Medi-Share

The alternatives to traditional health insurance you need to know about

by Ali

Let's go over a some cost-friendly options to consider when signing up for a health insurance plan. These differ from major medical plans, but can be smart choices and are worth a look. Here's what you need to know!

What is Medi-Share and how does it work?

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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 living a "Christian lifestyle". The requirements here aren't as stressful as you might think, but you will want to make sure Medi-Share is consistent with your values and beliefts. Medi-Share used to require references from churches to prove membership, but that is no longer the case.
  • 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. It does not cover pre-existing conditions that have had symptoms or treatment within the past 5 years. Medi-Share also won’t cover pregnancy if you are pregnant during enrollment.
  • 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! 
  • 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.

 

  What is Pivot and how does it work?

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Pivot provides short term medical insurance solutions until a qualified major medical health plan is chosen, helping reduce your financial risk. Pivot plans are renewable 90 day plans which in most states can be automatically renewed 4 times without additional medical screening to provide up to 12 months of continuous coverage. 

Short-term plans are very affordable but have certain restrictions and exclusions you should be aware of.

How Pivot is different than traditional insurance:

  • No networks any doctor or facility can be used
  • Not ACA Compliant does not meet “essential health benefits” standards of the Affordable Care Act and therefore individuals are not exempt from tax penalties.
  • Does not cover pre-existing conditions that have had symptoms or treatment within the past 5 years
  • Pregnancy is never covered unless there are complications
  • Preventative care and immunizations are not covered
  • Sign up anytime you do not need to wait for open enrollment or a qualifying special enrollment period to enroll in a short term Pivot plan. 
  • Specific duration rules regarding back-to-back plans apply in a few states. 

    Arizona

    After 180 days of coverage, individual must wait 63 days from termination of last short term policy before re-enrolling

    Michigan

    Limited to 185 days of coverage in a 365 day period.

    Wisconsin

    After 18 months of coverage, individual must wait 63 days from termination of last short term policy before re-enrolling.

How Pivot is just like traditional insurance:

  • Prescription Coverage (select plans) separate $500 prescription drug deductible, plus generic and brand prescription copay options
  • Copays (select plans) $30 primary physician copay, $60 Urgent Care and specialty physician copay benefits
  • Maximum out-of-pocket from $3,000 to $10,000 per person, per coverage period on select plans
  • Child-only coverage available
  • Ovarian cancer screen and one annual pap smear per year, per covered female age 18 and over
  • Coinsurance - the percentage of covered expenses you are responsible for after your deductible is met.
    • Pivot Health plans have 20% or 30% coinsurance options. For example, once you meet your deductible, your insurance pays 80% and you pay 20% of your covered medical bills up to your out-of-pocket limit. 

Short term plans aren’t for everyone but they can be a good option for the following:

  • Individuals and families who missed open enrollment period
  • Adult children losing coverage from parent’s plan
  • Waiting for employer benefits to start
  • Unemployed temporarily
  • Recent graduates who do not have coverage under parent’s plan
  • Uninsured due to life circumstances
  • Not eligible to apply for coverage on the marketplace during Special Enrollment
  • Employees without group insurance coverage

UHOne

UnitedHealthcare's Short Term Plans offer a lot of flexibility to those looking for a short term solution. First consumers choose the term length - from 30 day minimum up to the state maximum. Then they choose a deductible and coinsurance amount that fits the budget. Note that it's only available in FL, GA, NC, PA, TN, TX, and WI and it will be 364 days in those states.

Enrollees have access to United Health Care’s large network of doctors and hospitals. With United Health One plans you must use a network doctor or hospital in order for insurance to pay for eligible expenses, only emergencies are allowed out of network.

UHOne is different from traditional insurance in several ways:

  • Does not meet standards of Minimum Essential Coverage. This plan does not meet the standards of coverage required to be participate in QSEHRA.
  • Excludes preexisting conditions
  • Pregnancy not covered except for complications
  • Plans do not last the entire year
  • Enroll anytime- We recommend signing up for a duration that will allow you to utilize the next open enrollment period to sign up for a major medical plan (Nov 1- Dec 15 each year for plan starting Jan 1).

How UH One is just like traditional insurance:

  • Prescription Coverage- pay for your prescriptions at the pharmacy and then submit a claim to Unite Health One (max benefit $3,000)
  • Copays& Coinsurance- $75 Urgent Care; office visits vary by plan from $50 copay to coinsurance after deductible.
  • Maximum out-of-pocketfrom $2,000 to $10,000 per person (varies by plan)

Good for those:

  • Waiting for the next open enrollment to begin
  • Waiting for new coverage to start
  • Are between jobs
  • Retired early

Next Steps

Take Command Health is here to help you make an informed choice about what's best for you and your family. If the prices for plans are looking a little scary to you, make sure to consider these alternatives to traditional health insurance. Chat with us on our website and we would be happy to answer any questions!

About Take Command Health

Take Command Health launched three years ago with the goal of bringing awareness, advocacy, and transparency to the confusing world of health insurance for small businesses and individuals. Take Command Health is at the forefront of this issue, a recognized leader in QSEHRA administrationand small business tax strategy, with customers in every state. It operates in Arizona, California, Florida, Georgia, Indiana, Michigan, North Carolina, Pennsylvania, Texas, Tennessee, and Wisconsin for individual insurance and offers small business HRA administration nationwide.

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Hi, I'm Ali! I wrote this blog because I love helping people decode confusing insurance jargon and understand the fine print. I'm a licensed health insurance professional and specialize in simplifying health insurance for individuals and small businesses. My QSEHRA articles have been featured regularly on Accounting Today, Accounting Web, HRWeb, and other industry publications. I'm also a member of Take Command Health's client success team and a full-time mom. Learn more about me and connect with me on our about us page. Thanks!