The rising cost of healthcare has become an undeniable challenge for individuals, families, and businesses alike. For many, traditional health insurance premiums have become increasingly unaffordable, leading to a surge in interest in alternative models. MediShare, a health care sharing ministry (HCSM), is one such alternative that has gained significant traction in recent years.
While MediShare is not technically health insurance, it operates under a similar structure, providing members with a means of sharing medical costs within a community, often at a fraction of the cost of traditional insurance.
MediShare works on the premise of mutual aid—members contribute monthly to a common pool, which is then used to help pay for medical expenses incurred by fellow members. It is rooted in Christian principles, encouraging members to live a healthy lifestyle and share medical expenses in times of need. As attractive as this model sounds, it is not without its drawbacks, and it may not be suitable for everyone.
In this article, we will explore the pros and cons of MediShare in detail. We’ll cover what MediShare is, how it works, what it covers, and its potential advantages and disadvantages. By the end, you will have a comprehensive understanding of how MediShare operates and whether it might be the right healthcare solution for you and your family.
What is MediShare?
MediShare is a health care sharing ministry (HCSM) that facilitates the sharing of medical costs among a group of members. Unlike traditional health insurance, MediShare does not operate under insurance regulations, nor does it provide the typical insurance protections. Instead, it is based on the principles of mutual aid, where members agree to share the costs of one another’s healthcare needs. Members of MediShare are required to adhere to certain Christian-based guidelines that promote healthy living, which include refraining from tobacco, illegal drugs, and alcohol.
MediShare operates with the aim of fostering a community-driven model, where each member contributes a monthly share that goes into a pool. When a member incurs medical expenses, the costs are covered from that pooled money, provided the expenses meet the guidelines for eligible sharing. This type of system is often more affordable than traditional insurance, but the level of coverage and the claims process differ from what most people might expect from their health plans.
While MediShare provides a more affordable option for many, there are significant differences from traditional health insurance, and it’s important to understand exactly what MediShare does and doesn’t cover, the rules and eligibility requirements, and the potential risks involved.
How Does MediShare Work?
MediShare works on the basis of voluntary sharing. As members of the program, individuals contribute a monthly share, which is used to cover the medical expenses of other members who submit eligible bills. The key to this system is the concept of shared responsibility, where all members take on the financial burden of medical expenses as a community.
However, MediShare is not traditional health insurance and operates under different rules. For example, instead of paying premiums to an insurance company, members pay a monthly share to MediShare. The amount of the share depends on various factors such as the individual’s age, family size, and the level of coverage they choose.
MediShare is structured similarly to insurance in that there are deductibles, known as personal responsibility amounts. Members are required to pay for medical expenses up to this amount, after which the program covers the rest of the eligible costs. The program works by collecting these monthly shares into a fund that is used to pay for medical costs when a member submits a claim.
Importantly, MediShare does not operate like a typical insurance plan where every bill is automatically paid. Each medical bill is reviewed by the MediShare team to determine if it meets the criteria for eligible expenses. MediShare also operates with certain exclusions—pre-existing conditions, for example, may not be covered immediately, and there are guidelines on the types of treatment that qualify for sharing.
What Does MediShare Cover?
MediShare covers many common medical expenses that are typically included in traditional health insurance, but there are some important differences. The types of care typically covered by MediShare include:
- Hospitalization: Costs related to hospital stays, surgeries, and other inpatient care are typically eligible for sharing once the member’s personal responsibility is met.
- Outpatient Care: Visits to doctors, specialists, laboratory tests, and imaging services (like X-rays or MRIs) can be covered under MediShare, though pre-approval may be required for certain services.
- Prescriptions: Prescription medications are generally covered, but the coverage can vary depending on the plan. Some members may have access to discounted prescription services through MediShare’s network.
- Maternity Care: MediShare offers coverage for pregnancy and childbirth, including prenatal care, delivery, and post-delivery care. However, members may need to meet specific eligibility requirements.
- Emergency Services: Emergency room visits are typically covered by MediShare, as long as they are medically necessary.
- Mental Health: Some mental health services, such as counseling, may be covered. However, MediShare is not as comprehensive in its coverage of mental health as traditional insurance plans.
Despite these areas of coverage, MediShare does have some exclusions. For example, it generally does not cover routine dental or vision care, cosmetic procedures, or alternative therapies. There may also be restrictions on coverage for pre-existing conditions, which may not be covered immediately or may have waiting periods.
9 Pros of MediShare
1. Affordable Monthly Payments
MediShare is often significantly more affordable than traditional health insurance premiums. Because it operates on a health care sharing model and avoids the administrative overhead of insurance companies, it can provide members with lower monthly payments compared to standard health plans. This is especially appealing for individuals or families who are self-employed, have limited financial resources, or are looking for a more affordable way to manage healthcare expenses.
Many people are able to access a level of coverage through MediShare that would otherwise be financially out of reach with traditional insurance, making it an attractive option for those on a budget.
2. Community-Based Support
One of the unique aspects of MediShare is its community-oriented model. As part of a health care sharing ministry, members not only contribute financially but also support one another emotionally and spiritually. Members are encouraged to pray for each other, and many find a sense of belonging and shared responsibility within the community.
This sense of shared commitment can be a powerful motivator for individuals looking for not just financial assistance but emotional and spiritual support during times of medical need.
3. Christian-Based Approach
MediShare is grounded in Christian values, which resonate with individuals or families who prefer health coverage aligned with their faith. The program promotes healthy living, encourages members to avoid harmful behaviors like smoking and excessive drinking, and operates under principles that reflect Christian beliefs.
For many Christians, MediShare offers an opportunity to participate in healthcare sharing that aligns with their religious convictions. The program’s ethos of compassion, sharing, and faith is central to its operation, making it a strong fit for those who want to integrate their health care choices with their spiritual life.
4. No Lifetime or Annual Limits
Unlike many traditional insurance plans, which impose annual or lifetime coverage limits, MediShare does not place a cap on the total amount that can be shared for eligible medical expenses. This can be particularly beneficial for members who face significant medical needs, such as serious illnesses or long-term care, as there are no limits to how much financial assistance they can receive for eligible medical expenses.
This feature offers reassurance that in the event of a major medical event, MediShare members will continue to have their medical bills shared by the community.
5. Flexibility in Healthcare Providers
MediShare gives members the freedom to choose their healthcare providers without being restricted to a network of doctors or hospitals. This is a significant advantage for people who prefer seeing a specific provider or who live in areas where preferred healthcare providers might not be in a traditional insurance network.
With MediShare, members are free to select any licensed medical professional or healthcare facility. This flexibility can help members maintain continuity of care, especially if they already have established relationships with certain providers.
6. Lower Administrative Costs
MediShare’s operating costs are typically much lower than those of traditional health insurance companies, as it doesn’t need to cover large administrative teams or engage in the marketing and sales expenses that insurance companies often do. These savings are passed on to the members in the form of lower monthly contributions.
For many people, this translates into significant savings compared to traditional insurance premiums, while still providing essential healthcare coverage.
7. Emphasis on Preventive Care and Wellness
MediShare encourages healthy living and preventive care through its membership guidelines. The program offers various tools and resources designed to promote wellness, including discounts on health-related products and services. By incentivizing healthy habits, MediShare seeks to reduce the long-term healthcare costs associated with preventable illnesses.
In addition, the program promotes regular check-ups and screenings, which are often part of its preventive health initiatives. This focus on wellness can help reduce future medical expenses by addressing health concerns before they become serious conditions.
8. Transparency and Simplicity
The structure of MediShare is often considered more transparent than traditional insurance, as it directly shows how contributions are used to pay for medical expenses. There are no hidden fees or complex insurance jargon, which makes it easier for members to understand how the program operates.
The simplicity of the system also makes it easy for new members to understand what is covered, what the rules are, and how to submit medical expenses. This clarity can be a huge advantage for people who find the terms of traditional insurance plans confusing.
9. Financial Peace of Mind
For many people, MediShare offers the peace of mind that comes with knowing that their medical bills will be shared by the community. The transparency, flexibility, and faith-based approach provide members with a sense of security, as they are not navigating the uncertainty that often accompanies traditional health insurance.
While there are still out-of-pocket costs and personal responsibility amounts, MediShare helps ease the burden of unexpected medical expenses, making it easier to focus on recovery without the constant worry of medical debt.
8 Cons of MediShare
1. Limited Coverage for Pre-Existing Conditions
One of the biggest limitations of MediShare is its coverage restrictions for pre-existing conditions. If you have a chronic illness or a medical condition that you were diagnosed with before joining MediShare, there may be a waiting period before you can receive coverage for that condition. For some conditions, MediShare may not cover treatment at all, especially in the initial months of membership.
This can be a significant disadvantage for those with existing health problems who need immediate or long-term treatment, as they may face significant out-of-pocket costs before MediShare begins covering their expenses.
2. Not a Traditional Insurance Plan
MediShare operates as a health care sharing ministry, which is fundamentally different from traditional health insurance. While MediShare provides financial assistance for medical expenses, it is not regulated by state insurance laws and does not provide the same protections as traditional insurance. This means members may have fewer legal protections in the event of disputes over claims or coverage.
MediShare’s reliance on voluntary sharing, rather than insurance guarantees, may also make it less reliable for those accustomed to the structured security of insurance policies.
3. Personal Responsibility (Deductible Equivalent)
MediShare requires members to meet a personal responsibility (similar to a deductible) before expenses can be shared. While this can reduce the monthly cost of the program, it also means that members must pay significant out-of-pocket expenses for medical care before MediShare covers the rest. For individuals who face serious medical events, this personal responsibility can be burdensome.
While the personal responsibility is generally lower than traditional insurance deductibles, it still means that members must cover a portion of their medical bills themselves, which can create financial strain during major medical incidents.
4. No Coverage for Dental and Vision Care
MediShare generally does not cover dental or vision care, which are often included in traditional health insurance plans. For those who require routine dental checkups, fillings, or eye exams, MediShare members will need to seek out additional coverage or pay for these services out of pocket.
This exclusion of dental and vision services can be a significant drawback for families, especially those with young children or individuals who require corrective eyewear.
5. Limited Mental Health Coverage
While MediShare provides some coverage for mental health services, it is often much more limited than what is provided by traditional insurance. Counseling services, therapy, and psychiatric care may be covered, but they are subject to stricter guidelines and limits. For people who require ongoing mental health support, MediShare may not provide sufficient coverage, forcing members to find alternative resources.
This limitation is especially relevant for individuals with mental health conditions that require regular treatment or for those who rely on mental health services for overall well-being.
6. Potential for High Out-of-Pocket Costs
Despite the lower monthly shares, MediShare members can still face significant out-of-pocket expenses. In addition to personal responsibility amounts, members are required to pay for any medical expenses that are not covered by the program, which can add up quickly. For individuals who require extensive treatment, the cost of care may still be a substantial burden.
This unpredictability in costs is one of the major drawbacks for those who need more comprehensive coverage, especially when dealing with serious medical conditions.
7. Coverage Uncertainty for Certain Procedures
Since MediShare is based on a sharing model, there is some uncertainty about whether specific procedures or treatments will be eligible for sharing. For example, elective procedures, certain experimental treatments, or out-of-network services may not be covered by the program. Even medically necessary treatments may be scrutinized, leading to potential denials of claims.
For people requiring specific treatments, MediShare’s flexibility can feel limiting, and the uncertainty of whether a treatment will be covered can be a source of stress.
8. Eligibility Requirements and Restrictions
MediShare has strict eligibility requirements and lifestyle restrictions that may not be suitable for everyone. For instance, members are required to live a Christian lifestyle, which may include abstaining from certain behaviors such as smoking, excessive drinking, or drug use. Additionally, members must adhere to MediShare’s health guidelines.
These restrictions may be seen as a positive by some, but they can also be a barrier for individuals who do not follow these practices or who do not adhere to the faith-based principles on which MediShare is built.
Conclusion
MediShare offers an affordable, community-driven alternative to traditional health insurance, with the added benefit of a faith-based approach. For many, the ability to share medical expenses with others who have similar values can be a powerful and cost-effective solution to the rising costs of healthcare.
However, MediShare is not without its limitations. The lack of coverage for pre-existing conditions, personal responsibility requirements, and limited mental health, dental, and vision care may make it unsuitable for some individuals, especially those with ongoing or complex medical needs. Additionally, MediShare’s reliance on voluntary sharing and its non-regulated status means that members are not guaranteed the same protections that come with traditional health insurance.
Ultimately, MediShare may be a great choice for individuals or families looking for affordable health care with a strong sense of community and Christian values, but it’s essential to carefully evaluate whether it meets your healthcare needs and lifestyle before joining. As with any health care decision, it’s important to weigh the pros and cons, consider your specific health needs, and determine if MediShare aligns with your values and financial situation.