At ShareWELL, we believe healthcare should be transparent, practical, and focused on helping people spend less on the care they actually use. One of the first questions someone should ask when considering ShareWELL is about pre-existing conditions, often called pre-x. This topic is a major reason ShareWELL can offer a lower monthly cost than traditional insurance.
Because ShareWELL is designed to share expenses for new and unexpected medical events, there are some situations where it may not be the best fit right now. For example:
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Someone who is already pregnant or planning to deliver soon
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Someone who has been recommended for surgery or who has an injury that has not yet been evaluated by a doctor and may require a procedure
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Someone currently receiving treatment for an ongoing major condition, such as cancer or a recent heart procedure
- Someone taking a high-cost medication
In these cases, large expenses are already known or expected. Those costs would fall under the definition of a pre-existing condition, and since they cannot be shared during the initial membership period, another option may be a better fit until that care is complete.
You can find the full definition of what qualifies as a pre-existing condition in the Member Guidelines, available on your member portal or at ShareWELLHealth.org. Understanding this definition helps each member set clear expectations and make informed decisions about their care.
For most people, however, a pre-existing condition is something manageable, something that does not usually lead to high medical costs. That distinction is what makes ShareWELL’s approach so effective.
Understanding What “Pre-X” Really Means
The truth is that almost everyone has a pre-existing condition. It might be mild high blood pressure, seasonal allergies, or a bad back that flares up from time to time. For most members, those small or stable conditions do not lead to large medical bills. The more helpful question to ask is not “Will this be covered?” or “Will this be shared?” but rather:
👉 “What could this actually cost me?”
👉 “Will I need major care for this in the next year or two?”
If the answer is no, for example, if you manage your back pain with stretching, over-the-counter medication, or occasional chiropractic visits, then your situation may still be a good fit for ShareWELL.
The reality is that most families spend far more on monthly premiums for traditional plans than they ever use in benefits. While many of these plans cover basic wellness visits, members still face high costs for other everyday care, such as therapy, chiropractic visits, or specialty consultations, as well as deductibles and copays when more significant needs arise.
What makes ShareWELL different is that, instead of paying high premiums for “coverage” you rarely use, members save on their monthly costs and pay direct pricing when care is needed. This combination almost always results in lower overall healthcare spending each year.
It may not be what most of us are used to, but the numbers tell the truth. Lower monthly costs plus direct-pay pricing equal real savings. The fact is, the math checks out, and ShareWELL members see it every day.
The Bigger Picture: Real Cost Comparison
To understand how this plays out in real numbers, let’s look at a family comparing two options:
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Traditional plan: $1,700 per month
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ShareWELL membership: $600 per month
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ShareWELL Unshared Amount (UA): $1,500
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Traditional deductible: $5,000
That means this family saves about $1,100 every month, or $13,200 a year, just in monthly costs before even visiting a doctor.
Now, imagine that a family member needs a minor procedure, such as a cyst removal, that is considered pre-existing and therefore not eligible for sharing during the first year.
According to national pricing data from Healthcare Bluebook and Fair Health Consumer, a self-pay rate for a cyst removal might be around $1,500, while the billed rate under insurance might range from $4,000 to $6,000.
| Scenario | Monthly Cost | Annual Premium | Procedure Cost | Total Out of Pocket |
|---|---|---|---|---|
| Traditional Insurance | $1,700 | $20,400 | $5,000 procedure (meets deductible) | $25,400 total |
| ShareWELL | $600 | $7,200 | $1,500 direct pay (not shared) | $8,700 total |
Even when a procedure is not eligible for sharing because it is pre-existing, the total cost is still much lower with ShareWELL. In this example, the family saves around $16,700 a year.
Why “Not Covered” Matters Less Than You Think
ShareWELL’s purpose is not to cover every possible bill. Its purpose is to help members spend less on healthcare overall while maintaining control, choice, and transparency.
In the first year, members with a pre-existing condition can still take advantage of the lower monthly cost, the power of self-pay pricing, and clear communication about what is eligible. Most of the time, those manageable ongoing conditions are simply part of normal healthcare and do not result in large medical expenses.
When new or unexpected medical bills do arise, especially emergencies or surgeries, that is when the ShareWELL community steps in to share.
The Power of Self-Pay
Even medical bills that are technically covered by insurance can still lead to higher spending once deductibles, copays, and network rates are added in. According to the Kaiser Family Foundation, the average deductible for an individual health insurance plan in the United States is about $2,500, and many Marketplace plans have deductibles exceeding $4,500 before coverage begins.
Direct pay or self-pay pricing often provides discounts of 40-80 percent off billed rates. Members receive fair pricing upfront and avoid unexpected costs. That is the difference between coverage and clarity.
The Bottom Line
At ShareWELL, we understand that everyone has a medical history. The important thing is that members know and understand how pre-existing conditions may affect them, especially during their first year. When members understand the definition and how it applies, they can set proper expectations, plan confidently, and make the most of their membership.
Most pre-existing conditions are small, stable, and manageable, and will never reach a level where sharing even matters. When members focus on what their care will actually cost, rather than whether it is covered, they quickly see that ShareWELL offers more freedom, more control, and more savings.
Healthcare does not need to be complicated. It simply needs to be clear, fair, and focused on what matters most, helping members spend less and live well.