Medi-Share FAQs

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Medi-Share 65+ FAQs

You Have Questions,
We Have Answers.

Medi-Share 65+ Sharing

What may be considered for sharing with Medi-Share 65+?

If Medicare covers a member’s need, then it will be eligible for sharing with Medi-Share 65+.

Does a Medi-Share 65+ Member need to do a pre-eligibility review to see if something will be eligible for sharing?

No, if Medicare covers a member’s need, then it will be eligible for sharing with Medi-Share 65+. Please review Guideline Section IV G for more information.

Are prescriptions eligible with Medi-Share 65+?

No, prescriptions are not eligible for sharing with Medi-Share 65+.  Medi-Share 65+ is meant to assist where Medicare parts A and B are fully utilized (hospitalization and doctor’s visits).

How does Medi-Share 65+ work for Rx if I choose not to have a prescription plan?

If you wish to have prescription coverage, we recommend that you inquire into Medicare Part D (Medicare Prescription Drug Benefit).  Medi-Share 65+ does not replace the Medicare Part D Prescription Drug Benefit nor share in prescription costs. However, we do offer our members significant discounts on prescription medications through Navitus Pharmacy Solutions.

Can I be reimbursed for out-of-pocket expenses that are eligible for sharing with Medi-Share 65+?

Yes, you may submit medical bills for reimbursement with Medi-Share 65+ but must meet these requirements for sharing:
  1. Medicare must have processed the claim and must have issued an Explanation of Benefits (EOB) for the medical event.
  2. The provider bill (HCFA or UB) must be included
  3. The need must be eligible per the Medi-Share 65+ Guidelines, and you must turn in all the required information listed on the HCFA/UB Submission form located in your Member Center under the Forms tab.

Log in to your Member Center at member.medishare.com, click on the Resources tab, select Forms.

ms65formsscreenshot

Scroll down to the Reimbursement section and select Download PDF for the HCFA/UB Submission Form

Does a Member of Medi-Share 65+ qualify for the death benefit?

No, Medicare does not offer any death benefit; therefore, we would not be able to share in a bill that is not already approved by Medicare.  Medi-Share 65+ is a secondary provision and supplemental to Medicare, and only shares expenses that have already been processed by Medicare.

What if I have pre-existing conditions?

  • If you are currently a Medi-Share Member with pre-existing conditions, once you roll over to the Medi-Share 65+ program, any pre-existing limitations no longer apply. Medicare is the primary. Anything eligible on Medicare is eligible for sharing with Medi-Share 65+ if it does not violate our Biblical lifestyle agreement.
  • If you are a new applicant to Medi-Share 65+, pre-existing medical conditions will be eligible for sharing, provided you meet the other requirements for sharing contained in the Guidelines. However, if you join outside of their Medigap Open Enrollment period or without Guaranteed Issue Rights, medical bills for diagnosis or treatment of a Pre-Existing medical condition may not be eligible for a period of six months. The Medigap Open Enrollment period is for six months after an individual starts Medicare Part B.
  • Guaranteed Issue Rights (Medigap protections) are rights an individual has in certain conditions/circumstances when there is no pre-existing limitation applied.
  • In the event you do not meet the criteria above, pre-existing conditions will be eligible for sharing once you have been faithfully sharing for six consecutive months.
  • Pre-existing conditions are defined as any sign, symptom, diagnosis, testing (including labs and/or radiology studies), medication or treatment of a condition that a member has had or experienced in the 6-month period before the start of membership.

Does a Medi-Share 65+ Member need to do a pre-eligibility review to see if something will be eligible for sharing?

No, if Medicare covers the medical bill, then Medi-Share 65+ will share the need unless it does not meet Medi-Share lifestyle requirements.  Please review Guideline Section IV G for more information.

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