What Does Medi-Share NOT Cover?
All health insurance plans, and all health sharing plans, including Medi-Share, have certain exclusions. These are medical services or items that the plan will not pay or share costs for.
This article takes a close look at one of the largest, oldest, and most established and popular health sharing plans on the market today: Medi-Share.
A Note on Terminology
It’s important not to get health sharing confused with traditional health insurance.
They are not the same thing, and industry professionals are careful to reinforce the distinction by using different terms for similar concepts. Specifically, in health sharing, we do not say that a service is “covered.” Instead, we say that these costs are “shareable” or “not shareable under the plan, or that these services are included or not included.
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About Medi-Share
Medi-Share is a prominent healthcare sharing ministry operated by Christian Care Ministry, Inc. (CCM), a non-profit organization.
It offers an alternative to traditional health insurance by allowing members to share medical expenses in a community that adheres to Christian values. Medi-Share provides different program options tailored to meet the varying needs and budgets of its members, primarily through two plan tiers: Medi-Share Complete and Medi-Share Value.
How Medi-Share Works
Medi-Share is based on the Biblical principle of mutual burden sharing, according to the practices of early Christians described in the Book of Acts.
This program is not traditional health insurance; instead, it functions as a cooperative, where members contribute monthly “shares” that are used to help pay the eligible medical bills of other members. These funds can be used by any member to payfor paying their medical bills.
To receive cost sharing benefits, you must first pay a certain amount out of pocket. This amount is your annual household portion, or AHP, and it functions similarly to a health insurance deductible.
The Co-Share Option
With some plan tiers, members can select a co-share option, paying an additional 30% of total medical bills until a maximum is met.
People in good health who don’t expect to need much care may choose to do this in order to have a lower monthly contribution requirement, betting that they won’t need care during the plan year.
So What Does Medi-Share NOT Cover?
Potential and current members should clearly understand that some medical costs are not shareable. You may have to pay out-of-pocket, use a health savings account to pay with tax-free dollars, or line up additional coverage, such as a long-term care insurance or critical illness insurance policy.
Here is an abbreviated list of costs not eligible for sharing with Medi-Share plans:
1. Reproductive Health Services
- Birth Control – All forms of contraception are not covered.
- Infertility Treatments – Any procedure or testing related to infertility, including IVF or other assisted reproduction technologies, is excluded.
- Sterilization Procedures – Procedures such as vasectomies or tubal ligations are not covered.
2. Alternative Treatments
- Reflexology, Reiki, and Acupuncture
- Vitamins/Supplements without a diagnosis of a specific deficiency
- Acupuncture
- Services from unapproved providers
- Treatments regarded as experimental or investigational
- Integrative medicine
- Functional medicine
- Regenerative medicine
3. Non-Prescription Drugs and Supplements
- Over-the-Counter Medications – Any drug that does not require a prescription is not shareable.
- Vitamins and Mineral Supplements – All forms of dietary supplements are excluded.
- Health Foods – Any special dietary foods, even if recommended for health reasons, are not shareable.
4. Vision, Dental, and Hearing Care
- Hearing Aids – Full costs for hearing aids are out-of-pocket.
- Vision Care – Routine eye exams and corrective lenses are not included. However, emergency care for eye injuries or the cost to treat diagnosed diseases of the eye may be shareable.. .
- Dental Checkups – General dental care, including cleanings, fillings, or orthodontics, is not included.
5. Elective and Cosmetic Procedures
- Cosmetic Surgery – Any surgery performed for aesthetic reasons is not eligible for sharing.
- Elective Medical Procedures – Procedures not medically necessary or that could be postponed without a significant change in outcome are excluded.
6. Mental Health and Counseling Services
- Mental Health Care – Services including psychiatric treatment, counseling, and psychotherapy are not shareable. However, short-term counseling services are available by phone at no cost through Medi-Share’s telemental health service.
- Behavioral Therapies and Occupational Health Sessions – costs are not shareable.
7. Preventative Procedures and Vaccinations
- Screening Procedures – Colonoscopies, prostate exams, and mammograms are not shareable under Medi-Share. These are important screenings, but you should plan to pay for them with your own resources.
- Vaccinations and Immunizations – All costs related to immunizations are excluded.
In addition to the exclusions previously discussed, it’s important to address how Medi-Share handles other significant healthcare aspects such as pre-existing conditions, surgeries, diabetes management, and prescription medications, explained below:
Pre-existing Conditions
Medi-Share has specific guidelines regarding pre-existing conditions, which are defined as any condition for which medical advice, diagnosis, care, or treatment was recommended or received during the five years prior to one’s membership start date.
Here’s how Medi-Share handles these:
Limited Eligibility for Sharing
Costs related to pre-existing conditions are generally not eligible for sharing for the first 36 months of membership.
After this period, the eligibility for sharing may increase, provided the member has not had symptoms, treatment, or medications for that condition during the 36-month period.
Gradual Increase in Sharing
If the condition has not manifested during these 36 months, members might become eligible for sharing a limited amount in the fourth year and may receive full sharing eligibility in the fifth year, subject to the program’s guidelines.
Surgeries
All surgeries must be reviewed and approved as eligible by Medi-Share before the costs can be shared.
Medically necessary surgery is typically eligible for sharing, subject to a 90-day waiting period for new members. The 90-day waiting period is waived if the surgery is to treat an accidental injury that could not have been foreseen in advance.
Costs for elective surgeries that are not medically necessary are generally not shareable.
This includes surgeries like cosmetic procedures or any surgical operation that can be postponed without a significant change in outcome.
Diabetes Management
Managing chronic conditions such as diabetes involves continuous care, which can include regular check-ups, blood sugar monitoring supplies, and medications.
Here’s how Medi-Share handles diabetes:
Limited Coverage for Supplies and Treatment
Medi-Share does not generally cover the cost of ongoing treatments or routine diabetic supplies like insulin or blood glucose test strips. However, diabetic patients can now obtain a month’s supply of many insulin products for just $35.
Education and Self-Management
While the direct costs of managing diabetes might not be covered, Medi-Share often emphasizes the importance of lifestyle changes and self-management, which can be supported through community advice and resources.
Prescription Medication
Medi-Share typically shares eligible costs for prescription medications that are limited to a short duration, generally up to six months for the same or related diagnosis.
Costs for long-term prescriptions, such as those used to manage chronic conditions, are generally not eligible for sharing.
Members may need to seek alternative resources or programs to help cover these costs.
Value vs. Complete Plan Tiers
Medi-Share offers two separate plans: “Value” and “Complete.”
Value is designed to be a very limited benefit plan, but offered at a low monthly cost. It does not share costs for most major or catastrophic healthcare events.
The Complete tier, on the other hand, is designed to provide more comprehensive benefits, and to provide massive cost sharing power, even for significant and catastrophic medical events.
“Value” and “Complete” Tiers at a Glance
| Medical Service | “Value” Tier | “Complete” Tier |
|---|---|---|
| Maternity | ❌ | ✔️ |
| Emergency Room Visit | ❌ | ✔️ |
| Hospitalization | ❌ | ✔️ |
| Surgery | ❌ | ✔️ |
| Pre-existing conditions | Waiting period applies | Waiting period applies |
| Elective cosmetic surgery | ❌ | ❌ |
| Telehealth services | ✔️ | ✔️ |
| Discount plan access for prescription drugs, dental, and vision care | ✔️ | ✔️ |
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What to Do Now
Medi-Share is a proven health share organization with hundreds of thousands of actively sharing members. Its sharing benefits are broad, but there are a few limitations.
If after weighing the pros and cons, you believe Medi-Share might be a good plan for you, you can click here and get a quote, so you know exactly what your monthly expenses will be.
There’s no “open enrollment period.” You can enroll in Medi-Share or any other health sharing plan at any time during the year.
If you need help at any point choosing a plan or choosing your AHP or other plan options, you can click here to contact a Personal Benefits Manager for a complimentary consultation.
Or if you are comfortable, you can self-enroll online at the link in just minutes.
For Further Reading: The History of Health Sharing | Myths and Misconceptions about Health Sharing Plans | Best Healthshare Plans Comparison Guide 2024
