Medi-Share is a faith-based medical bill sharing program. While Medi-Share is very clear that they are not insurance, it sure looks like insurance and even “qualifies” as insurance in the eyes of the Affordable Care Act (ACA). Here’s how it lines up with traditional insurance:
How Medi-Share is just like traditional insurance:
- ACA Compliant – Under the ACA (Obamacare) everyone in the US is required to carry minimum health coverage or pay a penalty. Medi-Share meets the requirements just like plans from Blue Cross, Aetna, and others so you won’t have to pay a penalty fee.
- Doctor Network – Medi-Share has a Preferred Provider Organization (PPO) network of doctors. It’s built on MultiPlan’s PHCS network, which is the same company that manages networks for some of the major traditional insurance companies.
- Premiums – Medi-Share calls it your “share amount”, but it’s the monthly payment you have to make to stay on the plan. The only difference is that it's typically significantly less expensive than traditional insurance!
- Deductibles – Called the “Annual Household Portion” or AHP, this is the amount you have to pay out of pocket on your own before your bills are eligible for sharing (or reimbursement).
How Medi-Share is different from traditional insurance:
- Faith-based – Everyone must attest to Christian beliefs and lifestyle, and provide a church reference.
- Sign up anytime – No open enrollment limitations or deadlines.
- Limitations on pre-existing conditions – Medi-Share won’t deny you for a pre-existing condition, but there may be a “phase-in” period before you’ll get full coverage. As an example, if you’re pregnant and then sign up for Medi-Share, it won’t be covered.
- You pay for preventive care – On a traditional plan, your preventative care (annual physicals, kids’ immunizations, etc.) are covered at no cost to you. With Medi-Share, you'll be responsible for paying these costs, and they won't count towards the deductible.
- No coinsurance – Once you meet your deductible or “AHP” on Medi-Share, you "share" everything and pay nothing for things that are covered. The flip side is that you pay the full cost of expenses until you hit the deductible.
- No max-out-of-pocket limit – While Medi-Share covers most things you would expect a regular health plan to, it doesn’t cover mental health, substance abuse counseling, and a few other areas. Remember, there is no coinsurance, so you’re paying nothing for covered treatment after your deductible/AHP. Make sure you’re clear on what Medi-Share covers and doesn’t cover! (here’s more details from Medi-Share)
- No Tax Credits – If you qualify for a Federal Tax Credit (or subsidy) on Healthcare.gov, you can’t apply it to Medi-Share.
- No HSAs – Medi-Share is not eligible for use with Health Savings Accounts (HSAs). Note: you can still keep your HSA and use it if you have one, you just can’t make tax-free contributions to it.
You can find more guidance from Medi-Share here.