Learn more about the benefits for members, providers, and the system as a whole and how it works.
All providers are in-network. Coverage follows you across jobs. Vouchers paired with absolute price transparency keep payments simple and enable you to shop for the most cost-effective care. By choosing high-value providers, you can even earn money back into an HSA. Income-based subsidies guarantee affordability for all, while incentives for preventative care promote your long-term health.
Medisense is a proposal for an opt-in public insurance plan that prioritizes competition, protection, affordability, and simplicity. This program is opt-in and layers on top of our existing system, but Medisense is empowered to address the root causes of high healthcare costs and lack of transparency.
In short, likely yes. Medisense ensures affordability through three prongs. First, Medisense promotes competition among providers by empowering members to shop for the most cost-effective care. Second, Medisense avoids costly negotiations over reimbursement rates and procedure approval. Moreover, Medisense does not exist to make a profit. Third, Medisense sets income-based premiums, so that coverage is affordable for all, and people keep their coverage over the course of their life. These three prongs work together to bring down healthcare costs and thus premiums.
Yes! In fact, Medisense completely eliminates restrictive networks and out-of-network designations. You are free to visit any healthcare provider in the state, giving you significantly more freedom than almost any private plan today.
To ensure a smooth and stable transition, Medisense Phase 1 uses existing Medicare coverage guidelines as its foundation. This means the plan covers all standard medical, dental, vision, mental health, and prescription services that are deemed medically necessary under those guidelines. While Phase 1 leans on these central rules, Phase 2 of the Medisense proposal focuses on fully redesigning coverage policies to give even more clinical autonomy back to the doctor-patient relationship.
Instead of deductibles and coinsurance, Medisense uses a voucher system. Depending on the premium tier you choose, your voucher is worth a specific percentile (e.g., the 50th percentile) of the reported prices for a given procedure across the state. When you seek care, Medisense subtracts your voucher value from the provider's bill. If the provider's price is *greater* than your voucher, you pay the difference. If the provider's price is *less* than your voucher, you receive a portion of those savings directly into a Health Savings Account (HSA). Vouchers for routine preventative care are always active, while specialized care vouchers may require a PCP referral to unlock. You must also leave a quick review of the provider to finalize the voucher payment. This simple voucher-based system empowers you to shop for the most cost-effective care, while still ensuring that you are protected.
All Medisense plans offer the exact same medical benefits and access to care. The only difference is the *voucher tier* you select. You can choose to pay a lower monthly premium in exchange for a lower voucher percentile (e.g., the 40th percentile of market prices), which means you might have to shop around more for cost-effective care. Conversely, you can pay a higher premium for a higher voucher percentile (e.g., the 60th percentile), giving you the luxury of seeing higher-priced providers without incurring out-of-pocket costs.
The value of your voucher is tied to a specific percentile in the distribution of prices for that service. At the beginning of every year, providers report their prices and Medisense calculates voucher values for your area (e.g. $100 = 50th percentile price for routine bloodwork). Members select the tier of their vouchers when enrolling, with lower tiers meaning vouchers tied to lower percentiles. These cost savings are passed on as lower premiums for members. However, everyone receives the same coverage.
Medisense guarantees universal access through a simple sliding scale of income-based premium subsidies. For example, a state might offer a 100% premium subsidy for individuals earning below 150% of the Federal Poverty Level (FPL), and a 75% subsidy for those between 150-250% FPL. Subsidized members retain the exact same ability to shop around and earn HSA savings, empowering them to find the care that best fits their needs rather than being relegated to inferior, underfunded safety-net plans.
Medisense requires employers to equivalently subsidize Medisense premiums alongside their traditional plans. This can be achieved through a direct legal mandate (if a federal ERISA waiver is granted) or by making state corporate tax incentives conditional on offering Medisense. This means you can keep your exact same coverage across jobs, or easily retain it if you decide to launch a startup. It slashes administrative overhead for small businesses and entirely eliminates "job lock."
Because Medisense coverage can follow you across all stages of life, the system has a massive financial incentive to keep you healthy over the long term. Medisense actively rewards preventative care by offering *higher* voucher values for routine PCP visits, health screenings, and vaccinations—making it easier for you to earn HSA savings. Your HSA funds can then be flexibly spent on wellness programs, gym memberships, or wearables like an Apple Watch.
Suppose your primary care doctor refers you to get an MRI (a specific CPT code). You open the Medisense app and search for the procedure. The app shows that your specific voucher tier provides $600 for this MRI.
The app displays three options: a hospital charging $1,000, a standard clinic charging $600, and an independent imaging center charging $450. The interface highlights that if you choose the $450 center, you will pay $0 out-of-pocket AND earn a portion of the $150 savings directly into your HSA. You choose the $450 center, show up, present your digital voucher, receive your scan, and go home. Medisense pays the provider their reported price directly. There are no surprise bills, no deductibles to calculate, and you get rewarded for making a cost-effective choice.
Providers have the autonomy to freely set their own prices, which must be reported annually. Because all networks are eliminated, providers no longer have to negotiate fragmented rates with multiple private insurers. Medisense automatically pays providers their reported price based on the patient's voucher, drastically reducing administrative overhead and unpaid bills.
Medisense legally mandates that all providers disclose binding prices for each CPT procedure and service at the beginning of the year. Medisense translates this raw data into a user-friendly app, allowing patients to instantly compare prices and quality metrics. For common complex events (like childbirth), the app bundles these CPT prices together so patients understand the total expected cost. To protect patients in markets where competition cannot restrict prices (e.g., monopoly hospital towns or emergent care like ER visits), Medisense enforces price ceilings based on adjusted Medicare or median regional rates.
Yes. Medisense formally eliminates out-of-network designations for its members. Providers must adhere to the prices they reported and accept patients with Medisense. However, they gain the autonomy to set prices that fit their practice's needs, freeing them from the rigid reimbursement mandates found in other proposals.
Medisense significantly reduces administrative complexities. Besides the annual effort of disclosing prices, providers no longer have to individually negotiate rates with fragmented private insurers. Furthermore, network checking is eliminated. Providers are paid directly by Medisense based on the voucher, and Medisense handles collecting any out-of-pocket differences from the patient—eliminating the provider's burden of chasing down unpaid medical debt.
In Phase 1, Medisense relies on standard, existing Medicare coverage guidelines to determine what is medically necessary, ensuring a stable transition. Vouchers are unlocked based on these guidelines (often requiring a PCP referral for specialist care). Phase 2 of the Medisense proposal focuses specifically on reforming these centralized coverage policies to eliminate administrative denials entirely and return total clinical autonomy to the provider.
Medisense eliminates the need for providers to collect on unpaid bills by directly and automatically paying providers for full cost of care received. Individual patient responsibility for the cost of the care will be collected directly by Medisense.
Small and independent clinics benefit immensely. They enjoy drastically lower overhead costs and highly predictable compensation. Furthermore, because Medisense offers higher preventative voucher values, independent primary care practices become much more financially viable. On the other hand, low-quality providers will be forced to compete fairly on price and quality.
No, Medisense is a public option. Providers can still choose to accept and work with private insurers. However, employers will offer Medisense alongside private plans, and its transparency and simplicity are designed to make it highly attractive to the market.
Medisense addresses the root causes of affordability in healthcare by promoting competition and reducing administrative burdens. At the same time, Medisense ensures financial security to patients through income-based premiums, vouchers, and continuity of coverage across jobs. Medisense levels the playing field for small employers and independent providers and promotes long-term health. Finally, Medisense fits into state budgets and focuses on light-handed regulation to ensure feasibility.
By mandating binding, openly published prices and eliminating networks, Medisense creates a true free market. It strips away the psychological anxiety of surprise bills and slashes administrative waste. Most importantly, it allows providers to compete organically on price and quality. This rewards providers who are able to provide high-quality care at a low cost, and allows providers to set prices that best fit the needs of their patients. Competition relies on members having the tools and incentive to shop for care, which is a core part of the Medisense proposal. Moreover, in markets with insufficient competition, Medisense can have a greater role in regulating prices to ensure affordability.
First, it slashes the massive administrative bloat associated with network negotiations and billing complexities. Second, the voucher system gives patients a direct financial incentive (HSA cash-back) to shop around, forcing providers to lower prices to attract volume. Third, because Medisense members retain coverage for life, it is naturally incentivized to find and fund preventative care to improve long-term health and lower costs.
Substantial psychological burden is lifted -- hours spent on the phone with insurance companies are replaced with minutes spent on the Medisense app. Universal portability eliminates "job lock." Workers are free to leave their jobs, switch careers, or take risks to start new businesses without the fear of losing their family's health coverage. It levels the playing field for small businesses, who no longer have to negotiate complex insurance packages to attract talent. Independent clinics can better compete on price and quality without joining massive hospital groups. This improves the dynamism of the economy.Furthermore, continuous coverage reduces uncontrolled illness, which helps dramatically lower associated societal rates of homelessness and crime.
Unlike other proposals, Medisense Phase 1 is designed specifically for political feasibility. It does this by being cost-effective and generating a lot of winners. It limits new government spending by strategically re-routing existing Medicaid/CHIP funds and billions in fragmented local community health grants directly into the premium subsidy pool. Medisense exists with private insurance, so people are not forced into changing coverage. It generates powerful wins for members, ordinary providers, and small businesses, building a coalition strong enough to offset resistance from powerful hospital systems and insurance companies. Medisense achieves its goal of major reform while leaving as light a regulatory footprint as possible.
In order to make sure Medisense enables the virtuous cycle of affordability, it needs a strong start. All state agencies, public institutions, and public schools will offer Medisense as their exclusive insurance option. From there, it integrates into the broader market by requiring or heavily incentivizing private employers to equivalently subsidize it alongside their standard plans. Safety-net institutions like community hospitals and free clinics remain fully operational, but instead of relying on unpredictable taxpayer grants, they are funded reliably by Medisense patients bringing vouchers. Medisense will also need a one-time infusion of funding to conduct a massive public education campaign and to subsidize premiums for the first few years.