7 min read

Primary Care in a Sharing Model: What's Included, What's Not, and Smart Ways to Plan

Liberty HealthShare Mar 24, 2026 4:29 PM

Health Share Ministries Considering Membership Medical Cost Sharing Healthcare Costs Sharing Member Education Medical Bills Preventative Care Blog Radical Transparency

Primary Care in a Sharing Model: What's Included, What's Not, and Smart Ways to Plan

Primary care—routine doctor visits, wellness checkups, managing chronic conditions, and everyday health needs—forms the foundation of staying healthy. Understanding how healthcare sharing handles these ongoing needs is essential for making Liberty HealthShare work effectively for you.

Quick Answers: Primary Care Sharing

Are wellness visits eligible for sharing? Yes. One annual wellness visit with related lab work (up to $500 in Fair and Reasonable charges) is eligible for sharing, not subject to AUA, after a two-month initial waiting period for eligible Liberty HealthShare sharing programs.

Can I keep my current doctor? Yes. You're free to visit any provider. Using providers who participate in the PHCS network (large nationwide network) reduces balance bill risk. Balance bills are not eligible for sharing, but Liberty HealthShare provides access to a Patient Advocacy Center to assist members with balance bills.

Are sick visits eligible for sharing? Yes. Doctor visits for illness or injury become eligible for sharing after meeting your AUA and (if applicable) are subject to your co-share

What about preventive screenings? Many preventive screenings are eligible for sharing and are typically not subject to AUA when billed as preventive and within program limits: annual mammograms (age 40+), pap smears, PSA tests, Cologuard screening, and flu vaccines

How do pre-existing conditions work? Year 1: not eligible for sharing. Years 2-3: eligible for sharing up to $50,000 total. After 37 months of continuous membership: no pre-existing condition sharing limitations

Is telehealth available? Yes. DialCare Urgent Care provides 24/7 telemedicine. Five visits per person for Unite, Connect, and Essential members are eligible for sharing in full; $55/visit for Assist and Rise

Primary Care in a Sharing Model: The 4 Rules

1. Fair and Reasonable repricing applies

After bill submission and eligibility determination, Liberty HealthShare’s cost containment vendor reprices bills to the fair and reasonable amount. PHCS network providers streamline this process by being more likely to accept fair and reasonable pricing. Balance bills (charges above Fair and Reasonable) are not eligible for sharing, but Liberty HealthShare provides access to a Patient Advocacy Center to assist members with balance bills.

2. The $200 guideline exists

Medical expenses $200 or less in billed charges generally should not be submitted for most programs and may not be shareable. Some key exceptions: annual wellness visit (up to $500) and preventive screenings. Check your program's Sharing Guidelines for complete details.

3. Two-month initial waiting period (most programs)

First two months: Only accidents, acute illnesses, or injuries are eligible for sharing
After two months: Routine doctor visits, wellness care, and preventive screenings become eligible for sharing
Exceptions: Liberty Freedom and Liberty Assist have no initial waiting period. Well-baby visits (through 13 months) have no waiting period

4. Wellness ≠ Diagnostic

Same visit, different billing. If you mention symptoms or concerns to your provider, additional services can become diagnostic (subject to AUA). True preventive visits with no symptoms are eligible for sharing up to $500 as a wellness visit.

Preventive Care Snapshot: What's Not Subject to AUA

Annual Wellness Visit

One preventive wellness visit per year with related lab work (no symptoms or diagnosis in advance) - up to $500 in Fair and Reasonable charges, typically not subject to AUA or the $200 guideline. Includes primary care visits and annual gynecological visits for females. These services are eligible for sharing after the initial two-month waiting period; other program guidelines may apply.

Preventive Screenings Having No AUA

Typically not subject to AUA or the $200 guideline when billed as preventive and within program limits:

Pap smears: Annual
Screening Mammograms: Annual (age 40+)
PSA tests: Annual (age 50+); every two years (under age 50)
Cologuard: Annual (age 50+); every two years (under age 50)

Other preventive or diagnostic screenings (colonoscopies, bone density, etc.) are eligible for sharing but subject to AUA. See full Sharing Guidelines for complete details.

Critical Distinction: If new conditions based on symptoms are discussed during your preventive wellness visit, or if additional diagnostics/labs are ordered to determine treatment, those services become diagnostic and are subject to AUA.

Wellness vs. Diagnostic: The Same Visit Can Be Billed Two Ways

This distinction significantly impacts your sharing eligibility:

Wellness (Preventive):

Routine exam, no symptoms
Applies toward your wellness visit ($500 sharing limitation)
Typically not subject to AUA
Example: Annual physical with no additional concerns

Diagnostic:

You mention a symptom requiring evaluation
Doctor discovers potential issue during routine visit
Subject to AUA and co-share
Example: Same annual physical, but you mention chest pain

Key Insight: The same test can be preventive or diagnostic depending on why it's ordered. A mammogram as part of annual screening is preventive. A mammogram ordered because of a lump is diagnostic.

Office Visits: How Sharing Works in 5 Steps

1. Show Your Member ID Present your Liberty HealthShare Member ID card at registration

2. Provider Bills Provider may send your bills electronically to Liberty HealthShare (or you upload itemized bill through ShareBox within 180 days)

3. Repricing Liberty HealthShare’s cost containment vendor reprices bill to Fair and Reasonable amount

4. You Pay AUA/Co-Share You pay any AUA amount not yet met and applicable co-share percentage

5. Eligible Remainder may be facilitated for Sharing After AUA and co-share, Liberty HealthShare facilitates sharing from other members of remaining eligible expenses based on your program

Cost Example: $500 fair and reasonable cost for Office Visit (Single Member)

Actual costs vary by location and provider.

If AUA Not Met:

Member pays: Full $500 (applied toward AUA)

If AUA Met:

Liberty Essential (20% co-share): Member pays $100, $400 is eligible for sharing from Liberty HealthShare members
Liberty Connect (10% co-share): Member pays $50, $450 is eligible for sharing from Liberty HealthShare members
Liberty Unite (no co-share): Member pays $0, $500 is eligible for sharing from Liberty HealthShare members

Choosing a PCP and What to Say at Check-In

Provider Freedom with PHCS Network Advantage

You can see any provider you choose. However, using participating PHCS network providers reduces the likelihood of balance bills—charges beyond Fair and Reasonable pricing—which are not eligible for sharing. Though Liberty HealthShare provides access to a Patient Advocacy Center to assist members with balance bills

What to Tell Your Provider (Mini Script)

"I'm part of Liberty HealthShare, a healthcare sharing ministry. Here's my Member ID card—you can send the bills electronically to Liberty HealthShare. Liberty HealthShare facilitates sharing from other members for eligible medical expenses."

Key points:

Mention healthcare sharing upfront
Provide Member ID card
Request electronic bill submission
Discuss provider participation in PHCS Network

Use Claritev HST Connect to research providers for quality and pricing before your appointment.

If You Have a Pre-Existing Condition

Definition: A chronic or recurrent medical condition that exists at or prior to the enrollment date or can be reasonably expected to require medical intervention in the future.

Sharing Timeline:

Year 1: Not eligible for sharing
Years 2-3: Eligible for sharing up to $50,000 total for the pre-existing condition
After 37th month: No pre-existing condition sharing limitations

Continuous membership is required for the sharing limitation to expire. Sharing limitations only apply to the pre-existing condition itself—other conditions that develop during membership are not affected.

Medication Savings: Use GetMoreRx for 50%-95% savings on generic drugs at 56,000+ pharmacies, regardless of pre-existing condition sharing limitations

Learn more: Pre-Existing Conditions Support

Telehealth: DialCare Access

DialCare Urgent Care: 24/7 telemedicine for non-emergency illnesses

No Extra Cost: Liberty Unite, Liberty Connect, Liberty Essential (5 visits per member per year)
$55/visit: Liberty Assist, Liberty Rise
Not available: Liberty Freedom

DialCare Therapy: Mental wellness counseling (30-minute sessions)

No Extra Cost: Liberty Unite, Liberty Connect, Liberty Essential (12 visits per member per year)
$85/visit: Liberty Assist, Liberty Rise
Not available: Liberty Freedom

Not available in Vermont. Best for minor illnesses and follow-ups; use in-person care for exams and diagnostics.

Primary Care Cost Planning: What to Budget

If you use primary care services frequently, plan for:

Your Annual Unshared Amount (AUA): Amount you pay before expenses become eligible for sharing. Varies by program.

Co-Share (if applicable):

Liberty Essential: 20% of eligible expenses after AUA
Liberty Connect: 10% of eligible expenses after AUA
Liberty Unite, Liberty Rise, Liberty Assist, Liberty Freedom: 0%

Reduce costs by:

Using PHCS network providers to avoid balance bills
Using DialCare for minor illnesses (no extra cost or $55) instead of office visits
Maximizing your $500 wellness visit

Want more control? Explore how cost sharing empowers you.

Common Pitfalls to Avoid

"I mentioned a symptom at my physical → it became diagnostic" Keep wellness visits truly preventive. Schedule separate appointments for specific concerns to preserve your wellness sharing eligibility.

"Provider billed above Fair and Reasonable → balance bill risk" Use participating PHCS network providers when possible. Ask providers upfront if they participate in the PHCS network before scheduling your appointment. Contact Liberty HealthShare immediately if you receive a balance bill. Liberty HealthShare will guide you with access to a Patient Advocacy Center to assist members with balance bills

"Submitted after 180 days → may not be eligible" Bills must be submitted within 180 days of service. Don't delay submission—use ShareBox or have providers submit electronically immediately.

"I didn't meet my AUA, so nothing was shared" Track your AUA progress through ShareBox. All eligible expenses during the year count toward meeting your AUA threshold.

Smart Planning: Your Primary Care Checklist

Before You Enroll:

Join before you need care (account for two-month initial waiting period)
Document any conditions with treatment/symptoms in past 36 months
Research participating PHCS network providers in your area

After You Enroll:

Schedule your annual wellness visit after two months (consider your $500 sharing eligibility)
Get preventive screenings (mammogram, pap smear, flu vaccine) that are not subject to an AUA
Use DialCare for minor illnesses to conserve AUA
Track AUA progress through ShareBox

For Ongoing Care:

Schedule true preventive visits separately from symptom-based visits
Call Liberty HealthShare (855-585-4237) before appointments if unsure about sharing eligibility
Submit bills within 180 days
Use participating PHCS network providers to avoid balance bills

With Pre-Existing Conditions:

Budget for year one out-of-pocket costs
Use GetMoreRx for maintenance medications
Plan toward the 37-month milestone when pre-existing condition sharing limitations expire

Well-Baby Care: No Waiting Period

Well-baby visits (including immunizations) are eligible for sharing through 13 months after birth with no waiting period and not subject to AUA.

Newborns: Sharing begins immediately if added to existing membership within 60 days of birth.

Get Help + Key Reminders

Member Services: 855-585-4237

Verify sharing eligibility before appointments
Clarify wellness vs. diagnostic visits
Get help with provider billing issues

ShareBox Portal: Track AUA progress, submit bills, view sharing history

Don't Forget:

You're ultimately responsible for bills
Submit all bills within 180 days
Use participating PHCS network providers to reduce balance bill risk
Call before appointments if unsure about sharing eligibility

Liberty HealthShare's approach to primary care balances routine wellness support with the reality that healthcare sharing works best with significant medical needs. The comprehensive wellness sharing, preventive screening sharing, and telehealth access provide meaningful support for ongoing health maintenance within a sharing community framework.

What Changed Recently:

July 2025: Wellness visit expense sharing eligibility amount increased 25%
2025: Enhanced telehealth access and prescription discount programs

Critical Disclaimer: Liberty HealthShare is not an insurance company nor is it offered through an insurance company. Liberty HealthShare's Sharing Programs do not guarantee or promise that a member's medical bills will be paid or assigned to others for payment. Whether anyone chooses to pay a member's medical bills will be totally voluntary. As such, Liberty HealthShare's Sharing Programs should never be considered as a substitute for an insurance policy. Whether a member receives any payments for medical expenses and whether or not Liberty HealthShare continues to operate, the member is always liable for any unpaid bills.

For more information about Liberty HealthShare programs and primary care sharing, visit www.libertyhealthshare.org or call 855-585-4237.