In a world where healthcare costs are perpetually rising, many seek alternatives to traditional health insurance. One such alternative that has garnered attention in recent years is Medi-Share. But what is Medishare health insurance, and how does it work? Is it a viable option for you and your family’s healthcare needs? In this blog, we’re diving deep into the world of Medi-Share to demystify this unique approach to healthcare coverage.
What is Medishare Health Insurance?
Medi-Share is not health insurance in the conventional sense. Instead, it’s a health care sharing program. It means that members contribute to a shared pool of funds, and then the pool covers the medical expenses of those in need. It follows a model highlighting community and mutual support reminiscent of traditional mutual aid societies.
How Does Medi-Share Work?
Medi-Share is a healthcare cost-sharing program that provides an alternative to traditional health insurance. Christian healthcare-sharing ministries often associate it, intending it for individuals and families with similar religious beliefs. Here’s how Medi-Share typically works:
Monthly Shares
Instead of paying premiums, as with traditional insurance, Medi-Share participants pay a monthly “share” amount. A total is determined depending on the number of people in the home, their ages, and the Annual Home Portion (AHP) that they’ve selected. The AHP is similar to a deductible in traditional insurance.
Eligible Bills
When members have a medical need, they are responsible for their bills up to the amount of their AHP. Once they exceed this amount, they can submit their accounts to Medi-Share for sharing among members.
Direct Sharing
The shared funds are then used to pay eligible medical bills directly. It’s a process that operates outside the insurance model but provides a structure for individuals to get assistance with their medical expenses.
Participation and Accountability
As a member, you are expected to participate actively in the program, adhere to the guidelines, and promptly fulfill your financial and administrative responsibilities.
Pros and Cons of Medi-Share
As a health care sharing ministry, Medi-Share presents advantages and drawbacks compared to traditional health insurance. Here are the pros and cons to consider:
Pros of Medi-Share
Potentially Lower Costs
For some individuals and families, the monthly shares can be lower than traditional health insurance premiums, making it a more affordable option.
Community and Mutual Support
Members contribute to a communal pool and can see whose medical expenses they contribute to, fostering a sense of community and mutual aid.
Faith-Based Alignment
For Christians, Medi-Share offers an opportunity to be part of a program that aligns with their religious beliefs and values.
Flexibility in Provider Choice
Although there’s a preferred provider organization (PPO) network, members have the flexibility to see out-of-network providers.
Exemption from Past ACA Mandate
Members of Medi-Share were exempt from the individual mandate under the ACA (Affordable Care Act), which required people to obtain health insurance or pay a penalty.
The penalty for not having insurance has subsequently been decreased to zero dollars on the federal level.
No Share Increases Based on Health History
Unlike traditional insurance, which might increase premiums based on one’s health conditions, Medi-Share determines monthly share amounts based on age and household size, not health history.
Cons of Medi-Share
Not Traditional Insurance
Medi-Share is not insurance, meaning there’s no legal obligation to cover medical bills. This can be a risk if the shared pool cannot cover expenses.
Coverage Limitations
Specific procedures, especially those not aligning with Christian principles, must be covered. This includes some elective procedures or treatments related to behaviors deemed inappropriate by the program.
Pre-existing Condition Limitations
Pre-existing conditions might have waiting periods or specific sharing restrictions, potentially leaving members with significant out-of-pocket expenses.
Lifestyle and Belief Requirements
Members must adhere to specific lifestyle guidelines and agree to a statement of faith. This can be limiting for those who need to align with these principles.
Possible Out-of-Pocket Expenses
Seeing out-of-network providers or incurring medical bills outside the Medi-Share guidelines might result in higher out-of-pocket costs.
How Does the Claims Process Work with Medi-Share?
The claims process is a structured series of steps to ensure the sharing of medical expenses among members. It typically begins with pre-notification, where members inform the ministry about non-emergency procedures in advance.
After receiving medical care, members must submit their bills and related documentation to the ministry for evaluation. During this evaluation, the ministry assesses the eligibility of the expenses based on its guidelines. Once approved, members share the eligible amount, and the funds are often directly paid to healthcare providers.
Members must adhere to the ministry’s guidelines and instructions throughout this process to ensure the smooth processing of their claims and the timely sharing of medical expenses.
What Happens if Medical Bills Exceed the Available Shared Funds?
Medi-Share operates on the voluntary financial contributions of its members. It could pose a challenge if medical bills are within the available shared funds. However, there are a few things to note:
Historical Record
Historically, Medi-Share has been able to share 100% of eligible medical bills among its members. They have established processes and guidelines to manage the sharing of accounts effectively.
Adjustments
If there were ever a shortfall in shared funds, Medi-Share might adjust how bills are shared. This could mean delaying sharing certain accounts or implementing other measures to ensure the program remains functional.
No Legal Guarantee
It’s important to understand that because Medi-Share is not traditional health insurance, there is no legal guarantee that claims (or medical bills) will be paid. Members participate with the understanding that they voluntarily share medical expenses with other members based on mutual trust and shared beliefs.
Reserve Fund
Medi-Share may maintain a reserve fund to help handle larger-than-expected medical expenses or shortfalls, providing an additional layer of security.
Prayer and Additional Giving
In times of higher medical expenses or shortfalls, the community might be called upon to pray and consider giving more than their standard monthly share to help cover needs.
Conclusion
Medi-Share offers a distinct approach to healthcare coverage, emphasizing community and shared values. It can provide potential cost savings, flexibility in provider choice, and alignment with faith-based beliefs. Whether Medi-Share is right for you depends on your unique circumstances and values. It’s a solution that fosters a sense of togetherness and shared responsibility, making it a compelling alternative to traditional health insurance for those who find it aligns with their priorities and beliefs.
