket for minor medical needs not addressed by virtual care (e.g. splints, stitches, etc.) but who want the peace of mind knowing that major medical costs are shared. The underlying provider for the medical cost sharing component of this plan is Zion Health.
• Premium Care offers the same coverage as Care+ but uses Sedera as the underlying cost sharing provider. Because of the difference in cost sharing providers, this plan differs in areas such as IUA options offered, pre-existing condition lookback periods, etc. See plan guidelines or contact Smart Share for details.
• Direct adds certain preventive services on top of the Care+/Premium Care plans. While not MEC compliant, this plan supports an annual provider visit, youth immunizations, and certain health screenings such as mammograms and colonoscopies. Caps and age restrictions apply to some services. See plan guidelines or contact Smart Share for details.
• Secure HSA is the whole enchilada. It provides all the coverage of Direct plus full MEC compliant preventive services, HSA eligibility, and prescription benefits (via Rx Valet). Like Care+, the underlying provider for the medical cost sharing component is Zion Health.
• Premium HSA is the same as Secure HSA but has its medical cost sharing component provided by Sedera. Similar to Premium Care, plan attributes such as IUA options offered, pre-existing condition lookback periods, etc. differ when compared to Secure HSA. See plan guidelines or contact Smart Share for details.

What is an IUA?

An Initial Unshareable Amount (IUA) is similar to a deductible in standard insurance plans. There are some important differences, however. IUAs are the amount you pay before your costs can be shared (paid) by the plan. IUAs are specific to an ‘incident’ that causes you to seek medical treatment (e.g. an auto accident). You only pay the IUA once per incident regardless of the number of services received or time frame in which they are rendered. Let’s look at an example:

You have an auto accident where you are admitted to the hospital for a broken leg. The hospital charges you $5,000 for x-rays, setting the leg, etc. You then incur $500 for a follow-up visit to the Dr. and $1,500 for physical therapy. Your total bill for this incident is $7,000. If you selected a $1,500 IUA amount when you signed up for you plan, you will pay $1,500 and the remaining $5,500 will be shared (paid) by the plan. This is true even if the physical therapy, for example, occurs more than a year later.

What is my Out of Pocket Maximum?

You are limited to only paying three IUAs per rolling 12 month period. This is similar to an out-of-pocket maximum in standard health insurance. If you have more than 3 incidents in the 12 month period, they will be covered without you having to pay an additional IUA.

How can I be Sure MPB Health Will Pay my Sharing Request?

This is the biggest concern many have when moving from standard insurance to a health share plan. And for good reason. An insurance policy or health share plan is worthless if it doesn’t pay when you need it. And quite frankly, some early health share companies gave the industry a bad name. Let’s compare how standard health insurance companies and MPB handle claims:

• Standard Health Insurers: They reject on average 20% of in-network claims and 30% of out-of-network claims. Of these, many are due to the subscriber not having applied for prior authorization or going to an out-of-network provider. Subscribers can appeal these rejections and, once exhausting the appeals process with the insurance provider, can appeal to their state insurance commission. The industry average for successfully appealing a rejection is around 50%.
• MPB Health: MPB provides transparent, easy to understand guidelines so you know what is and is not covered. With MPB, there are generally no network requirements or required pre-authorizations to cause out of hand rejections like with traditional insurance providers. MPB further provides a complimentary concierge service that will validate your coverage prior to a procedure and even help you locate a provider. If a sharing request is rejected, you can appeal the decision and a committee will review your case.

So while having a state insurance commission to appeal to is admittedly a nice option, MPB’s no network, no pre-authorization approach is refreshing. And like any company, MPB must stand on its reputation in order to be successful. We suggest looking at customer reviews for MPB Health (and Zion Health and/or Sedera for plans leveraging those providers) as well as any other insurance or health share provider you are considering. Having done the research, we are confident you won’t find a health share provider with a better track record than MPB Health.

Are Pre-Existing Conditions Covered?

Not in the first year. Reimbursement for services related to pre-existing conditions in the 2nd and 3rd year of your membership will be capped at $25,000 and $50,000, respectively. Depending on the plan, coverage starting in the 4th year is either uncapped (Sedera backed plans) or capped at $125,000 (Zion backed plans).

What Qualifies as a Pre-Existing Condition?

Pre-existing conditions are defined as any health issue you were diagnosed with, or for which you had symptoms, during the ‘lookback period’. The lookback period is 2 years for Zion backed plans and 3 years for Sedera backed plans. For example, if you went to the ER with chest pains during the lookback period and you later had a heart attack, it will likely be considered a pre-existing condition and covered based on the phase-in approach discussed above. What is considered pre-existing varies between the Zion and Sedera backed plans. For example, the Zion backed plans do not consider high blood pressure, high cholesterol, and diabetes as pre-existing as long as they are managed (i.e. you are taking your medications) and you have not been hospitalized for the condition in the prior 12 months. It is important that you read the plan guidelines found under the Details section of each plan for specifics if you believe you may have a pre-existing condition.

Can Prescription Medication Costs be Shared?

Eligible prescription expenses may be shared when they are part of a larger, eligible medical need. Additionally, certain memberships include access to prescription benefits via RX Valet which provides deeply discounted pricing on thousands of prescriptions.

How do I Pay for Medical Services?

Simply tell the provider that you are a cash pay (uninsured) patient and pay the bill directly. Usually this will be at a discounted rate since the provider does not have the overhead of dealing with an insurance company. You will then open a sharing request with MPB through their web portal or mobile app for reimbursement once you meet your IUA requirement.

Am I Covered When Traveling Outside the U.S.?

Unplanned (emergency) medical procedures are covered as long as proper documentation is provided. Preventive and/or scheduled services are generally not covered.

What is MEC and HSA Eligibility

These are the components you don’t get from a typical health share plan and are covered covered in depth in our MEC + HSA eligibility guide. MPB Health makes them available in the MEC+ Essentials plan so they can be combined with a health share plan you already have. If you are also looking for a health share plan then Secure HSA and Premium HSA are good choices that already include the MEC and HSA components.

Additional Member Perks

Beyond medical cost sharing itself, all MPB Health memberships include:

• A concierge team that can help schedule appointments, arrange lab work, research pricing on medications, and help plan for surgeries or procedures
• Virtual care access to handle everyday care needs that don’t require an in-person Dr. visit
• Mental health and psychiatry access for diagnosis, medication management, and treatment planning
• Pet Telehealth for pet health and prescriptions
• Discounted vitamins, supplements, and wellness products

State Availability

Not every MPB Health plan is available in every state. Some states have insurance mandates that create conflicts with how health sharing plans are structured which can limit availability or plan options. Be sure to select your ‘Home State’ when viewing plans to ensure plans not available in your state are filtered out.

What Drives the Price

MPB Health monthly plan contributions depend on:

• Age — of the oldest member on the plan
• Household Size — individual, individual plus spouse, individual plus children, or family (individual plus spouse and children)
• IUA Selection — a higher IUA lowers the monthly contribution
• Plan Tier — Essentials, Care+, Secure HSA, etc.
• Tobacco Use — Tobacco use doesn’t preclude you from any plan but you will pay an additional premium (between $50 and $75 /mo depending on plan) if any covered member of the household uses tobacco products

Our plan comparison and pricing tool lets you specify the above and immediately see your cost per plan. No need to submit a request just to get a quote.

How to Compare This Against Other Options

If you’re weighing MPB Health against other plans, a few of our other guides may be helpful to you:

• If a faith requirement is a factor in your decision, see our guide to non-religious health sharing for how MPB Health’s secular structure compares to Christian statement-of-faith plans.
• If HSA eligibility is a priority, MEC + HSA eligibility walks through exactly how the MEC add-on unlocks that.
• If you’re still deciding whether health sharing as a model is right for you at all, our pros and cons guide lays out the trade-offs independent of any specific health share provider

Bottom Line

MPB Health’s plans are offered in tiers to support different needs — from lightweight everyday support with Essentials to full medical cost sharing, MEC compliance, and HSA compatibility with Secure HSA and Premium HSA. After selecting a plan, choose the highest IUA you are comfortable with to reduce your monthly premium. We also encourage you to read the plan guidelines found on the details page of each plan so you know exactly what is and is not covered.