What Employers Should Know Before Choosing a Healthshare
Every January, the renewal notices go out. And every year, a few more business owners in Fort Mill and across York County start Googling alternatives to traditional group insurance. It's not hard to understand why — according to the Kaiser Family Foundation's annual employer health benefits survey, average family premiums for employer-sponsored coverage have climbed more than 20% over the last five years, with small businesses absorbing a disproportionate share of that increase. Healthshares keep coming up as an alternative.
The problem isn't a lack of information. There's plenty of it. The problem is that most of it is either written by people trying to sell you a healthshare or written by people trying to scare you away from one. Neither version is particularly useful when you're trying to make a real decision for your team.
This post isn't a sales pitch for healthshares. New South Family Medicine doesn't sell them. What we do work with is the piece most employers overlook — the day-to-day primary care access that determines whether any healthcare strategy actually works for your employees.
Here's what the myths get wrong, and what Fort Mill employers need to know before signing anything.
What Is a Healthshare, Exactly?
A healthshare — sometimes called a health-sharing ministry or health cost-sharing program — is a membership-based organization where participants contribute monthly funds to a shared pool. When a member has a qualifying medical expense, the community shares in covering that cost.
Healthshares are not insurance. They are member-funded cost-sharing arrangements governed by their own guidelines — not by state insurance regulations.
That distinction matters more than most employers realize. It means healthshares don't have to follow the same coverage rules, guaranteed issue requirements, or consumer protections that insurance plans do. Some of that is a feature. Some of it is a risk. Understanding which is which is the whole ballgame.
How Healthshares Differ from Traditional Insurance
With traditional group insurance, your employees pay premiums and receive defined benefits outlined by the plan. Coverage is legally binding. Disputes have a regulatory appeals process.
With a healthshare, members contribute to a shared fund and submit eligible expenses for reimbursement. The healthshare's guidelines — not a state insurance commissioner — determine what's shareable. There are no guarantees, but there are also often far lower monthly contributions.
Myth #1: Healthshares Are Just Cheap Insurance
This is the most expensive myth in the room.
Employers who approach a healthshare the way they'd approach a cheaper insurance plan tend to find out the hard way that the two don't work the same way. Healthshares don't have networks in the traditional sense. They don't have the same pre-authorization structures. And they often have sharing limitations — dollar caps on what the community will cover for a given claim — that a traditional plan wouldn't have.
That doesn't make them bad. It makes them different. And different requires a different strategy.
The employers who do well with healthshares go in with clear eyes: they understand what is and isn't shareable, they pair the healthshare with a strong primary care solution for everyday needs, and they make sure employees understand how to use the benefit before they need it.
Going in expecting it to work like insurance is where the frustration starts.
Myth #2: Healthshares Don't Work
They can work — and the outcomes tend to depend heavily on what's underneath the healthshare.
Specifically, how well employees can access primary care before expenses escalate. When employees can't get in to see a doctor, they go to urgent care. When urgent care doesn't feel right, they go to the ER. Both of those pathways are expensive, and neither is where a healthshare shines.
When employees have a trusted primary care physician they can reach, they stop using the ER as their default — and that changes the math on any healthcare strategy.
That's not a coincidence. It's a design consideration. Employers who pair a healthshare with Direct Primary Care — a membership model that gives employees same- or next-day access to a physician — tend to reduce the high-cost utilization that strains any healthcare strategy.
Myth #3: Healthshares Cover Everything
They don't. And this is where employers need to read the fine print before their employees do.
Most healthshares have specific guidelines around what is and isn't "shareable." Common exclusions or limitations include:
Pre-existing conditions: Many programs have waiting periods of 12–36 months before pre-existing conditions become shareable. Some never become shareable at all. Consider what that means in practice: an employee with well-managed Type 2 diabetes who enrolls in a healthshare with a 24-month waiting period on pre-existing conditions is essentially unprotected for diabetes-related expenses for two years. That's a meaningful gap employers need to communicate clearly before enrollment.
Behavioral health: Mental health and substance use coverage varies widely. Many programs offer limited or no sharing for these expenses.
Maternity care: Some programs cover it fully. Others have waiting periods. Some cover only certain scenarios.
Elective and preventive care: Healthshares typically do not share preventive care costs in the same way insurance plans do.
Dollar caps and sharing limits: Many programs have annual or lifetime sharing maximums that a traditional insurance plan would not.
This isn't a reason to walk away from healthshares — it's a reason to build the right support structure around one. If employees have access to primary care that covers the everyday stuff, the healthshare is doing what it's designed to do: helping with larger, unexpected medical events.
What gets employers in trouble is presenting a healthshare to employees as equivalent to the coverage they had before without addressing these gaps transparently.
Myth #4: Healthshares Are Only for Certain Groups
This was more true ten years ago than it is today.
Many early healthshares were faith-based organizations, and some of the largest still are. Members were expected to affirm a statement of shared values or lifestyle commitments as a condition of membership.
The landscape has expanded. A growing number of secular, broader-membership healthshares exist that do not require religious affiliation. Eligibility criteria vary by program, but the assumption that healthshares are only available to a narrow religious demographic is no longer accurate.
That said, any employer evaluating a healthshare should review membership requirements carefully and understand how those requirements affect which employees can participate.
Why Some Fort Mill Employers Pair Healthshares with Direct Primary Care
The employers who get the most out of a healthshare approach are the ones who solve for primary care access first.
Direct Primary Care — DPC — is a membership model that gives employees unlimited access to a primary care physician for a flat monthly fee. There are no copays, no claims, and no waiting two weeks for an appointment. Employees can text their doctor directly, get seen same or next day, and have actual time in the visit to talk through what's going on.
Healthshares tend to work best for employees who are generally healthy, have access to preventive and primary care, and understand their benefit before they need it. That combination — strong primary care underneath, a healthshare on top — is the structure that produces real results.
At New South Family Medicine in Fort Mill, employer DPC memberships run $100 per employee per month for teams of five or more. Employees get same- and next-day appointments, direct physician access via text and phone, after-hours telephone coverage, wholesale-priced medications, and significantly discounted lab work. Starting January 1, 2026, employees can also use HSA funds to pay for DPC memberships under IRC 223 — a meaningful new tax advantage for employers structuring benefits thoughtfully.
What Direct Primary Care Adds to the Equation
When you pair DPC with a healthshare, the structure starts to make more sense:
DPC covers 80–90% of what employees actually need day to day: sick visits, chronic disease management, prescriptions, labs, and preventive care
The healthshare covers catastrophic events: hospitalizations, surgeries, major specialist care
A high-deductible insurance plan or stop-loss coverage can be layered in for additional protection
This combination won't be the right fit for every business or every workforce. But for employers with generally healthy employees who are spending too much on premiums for benefits their team rarely uses — it's worth a serious look.
Frequently Asked Questions
Q: Are healthshares legal alternatives to health insurance for employers? A: Yes. Healthshares are legal membership organizations in all 50 states. They are not insurance and do not carry the same regulatory protections. Employers who offer a healthshare as a benefit should be transparent with employees that it is not insurance and communicate clearly how the benefit works.
Q: What is Direct Primary Care, and how does it pair with a healthshare? A: Direct Primary Care (DPC) is a membership model where employees pay a flat monthly fee for unlimited access to a primary care physician — no copays, no insurance billing. When paired with a healthshare, DPC handles everyday primary care while the healthshare covers larger, unexpected medical expenses. Together they can create a lower-cost, higher-access alternative to traditional group insurance.
Q: What would a DPC employer benefit look like for a Fort Mill business with 15 employees? A: At New South Family Medicine, a Fort Mill business with 15 employees would pay $100 per employee per month — $1,500 total per month — for employer DPC memberships. Every enrolled employee gets same- or next-day appointments, direct physician access via text and phone, after-hours telephone coverage, wholesale-priced medications, and significantly discounted lab work. No copays, no claims, no deductibles. Starting January 2026, employees may also use HSA funds for DPC memberships under IRC 223.
Q: What do healthshares typically not cover? A: Common exclusions include pre-existing conditions (often subject to waiting periods of 12–36 months), behavioral and mental health care, elective procedures, and some types of preventive care. Most programs also have annual or lifetime sharing caps. Employers should review the specific guidelines of any healthshare before presenting it to employees.
Q: Is a healthshare right for every business? A: No. Healthshares work best for businesses with generally healthy employees who have access to strong primary care and who understand how cost-sharing works. Businesses with employees who have significant chronic conditions or complex health needs should evaluate carefully whether a healthshare's exclusions and limitations are appropriate. The right answer depends on the specific workforce.
Q: How do I find out if DPC is a good fit for my business in the Charlotte area? A: The best first step is a conversation. New South offers employer consultations to walk through how DPC works, what employees get, and how it compares to what you're currently spending. There's no obligation and no enrollment pressure. Reach out directly at drjessica@newsouthmed.org.
The Bottom Line
Healthshares are becoming a real part of the conversation for employers who are done watching premiums climb and getting less in return. They're not a magic fix, and they're not right for every business. But for employers who do the work — understanding what's shareable, communicating clearly with their team, and pairing the healthshare with strong primary care access — the math can work in their favor.
The piece most employers underestimate is primary care. It's the part employees use most, and it's the part that keeps larger expenses from spiraling. That's where New South comes in.
Talk to Us About DPC for Your Team
Your employees need a doctor they can actually reach — not an 800 number and a two-week wait. New South Family Medicine partners with Fort Mill and York County businesses to provide employer DPC memberships starting at $100 per employee per month, with no copays, no claims, and same- or next-day access built in.
Talk to Us About DPC for Your Team Schedule an employer consultation
Not ready to schedule? Start by understanding what DPC includes and what it costs.
References
Kaiser Family Foundation. (2024). Employer Health Benefits Survey. Retrieved from https://kff.org/health-costs/report/2024-employer-health-benefits-survey
Internal Revenue Code § 223. Health savings accounts. Consolidated Appropriations Act, 2025 (effective January 1, 2026). Retrieved from https://www.irs.gov/publications/p969
