Michael Botta’s Sesame Bet on Affordable Health Care Without Insurance

Michael Botta built Sesame Care on a simple premise: for a growing number of Americans, it would be cheaper and easier to pay for certain health care directly than through insurance. Sesame, the New York-based cash-based marketplace he co-founded, is built around that idea and extends it to places where demand is high, prices are invisible, and coverage is inconsistent. Childbirth is one example. Weight loss is another.

“Insurance is going down, and people have more deductibles, co-pays, and co-insurance,” Botta said in an interview with the Observer. He argues that in many cases, the price patients pay directly through Sesame is lower than what they would pay through insurance.

Instead of trying to directly insure, Sesame is betting that more patients will start treating parts of health care like retail shopping—comparing prices and paying out-of-pocket when coverage is limited or not worth it. Sesame says it has helped more than a million patients and offers more than 380 services nationwide.

Annual family premiums for employer-sponsored health care will reach $26,993 in 2025, up 6 percent from last year, according to the nonprofit health policy research group KFF. Employees contributed $6,850 on average. Consulting firm Mercer estimates that employer health benefit costs will rise another 6.7 percent by 2026, the largest increase in 15 years. Americans pay more for coverage even before they factor in deductibles, co-pays, and partially or completely covered services.

Child care shows many systemic weaknesses in one place. It is time sensitive, emotional and expensive. However, the prevalence varies greatly. Even if some services are covered, patients often face significant out-of-pocket costs. KFF estimates that one IVF cycle typically costs $15,000 to $20,000, and many patients need more than one.

Partnering with Costco

In March, Costco launched a fertility program in partnership with Sesame, which gives members access to virtual appointments for $99 a month. (Medication and lab fees are billed separately.) Costco began partnering with Sesame in September 2023 to offer discounted outpatient care to members. The partnership expands in April 2024 with a weight loss program that offers physician support and prescriptions for medications such as Ozempic and Wegovy.

Botta said Costco’s fertility launch brought thousands of patients to the platform in the first week. Sesame’s goal is to be the “front door” to that kind of care, he said.

Virginia Muma, 33, who uses Sesame, first turned to the stage when she had strep throat over the weekend and her doctor’s office was closed. He said the virtual visit was cheaper than expected, and after seeing his general practitioner for the same issue, it was cheaper than going to insurance. The experience, he said, led him to ask, “Why do I even pay for insurance?”

His biggest frustration, he added, is how opaque insurance can feel. “What exactly are you covering? What are you paying for? It doesn’t have to sound like a scam.” He said.

The self-pay model is growing

The demand for self-pay health care is growing. One Medical, the primary care company Amazon acquired for $3.9 billion in 2023, sells an annual membership for $199 without Prime.

In weight loss, drugmakers and telehealth companies have created direct payment channels for GLP-1 drugs as insurers have restricted coverage or made access more difficult. Novo Nordisk has offered Wegovy to cash-paying patients at introductory rates, while telehealth companies such as Ro and LifeMD have paired similar rates with membership fees.

Even employer-focused companies are moving this way. Maven Clinic, a women’s and family health company that builds much of its business through employers, said in March it will launch a platform to connect directly with consumers across the country.

Botta said Sesame aims to be “the first place people go” when they have a question about health care, whether they end up paying cash or using insurance.