If you’re in your 60’s, you are well aware that there are some major changes coming soon in how you will manage your healthcare. With Medicare now on your horizon, there is an abundance of new information you will need to address.
In my early 60’s, my mailbox filled every week with a myriad of offerings from every healthcare insurance program imaginable. Everyone in my age range faces a barrage of solicitations for healthcare, especially each fall during the open enrollment season. Those mailings continue today as the healthcare industry spends billions on advertising Medicare options annually. If we as consumers make the effort to search for the best option, sorting through the choices is challenging, to say the least.
So where to begin? Well, if you're a Medi-Share member, you already have a competitive option without having to look outside of your current healthcare choice. It’s called “Medi-Share 65+”.
The Background of Medi-Share 65+
Fourteen years ago, a new program called “Senior Assist” was developed for existing Medi-Share members when they turned 65 years old. The design for Senior Assist was to share in costs that enrollees in Medicare approved, but didn’t pay for. Because Medicare acted as the primary payee, we could offer Senior Assist to our members at a much lower monthly share than our standard Medi-Share program. Since members were already participating, our process was to simply transition them to Senior Assist. Our members could now meet their needs by utilizing their Medicare benefit and still continue to share in a Christian healthcare program.
Over the next ten years, Senior Assist grew to become a major contributor in the overall sharing model for Medi-Share. However, as the years passed, we recognized that the Senior Assist program needed to adapt to the changes the healthcare market was experiencing. So in 2022, we redesigned how our senior product worked and launched our new program, “Medi-Share 65+”.
How Does Medi-Share 65+ Work?
As you probably know, Medicare pays for your medical bills, but those payments have limitations, such as deductibles and co-insurance costs which must be paid by you. That is where Medi-Share 65+ steps in: To address costs that Medicare considers to be your responsibility.
Understanding Medicare Parts A and B
While Medicare pays your provider a portion of what they bill to you, there are remaining costs. Both Medicare Part A (hospitalization) and Medicare Part B (medical expenses like physician services, labs, outpatient services, and various other medical needs) each have a deductible that you are responsible for before any coverages take effect.
In 2025, for example, the Medicare Part A deductible is $1,676 per benefit period and the Medicare Part B deductible is $257 per year. And yes, each year those amounts increase. Additionally, Medicare Part B has a coinsurance factor of 80%, which means after you have paid for the medical bills attributed to your deductible, Medicare Part B will only pay for 80% of your remaining costs. Ultimately, you will need to pay for all your deductible amounts for Parts A and B and 20% of medical bills processed through Part B. As a senior with any medical needs (and let’s face it, most of us have them) that adds up. This is where Medi-Share 65+ is designed to help you.
The balance left as your responsibility after Medicare pays can become significant, especially if you’re retired and living on a fixed income. There is a significant gap in how you’ll meet your medical needs if you depend on Medicare alone. That is why Medicare supplemental plans, which are secondary payers, came into being.
Understanding MediGap and Advantage Plans
Medicare supplemental plans, commonly referred to as MediGap plans, are offered by private insurance companies, but their varying coverages are regulated by the government at both the federal and state levels. Some supplement plans will range from covering nearly all the medical costs above what Medicare will pay for, while others will either cover at lower percentages or completely exclude coverage of varying different types of services. Typically, the higher the cost of your MediGap plan, the more comprehensive the coverage options you’ll receive.
Medicare also offers a different coverage type known as an Advantage Plan. While you still need to enroll in Medicare Parts A and B, they work more like a traditional individual healthcare plan with copays, co-insurance, and deductibles you will be responsible for. There are a varying number of these plans available in most regions of the US. They are very popular because most of them have no monthly premium. This option can be very attractive if you have very little or no need to access medical services, but that is not typical for seniors. The more needs for services you have, the greater the probably for cost. To choose this option or to choose the original Medicare option with a secondary program is an individual choice based on your healthcare needs.
Understanding Medi-Share 65+
Our Medi-Share 65+ program is structured to be supplemental to Original Medicare. Our program provides medical sharing at the most comprehensive level, similar to the most comprehensive supplement – the MediGap G plan. The Medi-Share 65+ program is similar in most respects to a high deductible MediGap G plan but with an Annual Household Portion (AHP) of only $500. The AHP is the member’s responsibility each year toward the medical costs that Medicare A and B do not pay for.
To provide a visual reference of all the MediGap Plan coverages compared to Medi-Share 65+, please review the chart below:
To illustrate how the Medicare process works with Medi-Share 65+ in the simplest of terms, let’s use an example of a $6,500 hospital stay with a $20,000 surgical procedure. For the hospitalization portion of the bill totaling $6,500, the hospital would first send the bill to Medicare. Whatever costs on the bill that are eligible for coverage by Medicare would be paid for, minus the first $1,364, which is the deductible portion of Medicare A.
In this example, Medicare A would pay for $5,136. The hospital would receive an Explanation of Benefits document from Medicare detailing the coverage amounts along with a payment of $5,136. The hospital would then submit to Medi-Share 65+ the Explanation of Benefits (EOB) along with the unpaid portion of the bill of $1,364. Since Medi-Share 65+ has an AHP of $500, the remainder, $864, would be shared by the other members and the member would pay the hospital their $500 portion. The member has now satisfied their AHP for rest of the year.
Now let’s look at the surgical services portion of the bill, which could, for example, include the surgeon’s bill, a surgical assistant’s bill, anesthesiologist’s bill, etc. All those other bills are also sent to Medicare. Since this is not a hospitalization bill, it would be processed under Medicare B coverage at 80 percent, minus the deductible of $257. So, of the original $20,000 bill for the various medical providers, Medicare will send them EOBs along with payments totaling $15,744. Medicare will not cover $4,256 of the bill, which is your 20 percent coinsurance plus the $257 deductible. The surgical providers would then send the EOBs they received from Medicare, plus a bill for their remaining balances of $4,256, to Medi-Share 65+. Here’s the important part. Since you’ve already met your AHP for this year due to your hospitalization, those eligible bills would then be shared in their entirety.
While Medicare also significantly discounts original providers’ billing so the actual amounts may widely vary, ultimately, your $26,500 medical event cost you only $500. Understand that this is an oversimplified example of actual medical billing; however, it clearly illustrates the value of your Medi-Share 65+ membership.
Here’s another added value. Many who have chosen to retire will use their leisure time to take advantage of traveling to foreign countries. It’s important to know that Medicare does not cover medical costs outside of the US. However, Medi-Share 65+ will provide sharing in the event there’s a need for emergency or urgent care out of the country. Specifically, Medi-Share 65+ will share in emergency care outside the US at 80 percent once your AHP is met, with a lifetime limit of $150,000.
As our members love to share with each other in times of greatest need, it’s good to know that when the time comes to utilize your Medicare benefit, you can continue to take the opportunity to share with and bless your fellow Christians with Medi-Share 65+.
If you would like to talk to a representative about Medi-Share 65+, please call us at (833) 902-4253. To find the most comprehensive information on how Medicare can work for you, please go to Medicare.gov.
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