Health Insurance

How Does Medi-Share Work? A Complete Guide

Alyssa Orcuilo22 Mar 2021

Quick Digest:

  • Medi-Share is a non-profit, Christian-based medical expense-sharing program. Members share in each other’s health expenses.
  • Medi-Share covers services such as doctor visits, free telehealth access and, if you need to see a doctor in person, choose a physician that is a member of PHCS, Medi-Share’s preferred primary provider organization (PPO).
  • The cost of Medi-Share depends on your Annual Household Portion, state, marital status, your family size, and your age.

What is Medi-Share?

Medi-Share is a non-profit, Christian-based medical expense-sharing program. Members share in each other’s health expenses.

Every month, members place their monthly share (similar to a premium) into one large sum (technically a credit union account,) and those with expenses use that money to pay their bills. This is not insurance. However, for some, it is the ideal replacement for health insurance.

How does Medi-Share work?

The following factors are accounted for when using Medi-Share:

Provider Fee

A provider fee is comparable to a co-pay in traditional health insurance. 

Preventative or routine wellness appointments–such as annual physicals or dental and vision care are not covered by Medi-Share, so you need to be prepared for those expenses throughout the year.

Annual Household Portion

Members of Medi-Share choose an annual household portion (AHP), this is comparable to an annual deductible. 

The size of your portion would determine how much you'll have to pay out-of-pocket for covered medical expenses before the health share kicks in. For the AHP and monthly share, you are able to determine this yourself.

The size of the AHP you choose will determine your monthly share. The higher AHP you choose, the lower your monthly share. 

Preferred Provider Organization (PPO)

Medi-Share is partnered with a preferred provider organization known as PHCS, and members are encouraged to seek care from providers within the PHCS network. However, you can choose treatment with an out-of-network doctor. However, if you do so, a penalty may be applied for going out of network.

Health Incentive

Families may take up to 20% off their monthly share amount by qualifying for the health incentive. 

To qualify for the health incentive, all adult Medi-Share members in the household must meet specific health criteria. This includes blood pressure and BMI, and weight/waist measurement.

Doctor Visits

When receiving medical care such as a doctor visit, you provide your Medi-Share card in order to pay your provider fee, and the provider will then bill Medi-Share. 

The medical bill will be processed and discounted, and then your doctor will bill you for the amount you owe. Once the amount you pay meets your AHP for the year, your eligible medical bills will be approved for sharing.

How much does Medi-Share cost?

The cost of Medi-Share depends on your Annual Household Portion, state, marital status, your family size, and your age. You can check how much Medi-Share will cost you here.

For a 30-year-old person who is married and living in Georgia, the monthly share amount may range between $126- $291. 

To begin, Medi-Share has up-front costs: It costs $50 to apply, and you’ll pay a $120 one-time membership fee with your first monthly payment. The member would also pay another one-time fee of $2 to set up the “sharing account.”

As an example, we calculated costs for a 33-year-old man in Arkansas seeking membership for himself. Share amounts change annually, based on the oldest member of the household.

If he chose a $12,000 annual household portion, the amount in medical bills the member must pay out of pocket before being eligible for sharing — his standard monthly share would then be $110.

And, if he met certain health and fitness requirements, he could qualify for a Healthy Monthly Share, which would lower his cost even further.

As a Medi-Share member, you would visit a Medi-Share covered provider and pay $35 for doctor visits and hospitalizations, and $200 for emergency room visits. Telemedicine visits do not cost anything.

The rest of the bills would be submitted to Private Healthcare Systems (PHCS) for additional payment consideration.

Christian Care Ministry, which operates Medi-Share, is a 501(c)3, but your payments aren’t tax-deductible.

What does Medi-Share cover?

Here a few of the medical expenses that are eligible for sharing with Medi-share.

Doctors visits

  • Medi-share offers free telehealth access at no cost.
  • If you need to see a doctor in person, choose a physician that is a member of PHCS, Medi-Share’s preferred primary provider organization (PPO). You’ll pay a $35 provider fee that does not count towards your AHP. And you’ll also eligible for in-network discounts.

Prescriptions

  • Prescriptions: Members get up to 6 months of FDA-approved prescription drugs per eligible treatment

Emergencies & hospital visits

  • Members must pay a $200 provider fee for an emergency visit, this does not count towards your AHP.
  • Hospitalizations: Members must pay a $35 provider fee per hospital visit that does not count towards your AHP.

Family planning

  • Adoption costs: For members who meet certain criteria, up to two adoption events can be shared per household.
  • Sharing is limited to $125,000 for any single pregnancy event.
  • To be eligible, your AHP must be $3,000 or higher and you must have faithfully shared from the month of conception through the month of delivery.
  • Well-child care: Sharing for routine well-child care is eligible until the child reaches the age of six.

Disabilities

  • Disability expenses: Through their Manna program, Medi-Share is able to replace up to 80% of lost income for up to a year for Manna members.

Senior benefits

  • For Seniors: Seniors who have Medicare Parts A and B can enjoy the benefits of healthcare sharing of medical bills that Medicare doesn’t pay, including copayments, deductibles, hospitalization, and out-of-country urgent care.
  • Up to $5,000 of funeral expenses are eligible for sharing

What does Medi-Share not cover?

Medi-Share does not cover the following:

  • Dental, vision, and hearing- not eligible for sharing but can get exclusive discounts.
  • Routine and preventive care- this includes physicals, immunizations, vaccines, mammograms, lab studies, and colonoscopies
  • Fertility/infertility care: Including birth control, infertility testing, and sterilization
  • Alternative care: Including vitamins, acupuncture, and experimental treatments
  • Counseling: Including dietary counseling, diabetic counseling, lactation counseling, or genetic counseling
  • Behavioral or mental care
  • Cosmetic procedures
  • Non-prescription drugs
  • Hearing aids

Pros & Cons of Medi-Share

Pros

  • Healthcare sharing ministries are cost-effective because each family contributes a monthly specific dollar amount they choose based on program options.
  • Membership cannot be terminated for developing a medical condition.
  • Healthcare sharing ministries do not impose annual or lifetime limits.
  • Qualified adoption and funeral expenses can be covered.
  • Membership is not affected by the state of residence or employment status.
  • Healthcare sharing ministries can be audited annually by an independent accounting firm to ensure financial stability.
  • Healthcare sharing ministries provide a viable option for those who are looking for an alternative to shopping on the ACA Marketplace.

Cons

  • Many states do not consider healthcare sharing insurance, so consumers have little or no legal protection if a claim is not paid, coverage is denied, or the ministry goes bankrupt.
  • There are certain restrictions and payment caps relating to pre-existing conditions.
  • Certain pre-existing conditions, such as diabetes, may require a member to pay an additional monthly amount along with standard membership fees.
  • Because healthcare sharing ministries are faith-based organizations, they can have specific rules associated with membership. For example, members might be required to attend church regularly, abstain from tobacco and illegal drugs, and attest to a specific statement of faith.
  • Healthcare sharing ministries cannot be used with Health Savings Accounts (HSAs) or reimbursement plans, such as the qualified small employer HRA (QSEHRA).

Real Reviews From Medi-Share Users

"We use them, and they are always great to work with. Never any problems. I love how whenever you call them at the end they ask you for prayer requests, and actually pray for you right then. Also, they give a discount for being in healthy weight ranges, which has been a nice motivation for me to stay in shape." - Katayan via Reddit

"I recently went through the process of filing a "need" with Samaritan Ministries International. My wife injured her hand, and we had a large hospital bill. How the process ordinarily works is every month instead of paying a premium to a health insurance company, I am asked to give a gift to another family in the SMI member network in order to reimburse them for their published medical expenses.

Recently, I had a need published, and several members sent me their monetary gifts, letters of support, and prayers. The difference between this and traditional insurance is night and day. My family actually looks forward to paying our monthly share because we know it is directly going towards a Christian family in need. It's important to understand that the members are not "legally" required to send you their gift, this makes us more reliant on God's provision and the prayers of His people." - Bishop of Reddit via Reddit

“I've been with Samaritan for 6 years. We have had two babies and multiple ER visits. I cannot speak highly enough of the ministry. The only downsides we've experienced are that we get no help with regular doctor visits and prescriptions, and hospitals don't understand the system and treat you like you're a deadbeat.” - Superlewis via Reddit

Alternatives to Medi-Share

Mira

Mira can be used as a health insurance alternative or an add-on to insurance. For just $45/mo, members get access to hundreds of urgent care clinics across the country, low-cost lab testing, low-co-pays, and discounted prescriptions.

Mira is not insurance, however, the healthcare benefits that are offered can provide exceptional coverage when uninured. 

Healthcare Marketplace Insurance

Marketplace plans can be purchased from the health insurance marketplace during open enrollment season each year, usually in November. 

Options include gold, silver, and bronze plans. Your choice will largely depend on your budget, general health, and how much coverage you need.  

Medicaid or Medicare

Medicaid in the United States is a federal and state program that helps with healthcare costs for eligible individuals with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and personal care services.

Medicare is the federal health insurance program for individuals 65 or older. Some younger people with disabilities may qualify as well. 

Is Medi-Share right for me?

Medi-Share is not insurance, however, it could be a great option for you if you have found traditional health insurance plans are not affordable for you. If you already qualify for subsidized health insurance, you may be able to afford your healthcare. 

If you’ve been paying for unsubsidized health insurance, Medi-Share could help you save money. 

Sources:

https://ptmoney.com/medishare-review/

https://www.peoplekeep.com/blog/the-pros-and-cons-of-health-care-sharing-ministries

https://www.takecommandhealth.com/blog/medi-share-review-my-familys-experience-this-year

https://mychristiancare.org/medi-share/what-is-medishare/how-medi-share-works/find-a-provider/

Millennials are leaving health insurance carriers to join the new "CostCo" of healthcare.

"My insurance premiums went up 30% this year. My husband and I switched to Mira and never looked back," said Danna - Brooklyn, NYC