And Why We're Building an Escape Route

The emails are starting to hit inboxes now. Open enrollment. 2026 health insurance rates. If you haven't seen yours yet, brace yourself. The average family premium is projected to hit $25,572 in 2026. That's not a typo. Twenty-five thousand dollars. For a family of four. Before you've seen a single doctor.

Your deductible? Probably another $5,000-$8,000 before insurance actually covers anything meaningful. So you're paying $30,000+ for the privilege of... still paying for most of your healthcare out of pocket.

The Math That Doesn't Math

Let's break this down:

You're paying roughly $2,130 per month in premiums. Every month. Whether you're healthy or sick. Whether you use it or not. Then when you actually need care, you're paying full price until you hit your deductible. So that doctor visit? $150-$300. Those labs your doctor ordered? $800. That specialist referral? $400. All out of pocket.

You do this math and realize: I'm paying $25,000 a year for insurance that doesn't actually insure me against the costs I'm worried about. The routine stuff? You're paying for it anyway. The catastrophic stuff? Sure, insurance helps. If you can navigate the pre-authorizations, the in-network requirements, the claim denials, the appeals process.

Where the Money Actually Goes

Here's what most people don't realize: only about 80 cents of every dollar you pay in premiums goes to actual healthcare.

The rest? Administrative costs. Shareholder returns. Advertising. CEO compensation. The massive infrastructure required to decide which claims to deny. You're not paying for healthcare. You're paying for a system that's optimized for profit extraction, not health outcomes.

The 2026 Reality

Next year is going to be rough.

Regulatory headwinds are making everything more complicated. Insurance companies are exiting markets they don't find profitable enough. The ones staying are raising premiums to cover "increased utilization" and "rising pharmaceutical costs."

Translation: they're pricing risk, not care.

Meanwhile, hospitals are consolidating. Physician practices are being bought by private equity. Drug prices are negotiated in backrooms between pharmacy benefit managers and manufacturers, with you—the patient—having zero visibility or leverage.

The system isn't broken. It's working exactly as designed. Just not for you.

The Unbundling That's Already Happening

Here's what's interesting: people are starting to opt out.

Not by choice, exactly. By necessity.

They're paying the $25,000 premium because they're scared not to. But when they actually need care, they're:

• Ordering their own labs online because it's cheaper than going through insurance

• Using telehealth apps for quick questions instead of making appointments

• Paying cash at direct primary care practices

• Buying medications from Canadian pharmacies

• Joining health sharing ministries

• Just... avoiding care until something's really wrong

Healthcare is unbundling whether the insurance companies like it or not.

What Unbundling Actually Means

Here's the model that makes sense:

Pay for what you actually use. Get transparent pricing. Have direct access to care without layers of bureaucracy. Own your health data. Make decisions based on your situation, not what some algorithm decides to pre-authorize.

Revolutionary? No. It's literally how every other service in your life works. You don't pay $2,000/month for "grocery insurance" that might cover your food after you've spent $5,000 out of pocket. You just... buy groceries.

You don't pay "car insurance" that covers oil changes and tire rotations. You pay for catastrophic coverage and handle routine maintenance yourself.

Healthcare could work the same way.

The Direct Model

Imagine this instead:

$49/month gets you unlimited access to a primary care doctor. Not a 15-minute appointment three weeks from now. Actual access. Text your doctor. Get responses. Have real conversations about what's going on.

Need labs? $50-$200, depending on what you're testing. Transparent pricing. Results explained in language you understand. No surprise bills three months later.

Need a specialist? Your doctor coordinates it. Helps you find fair pricing. Actually prepares you for the conversation instead of just handing you a referral.

Need medications? GoodRx, Cost Plus Drugs, and other transparent pharmacy options are usually cheaper than going through insurance anyway.

For catastrophic stuff—the hospital stays, the surgeries, the真正 expensive things—you could get a high-deductible plan that costs $200-400/month instead of $2,130. Because you're only insuring against actual catastrophes, not routine care.

Do the math: $49 + $300 + occasional labs and medications. You're probably spending $6,000-$10,000 a year total. Not $30,000+ with worse access.

Why This Model Hasn't Taken Over

Partly because insurance is tied to employment. Your employer pays most of that $25,572 premium (you just see $400-800/month on your paycheck). So it feels "cheaper" than it is.

Partly because people are scared. What if something catastrophic happens and I don't have "good" insurance?

Partly because the system is designed to be opaque. You can't easily price-compare healthcare. You can't opt out without feeling like you're gambling with your family's safety.

But mostly? Because there haven't been great alternatives that bundle the direct access model with the technology to actually make it work.

What We're Building

This is why Openwell exists.

We're not trying to replace your insurance for catastrophic events. We're trying to replace the $25,000 you're spending on routine access to care that your insurance doesn't really cover anyway.

$49/month. Unlimited messaging with Dr. China, our primary care physician. Real conversations. Real access. No phone trees. No three-week waits. Need labs? We'll order them. Transparent pricing. Results uploaded to your account. AI companion helps you understand what they mean. Dr. China gives you context and recommendations.

Have questions about your health? Ask the AI companion anytime. 2 AM questions. Commute questions. "Is this normal?" questions. Get actual answers, not WebMD panic. Want to connect your Whoop, Apple Health, or other devices? Do it. Let's actually use that data to understand patterns instead of letting it sit in siloed apps you check once and forget.

Need medications? We'll help you find the best price, whether that's through Cost Plus, GoodRx, or traditional pharmacies. All your health data in one place. That you own. That we'll never sell. That actually helps you make decisions instead of sitting in portals you can't access.

The Regulatory Reality of 2026

Here's what we know is coming:

Insurance companies will keep raising premiums. They'll keep narrowing networks. They'll keep adding administrative barriers between you and care.

The government will tinker around the edges maybe some price transparency requirements, maybe some formulary reforms but the fundamental model isn't changing. Which means next year is going to be harder than this year. And 2027 will be harder than 2026.

Unless you opt into a different model.

Let's Get Through This Together

We're not naive. We know Openwell isn't going to fix the entire healthcare system. But we can create an escape route for people who are tired of paying exponentially more for exponentially worse access.

We can prove that direct access works. That transparent pricing works. That treating patients like humans instead of claim numbers works. And maybe, if enough people opt into this model, we can show the system that there's a better way.

What This Looks Like in Practice

It's December 2025. You're looking at your 2026 insurance options. The premium is obscene. The deductible is worse.

But you do the math: for routine stuff—doctor visits, questions, labs, prescriptions—you're paying out of pocket anyway until you hit that deductible. So what if you got a high-deductible catastrophic plan (way cheaper premiums) and used Openwell for everything else?

$49/month for actual access to care. $200-300/month for catastrophic coverage. Maybe $100-200/month for labs and medications as needed.

Total: $500-700/month. Not $2,130.

And you'd have better access. Faster responses. More control. Your data in your hands.

The New Wave

This is the unbundling of healthcare. It's happening whether insurance companies adapt or not. Direct primary care. Cash-pay specialists. Transparent pharmacies. Health data platforms. AI companions that actually help instead of just documenting for billing codes.

We're not alone in building this. We're part of a wave of companies saying: there has to be a better way. But we think we're building something unique: the combination of direct access to real doctors with AI that helps you understand your health with data ownership that means you're never locked into a system that doesn't serve you.

2026 Is Going to Be Hard

The insurance emails are coming. The premium increases are real. The regulatory headwinds are making everything more complicated. You can keep paying into a system that's optimized for profit extraction. Or you can try something different. We're building the something different. And we're inviting you to build it with us.

Let's Get Through This Together

We're launching our beta now. Starting with people who are as tired as we are of a system that doesn't work. Not because we have all the answers. Because we think the answers are going to come from actually trying new models instead of just complaining about old ones. $49/month. Real access to care. Your health data in your hands. A direct model that makes sense.

It won't solve everything. But it might solve enough that 2026 feels less impossible.