By Final 12 months, I wrote a evaluation of Medi-Share from my perspective as an insurance coverage skilled. This 12 months, I need to share my expertise as a Medi-Share member.
With main medical premiums rising and physician networks shrinking, I discovered myself in the identical state of affairs as lots of my purchasers: how do I afford this and preserve my household lined? Medi-Share appeared a pretty choice: decrease premiums, a PPO physician community that my spouse’s OBGYN and children’ pediatrician was on, a very tacky web site (it is gotten slightly higher), and decrease premiums (did I say that already?).
However how would it not truly work? We have been anticipating some main adjustments too–my spouse was pregnant and we have been anticipating child boy #3 throughout the summer season. Would this actually be a superb choice for us?
If you happen to’re on the lookout for a fast abstract, right here it’s: Medi-Share is a improbable choice however there’s slightly little bit of a studying curve concerned.
When you get the cling of it although, I feel most people and households might be happy. You’ll be able to bounce proper into our web site to check Medi-Share to different plans in your space, or proceed studying to get the small print.
Issues to know earlier than you join Medi-Share
Medi-Share doesn’t exclude individuals for pre-existing circumstances (just like main medical plans), however they will not pay for any pre-existing circumstances for the primary 36 months. Essential!
For our household, this meant my spouse was not a superb candidate since she was already pregnant after we have been signing up. We determined to go away her on the foremost medical plan we had earlier than (Aetna) and transfer me and the then 2-year-old twin boys onto Medi-Share. My spouse and new child would transfer over with us after the newborn was born (extra on that call later).
Signing up was straightforward, however slightly totally different than the opposite insurance coverage firms (keep in mind that studying curve factor I discussed?). When you apply to Medi-Share, you are not mechanically enrolled. There are a couple of extra types and signatures it’s essential full about your medical historical past in addition to signal a press release of religion and supply some church references. Nobody ever checked our references however now we have had purchasers inform us that their’s have been.
You additionally must arrange your sharing account with the financial institution. There is a small charge and a few paperwork concerned, however total fairly painless. There is no Open Enrollment requirement for Medi-Share which means you possibly can enroll anytime, however they suggest you submit your preliminary utility by the twentieth of the month in order for you your plan to start out the first of the subsequent month. Is sensible based mostly on our experience–it took a couple of week.
The PPO physician community is legit
One of many causes we selected Medi-Share personally and determined to characteristic it on our web site is that they have a authentic PPO physician community. Most of the different sharing ministries allow you to see any physician you need, however the benefit of being “in-network” with a PPO is you get negotiated reductions. This can be a nice place to begin versus having to haggle over money costs (typically higher, typically a lot worse)
More often than not, your physician’s front-office employees is not going to have heard of “the Medi-Share community”, so do not panic in the event you ask and so they take a look at you humorous. Medi-Share makes use of the “Multiplan PHCS community”. They’re going to probably nod their head in the event you ask about that.
We have added Medi-Share’s physician community to our physician search characteristic at in our insurance coverage information at TakeCommandHealth.com, so it’s going to be straightforward so that you can see in case your physician’s are “in community” or not. You’ll be able to nonetheless see docs “out of community” and Medi-Share pays, however they’re going to solely cowl what the negotiated price would have been and also you’re by yourself for the remaining. Sounds fairly honest to me. (Observe: If you happen to see go to an out-of-network hospital, there is a $500 charge along with any quantities over the negotiated price, until it is an emergency)
Medi-Share handles payments otherwise
The most important distinction with Medi-Share was determining how billing works. It was slightly complicated at first, however after you get the cling of it, I feel it is truly a lot extra simple than different main medical plans.
With Medi-Share, there are not any deductibles or max-out-of-pocket limits, simply this factor known as an Annual Family Portion (AHP) that’s form of like a deductible and max-out-of-pocket restrict rolled collectively. In actual easy terms–you pay every little thing earlier than your AHP, after which nothing after your AHP (for eligible companies, extra on that in a second).
Medi-Share additionally does not have co-pays for physician visits, they’ve a $35 “supplier charge”. You pay this charge everytime you see a physician (major care or specialist). It doesn’t depend in the direction of your AHP however does go in the direction of your physician invoice. Most individuals won’t ever know the distinction, however as an insurance coverage insider, right here it’s: Say your physician costs a $100 charge for a 15 minute session. In case your plan has a $35 copay, you’ll simply pay $35 and your insurance coverage would pay the remaining. With Medi-Share, you pay the $35 supplier charge after which get a invoice later for the remaining $65 (which does go in the direction of your AHP). Not a enormous deal as most individuals will in all probability by no means discover, however one thing to level out.
This is a useful graphic that explains how Medi-Share billing works:
This is a fast instance operating by way of the steps above. To illustrate you are on the AHP 2500 plan and get sick and spend an evening within the hospital:
- Is the invoice “eligible for sharing” –> Sure
- Is there an “in community” low cost? –> Assuming you went to a hospital in Medi-Share’s community, you’ll get the negotiated charges. To illustrate the price of your hospital keep is $8,000, however the negotiated price is $6,000. The hospital will ship your invoice to Medi-Share and so they’ll apply the proper charges for you.
- Have you ever reached your AHP? –> If that is the primary invoice you’ve got, then no, you have not. If you happen to’re on the AHP 2500 plan, you pay $2,500, after which the remaining $3,500 is revealed for sharing. Another eligible payments you or anybody in your loved ones have that 12 months are lined since you have met your AHP.
In abstract, your $8,000 hospital invoice prices you $2,500 out-of-pocket. Not dangerous! And far more easy than making an attempt to determine your deductible, coinsurance, and copays on an everyday medical plan.
Preventive care isn’t actually lined
My spouse and I welcomed child boy #3 this July. I discussed I left my spouse on our outdated Aetna plan whereas she had the newborn since we weren’t enrolled in Medi-Share earlier than the being pregnant and thus it will have been excluded from protection above (would have failed query #1). That was a superb transfer. I then moved my spouse and new child over to Medi-Share to save cash (they Aetna premiums have been loopy excessive). That was a medium-good transfer. I will clarify.
I had learn within the Medi-Share pointers that preventive care was “eligible for sharing” for newborns and children as much as 5 years outdated. This was good as a result of our new child was about to have all of his new child check-ups and immunizations, all issues which might be thought-about preventive and lined for $0 with a significant medical plan.
Not so with Medi-Share. I bought a invoice for almost $1,000 for my child’s immunizations! Going again to the chart above, simply because preventive care for teenagers as much as 5 years outdated is “eligible for sharing”, doesn’t suggest it will not price me one thing. It was eligible for sharing (passes step 1), the in-network low cost was utilized (step 2), however I had not reached my household’s AHP but (step 3) so I bought a invoice for the immunizations.
It is smart looking back, however was slightly sudden. As a aspect observe, I submitted the invoice to our new negotiation service with Take Command Well being–they known as the pediatricians workplace and labored with Medi-Share to get a couple of hundred {dollars} knocked off for me. Not dangerous! I’ve additionally since discovered you can get immunizations for kids fairly low cost on the county hospital–I’ve had some extra expertise Medi-Share mother and father suggest paying for the physician go to together with your pediatrician after which go to the county for immunizations.
At first, I used to be kicking myself for not leaving my new son on the outdated Aetna plan for one more month or two the place his new child checkups and immunizations would have been $0. Nonetheless, Medi-Share units their premium charges for singles, {couples}, after which households of three or extra. With 5 individuals on our Medi-Share plan, I wasn’t going to avoid wasting any cash by leaving one child and even my spouse and child on Aenta. So lengthy story brief, I nonetheless got here out approach forward with the cheaper premiums on Medi-Share however was caught off guard slightly bit by the immunization invoice.
Customer support and add-ons
Medi-Share’s customer support has been nice. They typically pray for you while you name too. At first I assumed it was unusual over the cellphone, however the account managers actually know their stuff and sustain with you and your loved ones. We’ve not crossed our AHP but to have our payments shared, however we usually get postcards to hope or write notes for different households which have. They do not disclose why (that will be a privateness violation) but it surely’s nonetheless fairly cool.
Medi-Share not too long ago added some primary ancillary merchandise together with telemedicine with MDLive and a dental low cost program with Carrington. These are mechanically included in your month-to-month share quantity. Telemedicine is a great transfer as a result of as an alternative of paying the $35 supplier charge, you possibly can name and get primary prescriptions over the cellphone for $0.
Nonetheless, I am actually glad I used Take Command’s Premier membership plan together with Medi-Share. Though our telemedicine supplier Teladoc and MDLive are admittedly slightly redundant, Take Command’s dental community with Aetna was a lot bigger and had our dentist whereas the Carrington community didn’t. Additionally, the invoice negotiation service paid for itself with the cash it saved me on the primary invoice.
Full Disclosure: Sure, we made a small margin while you join Take Command’s Premier membership plan, however I discovered it to be price it and a pleasant complement as a Medi-Share member.
Conclusion and subsequent steps
We’ll be persevering with with Medi-Share this subsequent 12 months and would extremely suggest it! As I discussed, there’s a little little bit of a studying curve and I am actually grateful I had our invoice negotiation service at my disposal to assist. Though the immunization invoice caught me abruptly, now that I perceive Medi-Share’s billing course of slightly higher issues like that will not shock me. If you think about what we’re saving on premiums every month, we nonetheless come out approach forward on Medi-Share than we might with a significant medical plan.
If Medi-Share is constant together with your values and religion, I feel it is price a critical look. If you happen to’re eligible for a tax-credit or have a expensive pre-existing situation, I might ensure to weigh your different choices earlier than signing up.
The very best factor to do? See how Medi-Share compares to different main medical plans in your space by going by way of our self-guided interview at TakeCommandHealth.com. So far as we all know, we’re the one web site that allow’s you examine Medi-Share side-by-side with Market and off-exchange main medical plans in your space. Use our free web site to shortly seek for your docs and prescriptions and simulate your circumstances to see if Medi-Share can be a superb match for you and your loved ones.
And naturally, in case you have any questions, be happy to ask within the feedback under or e-mail me at help@takecommandhealth.com and I would be glad to reply your questions!
Observe: Medi-Share doesn’t pay commissions like typical medical plans, however we do make a small advertising charge when customers enroll by way of our web site. It retains us in enterprise and doesn’t price you a penny.
About Take Command Well being
Take Command Well being launched three years in the past with the purpose of bringing consciousness, advocacy, and transparency to the complicated world of medical health insurance for small companies and people. Take Command Well being is on the forefront of this challenge, a acknowledged chief in QSEHRA administration, ICHRA administration, small enterprise medical health insurance and small enterprise HRA tax technique, with prospects in each state. It operates in Arizona, California, Florida, Georgia, Indiana, Michigan, North Carolina, Pennsylvania, Texas, Tennessee, and Wisconsin for particular person insurance coverage and affords small enterprise HRA administration nationwide.
