For Providers:
Medi-Share 65+/Senior Assist

Medi-Share 65+ Guidelines   Senior Assist Guidelines

Determining Eligibility 

The member-voted Medi-Share 65+ or Senior Assist Guidelines explain the program requirements and how Christian Care Ministry facilitates medical bill sharing

• Because Medi-Share 65+ Members are enrolled in Medicare Parts A and B, sharing of Eligible Medical Bills will be secondary to Medicare. Once the Annual Household Portion (similar to a deductible) has been met, the portion of Eligible Medical Bills that Medicare has not paid (the difference between the Medicare allowable amount and the amount paid) will be approved for sharing, subject to the provisions of these Guidelines.
  • The AHP is the dollar amount a Member Household agrees to pay toward Eligible Medical Bills before any eligible bills may be shared among the Members. Even if the AHP is not yet met, providers should still submit all medical bills to Medi-Share for processing. This ensures all Eligible Medical Bills will be applied toward the AHP and allows for the possibility of discounts.
• Medical bills will be eligible for sharing in those instances where Medicare Parts A and B have approved treatment, but do not pay all or part of the treatment, except for those conditions or services listed below in the member guidelines, Sections IV. G. & H. This includes copayments, coinsurance, deductibles, and "excess charges or fees", (as defined by Medicare). It is the Member’s responsibility to know what conditions and services are covered by Medicare.
• A condition or service will not be eligible for sharing if:
  • the medical bills related to that condition or service have not been submitted to or processed by Medicare
  • the charges have already been paid by Medicare
  • the services are not approved by Medicare Part A or B, except for urgent care when out of the country
• For a full list of other treatments, medical conditions, procedures, and services that are ineligible for sharing, see Section IV.I. of the Guidelines.

How bills are processed and shared

Medi-Share 65+ and Senior Assist are not Medicare Advantage plans. Medi-Share 65+ and Senior Assist are secondary to Medicare.

• If your patient is a Medi-Share 65+ or Senior Assist Member, submit the bill to Medicare first.
• When an EOB is received, forward the original bill and EOB to Medi-Share using EDI number 59355. Providers can check Member Eligibility and Bill Status using our 24/7 automated phone system at (800) 264-2562 and press 3 for providers.
• Medi-Share will provide a statement with details of processing to both the Provider and the Member.