At Take Command Health, we recently started offering Medi-Share as a health insurance option on our website. For the first time, you can search for your doctors and compare your estimated out of pocket costs on Medi-Share side by side traditional carriers like Blue Cross, Aetna, Humana, and others.
We get a lot of questions about Medi-Share though (especially when people see how inexpensive it is!), and wanted to put together this review on how Medi-Share compares to traditional plans. It's definitely a great option for some, and may not be a fit for others.
Full disclosure: This is our first year to offer Medi-Share. Although I am planning trying it with my family in 2016, we nor our existing clients have any direct experience with it yet. If you have friends or family that use it, make sure to ask them too! We'll share more about our experience later next year.
UPDATE: I did use Medi-Share in 2016 with my family. It was great but there is a little bit of a learning curve. Learn about our personal experience here.
The basics: What is Medi-Share?
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 a quick video from Medi-Share:
What makes Medi-Share so much more affordable?
Medi-Share is essentially doing what insurance companies used to do in terms of restricting their risk pool. They don't take anyone who smokes, uses illicit drugs, etc. Everyone must testify to their faith in Jesus Christ and provide a church reference that they are actively living a Christian lifestyle. They won't deny you if you have a pre-existing condition, but you have to join their "health partners" group which costs a little more each month ($80). This makes their underwriting so much cheaper and efficient compared to insurance companies--who have to take anyone and everyone at the same price. While Christians are not necessarily healthier, turns out they are a lot less "risky", and therefore less expensive to insure.
How is Medi-Share the same as 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. Using "in network" doctors is important because you'll get better rates if you see doctors that Medi-Share has contracted with. Medi-Share is one of the last remaining PPO networks on the individual market in Texas and although it's not huge it's legit! It's built on MultiPlan's PHCS network, which is the same company that manages networks for some of the major traditional insurance companies. At TakeCommandHealth.com, we've loaded Medi-Share's doctors into our system so you can see if yours is "in network" or not.
- Premiums - Medi-Share calls it your "share amount", but it's the monthly payment you have to make to stay on the plan.
- Copays - When you see a doctor or need services, Medi-Share has copays just like traditional plans. They're actually pretty good! ($35 doctor visits for primary or specialists, $125 emergency room, etc)
- 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 is Medi-Share different from traditional insurance?
- 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 a member of Medi-Share before you get pregnant, the delivery will be covered. If you're pregnant and then sign up for Medi-Share, it won't be covered. You can find more guidance from Medi-Share here.
- You pay for preventive care - On a traditional plan, your annual physicals, kids' immunizations, and anything else considered "preventive" are covered at no additional cost to you (you're paying those high premiums for something!). With Medi-Share, your typical office copays ($35) will apply and you'll have to pay out of pocket for immunizations (approximately $20-120 each).
- No coinsurance - On a traditional plan, after you meet your deductible, you typically have to pay a percentage (known as coinsurance) until you hit your max out of pocket limit. Once you meet your deductible or "AHP" on Medi-Share, you share everything and pay nothing for things that are covered. This is very similar to a Bronze or Catastrophic plan from a traditional carrier.
- No max-out-of-pocket limit - This sounds scary, but remember there is no coinsurance, so you're paying nothing for covered treatment after your deductible/AHP. While Medi-Share covers most things you would expect a regular health plan to, it doesn't cover mental health or substance abuse counseling. If you need a lot of those services, you could blow past your AHP and not get any sharing benefits. Make sure you're clear on what Medi-Share covers and doesn't cover!
- 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). This is a big bummer for some people and something Medi-Share is actively petitioning for. Note: you can still keep your HSA and use it if you have one, you just can't make tax-free contributions to it.
So what do we think?
Medi-Share can be a great option for many believers. The premiums are much more affordable and the PPO network is the most flexible network you'll find on the individual insurance market. If you or a loved one need care that Medi-Share doesn't cover (like substance abuse counseling) you could rack up some big bills fast, so understanding the fine print is important.
We've worked hard to incorporate Medi-Share into our website so you can easily compare it to your other options on and off the exchange from traditional carriers like Blue Cross, Aetna, Humana, and others. Use our guide at the link below to see if your doctors participate in Medi-Share and estimate your out of pocket costs!