Quick fit check
Is this combination a good fit?
AFP Direct is membership-based primary care: everyday and ongoing care with a local clinician — including chronic conditions — without running ordinary visits through a claim.
Sedera is a medical cost-sharing community for large, unexpected eligible medical needs under published guidelines. It is not health insurance. Sharing is voluntary and not guaranteed.
This short check is about expectations, not to turn people away for having a condition. Ongoing care belongs with the doctor. Sedera’s limits show up on certain large needs and on ongoing prescriptions.
Ongoing care & prescriptions
Do you (or anyone you’re enrolling) currently:
- Manage an ongoing condition (for example diabetes, high blood pressure, thyroid, cholesterol, asthma, or similar), and/or
- Take ongoing prescription medication for any condition?
That does not disqualify you. AFP Direct is built for ongoing care and the doctor relationship. Sedera generally does not share maintenance medications (ongoing prescriptions). Large needs tied to a condition that had symptoms, treatment, or medication in the last 36 months follow a sharing schedule — next screens spell that out.
Large needs in the last 36 months
In the last 36 months, have you (or anyone you’re enrolling) had a major event related to a condition — for example hospitalization, surgery, or specialist procedures beyond routine management?
A “yes” or “not sure” is a signal to read the next screen carefully (and talk with us if the history is complex). It is not an automatic “no.”
How the two pieces work together
| Type of care | Who handles it | What to know |
|---|---|---|
| Everyday & ongoing management | AFP Direct | Built for this — conditions and relationship care |
| Ongoing / maintenance prescriptions | You + AFP guidance | Generally not shareable through Sedera |
| Large, unexpected medical needs | Sedera | Eligible needs under guidelines; existing-condition schedule may apply |
Under Sedera’s guidelines, a condition is treated as an existing medical condition if you had symptoms, treatment, or medication in the 36 months before your membership start date. Large needs tied to that condition follow the schedule below. A new condition or injury after you start is not on this schedule and may be eligible under the normal guidelines (still subject to IUA and the Membership Guidelines).
Sharing schedule for large needs tied to an existing medical condition:
| Time after start date | Shareable amount (tied to existing condition) |
|---|---|
| First 12 months | Not shareable |
| Months 13–24 | Up to $25,000 |
| Months 25–36 | Up to $50,000 |
| Month 37+ | Fully shareable under the guidelines |
Does this split make sense for your situation?
Maintenance medications
Maintenance medications are prescriptions you take on an ongoing basis to manage a known condition — for example blood pressure, diabetes, thyroid, cholesterol, or asthma. That is different from a short course of medication tied to a one-time event.
Those ongoing prescriptions are generally not eligible for sharing through Sedera — whether the drug is inexpensive or very costly. Sedera is built for large, episodic medical needs, not monthly pharmacy.
AFP Direct remains the home for ongoing care and can help you navigate transparent pricing and access. If medication cost would make or break this decision, talk with us before you enroll.
Cash-pay for large needs
For large services, members typically work as cash-pay (self-pay) patients with the physician or facility, then submit eligible needs under Sedera’s guidelines after the Initial Unshareable Amount.
That often means more participation than handing a card to a billing desk — requesting self-pay pricing, engaging early, and following the process. Are you comfortable with that approach?
This looks like a solid match
AFP Direct for ongoing care and the doctor relationship. Sedera for large eligible needs under published rules — with eyes open on existing conditions, medications, and the cash-pay process.
Thanks for being straightforward
A short conversation will make sure expectations match your situation — conditions, medications, or how large needs work — before you enroll.
Contact Richard →Appreciate the honesty
This path isn’t for everyone. If the Sedera side — limits on some large needs, medications, or the cash-pay process — doesn’t fit, it’s better to know now.
A parallel system
Leave the system that was never built for you.
Direct Primary Care is membership-based medicine: a flat monthly fee to a practice, everyday care included — visits, messaging, the ongoing relationship — without running ordinary medicine through a claim. AFP Direct is that model at Amarillo Family Physicians: unlimited visits, same- or next-day access, after-hours urgent care, a doctor who knows you. Beside it, Sedera is a medical cost-sharing community for large, unexpected eligible needs under published guidelines.
Two tools. One honest split. You see the number before you commit.
Local relationship care. Community medical cost sharing for large eligible needs. Eyes open.
Two tools. One clear split.
You don’t need a policy for groceries. Everyday care shouldn’t work that way either. Keep a doctor for the ordinary stuff, and a different tool for the large and unexpected — we separated the two on purpose.
Everyday care, handled
AFP Direct Membership: unlimited office visits, same- or next-day access, unlimited after-hours urgent care, 24/7 messaging, annual wellness, basic labs, and minor procedures. Most routine care at no extra charge.
Large needs, shared
Sedera is a medical cost-sharing community — members voluntarily share eligible large medical needs under published guidelines. You choose your Initial Unshareable Amount. You choose your providers.
You keep the relationship
Neither piece is health insurance. Day-to-day care stays local with your doctors. Large eligible needs follow Sedera’s Membership Guidelines — published rules, voluntary sharing.
If we designed a sensible healthcare arrangement from scratch, it would not look like what most families and employers have today.
It would start with a real relationship with a doctor — not a directory of strangers and a stack of forms. Care would be priced like other goods and services: in cash, with honest prices up front. And there would be a clear way to handle large, unexpected medical events — without running ordinary care through a claims bureaucracy.
That is the parallel system.
Amarillo Family Physicians and I built AFP Direct as the first iteration of that model: relationship-based primary care, transparent pricing, the patient at the center. Alongside it, medical cost sharing helps with the large, unexpected medical events — under published rules, not as a blank check.
We are not trying to tear down the insurance-based system. We are building something efficient, affordable, and easy to understand for people who want a better way.
This is your invitation to better.
— Richard Walton
Amarillo Family Physicians
Meet your team
Direct membership means a real care relationship — not a rotating network directory. After you enroll, the practice matches you with a clinician and welcomes you in. Preferences can be noted on your welcome call.
Dr. Montana J. O’Dell
Physician · Family Medicine
Board-certified in Family Medicine. Amarillo native; trained at Texas Tech (medical school in El Paso, residency in Amarillo). Glad to stay home and serve the Panhandle. Enjoys weightlifting, traveling, hiking, and time with family. Board member of Camp Alphie for children with cancer and survivors.
Dr. Lance S. Martin
Physician · Family Medicine
Board-certified in Family Medicine. West Texas native (Sudan, TX); Texas Tech undergrad, medical school, and residency. Practiced family medicine in Seminole for five years before joining AFP in 2019. He and his wife, Alena, have three sons. Avid golfer when the weather cooperates.
Dr. Armando Salcido Jr.
Physician · Family Medicine
Board-certified in Family Medicine. Raised in Amarillo (Randall High School); West Texas A&M undergrad; Texas Tech medical school and Amarillo residency. Hospitalist in Borger before joining AFP in 2016. Enjoys church, travel, music, biking, running, and the outdoors with his wife, Courtney, and their family.
Allison Bromwell, FNP-C
Family Nurse Practitioner
AANP board-certified Family Nurse Practitioner. West Texas A&M (BSN and FNP). Joined AFP in 2018 after rural health clinic practice; background in med-surg, bariatric and trauma nursing, home health, and palliative care. Enjoys time with her husband, Cory, and their two children, sports, and gardening.
Bios and photos adapted from Amarillo Family Physicians’ published team information.
Know the number before you commit
Household, age of the oldest member, and your Initial Unshareable Amount. The total updates as you choose.
Prices may vary depending on membership elections. Please see Sedera’s Membership Guidelines for full sharing rules. Sedera membership may not be available in all states.
See your monthly cost
No application required to see the number. Adjust until it fits.
Estimate for pricing. At enrollment, the rate is locked to the oldest actual date of birth on the membership.
What you pay first on a large need before the community shares.
One price for AFP Direct membership and Sedera membership share, arranged together. Tobacco surcharge (if any) is added at enrollment.
— —What happens after you enroll
Two onboardings. One clear start date. We stay with you through the handoff.
You enroll
Complete the form and payment. You’ll get a confirmation with your start date and what comes next.
Welcome call
We schedule a short call to walk through next steps, answer questions, and make sure nothing feels unclear.
Meet your clinic
Amarillo Family Physicians activates your Direct membership. Watch for their welcome, then book or request your first visit.
Finish Sedera setup
Sedera emails you to complete the Membership Agreements and existing medical condition disclosure in their portal. Medical needs can’t be submitted until that’s done.
You’re live
On your start date — always the 1st of a month — you have a local doctor for everyday care and a clear path for large, unexpected needs.
The honest objections
Skepticism is welcome. These are the strongest criticisms of the model — and the straight answers.
“This isn’t insurance. Sharing isn’t guaranteed.”
Correct. Sedera is a medical cost-sharing community, not health insurance. Members voluntarily share eligible medical needs under published Membership Guidelines. There is no contractual right to payment, and neither you nor Sedera can compel other members to share. If you need a legal guarantee of payment, this is not the tool.
“What about pre-existing conditions?”
Day-to-day management — diabetes, blood pressure, thyroid, and the like — belongs to AFP Direct: unlimited visits, an ongoing relationship. That side is not limited by Sedera’s existing-condition sharing schedule. On the Sedera side, a condition is treated as existing if you had symptoms or treatment in the 36 months before your start date. Large needs tied to that condition follow the schedule: not shareable in the first 12 months, then stepped limits, fully shareable after 36 months. New conditions and injuries are not on that clock. We put that distinction in the Quick Fit Check on purpose.
“Maintenance meds aren’t covered.”
Also correct. Ongoing prescriptions are generally not shareable through Sedera. Sedera is built for large episodic medical needs, not monthly medications. AFP Direct supports ongoing care and transparent access to meds. If you expected blood pressure or diabetes prescriptions to be shared by the community, this model will disappoint you — and we say so before you enroll.
“Cash-pay and bill negotiation sound like a hassle.”
For large bills, members are cash-pay patients; cooperation with negotiation is expected. That is how the community keeps monthly contributions sustainable. It is more work than handing a card to a billing desk and walking away. It is also how inflated bills often get reduced. If you want zero involvement after a bill arrives, a traditional health insurance policy is a different product — this is not that.
“Isn’t this only for healthy people?”
No. Chronic conditions are common among members and are a natural fit for Direct Primary Care. The model is a poor fit when someone needs immediate, large sharing for a recent or active major condition. That is why the screening exists. The target is not “perfect health.” It is people who want predictable primary care and a clear, limited approach to catastrophic risk.
“Don’t I need a network?”
A closed provider list is often a substitute for trust — and a set of rules you didn’t write. It can decide which doctors you’re “allowed” to see, what requires prior authorization, what gets denied, and on what payment terms. Ordinary care shouldn’t run through that machinery. When primary care is a direct relationship, you don’t need a permission slip for everyday medicine. For large needs under Sedera, you choose the physician or facility that makes sense and work the bill as a cash-pay patient under published Membership Guidelines. That is not the same thing as a doctor you trust.
“Why not just buy normal insurance?”
You can. Many people should. A traditional health insurance policy is often right when someone needs guaranteed issue, broad immediate protection for complex conditions, or simply prefers the familiar model. This path is for people who have looked at the tradeoffs — and chosen local relationship care plus community sharing for the large and unexpected, with eyes open.
FAQ
Questions people actually ask
No. AFP Direct is a Direct Primary Care membership. Sedera is a medical cost-sharing community — not health insurance. You remain responsible for your medical bills. Sharing of eligible medical needs is voluntary and follows published Membership Guidelines.
Unlimited office visits, same/next-day access, unlimited after-hours and urgent care visits, 24/7 messaging, annual wellness exam, basic labs, minor procedures, and ongoing primary care management. Most routine care is designed to land at $0 additional cost. Advanced labs, imaging, specialty care, and most medications sit outside the membership at transparent rates.
The Initial Unshareable Amount (IUA) is the amount you pay first on a large eligible medical need before any sharing. You choose $500, $1,000, $1,500, $2,500, or $5,000. Higher IUA generally means a lower monthly contribution. It applies per medical need under the Membership Guidelines.
For eligible medical needs, Sedera’s Membership Guidelines do not use a lifetime maximum. Eligible large expenses can be submitted under those guidelines without a lifetime cap.
That is not the same as “unlimited” or “guaranteed.” You still pay your Initial Unshareable Amount first. Needs tied to an existing medical condition follow the 12 / 24 / 36-month schedule. Other published limits still apply — including certain limits for tobacco use. Sharing is voluntary; it is not a contractual right to payment.
Always on the 1st of a month. If you enroll after the 20th, the earliest available start is the 1st of the month after next. You can choose among the next three available start dates.
You’ll receive a confirmation with your start date. We schedule a short welcome call to walk through next steps. Amarillo Family Physicians activates your Direct membership and will welcome you to the practice — that’s when you book or request your first visit. Separately, Sedera emails you to complete the Membership Agreements and existing medical condition disclosure in their Member Portal; medical needs cannot be submitted until those steps are finished. Membership always starts on the 1st of a month.
Contact Sedera early — as soon as you know a large medical need is likely, not after bills have stacked up. Starting the process early gives you access to guidance and resources while decisions are still being made. Waiting usually makes everything harder.
With the doctor or hospital, you are a cash-pay (self-pay) patient from start to finish. Ask for cash-pay or self-pay pricing. Avoid describing medical cost sharing at the registration or billing desk — it often confuses the process and can make the bill harder to work with.
When a medical need is eligible, sharing follows the Membership Guidelines after your Initial Unshareable Amount. Your Direct membership with Amarillo Family Physicians remains the home for everyday and ongoing care. Sedera does not direct your treatment decisions.
If you’re unsure what to say or when to call, reach out before the appointment. That’s what the welcome call and ongoing support are for.
Yes. Many employers use defined contribution (including ICHRA) or list-bill arrangements so the company contributes a fixed amount and employees choose the path that fits. Switch to the Employers tab for the strategic view, or contact us to model a specific group.
Households with one or more tobacco/vape users pay a $75 monthly surcharge (once per household, not per person). Sedera uses a 12-month look-back for tobacco status. For members age 50+, until cessation is documented, sharing is limited to $25,000 per need for cancer, respiratory disease, vascular disease (including coronary disease and stroke), oral and esophageal disease, and gastric and duodenal ulcers. Failure to report tobacco use can result in membership termination.
Ready when you are
See the number. Run the fit check. Or start a conversation. No pressure either way.
Medical cost sharing is not health insurance. Sedera is not an insurance company. Membership is voluntary. Members remain responsible for payment of medical bills. Amarillo Family Physicians Direct Membership is a Direct Primary Care membership, not insurance. Sharing of medical expenses is not guaranteed and is subject to the Membership Guidelines.
For employers
You can optimize everything and still take on risk you don’t want.
One high-cost claim can erase five years of favorable rates. The employers who see that clearly are refusing to play the game — and moving to true defined contribution.
Years 1–5
Everything done right
- ✓ Wellness incentive program
- ✓ Reference-based pricing
- ✓ Transparent PBM + audit rights
- ✓ On-site / near-site clinic
- ✓ Aggressively negotiated stop-loss
- Zero specific stop-loss claims
Year 6
One event rewrites the economics
- → Rare autoimmune diagnosis
- → $380K claims in one year
- → Spec hit on stop-loss
- → Laser at renewal
- → Favorable rates disappear
- No wellness program prevents a rare disease.
The risk was always latent. Optimization only delayed it. It never fixed the structural mismatch.
The strategic fork
1. Own the risk
Fully self-fund. Accept the fiduciary, administrative, and balance-sheet exposure of running an accidental insurance company.
2. Refuse the old game
Shift to true defined contribution via ICHRA. Pair Direct Primary Care for routine care with medical cost sharing or individual plans for large events. Predictable costs. Real choice. Portability.
How ICHRA works in practice
A streamlined, compliant architecture that removes the administrative burden from HR while empowering the employee.
Define the budget
Employer sets and funds a fixed monthly allowance by employee class. Cost is instantly predictable.
Admin & compliance
A specialized ICHRA administrator handles compliance and the tax treatment of every dollar.
Employee choice
Employees shop the individual market with their allowance — or put those dollars toward Direct Primary Care and medical cost sharing instead.
Strategic allocation
The right tool for the right risk
Predictable, known costs run a fraction of the price of large, unexpected ones. Separate the two, and each can be handled by the tool actually built for it.
Foundation — every employee
AFP Direct Membership
Handles everyday medical needs for nearly everyone at a low, fixed cost. Unlimited access to a doctor — including after-hours urgent care — transparent labs, and ongoing care without touching an insurance claim.
of total healthcare spend is all the bottom 50% of claimants generate — about $433 a year per MEPS. Insurance was never the right tool for this half of the risk pool.
Generally healthy employees
Medical cost sharing (Sedera)
Employees confident in their health can participate in Sedera medical cost sharing for large, unexpected eligible medical needs — under published guidelines, with voluntary sharing. DPC handles the day-to-day.
Ongoing health needs
Individual ACA plan via ICHRA
Employees managing ongoing conditions self-select an ACA plan that fits, reimbursed tax-free through the ICHRA — guaranteed issue regardless of health history.
The bottom line
No matter which path an employee takes, the employer's cost stays defined, capped, and predictable.
A first-principles bet
Insurance was never going to innovate healthcare.
An insurance plan is a financial instrument. It pools risk and pays claims after the fact — it was never built to reinvent how care is delivered, priced, or accessed.
Real innovation in healthcare has always happened outside the insurance chassis, never inside it.
That's why Direct Primary Care lives outside the claims system. A better doctor relationship and transparent pricing couldn't be built by the entity whose model depends on adjudicating claims.
Ready to exit the renewal treadmill?
Model current spend against a defined contribution. Place AFP Direct and Sedera where they belong. Build a strategy that scales from small groups to large.
Richard Walton, CEBS · (806) 679-0816 · rwalton@sedera.com
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