Nonprofit Cost Saving Resources
From ACRE's Current LinkedIn Newsletter: The Nonprofit Savings Brief
Employee Health Benefits
Keep Getting Costlier
What Choices Do Small Nonprofit Employers Have?
Read The Full Article
For nonprofits with a small staff and limited budget, providing traditional group health insurance for their employees is often financially out of reach. And it appears to be getting farther and farther away. As hefty premiums continue to grow, smaller percentages of small business and nonprofit employers are offering group insurance plans.
The Numbers Aren’t Encouraging
According to the 2024 Kaiser Family Foundation (KFF) Employer Health Benefits Survey, 49% of small firms with 3–49 workers do not offer health benefits to their employees. The Employee Benefit Research Institute (EBRI) reported that for employers with fewer than 10 employees, 77.5% did not offer health benefits in 2023.
There’s not much data showing how for-profit small businesses compare to small nonprofit employers, but at least one source indicates the difference is negligible. KFF data shows that, overall, the share of workers covered by their own employer is higher in public organizations (72%) compared to private not-for-profit firms (60%) and private for-profit firms (59%).
And the trendlines are down and to the right. EBRI reports that between 1996 and 2023, the percentage of employers with fewer than 10 employees offering group health benefits plummeted from 34.2% to 22.5%. That tracks with what’s happening to premiums. KFF says between 2015-2025, small employers experienced more than a 50% increase in family plan premiums, rising from $16,625 to $26,054.
They Aren’t Perfect, But There Are Low-Cost Alternatives
Of course, not offering group health care coverage can seriously undermine a nonprofit’s staff recruitment and retention efforts. But what’s a small nonprofit to do? There are a growing number of lower-cost alternatives to group health insurance. Most obviously don’t come close to matching the comprehensive coverage that group plans typically provide, although some help employees obtain similar insurance coverage on their own. Others provide different types of assistance but typically leave employees exposed to major medical bills.
Help Employees Buy Individual Insurance Through an HRA
Companies such as Take Command, PeopleKeep and StretchDollar administer Health Reimbursement Arrangements, or HRAs (not to be confused with HSAs/Health Savings Accounts.) In an HRA, the nonprofit provides a monthly allowance per employee to help them pay the premiums for their own individual insurance and eligible medical expenses.
A Qualified Small Employer Health Reimbursement Arrangement, or QSEHRA, generally is available to employers with fewer than 50 full-time-equivalent employees that do not offer a group health plan. An Individual Coverage HRA, or ICHRA, can be offered by employers of any size and permits more flexibility in establishing eligible employee classes.[4]
Cost: The employer chooses the amount of its reimbursement allowance. Then there are administration fees. Take Command advertises QSEHRA administration starting at $25 per
participating employee per month. PeopleKeep advertises QSEHRA administration at $25 per employee per month plus a $50 monthly base fee.[5][6]
For 2026, a QSEHRA may reimburse up to $6,450 annually for self-only coverage or $13,100 when family expenses are eligible. But again, the employer can set a lower allowance.[7]
Employee requirements: Employees must obtain qualifying coverage and complete the administrator’s premium-verification or reimbursement process.
Pros:
- Helps employees obtain actual insurance against hospitalization and major medical
- Gives the nonprofit a predictable maximum financial
Cons:
- Employees must evaluate and select their own insurance
- Depending on various factors, participation in an HRA might reduce the amount employees could qualify for in Marketplace premium tax credits.[8]
Health Benefit Alternatives:
Comparison at a Glance
The prices below are published prices reviewed in July 2026. Provider terms and pricing should be verified before purchase.
Medical Discount Plans
AmeriPlan and Careington arrange negotiated discounts with participating medical, dental, vision, pharmacy, and other providers. These programs do not pay medical claims. Employees remain fully responsible for the discounted bill.
AmeriPlan currently advertises a small-business program at $39.95 per month per employee. Members of employee households can also use the discounts.[9]
Careington offers customizable discount programs for employers of different sizes and for employees with different benefit and employment statuses. Group pricing is quote-based.[10]
Employee requirements: Employees must locate participating providers, confirm the available discount and pay the entire discounted fee when receiving care.[11]
Pros:
- Costs substantially less than
- Can include part-time, seasonal and otherwise uninsured
Cons:
- Does not pay claims or limit an employee’s exposure to large medical
- Its value depends on the provider network and the discounts available where employees live.
NAIC guidance frames discount plans as fee-for-access arrangements rather than insurance, since they don’t directly pay a member’s medical bills.12]
Broader Health Care Memberships
Mira is a “health care membership” designed partly for people without insurance. Its services include access to routine, urgent and preventive care, prescriptions, laboratory testing and certain other health services at established copays or discounted prices.
Mira currently advertises individual membership at $50 per month. Its employer page describes employer health benefits priced below $100 per employee, plus a flat fee for the organization, but does not publish a more specific standard employer price.[13][14]
Employee requirements: Employees use Mira’s services and pay the applicable copay or discounted price.
Pros:
- Provides more practical access to everyday care than a basic discount
- Offers a relatively broad collection of non-major medical services for less than comprehensive insurance.
Cons:
- Mira is not health
- It does not provide comprehensive protection against hospitalization, surgery or other catastrophic expenses.[13]
Cash-Pay Health Care Marketplaces
The company Sesame at Work gives insured and uninsured employees access to doctors, specialists, laboratory services, prescriptions and other care at posted cash prices.
When Sesame at Work was introduced in 2023, the company described it as free for employers. The current website does not address employer pricing but appears to limit financial responsibility to individuals when they schedule the service, with prices varying by service.[15][16]
Employee requirements: Employees search the marketplace, select a provider and pay the posted cash price.
Pros:
- May give a nonprofit a useful employee resource at little or no direct
- Allows employees to see prices before scheduling many types of
Cons:
- Employees still pay for every service they
- The program does not protect them against emergency, hospital or major medical
Direct Primary Care
With Direct Primary Care, or DPC, an employer or employee pays a recurring membership fee directly to a primary-care practice. The membership commonly includes routine visits, preventive care, chronic-condition management, virtual consultations and improved appointment access.
Hint Connect gives employers a ready-made way to add DPC by tapping into its multi-state roster of contracted, independently owned practices. Hint Connect states that participating employers pay recurring membership fees to the practices. It does not publish a standard employer price because fees and services depend on the participating practice and location.[17]
Employee requirements: Employees must enroll with an available DPC practice and use that practice for included primary-care services.
Pros:
- Gives employees continuing access to an actual primary-care
- Routine visits may be included without additional visit
Cons:
- A suitable participating practice may not be available near every
- DPC does not replace Specialists, hospitals, surgery and complex treatment generally fall outside the membership.[18]
Customized Packages of Non-Insurance Benefits
The New Benefits company allows employers and benefit advisers to assemble packages from numerous services. Health-related options include telemedicine, virtual behavioral health, prescription discounts, price-comparison tools, caregiving assistance and medical-bill advocacy.
Its health advocates can help employees understand care options, identify billing errors, compare prices, and negotiate discounts or payment arrangements. Pricing is based on the services selected.[19]
Employee requirements: Employees register through the platform and use the individual services included in the employer’s package.
Pros:
- Lets a nonprofit select services its employees are most likely to
- Medical bill review and navigation may help employees avoid or reduce unnecessary expenses.
Cons:
- The value depends heavily on employee awareness and
- Even a broad package remains a collection of non-insurance services, not major-medical [19]
Interest-Free Financing for Medical Expenses
Paytient’s employer-sponsored Health Payment Account gives employees a revolving credit balance for qualifying medical, dental, vision, and pharmacy costs, repaid on a flexible schedule with no added interest.
Paytient’s Essential plan currently provides $2,000 in purchasing power for $10 per employee per month plus a $100 monthly platform fee. Its Plus plan provides $5,000 for $18 per employee plus the same platform fee.[20]
Employee requirements: Employees must activate their accounts, satisfy the program’s approval requirements and repay the amount they spend. The Paytient card cannot be used to pay health insurance premiums.[20]
Pros:
- Allows an employee to obtain non-emergency care immediately rather than waiting until sufficient cash is available.
- The employer is not responsible for an employee’s unpaid or delinquent [20]
Cons:
- It finances medical expenses; it does not reduce them or provide employer-funded
- Employees may exchange an immediate medical bill for an ongoing repayment
Medical Cost Sharing
Sedera and Zion HealthShare are two of the organizations that operate communities in which members make monthly contributions that may be shared to pay for other members’ eligible medical expenses.
Zion offers an employer-oriented Essential Membership requiring at least two participating members, with no required employer contribution. Pricing depends on factors such as household composition, age and the selected Initial Unshareable Amount (like a deductible, the amount a member must pay before eligible expenses may be shared.) [21]
Employee requirements: Employees must make the applicable monthly contribution, pay their Initial Unshareable Amount, submit sharing requests, and comply with the program’s eligibility rules.
Pros:
- Monthly contributions may be lower than comprehensive insurance
- Some programs may assist with large eligible medical
Cons:
- Medical cost sharing is not insurance, and payment of an employee’s expenses is not contractually guaranteed.
- Pre-existing conditions, prescriptions, preventive care and other services may be subject to exclusions, waiting periods or sharing [22]
Sedera describes contributions as voluntary; members decide case-by-case whether to help cover another member’s costs, and no one, including Sedera, can force payment.[23]
The NAIC warns that health care sharing arrangements do not provide the same regulatory protections as insurance and cannot guarantee payment of medical claims.[12]
Which Option Offers the Most Real Protection?
For a nonprofit that wants employees to have genuine protection from major medical expenses, an HRA that helps employees purchase individual insurance is regarded as the strongest alternative to a traditional group plan.
The other models solve narrower problems. Nonprofits should ensure they understand and communicate to their employees the narrow nature of these alternative approaches and that they do not provide the financial protections of health insurance.
Combining Models May Produce a Better Benefit
A small nonprofit isn’t limited to choosing only one approach.
It might establish a modest HRA to help employees buy individual insurance and add a lower-cost service that improves everyday access. Examples include:
- An HRA plus Direct Primary
- An HRA plus telehealth and prescription
- Individual insurance support plus medical-bill
Important Considerations
Before selecting any of these alternative programs, the nonprofit should understand:
- The employer’s total annual
- The expenses employees must pay to receive
- Whether major hospital and specialist expenses are
- Provider availability where employees
- The effect on employee tax credits through the Marketplace.
- Tax, ERISA, Affordable Care Act and state-law requirements and
This article provides general educational information and is not legal, tax, insurance, or employee-benefits advice.
Endnotes
[1] Kaiser Family Foundation (KFF). (2024). 2024 Employer Health Benefits https://files.kff.org/attachment/Employer-Health-Benefits-Survey-2024-Annual-Survey.pdf
[2] Employee Benefit Research Institute (EBRI). (2024). “New Research Finds Percentage of Small Employers Offering Health Benefits in ” https://www.ebri.org/content/new-research-finds-percentage-of-small-employers-offering-health-benefits-in-decline-but-employment-based-health-coverage-still-most-common-source-of-health-coverage-for-nonelderly-population
[3] Kaiser Family Foundation (KFF). (2025). 2025 Employer Health Benefits https://files.kff.org/attachment/Employer-Health-Benefits-Survey -2025-Annual-Survey .pdf
[4] Healthcare.gov, “Qualified Small Employer Health Reimbursement Arrangement” and “Individual Coverage HRA”:https://www.healthcare.gov/small-businesses/learn-more/qsehra/ https://www.healthcare.gov/small-businesses/learn-more/individual-coverage-hra/
[5] Take Command, QSEHRA administration and pricing: https://www.takecommandhealth.com/qsehra-administration
[6] PeopleKeep, HRA pricing: https://www.peoplekeep.com/pricing
[7] PeopleKeep, “QSEHRA FAQs,” including 2026 reimbursement limits: https://www.peoplekeep.com/blog/qsehra-faqs
[8] HealthCare.gov, QSEHRA and Marketplace premium-tax-credit guidance: https://www.healthcare.gov/job-based-help/qsehra/
[9] AmeriPlan, small-business membership information: https://sb.ameriplanusa.com/
[10] Careington, employer and organizational programs: https://www.careington.com/businesses-and-organizations/
[11] Careington, instructions for using a discount plan: https://www.careington.com/members/how-to-use/
[12] National Association of Insurance Commissioners, comparison of insurance and non-insurance health products: https://content.naic.org/article/consumer-insight-worried-about-high-cost-health-care-health-coverage-can-help-not-all-health-plans-offer-same
[13] Mira, membership services, pricing and non-insurance disclosure: https://www.talktomira.com/
[14] Mira, employer health-benefit information: https://www.talktomira.com/employer
[15] Sesame, employer program: https://sesamecare.com/join/employers
[16] Sesame, announcement introducing Sesame at Work: https://sesamecare.com/blog/sesame-announces-first-sesame-work-partners
[17] Hint Connect, information for employers and benefits advisers: https://connect.hint.com/advisors
[18] Hint Connect, Direct Primary Care program overview and insurance disclaimer: https://connect.hint.com/
[19] New Benefits, employer health packages and non-insurance services:https://www.newbenefits.com/benefits/packages/health/
[20] Paytient, Health Payment Account pricing, repayment and employer-liability information: https://www.paytient.com/pricing
[21] Zion HealthShare, Essential Membership for employers: https://zionhealthshare.org/memberships/essential/
[22] Zion HealthShare, member guidelines and sharing limitations: https://zionhealthshare.org/how-it-works/member-guidelines/
[23] Sedera, team membership disclosures: https://sedera.com/memberships-teams/
For more resources and assistance to help your charitable organization or association identify and reduce excess costs in new and meaningful ways, visit Administrative Cost Reduction Experts at https://ACREcutsCosts.com.
Your Nonprofit Can Be Paying $0
In Credit Card Fees!
Yes, It’s a Thing Most Nonprofits Qualify For
But is It the Right Call for You?
Read The Full Article
DISCLOSURE: ACRE participates in affiliate/referral programs with various companies that provide products and services to the nonprofit community. Referral payments help ACRE provide free cost-saving services to nonprofit organizations. ACRE may receive payment if readers click on hyperlinks on this page that take them to Zeffy’s website and then sign up for their service. The information below is nonetheless intended to be an objective overview of Zeffy’s service offering, features, and limitations that some nonprofits may want to consider.
A while back I posted an article about ways to meaningfully reduce the amount of money your nonprofit pays in credit card fees. There are a couple of great strategies to do it that don’t require you to change your credit card processor or limit the payment methods you accept. But if you’re open to making a few changes, the payoff could be more than just reducing what you pay, you could eliminate paying those fees completely.
Not just no processing fees. You don’t even have to pay the credit card companies’ fees.
Many nonprofit executives have heard of Zeffy and its zero-fee model. Zeffy absorbs the entire processing charge itself. The company sustains itself by prompting donors, at checkout, to optionally add a small tip that offsets what the nonprofit would otherwise pay in fees. Zeffy suggests an amount for the voluntary payment, but donors have the option to reduce or zero-out that additional payment without reducing the amount received by the nonprofit. [1]
Sounds great, right? And for many nonprofits, it is an ideal solution. After about a decade in business, the company says it now works with more than 100,000 nonprofits in the U.S. and a handful of other countries.
“Zeffy is used by nonprofits of all sizes, though the majority are small, grassroots organizations,” says Julia Manoukian, Brand Director at Zeffy. “The platform is built to scale with organizations as they grow.”
So is there a catch? Is Zeffy an option you might want to consider?
Who Actually Qualifies?
This one surprised me. For U.S. organizations, Zeffy is much more inclusive of the broader nonprofit landscape than you may realize.
A nonprofit doesn’t have to be a 501(c)(3) charitable organization to use Zeffy. The company lists numerous eligible classifications, including 501(c)(4), 501(c)(5), 501(c)(6), 501(c)(7), and 501(c)(19).
The primary qualifying requirements in the U.S. couldn’t be simpler:
- Have an Employer Identification Number (EIN)
- Have a bank account in the organization’s name
- Operate as an eligible nonprofit organization
Even if you’re still waiting for IRS recognition, you may be able to begin using Zeffy if you already have an EIN and a separate bank account. [2]
Understanding the Limits
I found no published minimum or maximum monthly transaction requirements. A nonprofit can apparently use Zeffy for one campaign, selected transactions, or its entire fundraising program. Zeffy also states that there is no subscription, contract, or long-term commitment. An organization can establish an account and use it or not use it whenever it wants. [3]
But there are limits on individual transactions:
Payment Method | Current Transaction Limit |
Credit and CVV debit cards | $4,999 |
Apple Pay and Google Pay | $1,000 |
ACH bank transfer | $20,000 |
For a nonprofit that regularly receives individual gifts above these amounts, checks, wire transfers, or another processor may still be necessary. [4]
Not All Payment Methods Are Accepted
Zeffy accepts major credit cards, CVV debit cards, ACH payments, and, on eligible forms and devices, Apple Pay and Google Pay. It also offers in-person Tap to Pay functionality.
However, it currently does not support PayPal, Venmo, Zelle, or Apple Pay/Google Pay on auction forms and embedded website forms. The company adds that text-to-give capability is likely on the horizon, but not yet. Zeffy’s online check option is limited to checks above $1,000, although smaller offline checks can be entered manually into the organization’s Zeffy records. [5]
For many organizations, these limitations are manageable. A nonprofit can also use Zeffy for the transactions it’s best suited for while maintaining another processor for other donors. Operating multiple systems, however, splits donor data, payment records, and reporting across platforms, creating extra work to keep everything reconciled.
You Must Use the Zeffy Donation Form
Zeffy cannot simply be connected as the no-fee payment processor behind an outside donation form, registration platform, or shopping cart.
To receive Zeffy’s zero-fee services, the transaction must be completed through a Zeffy campaign form. Zeffy processes payments through its customized Stripe integration and does not cover fees for transactions conducted through an outside platform. [6]
That leaves two primary website options:
- Link to a Zeffy-hosted page: A Donate, Register, or Purchase button on the nonprofit’s website sends the visitor to a full Zeffy campaign page. This is the easiest option and displays the campaign’s description, photographs, and available digital-wallet choices. The drawback is that the donor leaves the nonprofit’s website.
- Embed the Zeffy form: Nonprofits can paste Zeffy’s HTML code into its own website, providing a more continuous website experience. But according to Zeffy, there can be no customized visual branding on the embedded form, so no nonprofit or campaign name, logo, photos, or write-up appear on the form itself. The embed shows only the payment fields. [7]
Navigating the Donor Experience
Zeffy’s voluntary contribution request is the mechanism that finances the platform, so there are specific guidelines related to how that request appears. The company says the contribution request shows up twice during the transaction. The wording and suggested contribution amounts cannot be customized by the nonprofit. The suggested percentage is set based on the size of the transaction, with a lower percentage generally suggested for larger payments. [1]
To avoid donor confusion or pushback, nonprofits may want to explain the voluntary-payment arrangement, how it benefits the nonprofit, and the options that the donors have, before they start to fill out the donation form.
The Cost of Switching
A small nonprofit testing Zeffy for one event or donation campaign may need to do little more than create an account, complete verification, connect its bank account, build a form, and add a link or embed code to its website.
For a full conversion, the nonprofit may need to import donor contacts and historical gifts, rebuild donation and event forms, update website links, reconfigure accounting connections, and establish new payout procedures.
The biggest complication may be related to recurring donations. Zeffy can import historical records, but active recurring payment schedules cannot be transferred from another platform. Existing recurring donors must cancel their existing payment process and create a new recurring donation through Zeffy. [8]
For a nonprofit with minimal recurring donors, that may be a manageable communication project. For those that have a lot, potential donor attrition during the transition and the administrative effort involved in getting them all to formally recommit could be prohibitive.
Summary
Zeffy’s model is real: eligible nonprofits can receive the entire amount of qualifying transactions without paying any platform or processing fees.
It is especially attractive to smaller nonprofits with relatively straightforward fundraising needs, as long as they’re willing to use Zeffy forms and accept some limitations on payment methods.
It is less clearly suited to nonprofits that depend heavily on donations via PayPal or Venmo, frequently receive individual payments above Zeffy’s transaction limits, require highly customized checkout systems, or have a large recurring-donor portfolio that would need to be reestablished.
Because Zeffy requires no contract or minimum usage, a nonprofit may want to test it out with one event, campaign, or payment category, evaluate donor reaction and administrative demands, and then decide whether a larger migration is justified.
Learn more at Zeffy.
ACRE participates in affiliate relationship programs, including Zeffy’s, and may receive payment when a reader clicks links on this page to go to Zeffy’s website and then signs up for their service. ACRE’s participation in affiliate programs allows it to provide free cost-saving services to the nonprofit community.
References
[1] Zeffy Really Is Free: No Fees. No Catch [
2] Is My Organization Eligible to Use Zeffy?
[3] Exploring Zeffy: Where to Begin
[4] Supported Payment Methods on Zeffy
[5] Payment Methods We Don’t Support Yet
[6] Integrating Zeffy as a Payment Processor Into an External Form
[7] How to Embed Your Zeffy Campaign on Your Website
[8] Importing Recurring Payments and Donations
For more resources and assistance to help your charitable organization or association identify and reduce excess costs in new and meaningful ways, visit Administrative Cost Reduction Experts at https://ACREcutsCosts.com.
DISCLOSURE: ACRE participates in affiliate/referral programs with various companies that provide products and services to the nonprofit community. Referral payments help ACRE provide free cost-saving services to nonprofit organizations. ACRE may receive payment if readers click on hyperlinks on this page that take them to Zeffy’s website and then sign up for their service. The information below is nonetheless intended to be an objective overview of Zeffy’s service offering, features, and limitations that nonprofits may want to consider.
From the ACRE Archives
Is Your Budgeting Process Costing You Money?
The many ways nonprofits unintentionally lock in excess spending when they create their budget.
How To Vastly Reduce Credit Card Fees!
You can’t stop accepting credit cards. You don’t want to limit the ways members or donors can pay you. So instead of limiting options, why not expand them?
The Nonprofit Guide To Creating A Cost-Conscious Culture
Demonstrate to current and potential donors and members that your organization is a truly outstanding steward of the money they give.