Historically, Medigap premiums have increased by 5% to 8% per year. That’s much faster than inflation. These rate increases have put increasing pressure on seniors’ household budgets. Especially for those living on fixed incomes.
Fortunately, today’s Medicare beneficiaries have a better alternative: The Medishare 65+ health sharing plan is an innovative and affordable alternative to traditional Medicare supplement insurance (Medigap).
This blog post will discuss the importance of having additional protection, how the Medi-Share 65+ plan works, how it saves money compared to the best Medigap plans, and its various advantages and disadvantages.
Why Medicare Alone Isn’t Enough
Original Medicare (Parts A and B) is a great safety net for seniors leaving the workforce.
But it doesn’t pay for everything.
Even with Medicare, you potentially face massive out-of-pocket costs in the form of deductibles and coinsurance.
For example, under Medicare Part A (hospital insurance), you face a $1,600 out of pocket deductible as of 2023 before Medicare kicks in to help pay your bills.
And that’s per qualifying event, not per year. You could potentially have to pay multiple Part A deductibles in any given year.
With Part B (physicians fees, lab fees, and durable medical equipment), the current $216 annual deductible is manageable. But the real risk comes in the form of your 20% coinsurance portion.
If you have a major medical event, like cancer surgery, you could face tens of thousands of dollars or more in out-of-pocket costs in the form of Part B coinsurance.
Both Medigap plans and the Medi-Share 65+ health sharing plan exist to help you cover your out-of-pocket costs under Original Medicare – while still allowing you the freedom to choose your own doctor.
The Medi-Share 65+ health sharing plan, however, is typically available at a fraction of the cost of the more comprehensive Medigap Plans G, F, N, and C plans, especially in higher-cost-of-living areas.
And it delivers comparable protection power against the high cost of medical care.
This blog will discuss what Medi-Share 65+ is, how it works, its advantages and disadvantages, and how it compares with Medigap Plan G, the most comprehensive competing plan available to new members.
If you like what you see, click here, go to the menu in the upper left hand corner, select your state, and click the “FREE QUOTE” box to sign up online in minutes!
And if you want more personalized analysis and recommendation, click here, and make an appointment to speak with a MediGap Advisors Personal Benefits Manager.
What is Health Sharing?
Health sharing is a non-profit, money-saving alternative to for-profit traditional insurance approaches.
Instead of going through a for-profit insurance company, Medi-Share 65+ members are part of a non-profit, voluntary association of like-minded individuals who agree to band together to help shoulder the medical expenses of the group.
Health sharing serves a similar function to insurance. But it’s not regulated the same way as insurance is, and payouts are structured differently.
Medi-Share 65+ and Your Medicare Deductibles and Co-pays
With Medi-Share 65+, you are responsible for the first $500 in medical expenses per plan year per household covered under Medicare Parts A and B that are approved but not paid.
The plan shares 100% of all other Part A and B costs.
In this regard, Medi-Share 65+ is very similar to Medigap Plan G.
Under Medigap Plan G, you are responsible for your Part B deductible, which is $216 as of 2023.
However, with Medigap plans, that deductible is calculated per individual, not per household: Once one spouse on Medi-Share 65+ has $500 in expenses in a given year, the other spouse’s expenses for the year are completely covered.
As with all health plans, though, there are certain exceptions and exclusions. We’ll address them in this blog post, below.
The Medi-Share Statement of Faith
Like many other health sharing organizations, Medi-Share 65+ is a faith-based organization.
In this case, it’s a non-denominational Christian association. Members are expected to live according to Biblical principles, maintain a healthy lifestyle abstaining from the abuse of alcohol or illegal drugs, and affirm the organization’s Statement of Faith.
This involves acknowledging the divinity of Christ and the nature of the Trinity.
Members are also expected to actively support a fellowship of believers, avoid tobacco use, abstain from sex outside of Christian marriage, and attest to not having engaged in substance abuse, including prescription medications or alcohol, for at least twelve months before joining.
How Much Can Medi-Share 65+ Save?
Medi-Share 65+ typically saves members a substantial amount every month compared to Medigap Plan G.
While the average Medigap Plan G premium nationwide is over $160 per month, insurance companies in some areas sell Medigap Plan G for as much as $361 per month or more.
If you’re currently enrolled in Medigap, whether it’s Plan G or any other plan, compare your current pricing to Medi-Share 65+’s monthly costs:
- Age 65 – 74: $99 per month.
- Age 75 and up: $150 per month.
- Currently, all new enrollees under age 75 receive a guarantee of level pricing, with no increases in premiums, until their 75th birthday.
Telehealth Benefits for 24/7 Healthcare Access
Medi-Share 65+ recognizes the importance of quick and accessible healthcare for seniors.
Members enjoy round-the-clock telehealth access to board-certified physicians, 365 days a year, with zero copay.
This invaluable benefit ensures you can consult with doctors promptly, even for common health issues like colds, flus, sinus infections, and earaches—all without the concerns of cost or arranging transportation.
Typically, health sharing plans like Medi-Share impose a waiting period before they will share costs related to pre-existing conditions.
However, If you enroll in Medi-Share 65+ during your initial Medicare eligibility period, those waiting periods are waived.
They are also waived if you enroll during the Medicare Fall Enrollment Period, which runs from October 15th through December 7th each year.
That means that even if you have pre-existing conditions, your eligible medical costs under Medicare Part A and Part B in excess of $500 per year per household are 100% shareable.
You pay nothing additional out of pocket.
You just pay your monthly sharing contribution amount required for membership.
For all other enrollments, Medi-Share will begin sharing your costs for treatment of pre-existing conditions incurred after you have been a contributing member in good standing for 6 months.
Medi-Share 65+ and Prescription Drugs
Neither Medi-Share 65+ nor its Medigap competitors include prescription drug coverage. If you want to stay in Original Medicare, plus either plan, you should consider purchasing a standalone Medicare Part D prescription drug plan.
Alternatively, you can buy a Medicare Advantage plan that includes prescription drug coverage.
More details on this option are listed in the table below.
Other Medi-Share 65+ Discount Programs
Medi-Share, with its vast membership of over 400,000 individuals across the nation, has harnessed its immense collective bargaining power to negotiate substantial discounts with top medical service providers.
Not just pharmacies.
These discounts extend to various healthcare services, including dental and vision care.
Medi-Share 65+ community members also receive a Select Savings Card, unlocking significant savings on essential items such as diabetes care supplies, hearing aids, and even Lasik surgery.
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How Does Medi-Share 65+ Compare to Other Programs?
As a Medicare beneficiary, you have three primary options to shield yourself from Medicare’s uncovered expenses. Let’s break down the key differences:
- Non-insurance alternative
- Shares all deductibles, co-pays, and coinsurance for Medicare Parts A and B over $500 member responsibility amount
- Freedom to see any provider
- No need for specialist referrals
- Applicable anywhere in the U.S., with international use available
- Low monthly contributions ($99 for ages 65-74, $150 for ages 75+)
- No prescription drug coverage
- Monthly sharing amount + member responsibility amount
- No copays to providers
- Requires medical underwriting to join
- Includes Mayo/Cleveland Clinic
Medigap Plan G
- Medicare provided by a private company
- $226 deductible for Medicare Part B (as of 2023)
- Covers all other out-of-pocket costs for Part A and B services
- Allows you to see any provider
- No need for specialist referrals
- Applicable anywhere in the U.S.
- Premiums vary but can be up to $400+/month
- No prescription drug coverage
- Premiums + $226 Part B deductible
- No copays, depending on the plan
- Guaranteed issue within 6 months of enrolling in Medicare Part B
- Includes Mayo/Cleveland Clinic
- Managed care plans with narrow networks
- Plans vary, with non-emergency care restrictions within network
- Some plans require referrals from PCPs (HMOs)
- Networks are often regional
- Applicable only within the U.S.
- Variable premiums, with some zero-premium plans
- Some plans include prescription drug coverage
- Premiums, deductibles, co-pays, coinsurance
- Copays are typical, and run from $20 to $50. ER visits may cost more, especially if they don’t result in a hospital admission
- Guaranteed issue during initial eligibility period and annual election period (limited window to enroll)
- High-tier providers may not be included in the network
Medi-Share 65+ Exclusions
Due to its nature as a Christian health sharing ministry, The Medi-Share 65+ cost sharing plan has the following exclusions:
- Excludes expenses arising from suicide or attempted suicide
- Self-inflicted injuries
- Abortion of a live fetus
- DUI-related injuries, even if you were only a passenger
- Treatment for drug or alcoholism addictions
- Injuries from activities with flagrant disregard for safety
- Involvement in a felony
- Limits cost sharing for motorcycle accident-related injuries to $100,000 per plan year (except for missionaries traveling abroad, using motorcycles in connection with their missionary activities)
Medi-Share 65+ Advantages and Disadvantages
- 10-year price lock-in guarantee for those joining at age 65
- No co-insurance: Once you meet your minimum household contribution, all expenses not covered by Medicare Parts A or B are 100% shareable.
- Unlimited 24/7/365 telehealth access to board-certified physicians
- No annual or lifetime limit on sharing benefits (except for injuries from motorcycle accidents)
- Discounts on medical services not covered by Medicare
- No in-network restrictions: You can choose any doctor or facility that accepts Medicare
- Pre-existing conditions covered after six consecutive months of sharing or during your six-month Medigap Enrollment Period
- Not regulated by state insurance commissioners
- Sharing is voluntary, and you have no contractual claim against Medi-Share or other members if they don’t share your expenses
- Limited sharing for motorcycle accident-related injuries (up to $100,000 per 12-month period)
- Excludes alcohol and drug-related illnesses or injuries
- Does not cover injuries resulting from DUI incidents, even for passengers
- Monthly contributions required
If you’re considering Medi-Share 65+ or have questions about how it might fit your healthcare needs, you have options:
- Get an instant quote and sign up in about 10 minutes by running an Instant Quote on the top of this page.
- Schedule a call with one of our advisors for personalized guidance.
- If Medi-Share 65+ isn’t the right match for you, explore our other insurance options and non-insurance alternatives.
Navigating healthcare can be complex, but you don’t have to go it alone. Our experienced personal benefits consultants are here to simplify the process, ensuring you enroll in the best plan for your unique circumstances.
Schedule your free, no-obligation consultation here. Or call us today at 800-913-3416.Here are some additional blogs for reference: MediShare 65+ Health Sharing Plan vs. Medigap Plan G | Does Medi-Share 65+ Pay When Traveling Outside the U.S? | Which is Better: Medicare Advantage or a Medicare Supplement Plan?
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Frequently Asked Questions
How does Medi-Share 65+ handle Medicare deductibles and copays?
Medi-Share 65+ is specifically designed to assist seniors with their Medicare deductibles and copays.
Once you meet the $500 annual contribution threshold, 100% of your out-of-pocket costs for Medicare-approved services become eligible for sharing, subject to a few specific exclusions, listed above.
Are there secular health sharing organizations as well?
Yes. But none of them are currently marketing health sharing to the Medicare beneficiary market at this time.
There are several secular health sharing organizations catering to members who are under age 65, however.
Contact a Personal Benefits Manager if you have members of your household who are not yet 65 and you want to save money compared to paying outrageous traditional health insurance premiums.
Does Medi-Share 65+ offer telehealth benefits, and how do they work?
Yes, Medi-Share 65+ provides members with round-the-clock access to board-certified physicians via telehealth.
This benefit allows quick consultations and diagnoses for common health issues, and it’s available 365 days a year, ensuring accessible healthcare without concerns about cost or transportation.
What discounts and savings programs does Medi-Share 65+ offer?
With over 400,000 members nationwide, Medi-Share leverages its collective bargaining power to negotiate discounts with top medical service providers, including dental and vision care.
Members also receive a Select Savings Card for substantial discounts on items such as diabetes care supplies, hearing aids, and even Lasik surgery.
How does Medi-Share 65+ compare to other healthcare programs like Medigap and Medicare Advantage?
Medi-Share 65+ is a non-insurance alternative designed to share all deductibles, co-pays, and coinsurance for Medicare Parts A and B over a $500 member responsibility amount.
It offers flexibility in choosing providers, has low monthly contributions, but does not cover prescription drugs.
Is there a price lock-in guarantee with Medi-Share 65+?
Yes, members who join Medi-Share 65+ at age 65 are eligible for a 10-year price lock-in period.
Monthly contributions will not increase for a decade after signing up, a feature not offered by Medicare supplement insurance carriers.
What pre-existing condition restrictions apply to Medi-Share 65+ enrollment?
During your initial Medicare open enrollment period, there are no pre-existing condition restrictions for enrollment.
If you enroll between October 15th and December 7th each year, there are also no restrictions. Outside of these windows, Medi-Share 65+ covers pre-existing conditions after sharing costs for six consecutive months.
What medical expenses are excluded from cost-sharing under Medi-Share 65+ due to its nature as a Christian health-sharing ministry?
Medi-Share 65+ does not cover expenses arising from suicide or attempted suicide, self-inflicted injuries, abortion of a live fetus, DUI-related injuries (even for passengers), treatment for drug or alcoholism addictions, injuries from activities with flagrant disregard for safety, and injuries resulting from the commission of a felony.
Cost sharing for motorcycle accident-related injuries is also limited to $100,000 per plan year.
Are there any limitations on sharing expenses for treatments outside the United States with Medi-Share 65+?
Medi-Share 65+ limits sharing of expenses outside the U.S. to medically necessary urgent medical care and only shares up to 80% of these expenses.
The remaining 20% is the responsibility of the member.
Can non-U.S. citizens join Medi-Share 65+?
Medi-Share 65+ membership is open to full-time legal residents of the United States. Medical bills incurred while not a legal resident, are not eligible for cost sharing.
Can individuals who are not eligible for Medicare still join Medi-Share 65+?
Medi-Share 65+ is exclusively available to those aged 65 and older who are enrolled in Original Medicare (Part A and Part B).
However, Medi-Share offers other health share programs for those not eligible for Medicare. These plans typically save 40 to 50% compared to the unsubsidized costs of traditional “Obamacare”-style Marketplace insurance policies.
To learn more, contact a Personal Benefits Advisor.
Is it possible to suspend membership fees in case of income loss due to illness or injury?
Monthly contributions may be waived for up to three months per 12-month period if a member’s illness or injury causes a loss of income. Approval and monthly review by CCM are required, along with the submission of supporting evidence.
How often is the annual household portion (AHP) reset in Medi-Share 65+?
The AHP is reset to $500 every year on the anniversary of the Effective Date.
NOT the calendar year.
What is the maximum limit for sharing benefits in Medi-Share 65+?
Except for injuries arising from motorcycle accidents, there are no annual or lifetime limits on sharing benefits within Medi-Share 65+.
Whitney Kline is one of your Personal Benefits Managers at Medigap Advisors. She loves working for Medigap Advisors especially helping clients choose the right Medicare plan.