Located in the Tampa Bay Area
Tampa | Clearwater | St. Petersburg
We help self-employed individuals, early retirees, and pre-Medicare households understand their options — with complete transparency about how each one works.
The programs on this page are healthcare cost-sharing communities — not insurance. Members voluntarily share each other's eligible medical expenses, which can result in significant savings compared to traditional premiums. These programs are not regulated by state insurance departments, carry no legal obligation to pay any claim, and do not guarantee payment of your medical bills regardless of the circumstances.
They work well for many healthy individuals and families. They carry real risk for others — particularly those with pre-existing conditions or the potential for large, unexpected medical events. I share this so you can make a fully informed decision. If you have questions about whether a program is right for your situation, I'm happy to walk through it with you.
— Carmen Cuevas, LaVista Planning Group | 813-847-2262
LaVista Planning Group discusses two distinct types of health coverage. Understanding the distinction is essential before enrolling in any plan.
ACA Marketplace plans are Qualified Health Plans (QHPs) certified under the Affordable Care Act and sold through federally facilitated or state-based exchanges. These are licensed, regulated insurance products.
Healthcare cost-sharing programs are membership organizations in which members share each other's eligible medical expenses. They are NOT insurance and are not regulated by state insurance laws.
One program Carmen introduces clients to is Impact Health Sharing — a non-profit community of 22,500+ members with plans that can significantly reduce monthly costs for healthy individuals, the self-employed, and pre-Medicare retirees.
Program referenced: Impact Health Sharing →
This comparison is illustrative and educational only. Actual premiums, contributions, exclusions, and outcomes vary by age, state, household profile, and the specific plan or program selected.
| Feature | ✅ ACA Marketplace Health Insurance | ⚠️ Healthcare Cost-Sharing Program |
|---|---|---|
| Legal Status | Regulated insurance — subject to ACA rules and state/federal consumer protections | NOT insurance — a voluntary sharing arrangement, not subject to insurance regulations |
| Pre-Existing Conditions | Must be covered. Cannot be denied coverage or charged more based on health status. | May be excluded, delayed, or only partially eligible for sharing |
| Payment of Bills | Covered claims are a contractual obligation of the insurer | Sharing is discretionary — no legal guarantee that any bill will be paid |
| Out-of-Pocket Cap | Required by law — your maximum exposure is capped annually | No legal requirement for an out-of-pocket cap |
| Monthly Cost | Often higher for self-employed households; APTCs may reduce cost | Often lower, especially for healthier members who meet lifestyle guidelines |
| Premium Tax Credits | May qualify for APTCs to reduce monthly premium | Not eligible for ACA premium tax credits |
| Provider Pricing | Carrier-negotiated rates apply — significant discounts vs. billed rates | Members may be billed at full (non-negotiated) provider rates |
| Essential Health Benefits | All 10 EHBs required (prescriptions, mental health, maternity, etc.) | Not required to cover ACA essential health benefits |
| State Regulation | Yes — state Department of Insurance oversight and consumer protections | Exempt from insurance regulation in most states (30+ states) |
| Appeals Rights | Legally protected formal claims appeal process | Internal review only — no legal mandate for external appeals |
| Best Fit | Those wanting regulated coverage, predictable benefits, and stronger legal protections | Relatively healthy individuals who want lower monthly cost and accept more uncertainty |
| Note: This table is for general educational purposes only. It does not constitute a guarantee of premium, eligibility, subsidy amount, benefits, provider access, claim approval, or bill-sharing outcome. | ||
Those who purchase their own health coverage and are not eligible for employer-sponsored plans may explore cost-sharing as a way to reduce monthly spending — particularly if they are in good health.
Individuals between retirement and age 65 who need to bridge the gap before Medicare eligibility sometimes consider cost-sharing programs to manage their monthly healthcare budget.
Households with lower anticipated medical needs who are comfortable reviewing program guidelines carefully and understand they are accepting more uncertainty than with major medical insurance.
Anyone with ongoing medical conditions, anticipated surgeries, high prescription costs, or a need for predictable regulated benefits should review guidelines very carefully — and compare against ACA-compliant coverage before enrolling.
Review exclusions, waiting periods, sharing caps, maternity rules, prescription treatment, mental health coverage, and provider access. Lower monthly cost does not always mean lower total risk.
Some programs impose lifestyle, faith-based, or membership rules that do not apply to ACA-compliant insurance. Certain behaviors or conditions may affect eligibility or the shareability of your bills.
Please read this disclosure carefully before making any coverage decision.
Impact Health Sharing is available in 48 states. The only states currently unavailable are Rhode Island and Washington State due to local regulatory restrictions.
Let Carmen walk through your specific situation, compare options side by side, and help you make a fully informed decision about your health coverage.