Yes, the cost of emergency room visits may be eligible for sharing, under the popular Medi-Share health sharing plan. However, you may have to spend a certain amount of money before your health sharing benefits are covered.
Note that Medi-Share is not insurance, so it does not technically “cover” anything. But it does facilitate sharing of medical needs among members.
Here’s how it works:
Before any medical bills are eligible for cost sharing, you must have reached your out-of-pocket annual household portion. This is the amount you must pay out of your own resources during a given year before cost sharing kicks in.
With Medi-Share, you select that number when you first enroll.
Once you reach that number, Medi-Share only requires you to pay the provider’s fees, up to $35 for an office visit, or $200 for emergency room visits.
Once you’ve made your annual household portion amount, or AHP, all your emergency room visit charges above the $200 out-of-pocket providers’ fee are eligible for sharing. However, restrictions on sharing costs related to pre-existing conditions may apply. See the section below on pre-existing conditions.
How Sharing Works
If you need to visit the ER, you should present your membership ID card, and have the provider send the bill directly to Medi-Share for consideration.
If the incident is eligible for sharing, Medi-Share will work with the provider and negotiate a discounted price. Medi-Share then pays all costs eligible for sharing, minus your AHP.
You’ll receive a separate bill from the provider for the balance: Normally any remaining AHP amounts you need to cover for the year, plus the ER provider fee of $200.
Members are always responsible for paying the provider fee, even after the AHP has been met.
About Medi-Share
With more than 250,000 members, and over $1.7 billion in health care costs shared, Medi-share is one of the biggest and most established health sharing ministry organizations in the country. Originally established in 1992 as a non-profit, Medi-Share is the first accredited national health sharing organization in the country.
They currently enjoy a 98% customer satisfaction rating – more than twice the average customer service rate for the industry.
Medi-Share and Pre-Existing Conditions
Like other health sharing ministry organizations, Medi-Share limits what it will pay for treatment of pre-existing conditions.
Specifically, Medi-Share will only share costs for pre-existing conditions if medical records state that the condition or diagnosis has gone 36 months without signs or symptoms, nor treatment, nor medication, OR you’ve been faithfully sharing expenses with other members for at least 36 consecutive months.
After 36 months, Medi-Share will share bills up to $100,000 per calendar year.
Once you reach 60 consecutive months without treatment or symptoms, or you’ve been faithfully sharing for at least 60 months, Medi-Share will share up to $500.000 per calendar year.
Note: Medi-Share does not treat high blood pressure or cholesterol that is controlled by medication or lifestyle as a pre-existing condition under this provision.
If you have pre-existing conditions, and it was those pre-existing conditions that caused your ER visit, those bills may not be eligible for sharing, depending on when you last received treatment for that condition, and depending on how long you’ve been a Medi-Share member.
Compare Pricing on the Best HealthShare Plans Available
Does Medi-Share Cover Hospitalization?
Hospitalization costs are generally shareable under Medi-Share’s plans, provided you’ve reached your annual household portion (AHP), and the cause of hospitalization doesn’t fall under the pre-existing condition exclusions above.
However, you’ll still be responsible for the provider fee, which is $200 for ER visits, and $35 for other incidents.
Does Medi-Share Cover Surgery?
Surgery costs are generally shareable under Medi-Share’s plans, provided you’ve reached your annual household portion (AHP), and the cause of hospitalization doesn’t fall under the pre-existing condition exclusions above.
This also includes anesthesiology fees, and rehab costs following surgery.
However, you’ll still be responsible for the provider fee, which is $200 for ER visits, and $35 for other incidents.
Also, unlike some other health sharing ministries, Medi-Share does not impose a waiting period for cancer-related surgeries.
Does Medi-Share Cover Cancer Treatment?
Yes, Medi-Share does cover cancer treatment, including radiation, surgery, and chemotherapy – provided the cancer is not listed in medical records as a pre-existing condition.
That means you cannot have shown symptoms or received treatment or medication for your cancer for at least 36 months. See the section above describing Medi-Share’s sharing policy related to pre-existing conditions.
Unlike many other health sharing ministries, Medi-Share does not impose a “waiting period” on sharing expenses related to a new cancer diagnosis – that is, for cancers not documented in any previous medical records.
You’ll have to cover provider fees: Usually $35 per physicians’ visit, and $200 for ER visits.
You’ll also have to cover your annual household portion.
If there are no pre-existing condition restrictions, cancer treatment costs are sharable, and Medi-Share will share them, minus your AHP amount outstanding for the year, plus the provider fees.
Does Medi-Share Cover COVID Hospitalization?
Medi-Share will generally assist you with the cost of a COVID hospitalization, minus your annual household portion. If you go to the ER, you’ll be responsible for a $200 provider fee, in addition to any AHP amount you may have left over going into your hospital visit.
If you’re admitted to the hospital, you should present the entire bill to Medi-Share for sharing. They’ll negotiate the eventual price, and pay any shareable amounts on your behalf.
Does Medi-Share Cover Cataract Surgery?
Medi-Share generally considers cataract Surgery is generally considered a shareable expense. You should present your Medi-Share ID card at the time of treatment.
If you’re a Medicare beneficiary and enrolled in Medi-Share’s “65+” cost sharing plan,the provider will bill Medicare for the costs of the surgery. Once Medicare pays its portion under Medicare Parts a and B, then they’ll bill Medi-Share for amounts left over.
Medi-Share will then pay any costs eligible for sharing, minus any annual household portion (AHP) you still have to cover.
Medi-Share members are always responsible for paying the provider fee of $35.
For Medi-Share’s other plans, you should still have the provider send the whole bill to Medi-Share for consideration. Medi-Share will pay any sharable amounts, minus any annual household portion (AHP) you still have left over for the year.
Note: If the cataracts are a pre-existing condition, limitations may apply – especially within the first 36 months of membership.
Does Medi-Share Cover Weight Loss Surgery?
Yes, Medi-Share generally considers medically-necessary bariatric and/or liposuction and similar surgeries to be sharable medical expenses, though subject to some pre-existing condition restrictions.
Elective weight loss surgery will not qualify as shareable with Medi-Share. Only medically-necessary surgery.
You’ll still be responsible for your annual household portion (AHP), and a $35 provider fee.
As with the other conditions listed above, you should ask the provider to send the entire bill to Medi-Share for consideration. Medi-Share will make sure the bill is shareable under the pre-existing condition terms of the health sharing agreement. They will then subtract the provider fee and any annual household portion amounts you still have for the year.
Sign Up Now for Health Sharing!
Health sharing is a proven way for Americans to save up to 50% compared to unsubsidized traditional health insurance premiums. It’s particularly effective for people in good health who don’t qualify for a significant subsidy under the Affordable Care Act.
Medi-Share is a great money-saving option. But it’s just one of many possible health sharing organizations.
To learn more about how health sharing may benefit you, or to find out how to save money, improve your protection against unexpected medical costs, or both, click here and make an appointment with a Personal Benefits Manager today!
The process is very easy, simple, and low-stress. And our services are always free: There’s no charge to you whatsoever!
You can also Apply Online if you are ready to sign up.
Here are some additional blogs: Does Medi-Share Cover Maternity Expenses?
