- Updated March 2024
As a faith-based health care sharing ministry, Medi-Share provides an alternative to health insurance. Under the Christian Care Ministry umbrella, Medi-Share strongly emphasizes biblical values and community support. We have compiled some of our most frequently asked questions to help you better understand what Medi-Share is and if its God-centered, Christian approach is right for you and your family. Join us as we explore how we handle pre-existing conditions, prescription drugs, pregnancy, and more.
What expenses are eligible for sharing?
One of the most common questions is about which medical expenses are eligible for sharing. Let’s start this article by examining some common medical expenses and how Medi-Share handles those issues.
Q: How Does Medi-Share Handle Pre-existing Conditions?
Medi-Share takes a detailed and compassionate approach to pre-existing conditions, balancing the need for comprehensive care with the principles of a health care sharing ministry. Here’s what you need to know:
- A pre-existing condition in Medi-Share is defined as signs/symptoms, testing, diagnosis, treatment, OR medication for a condition within 36 months prior to membership (based on medical records).
- These conditions are evaluated based on medical records and member disclosures when joining Medi-Share. This process ensures that all conditions are fairly assessed per the ministry’s guidelines. This sharing guide video can help you determine whether your condition is considered pre-existing.
- Medi-Share implements waiting periods for sharing medical expenses related to pre-existing conditions. This period is 36 consecutive months, after which time up to $100k, per Member per year, related to these conditions may be shared by the members.
- That amount increases to $500k, per Member per year, after 60 months of faithful sharing.
Members of Medi-share with pre-existing conditions are guided through a clear process, helping them understand how and when their medical expenses might be shared among the Medi-Share community.
Q: Is Maternity Medical Care Shared?
A: Yes, maternity can be eligible for sharing. Married* pregnant Members with an Annual Household Portion of $3,000 or higher who have faithfully shared from the month of conception through the month of delivery are eligible for maternity sharing. For more details, see Section VII of the Medi-Share guidelines.
* Even if you are joining as an individual, you must indicate “married” upon application or when changing your AHP level in order for maternity to be eligible for sharing.
Q: Are Prescriptions Shared?
A: Prescription drugs for treating an eligible medical condition must be paid out of pocket first. These out-of-pocket payments are eligible for reimbursement. Prescription reimbursement forms can be found in the Member Center.
Prescriptions are eligible for up to six (6) months of treatment for each medical-specific condition over the member’s lifetime. Eligible prescription expenses are applied toward your AHP once they are sent in. If your AHP has been met, those expenses will then be submitted for sharing.
Q: Are immunizations Eligible for Sharing?
A: Medi-Share highly values the importance of family and wants to ensure newborns and children receive the very best care in the early stages of their life. Sharing for routine well-child care is eligible until the child reaches the age of six. Well-child care is defined as recommended, routine check-ups and associated lab work, excluding vaccinations and/or immunizations.
Q: Does Medi-Share Offer Telehealth Services?
A: Medi-Share does offer telehealth services at no additional cost, allowing members to consult with licensed health care professionals remotely. Utilizing telehealth can help reduce overall medical costs and is particularly useful for members with limited access to health care facilities. It also aligns with Medi-Share’s commitment to providing comprehensive, accessible health care options.
Q: Is Medi-Share HSA-Compatible?
A: Generally, no. Health Savings Accounts (HSAs) are designed to be used alongside high-deductible health insurance plans. Since Medi-Share is a health care sharing program and not an insurance plan, it does not qualify for HSAs.
Q: What are some services that are not shared in by Medi-Share?
A: Here are some of things deemed ineligible for sharing in Medi-Share’s member-voted guidelines:
- Elective Procedures: Medi-Share does not share in elective procedures that are not medically necessary. This includes cosmetic surgeries or other medical services for enhancement rather than health-related reasons.
- Unbiblical Lifestyle Choices: Medi-Share’s stance is clear in not sharing costs that arise from lifestyles contrary to biblical teachings. This includes, but is not limited to, expenses related to substance abuse, abortion, or injuries sustained in activities deemed hazardous or morally questionable.
- Prescription Drugs: While some prescription drugs are eligible for sharing, those related to excluded conditions or unbiblical lifestyles are not eligible for sharing.
- Mental Health and Preventative Care: Sharing in mental health treatment and certain preventive care services may have limitations based on Medi-Share’s faith-based guidelines. Members are encouraged to consult the guidelines for details on what is and isn’t shared in these areas.
Q: Why aren’t well-visits, routine care, or preventative care eligible for sharing?
A: The primary purpose of Medi-Share is to help share members’ burdens. Burdens are those unexpected medical bills you are unable to plan for (i.e., broken bones, cancer, etc.). Low monthly share amounts enable you to save and budget for your family’s routine care, which can be planned. There are exceptions for eligible annual physicals for those on qualifying program levels, as well as well-child care up until the age of six. Our member support teams can still help you negotiate those routine visits with doctors’ offices to help discount their cost to you.
How Does Medi-Share Work?
Medical cost sharing may be a new concept for some people. Let’s take a moment to talk about how the Medi-Share program works.
Q: Is Medi-Share Christian insurance?
A: No. Medi-Share is not insurance. Medi-Share is a not-for-profit health care sharing ministry in which Christians share their financial resources to pay each other’s medical expenses. Resources are shared directly between members. There is no pooling of funds as practiced by insurance groups.
Q: Why should I consider Medi-Share?
A: Medi-Share is a great option for people looking for a Christ-centered health care option:
- Good Stewardship – Most Medi-Share members are able to significantly cut their annual medical expenses, leaving them with more income to support their families and the Lord's work.
- Promotes Biblical Lifestyles – Medi-Share members and their dollars do not pay for abortions, gender reassignment procedures, or any other unbiblical options.
- Sharing with Brothers and Sisters in Christ – Knowing that you are blessing another brother or sister in Christ with your sharing is very gratifying. Those being shared with are greatly encouraged in their time of need by prayers and support of others.
Q: What is the deductible?
A: Medi-Share does not have deductibles. In Medi-Share's cost-sharing structure, the Annual Household Portion (AHP) functions similarly to a deductible in health insurance plans, representing the amount a member household is responsible for paying out-of-pocket before any medical bills are eligible for sharing.
The AHP is selected by members based on their financial situation and anticipated health care needs. It ranges from $3,000 to $12,000 for the household, offering flexibility to accommodate various budgets. Putting adequate thought into this step is very important as it impacts the extent of cost-sharing for the year.
Once a household's AHP is met, Medi-Share facilitates sharing eligible medical bills from members’ sharing accounts. This means that after reaching the AHP threshold, members can have their subsequent eligible medical expenses shared, significantly reducing any financial burden. The AHP model encourages responsible health care spending and helps keep Medi-Share's monthly share amounts more manageable compared to the monthly premiums of health insurance plans.
Q: What is the monthly premium?
A: Members do not have a monthly premium. Our members contribute a monthly “share amount” based on a number of factors. Members deposit their monthly share into an individual sharing account and the funds are matched with a fellow member’s account for sharing in eligible bills.
Q: How does the sharing process work?
A: Members do not file claims, nor does the ministry handle claims because we are not an insurance company. Your eligible medical bills are paid with funds received directly from other members. Members present their member ID card to their service provider. The bill is then sent to Medi-Share where we negotiate for discounts available through the Preferred Provider Organization. Here, we review the services provided to determine if the bill is eligible for sharing. After the AHP has been met and if the bill is eligible, it is approved for sharing.
Q: How do I meet my AHP?
A: You will present your card whenever you visit a medical provider. Your provider will submit your medical bills to Medi-Share directly. They are processed and discounted. Then, your provider will bill you for the portion you owe. Once the amount you pay out-of-pocket meets your chosen AHP level, your Eligible Medical Bills will be submitted for sharing.
Q: What is the Health Incentive?
A: Medi-Share actively encourages its members to lead healthy lifestyles so Medi-Share offers health incentives discounts to members who meet certain criteria related to blood pressure and Body Mass Index (BMI). By maintaining these health metrics within recommended ranges, members can qualify for reduced monthly share amounts. This promotes a culture of health and wellness in addition to the financial advantages.
Q: Do I have to worry about in- and out-of-network providers?
A: Medi-Share partners with Private Health Care Systems (PHCS) and First Health, two of the largest provider networks in the United States. These partnerships offer members access to a wide range of medical professionals and facilities.
- Advantages of Staying In-Network: When members choose providers within the Preferred Provider Organization (PPO), they benefit from negotiated rates, which typically results in lower overall medical costs. This can be particularly advantageous when meeting the AHP and reducing out-of-pocket expenses.
- Flexibility and Choice: While members are encouraged to use the PPO network, they can select out-of-network providers. However, choosing in-network providers maximizes access to discounted rates and ensures more predictable health care costs.
Medi-Share’s sharing in medical expenses through the PHCS and First Health Networks provide members with the assurance of quality care and the financial perks of negotiated medical costs, all within a framework that supports and reflects their Christian values.
Q: What do I do when I need to go to the doctor?
A: Members are encouraged to search for a provider within one of our provider networks. Once at the in-network doctor, members are responsible for paying a provider fee. A provider fee is similar to what insurance would call a co-pay. The fee is $35 for office visits and urgent care, and $200 for emergency room visits. The bill is then sent to Medi-Share for processing and discounting, and then submitted for sharing if your annual household portion has been met. If it hasn’t, the balance (what you owe the provider) is applied to your AHP.
For out-of-network visits, the process will be based on the specific provider's needs.
Q: Is there anything else I pay the doctor or hospital when visiting?
A: Not for in-network visits. Even if you know you have not met your AHP, you should have the providers submit the bills to Medi-Share for discounting and eligibility determination. Your provider will then bill you for the balance (which is the discounted amount minus the provider fee).
Partner With Medi-Share, Partner with a Community.
We hope this list of FAQs has helped answer some of the most important questions you have about Medi-Share’s programs and how they support members’ medical needs. We encourage you to read more of our blog posts that serve to answer additional questions and concerns.
As you consider the Medi-Share program for your health care needs, we encourage you to look into the specifics by reading through the Medi-Share Complete Guidelines. This resource will provide the detailed information you need to make an informed decision that aligns with your health care requirements and biblical values.
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