#1. What is Medi-Share?
Midi-Share is a non-profit Health Care Sharing Ministry (HCSM) that was started in 1993. What is a health care sharing ministry you ask?
According to Healthinsurance.org HCSM’s are defined as “non-insurance entities in which members share beliefs and share medical expenses among members according to those beliefs.” Over 100 such entities exist today and are certified by the federal department of Health and Human Services (HHS).
Medi-Share states that they are a community of Christians who agree to live as a church. They share the burden of medical costs together with other members of the Medi-Share community. The pooled financial resources of the group help to pay for medical expenses for those who require medical care.
#2. Does Medi-Share count as insurance?
While Medi-Share claims to be a proven biblical healthcare model, make no mistake this is NOT health insurance!
Rather, as the name implies it is simply a way for healthcare costs to be shared amongst a group. At a federal and state level, Medi-Share is not recognized as insurance. Because of this, it puts you at risk if you intend to treat it like insurance.
Some important things to keep in mind about Medi-Share’s insurance status:
- There is no legal recourse for you over a medical or prescription claim that is not paid.
- If Medi-Share goes bankrupt you have no state insurance guarantee like you do with normal healthcare insurance.
- Health Savings Accounts (HSAs) can’t be utilized to pay for qualified medical expenses with Medi-Share.
- Medi-Share is not viewed as a charitable gift if you use it to cover medical expenses.
- As of January 1, 2019 health insurance is no longer mandatory, however some states still require it to avoid a tax penalty. Medi-Share would work as an exemption for this tax penalty.
- The amount you pay for Medi-Share is not tax deductible like health insurance is, because this is NOT health insurance.
#3. What cost sharing insurance?
Cost sharing insurance is when health insurers set up parameters for when patients will pay out of their own pocket for certain goods or services. This is typically in the form of one of the following:
The setup of Medi-Share is similar, however remember it is NOT INSURANCE.
#4. How much is Medi-Share monthly?
The monthly cost of Medi-Share is variable and it depends on several factors. Medi-Share recommends that members choose an Annual Household Portion (AHP) that is similar to the annual deductible they had with their previous insurance. Like a deductible, this AHP will be the amount members pay out of pocket before any health sharing kicks in.
Once the amount of AHP has been selected the member can then determine how much the monthly share will be. Currently, AHP can range from $1,000 to $10,500 according to the Medi-Share website. Keep in mind that AHP only applies to “Eligible Medical Bills” and eligibility is determined by Medi-Share.
The table below is an EXAMPLE ONLY, actual costs would depend on your age and state of residence. Medi-Share claims to have sharing plans in all 50 states.
|Monthly Share||Annual Household Portion|
Monthly share is similar to a monthly premium for standard insurance. Each member is set up with an individual account for sharing. From this account your funds will be available to use for your medical expenses or sharing for others expenses.
#5. Medi-Share Fees
In addition to the AHP and your monthly share there are some fees to be aware of. It appears these fees cover the administrative expenses of maintaining the HCSM.
- $120 New member approval fee
- $50 application fee
- $2 fee for setting up a sharing account
- $3 monthly fee if you do not setup auto payment to your monthly share account
#6. How does it work?
Every month every person who is in the health care sharing ministry deposits their monthly share in their own account. This creates a pool of money that can be utilized to pay for eligible medical expenses of the entire group.
When someone needs medical attention they go to a provider who is in the Medi-Share Preferred Provider Organization (PPO), just as you would with insurance. Forgetting to take this step can be costly as providers outside the PPO may not accept Medi-Share and consider you uninsured.
Where should the doctor send the bill?
Members present their Medi-Share member ID card to the doctor or other service provider, just like they would an insurance card. The provider will discount the bill at the rate agreed to with Medi-Share. After that any remaining amount due is paid by the member up until they meet the AHP.
Once they have met the AHP, a request is made for Medi-Share to pay the remaining amount. In an online portal someone from Medi-Share will approve and pay the amount using money from other members monthly share account.
When payment has been made, other members know who the money was used by and are encouraged to pray for those in need.
In some cases the request may be denied due to not adhering to a Christian lifestyle (see more below) or other reason. In those cases the member must pay for the expense out of pocket.
#7. What is covered?
It is very important to understand that to get the optimal amount of coverage from Medi-Share you must follow these steps.
- Sign up for Health Incentives (a wellness program) and get 20% off your monthly share.
- Find providers in the PPO network, specifically Medi-Share works with the PHCS network.
- Do not go out of network, or risk incurring a penalty.
- Sign up for telehealth before you need medical help, this is the preferred method of doctor visit and is free in Medi-Share.
- Present your Medi-Share card and confirm the provider will send your bill to Medi-Share.
|Provider office visit||$35|
|Emergency room visit||$200|
|Prescription drug||Up to 6 months can be shared|
|Maternity||$125,000 per pregnancy|
|Well child visit||Until age 6|
|Adoption costs||Up to two adoptions|
Some important things to consider for prescription medications they must be for an eligible use. Therefore, numerous medications are likely to be excluded from coverage. Also, the maternity coverage requires that your AHP is at least $3,000.
Case by case basis
When certain things are deemed medically necessary and approved by Medi-Share the following services may also be covered.
- Ambulance or medical transport
- Chiropractic care
- Durable Medical Equipment
- Cardiac rehabilitation
- Speech therapy
- Genetic testing
- Physical therapy
Medi-Share also provides discounts for the following services:
- Dental procedures
- Eye exams
- Eye glasses
- Contact lenses
- Lasik Surgery
- Hearing aids
#8. What is not covered?
Since the passage of Obamacare, all insurances have been covering preventative services free to patients. Preventative services include things such as physicals, screenings for various diseases, vaccinations and certain types of counseling. These services are important to help catch things early or prevent diseases that can be expensive to treat. Medi-Share does NOT cover preventative services. Make sure you keep this cost in mind when deciding if Medi-Share is right for you.
Other services that Medi-Share does not cover include dental, vision and hearing services. However, most health insurances will have these services carved out as well and you can still buy coverage for these outside of an existing health insurance if so desired.
Does Medicare Share cover pre-existing conditions?
Pre-existing conditions are an important thing to consider when looking at Medi-Share. The term pre-existing condition refers to a medication, disease or condition that had been treated or diagnosed before enrolling in a new health plan. Conditions that are chronic or long-term make up the majority of pre-existing conditions. A few examples include diabetes, asthma, COPD, cancer or sleep apnea.
The Affordable care act made it illegal for health insurance companies to deny coverage based on a pre-existing condition. However, since Medi-Share is not insurance it does not have to adhere to those guidelines.
Medi-Share requires that you share your medical history with them when you apply for coverage. After that they may not provide you with coverage if you do have certain pre-existing conditions. This does help them to manage the risk pool of people in their network. If they accepted everyone who had very expensive disease states, then the other members would have to increase the amount they share to keep share coverage.
It is a fine line to walk and if you have conditions that may fall into this category you will have to apply and see what happens.
Who makes the final decision?
One difference between Medi-Share and typical health insurance plans is the leadership structure. In Medi-Share members make the rules. All members have an opportunity to vote on care for others. Ultimately, a board of directors then review the suggestions of the members. However, decision on payment of individual bills is not something they vote on.
#9. Christian lifestyle requirement
Medi-Share makes it very clear up front who the program is for and who it is not. They do not cover medical claims that are for what they claim to be non Christian behavior. That means that every claim submitted is reviewed for this type of assurance.
They pose the following as non Christian behaviors that could result in a bill not being paid.
- Disease from sex outside of marriage
- Condition related to tobacco or illegal drug use
- Abuse of legal drugs like alcohol
- Lack of attendance at church regularly
- Participating in the plan before a pregnancy (You can’t apply once you find out your are pregnant)
#10. Medi-Share and Medicare?
Medi-Share offers a program called Senior assist for people 65 year of age and over. The idea is for Medi-Share to supplement the money a Medicare patient pays out pocket. To be eligible members must be enrolled in Medicare Part A & B.
How senior assist works
Similar to regular Medi-Share, senior assist members have a AHP but it is set at $1250. Meaning they pay for everything Medicare won’t cover out of their pocket up to $1250.
In addition to the AHP, senior assist members must pay a monthly share at the following rate:
- 65-70 years old = $70 per month
- 71-75 years old = $85 per month
- 76 and older = $95 per month
#11. Health Savings Accounts (HSA)
As already mentioned Medi-Share does not provide the ability to fund an HSA account. HSA accounts can only be paired with high deductible health plans and Medi-Share does not qualify as it is not insurance.
However, if you have an existing HSA from previous insurance, those funds can be used to pay for qualified medical expenses that Medi-Share does not cover.
#12. Other things to consider
Out of pocket maximum
Just like with health insurance plans the more you are willing to pay out of pocket overall like a deductible, the less your monthly share (premium) will be. If you have a high deductible health plan one thing to pay close attention to is your maximum out of pocket expense. This can be a very large number depending on what plan you have. Medi-Share does not have a maximum out of pocket amount.
Time of enrollment
Medi-Share also allows for enrollment at any time during the year. Compare that to normal health insurance where you can only change your plan during a set open enrollment time. Qualifying life events do allow for changes during the year but only for things such as marriage, childbirth, death, etc.
Some medical facilities may not take Medi-share and may consider you as an uninsured patient. In these cases they will end up sending bills to you directly. This can be a major pain point because Medi-Share advised you to have bills directed to them. If you pay out of pocket and then request reimbursement from Medi-Share you could be in for a long, process trying to get that straightened out.
On your own
Finally, remember if you have a disagreement with Medi-Share about their decision to not pay for a bill you have no recourse. That means that because it is not insurance you can not make a case with your state insurance commission. They will not try to enforce any regulation on Medi-Share because they are not health insurance.
#13. Key Points
Below are the big advantages and disadvantages to Medi-Share. If you decide it is right for you then apply here.
- Members are like minded Christians.
- You can join at anytime during the year.
- There are no maximum out of pockets.
- Monies paid do not subsidize other non Christian belief practices.
- No lifetime limits exist.
- Telemedicine doctor consults are free.
- Members support each other through prayer.
- Could save you money if you are in good health.
- For seniors with Medicare it can be a good way to offset costs Medicare doesn’t pay for.
- This is not insurance, you have no recourse if you disagree with a payment decision.
- Some providers may consider you uninsured.
- Catastrophic medical problems may not be paid for in full, leaving you on the hook for a large bill.
- Pre-existing conditions could prevent you from being accepted or a claim from being paid.
- There is no ability to fund a Health Savings Account (HSA)
Click here to get Dr. Jason Reed’s exclusive list of medication questions you MUST ask your doctor, for FREE!
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