One Man LBO@OneManLBO
In 2026, our family of four is ditching traditional healthcare insurance and covering most of our medical needs for $600 / month. Here’s how we’re doing it.
For anyone self-employed and / or looking for coverage options more affordable than traditional ACA exchange insurance, here are my notes from just having done a deep dive into this over the last couple of weeks.
Note that A) none of this is medical advice, B) this may NOT fit your family’s personal needs given this is NOT health insurance, and C) you may face additional complications and penalties if you’re located in the handful of states that impose an individual health insurance mandate. We happen to be in a state that has no such mandate.
For next year, we have decided to do a combination of @JoinCrowdHealth and Direct Primary Care (DPC), which should cover basic healthcare needs for our family of four for an all-in cost of less than $600 / month.
What is CrowdHealth?
It’s not health insurance, but a community of members that crowdfunds higher-cost health events (ER visit, surgeries, etc.), which you submit with a self-participation amount of $500. So as an example, if you have to go to the ER and end up with $2,500 worth of bills, you submit this amount to “the crowd”, and if it gets funded, you pay $500, and the community pays $2,000.
Funding is not guaranteed and since this is not health insurance, you have no regulatory recourse, but the historical track record looked good enough to me to get comfortable with this risk (something like 99%+ of claims submitted for funding did get funded).
My main concern here were extreme high-cost events like cancer. I tried to actively locate stories of funding denial, but ended up coming across mostly positive anecdotes. The company features several case studies of funded health events (including cancer) on their Twitter page, and overall anecdotal feedback from Twitter friends was also positive, including one that got ER events funded.
CrowdHealth reduces cost of care through two primary means:
1) focusing on non-obese, non-smoking members, with very limited coverage for pre-existing and chronic conditions (so their risk pool is quite healthy on average, much healthier than for ACA plans), and
2) aggressively negotiating down medical bills with hospitals and other medical providers, which treat you as a self-pay / cash pay patient and therefore are not bound by insurance negotiated rates.
What is Direct Primary Care?
Think about this as basic-medical-care-as-a-service. You pay a primary care physician practice a fixed monthly subscription fee per month, and in exchange you can come in for virtually unlimited appointments and basic services (some of these practices include lab test coverage, others charge you very low wholesale pricing they have negotiated with third-party labs).
Often these primary care doctors will also provide pediatrics, basic dermatology, and women’s health services. The basic idea is that your family physician should be able to cover 95%+ of your routine (non-acute) healthcare needs in-house, without having to refer you to an army of specialists, and to prevent higher-cost urgent care and ER visit episodes unless absolutely necessary.
In our area, we can enroll our family at a DPC provider for $200 / month. That is a really good deal, considering that I estimate that a single doctor visit billed through traditional insurance would likely run us $100-$200 (going straight to deductible), even after discounts.
How can DPC care be so cheap? It's mainly because most of these DPC providers don't work with insurance plans at all. They get paid direct cash subscription fees by their members. So they have radically lower and simpler overhead (less billing, coding, and collection admin), and the doctors can spend more time with patients and focus on medical care provision rather than dealing with insurance headaches.
Putting CrowdHealth + DPC together
CrowdHealth charges a family of four a $240 / month basic administrative fee ($60 per member), and then the monthly contribution towards other members’ medical expenses is a maximum of $420, but has run closer to $255 / month actual for most of 2025 (you only pay for actual expenses that the risk pool incurs every month).
However, if you and your spouse agree to submit a couple of lab tests showing that you are in good health (test costs also partially reimbursable by CH), you can get a discount of 10%-20% on this monthly contribution. So in theory, if you secure a 20% discount on the $255 / month medical contribution, you end up closer to ~$200. Add in the $240 admin fee and your monthly all-in CrowdHealth bill could be as low ~$450 / month.
But it gets better.
CrowdHealth allows you to submit up to $300 per member per year for “wellness expenses”, which could be an annual physical, dental, or, importantly, DPC membership fees.
So if a family of four is in theory eligible for up to $1,200 / year ($100 / month) reimbursement, then if you submit your DPC membership costs for funding, the effective cost drops from $200 to as low as $100 / month. For the entire family.
So now you have
1) $450 / month for CrowdHealth (for catastrophic / high cost events), plus
2) $100 net cost / month for virtually unlimited basic DPC services from your primary care physician practice.
$550 / month all-in for a family of four. That’s pretty good. Any stuff not covered by the DPC (labs, specialist visits, higher acuity outpatient procedures etc.) would obviously come on top of this.
Again, this is just one man’s opinion and decision. This is not health insurance. This requires a leap of faith and some risk tolerance. Do your own diligence, choose your own path. Do what’s right for YOUR family (which I can't tell you).
I’m just posting this in case it’s helpful to some folks, knowing about one option that I was completely unaware of up until a couple of weeks ago.
