Michael Botta’s Sesame Wants to Make Health Care a Cash-Pay Bargain

Michael Botta built Sesame Care on a simple premise: for a growing number of Americans, it can be cheaper and easier to pay for some health care directly than to go through insurance. Sesame, the New York-based cash-pay marketplace he co-founded, is built around that idea and expanding it into areas where demand is high, pricing is opaque, and coverage is inconsistent. Fertility is one example. Weight loss is another.

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

Rather than trying to replace insurance outright, Sesame is betting that more patients will begin treating parts of health care like a retail purchase—comparing prices and paying out of pocket when coverage is limited or not worth the hassle. Sesame says it has served more than 1 million patients and offers more than 380 services nationwide.

Annual family premiums for employer-sponsored health coverage reached $26,993 in 2025, up 6 percent from a year earlier, according to the nonprofit health policy research group KFF. Workers contributed $6,850 on average. Consulting firm Mercer estimates employer health benefit costs will rise another 6.7 percent in 2026, the largest increase in 15 years. Americans are paying more for coverage even before facing deductibles, co-pays, and services that are only partially covered or not covered at all.

Fertility care illustrates many of the system’s weaknesses in one place. It is time-sensitive, emotionally fraught and expensive. Yet, coverage varies widely. Even when some services are covered, patients often face substantial out-of-pocket costs. KFF estimates that a single IVF cycle typically costs $15,000 to $20,000, and many patients require more than one.

Partnering with Costco

In March, Costco launched a fertility program in partnership with Sesame, offering members access to virtual appointments for $99 per month. (Medication and lab costs are billed separately.) Costco first partnered with Sesame in September 2023 to offer discounted outpatient care to members. The relationship expanded in April 2024 with a weight-loss program that provided clinician support and prescriptions for drugs such as Ozempic and Wegovy.

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

Virgynia Muma, a 33-year-old Sesame user, first turned to the platform when she developed strep throat over a weekend and her doctor’s office was closed. She said the virtual visit was cheaper than expected and, when she later saw her regular doctor for the same issue, cheaper than going through insurance. The experience, she said, led her to ask, “Why do I even pay for insurance?”

Her larger frustration, she added, is how opaque insurance can feel. “What are you actually covering? What are you paying for? It shouldn’t feel like a scam.” She 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 annual memberships for $199 outside of Prime.

In weight loss, drugmakers and telehealth companies have built direct-pay 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 prices, while telehealth companies such as Ro and LifeMD have paired similar pricing with membership fees.

Even employer-focused companies are moving in that direction. Maven Clinic, a women’s and family health company that built much of its business through employers, said in March that it would launch a direct-to-consumer platform nationwide.

Botta said Sesame aims to be “the first place people go” when they have a question about their health care, whether they ultimately pay cash or use insurance.