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Bill of Health

Bill of Health

By: Core360 Benefits Group
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The podcast designed to help everyday Americans make smarter healthcare and financial decisions. I’m your host, Bill Fi, The Health Insurance Guy.2026 Economics Hygiene & Healthy Living Personal Finance Physical Illness & Disease
Episodes
  • What If Your Employer Let YOU Choose Your Health Insurance? With Mike Markland (Bill of Health Ep.9)

    What If Your Employer Let YOU Choose Your Health Insurance? With Mike Markland (Bill of Health Ep.9)
    5 Oct 2026
    Every year, employers face rising health insurance premiums while employees are left choosing between the same handful of plans that may not fit their healthcare needs or their budget. If the traditional group insurance model keeps producing the same results, perhaps it’s time to explore a different approach. In this episode of the Bill of Health Podcast, presented by Core 360 Benefits Group, I’m joined by Mike Markland of Atma to discuss Individual Coverage Health Reimbursement Arrangements (ICHRA), also referred to as CHOICE Arrangements, and how they are changing the way businesses offer employee health benefits. Rather than purchasing a one-size-fits-all group health plan, an ICHRA allows employers to establish a defined contribution that employees can use to purchase qualifying individual health insurance. This gives employers greater control over their benefits budget while allowing employees to choose coverage based on their own health, financial situation and preferences. We also explore how ICHRA can fit into a broader employee benefits strategy, including direct primary care, medical cost sharing and supplemental benefits, along with how companies like Atma help manage enrollment, administration and compliance. In This Episode of Bill of Health: Mike and I discuss: What an ICHRA is and how CHOICE Arrangements workWhy employers are exploring alternatives to traditional group health insuranceHow defined contributions can help businesses manage their benefits budgetsWhy employee choice can lead to more personalized healthcare decisionsHow Atma simplifies enrollment, payments and administrative responsibilitiesWhere direct primary care and medical cost sharing fit into a broader benefits strategyWhat employers and employees should consider before transitioning to an ICHRA What Is an ICHRA? An Individual Coverage Health Reimbursement Arrangement (ICHRA) allows employers to contribute a defined amount of money toward an employee’s qualifying individual health insurance rather than purchasing one group policy for everyone. Instead of being limited to a handful of plans selected by their employer, employees can shop for individual coverage that better reflects their healthcare needs. The arrangement also provides tax advantages when established and administered according to applicable requirements. More Choice for Employees, More Budget Control for Employers Traditional group health insurance requires employers to select coverage for an entire workforce, even though employees may have very different healthcare needs. ICHRA changes that relationship by allowing employers to establish their contribution while giving employees more control over the coverage they purchase. The transition also doesn’t mean employees are left to figure everything out themselves. Education, plan comparisons and enrollment assistance remain important parts of helping people make informed choices. Simplifying Benefits Administration Managing individual insurance policies for an entire workforce might sound more complicated than administering a traditional group plan, but technology can help reduce that workload. Atma supports ICHRA implementation through enrollment assistance, premium payment coordination, reporting and administrative services. Rather than requiring employers to manage numerous individual insurance payments, the process is designed to function much like the familiar group benefits model. Building a More Personalized Benefits Package ICHRA can also serve as the starting point for a broader discussion about employee benefits. Depending on an employee’s needs and eligibility, employers and benefit advisors may explore additional options such as direct primary care, supplemental benefits and medical cost sharing. These options are not interchangeable with traditional insurance, but they illustrate why a personalized benefits strategy deserves consideration instead of automatically renewing the same plan each year. Jargon Jar: What Is Reimbursement? A Health Reimbursement Arrangement (HRA) is an employer-funded benefit that reimburses employees for eligible healthcare expenses under established rules. Traditional reimbursement models can involve collecting receipts, submitting documentation and waiting for expenses to be processed. With a properly administered ICHRA, much of that work can be handled through technology and a third-party administrator, including qualifying premium payments, enrollment verification and required documentation. About Mike Markland Mike Markland is the founder and CEO of Atma PMF, an employee benefits organization specializing in ICHRA solutions and alternative benefits strategies. His background includes payroll, professional employer organizations (PEOs) and traditional employee benefits. Connect with Mike: LinkedIn: Mike Markland Company: Atma PMF For direct inquiries, contact Mike through his LinkedIn profile. A complete public direct email address was not independently ...
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    31 min
  • Her Son Broke His Femur — Did Their Health Share Actually Work? With Niki Chamberlain (Bill of Health Ep.10)

    Her Son Broke His Femur — Did Their Health Share Actually Work? With Niki Chamberlain (Bill of Health Ep.10)
    12 Oct 2026
    Switching away from traditional health insurance can sound good in theory. The real question is what happens when someone in your family actually needs serious medical care. In this episode of the Bill of Health Podcast, presented by Core 360 Benefits Group, I’m joined by Niki Chamberlain, a self-employed mother of three from Amarillo, Texas, who made the move from traditional health insurance to Sedera Medical Cost Sharing and direct primary care. Niki and her family had spent years dealing with high premiums, large deductibles and coverage that still left them paying significant healthcare costs out of pocket. Eventually, they decided to try a different approach. Then came the test nobody wants. During a family ski trip, Niki’s son suffered a serious accident that left him with a broken femur, a long ambulance ride, surgery, a hospital stay, physical therapy and eventually a second procedure. For the first time, Niki had to find out whether the medical cost-sharing model they had chosen would actually work when her family needed it most. Her experience offers a firsthand look at what being a cash-pay patient really means, how medical bills are handled and what happens after a large healthcare need is submitted to a sharing community. In This Episode of Bill of Health: Niki and I discuss: • Why her family moved away from traditional health insurance • How direct primary care fits alongside medical cost sharing • What happened when her son broke his femur on a ski trip • What it was actually like entering a trauma center as a cash-pay patient • How cash-pay discounts changed the hospital bill • How Niki submitted bills and receipts through Sedera • Why understanding your Initial Unshareable Amount matters Why Niki’s Family Made the Change As a self-employed family, Niki and her husband had tried traditional health insurance but kept running into the same problem: expensive premiums, high deductibles and significant costs even when they used the coverage. They eventually chose a combination of direct primary care for routine healthcare and Sedera Medical Cost Sharing for larger, unexpected needs. For everyday care, direct primary care gave the family a simpler relationship with their provider and predictable cash pricing. The health share remained in the background for the kinds of medical events nobody plans for. Then Came a Broken Femur Several years after joining Sedera, Niki’s family was skiing when her son suffered a major accident and broke his femur in two places. The situation included hours with ski patrol, a three-and-a-half-hour ambulance ride, a Level II trauma center, surgery, a metal plate, multiple nights in the hospital and months of follow-up care. It was also the first time Niki had ever needed to use the health share for a major medical event. One of her biggest concerns was the same concern many people have when considering medical cost sharing: What happens when I tell the hospital I’m a cash-pay patient? The answer was far less dramatic than she expected. Her son received the care he needed, and the hospital automatically applied a substantial cash-pay discount before sending the final bill. How the Sharing Process Worked After the accident, Niki opened a medical need with Sedera and began submitting receipts and bills as they arrived. That included expenses from ski patrol, physical therapy, follow-up appointments and the hospital itself. Once the family reached its selected Initial Unshareable Amount, eligible expenses associated with the medical need were shared according to Sedera’s membership guidelines. Niki had chosen a $2,500 Initial Unshareable Amount, meaning her family knew in advance how much they were prepared to be responsible for before sharing began. Her son later needed a second surgery to remove the metal plate, along with additional physical therapy and follow-up care. Because those expenses were connected to the original medical need, they continued through the same sharing process. Cash Pay Doesn’t Mean You’re on Your Own One of the biggest misconceptions Niki’s story addresses is the idea that a cash-pay patient must walk into an emergency room with enough money to pay the entire bill before leaving. She received medical care first, bills came later and Sedera provided a needs coordinator who remained involved throughout the process. Niki describes having the same person available as bills, invoices and reimbursements moved through the system. She also found the medical bills themselves easier to understand because she could clearly see the services provided, the cash-pay discount and the amount actually owed. Jargon Jar: What Does Cash Pay Mean? Being a cash-pay patient means healthcare providers are not billing a traditional insurance company for your care. That does not necessarily mean paying every medical expense upfront. Depending on the provider and situation, bills may arrive afterward, and cash-pay discounts may be ...
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    28 min
  • Can You Really Leave Traditional Health Insurance Behind? (Bill of Health Ep.8)

    Can You Really Leave Traditional Health Insurance Behind? (Bill of Health Ep.8)
    28 Sep 2026
    Traditional health insurance can make people feel trapped. Premiums keep climbing, deductibles stay high, and many families rarely use enough healthcare to reach the point where their plan starts paying much. In this episode of the Bill of Health Podcast, presented by Core 360 Benefits Group, I’m joined again by Richard Walton, CEBS, of Sedera for part two of our conversation about medical cost sharing and healthcare alternatives. Episode 7 covered the basics of how health shares work. This time, we get more practical and dig into the questions that usually come up once someone starts seriously considering whether to leave a traditional insurance plan. We talk about preexisting conditions, what it really means to become a cash-pay patient, how Sedera helps members negotiate medical costs and why health share members are not expected to navigate large bills entirely on their own. Richard also explains how medical cost-sharing communities think about financial stability and why consumers should look closely at a health share’s track record, rules and reputation before making a decision. In his Episode of Bill of Health: Richard and I discuss: • What to consider before leaving an employer-sponsored health plan • How health shares handle preexisting conditions • Why becoming a cash-pay patient does not mean navigating healthcare alone • How medical bills and scheduled procedures can be negotiated before or after care • Why knowing the true price of healthcare can change the way you spend • How health share communities approach financial sustainability • Who may be a good candidate for medical cost sharing Preexisting Conditions and Health Shares Preexisting conditions are one of the first concerns people raise when they begin exploring medical cost sharing. Health shares do not handle them the same way traditional insurance does. Richard explains that Sedera uses a graduated sharing approach for certain preexisting conditions, allowing the amount eligible for sharing to increase over time. That makes it especially important to understand the specific membership guidelines before joining. Every person’s situation is different, and no one should assume a health share works exactly like an insurance plan. Becoming a Cash-Pay Patient Operating outside a traditional insurance network can sound intimidating, but cash-pay healthcare does not mean paying every large medical bill upfront or negotiating everything by yourself. For emergencies, the priority is getting care. Once the bill arrives, Sedera can help review and negotiate the cost before payment. For scheduled procedures, members can request a good faith estimate in advance and compare the price with other options. In some cases, moving a procedure from a hospital to an outpatient facility can significantly reduce the cost without changing the physician providing the care. The goal is not to become an expert in medical billing. It is simply to understand that you have options and support. Shopping for Healthcare Healthcare prices are often treated as if they are fixed, even though they can vary dramatically from one provider or facility to another. Richard’s point is simple: consumers already know how to shop. If you would drive to another town to save $1,000 on a vehicle, you can apply the same mindset to healthcare when the situation allows it. Tools, direct primary care providers and medical cost-sharing communities can help make those comparisons easier. Can a Health Share Be Financially Sustainable? Long-term sustainability is another important question for anyone considering medical cost sharing. Sedera operates as a nonprofit medical cost-sharing community rather than an insurance company holding large reserves. Richard describes the model more in terms of ongoing community cash flow, membership size and the ability to manage large medical needs as they arise. Consumers should still do their homework. Look at the organization’s track record, understand its guidelines and talk with people who have experience using the model. Jargon Jar: Claim vs. Need Traditional insurance uses the word claim. A claim is a contractual request for payment under an insurance policy. Health shares use the term need. A need is a medical event, illness or injury for which a member asks the sharing community for financial assistance according to the organization’s guidelines. The language reflects an important difference between the two models: insurance is based on contractual coverage, while medical cost sharing is built around voluntary community sharing. About Richard Walton Richard Walton, CEBS works with Sedera and has spent more than two decades in the employee benefits industry. His work focuses on medical cost sharing, direct primary care and alternative approaches to paying for healthcare. Connect with Richard: LinkedIn: Richard Walton, CEBS Email: rwalton@sedera.com Phone: 806-679-0816 Sedera: www.sedera.com Learn More Interested in ...
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    26 min
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