MightyWELL Health Concierge Membership Bundle
Primary & Routine Care
Primary Care: $20 copay
Specialist: $50 copay
Urgent Care: $50 copay
Telemedicine: $0
Chiropractic: $35 copay
Diagnostic X-Ray: $50
Advanced Imaging: $200 in-network / $300 out-of-network
Lab Services: $0 through Affordable Labs & Imaging
Imaging through AL&I: $150 per image/body part
Preventive Care
100% covered up to $2,500 per member per year.
Includes annual wellness exams, preventive checkups, screenings, routine labs, vaccines, women's preventive care, pediatric preventive care, and preventive medications.
Prescription Benefits
ACA preventive medications: $0
Tier 1 generics (Top 200): $0
Other Tier 1 generics: $15
Tier 2 preferred brands: $40
Tier 3 non-preferred brands: $65
Access to 65,000+ retail pharmacies nationwide.
Major Medical Event Support through ShareWELL
Choose a $1,500, $2,500, or $5,000 Unshared Amount before eligible sharing begins.
Once the UA is met, eligible expenses can be shared according to the member guidelines, with no annual or lifetime limit on eligible expenses.
Household safeguard: maximum responsibility of two UAs during a rolling 12-month period for eligible sharing requests.
Provider Access & Virtual Care
Provider Access: PHCS MultiPlan Practitioner & Ancillary Network and Prime Health Network, with the ability to use out-of-network providers as well.
24/7 Virtual Urgent Care through Lyric with licensed physicians.
Important Information
Your Responsibility Amount is different from a deductible. It is the amount you are responsible for when you have an eligible major medical event before the program begins sharing eligible expenses.
You can choose between a $2,500 or $5,000 Responsibility Amount.
$2,500 Responsibility Amount
Ages 18–45
-
Individual — $360/month
-
Individual + Spouse — $560/month
-
Individual + Child(ren) — $589/month
-
Family — $800/month
Age 46+
-
Individual — $445/month
-
Individual + Spouse — $695/month
-
Individual + Child(ren) — $732/month
-
Family — $992/month
$5,000 Responsibility Amount
Ages 18–45
-
Individual — $315/month
-
Individual + Spouse — $503/month
-
Individual + Child(ren) — $532/month
-
Family — $737/month
Age 46+
-
Individual — $389/month
-
Individual + Spouse — $622/month
-
Individual + Child(ren) — $659/month
-
Family — $913/month
What's the Difference?
The $2,500 option costs more each month, but gives you a lower Responsibility Amount if a major medical event happens.
The $5,000 option costs less each month, but you take on a higher Responsibility Amount if a major medical event happens.
Simple way to look at it:
Pay more each month → Lower Responsibility Amount
Pay less each month → Higher Responsibility Amount
There is no traditional deductible, so you do not have to spend thousands of dollars first just to begin using eligible everyday plan benefits.
Pricing is based on your age at enrollment.
MightyWellHealth FAQs
What is MightyWellHealth?
MightyWellHealth combines everyday healthcare benefits with a health-share program for larger medical expenses. It’s designed as an alternative to traditional major-medical insurance, with predictable copays and lower monthly costs.
Is this traditional health insurance?
No. The major-medical portion is a health-sharing program, not ACA-compliant health insurance. Members also receive separate everyday healthcare benefits depending on the plan.
What networks can I use?
Members have access to the MultiPlan PHCS Practitioner & Ancillary PPO and First Health PPO networks.
Can I go out of network?
Yes. Out-of-network eligible expenses may use Reference-Based Pricing, generally around 150% of the Medicare allowed amount, subject to program rules.
Do I need referrals to see specialists?
No referrals are typically required. Because the program uses PPO-style networks, members usually have more flexibility than with an HMO. Always verify provider participation and benefit eligibility before care.
What are typical copays?
On the Copay Bundle (where eligible and subject to plan limits):
- Primary care: about $20 per visit
- Specialists: about $50 per visit
- Urgent care: about $50 per visit
- Telemedicine: often $0
- Chiropractic: about $35 per visit
How are labs, X-rays, and imaging handled?
Where eligible and subject to plan rules:
- Routine lab work can be very low cost under the Copay Bundle
- X-rays are often around $50
- Advanced imaging (MRI, CT, ultrasound) can be around $200, depending on the benefit and limits
Are prescriptions included?
Yes. Eligible prescriptions generally follow a tiered copay structure (for example, common generics at lower copays and higher tiers for brand-name medications), subject to plan rules.
Is mental-health care included?
Eligible virtual mental-health visits can be as low as $0, while in-person mental-health specialists may have a copay similar to other specialist visits, subject to plan limits.
What happens if I have a major medical event?
Major eligible medical expenses are handled through the health-sharing portion. You first meet your selected Responsibility Amount (for example, $1,500, $2,500, or $5,000). After that, eligible expenses for that incident may be submitted for sharing according to the program guidelines.
Do I pay the Responsibility Amount every year?
The Responsibility Amount is generally tied to an eligible medical incident, not a traditional annual deductible. Follow-up care for the same approved incident may continue under the same sharing request, subject to guidelines.
Are pre-existing conditions covered?
The health-sharing portion has specific pre-existing-condition rules and lookback periods. Everyday copay benefits may still apply even when a condition is not immediately eligible for sharing.
Is maternity included?
Maternity benefits may be available for eligible members, generally using one Responsibility Amount for the maternity event, with additional maternity-related benefits depending on the plan.
Does it cover emergency-room visits?
The everyday-benefit portion may provide a limited ER benefit per year, while larger eligible ER expenses may fall under the health-sharing portion, subject to guidelines.
Can I cancel at any time?
Membership is generally month-to-month, so you’re not locked into a long-term annual contract.
When does coverage start?
Effective dates are typically set for a future date (such as the first of the next month), depending on when enrollment is completed and program rules.
Can families enroll?
Yes. Individual, member-plus-one, and family options are available.
Is there an HSA option?
Yes. MightyWellHealth offers an HSA Bundle in addition to the Copay Bundle, focusing more on preventive services, telemedicine, and HSA-friendly benefits.
How do I know if my doctor participates?
You can search the MultiPlan PHCS Practitioner & Ancillary PPO or First Health PPO directories and confirm participation directly with your provider before receiving care.
Who helps me after I enroll?
Your agent can help you understand how to use the plan, find participating providers, and connect you with the right member resources when you need support.