Medishare is a health-sharing ministry, not insurance, so it does not coordinate with Medicare the way a Medigap or Medicare Advantage plan does

Medishare is a faith-based health-sharing ministry where members contribute monthly to a shared pool that pays for medical expenses. It is not an insurance company and does not have contracts with Medicare. If you are on Medicare and use Medishare, the two programs operate separately — Medishare does not automatically pay Medicare's copays, coinsurance, or deductibles the way Medigap or Medicare Advantage plans do.

The key difference: Medicare is a federal insurance program. Medigap and Medicare Advantage are insurance products that work within Medicare's framework. Medishare exists outside that framework entirely. You can be on both Medicare and Medishare at the same time, but they do not share information or coordinate payments.

This matters because if you are counting on Medishare to cover what Medicare does not, you need to understand what Medishare actually covers and what it does not — and those gaps may be larger than you expect.

Key Takeaways

  • Medishare does not integrate with Medicare; the two programs do not exchange information or coordinate who pays first.
  • Medishare typically does not cover preventive care, prescription drugs, or routine office visits — services Medicare covers — so you still face out-of-pocket costs.
  • If you are on Medicare and Medishare, Medicare is your primary payer, and Medishare may or may not cover what Medicare leaves unpaid, depending on your membership level.
  • Medishare has waiting periods (usually 30 to 90 days) before it covers most conditions, and pre-existing conditions may not be covered at all.
  • If cost is your main concern, Medigap or Medicare Advantage plans are designed to work with Medicare and may offer more predictable coverage than Medishare.

What Medishare actually covers when you are on Medicare

Medishare members share the cost of major medical events — hospitalizations, surgeries, emergency care — but the program has significant gaps. Medishare does not cover preventive care (annual wellness visits, screenings, vaccines), prescription drugs, or routine office visits. These are services Medicare covers, often at no cost to you.

If you are on Medicare and join Medishare, you still pay Medicare's Part B premium, Part D premium (if you choose drug coverage), and any copays or coinsurance Medicare requires. Medishare then may or may not cover those out-of-pocket costs, depending on your membership level and the specific service. There is no may provide Medishare will pay what Medicare does not.

Medishare also excludes certain conditions outright: mental health treatment, substance abuse treatment, and conditions related to drug or alcohol use are typically not covered. Dental, vision, and hearing care are not covered. Maternity care is not covered unless you have been a member for at least 10 months.

How the payment order works when you have both Medicare and Medishare

Medicare is always your primary payer. When you receive care, Medicare processes the claim first and pays its share. You then owe any copay, coinsurance, or deductible Medicare requires. At that point, you can submit the bill to Medishare and ask them to review it.

Medishare will not pay anything until Medicare has already processed the claim. This means you may have to pay Medicare's out-of-pocket costs upfront, then wait for Medishare to decide whether to reimburse you. The reimbursement process can take weeks, and Medishare may deny the claim if it falls outside their coverage rules.

Unlike Medigap plans, which have contracts with Medicare and pay claims automatically, Medishare operates on a case-by-case basis. Each claim is reviewed individually. There is no may provide of payment, even for services that seem like they should be covered.

Waiting periods and pre-existing condition limits

Medishare imposes a waiting period before most conditions are covered. The standard waiting period is 30 to 90 days, depending on your membership level. During this time, if you need care for a condition that is not an emergency, Medishare will not pay.

Pre-existing conditions — illnesses or injuries you had before joining Medishare — are often excluded entirely or covered only after a longer waiting period. If you are already on Medicare and have existing health conditions, Medishare may not cover treatment for those conditions at all, or may cover them only after you have been a member for 12 months or longer.

Emergency care is usually covered when ready, even during the waiting period. But "emergency" has a specific definition in Medishare's guidelines, and routine or urgent-care visits may not may have access to.

Why Medigap or Medicare Advantage might be a better fit

If you are on Medicare and looking for help with out-of-pocket costs, Medigap (supplemental insurance) and Medicare Advantage are designed specifically to work with Medicare. Both are regulated insurance products, not health-sharing ministries.

Medigap plans pay Medicare's copays and coinsurance automatically. You do not have to submit claims or wait for reimbursement. Medicare Advantage plans bundle Medicare benefits into one plan and often include prescription drug coverage and dental or vision benefits. Both have predictable costs and no waiting periods for coverage.

Medishare costs less in monthly contributions than many Medigap plans, but that lower cost comes with higher uncertainty. You may face large out-of-pocket costs if Medishare denies a claim, and you have no legal recourse the way you do with insurance. Medishare is not required to follow insurance regulations, and disputes are often resolved through arbitration, not the courts.

What to do if you are already on both Medicare and Medishare

If you are currently a Medishare member and on Medicare, review your Medishare membership agreement carefully. Understand exactly what is and is not covered, what the waiting periods are, and how claims are submitted and reviewed. Call Medishare's member services and ask them to walk you through how they handle claims when Medicare is the primary payer.

Keep detailed records of all medical bills and claims you submit to Medishare. Document what Medicare paid, what you owe, and what you submitted to Medishare. If Medishare denies a claim, ask for the reason in writing and review it against your membership agreement.

If you are unhappy with Medishare's coverage or claims decisions, you can switch to a Medigap or Medicare Advantage plan during the Medicare Annual Enrollment Period (October 15 to December 7 each year) or during a may have access to life event. You do not have to stay with Medishare.

The cost difference: Medishare versus Medigap

Medishare monthly contributions are typically lower than Medigap premiums — sometimes $100 to $200 per month less, depending on your age and location. But that lower cost does not mean lower total spending. With Medishare, you may face large out-of-pocket costs if a claim is denied or falls outside coverage. With Medigap, your costs are predictable: you pay the premium and the copays Medicare sets, and nothing more.

The trade-off is between lower premiums (Medishare) and predictable coverage (Medigap). If you are healthy and rarely use medical care, Medishare's lower cost may appeal to you. If you have ongoing health needs or want certainty about what you will pay, Medigap or Medicare Advantage is usually the safer choice.

Frequently Asked Questions

Can Medishare cover my Medicare deductible?

Medishare may cover Medicare's deductible, but only if your membership level includes that benefit and the claim meets Medishare's coverage rules. There is no may provide. Unlike Medigap Plan G or Plan F, which automatically cover Medicare's Part B deductible, Medishare reviews each claim individually.

What happens if Medishare denies a claim that Medicare already paid for?

You are responsible for the out-of-pocket cost. Medishare's decision is final unless you go through their appeals process, which can take weeks. You cannot appeal to Medicare or file a complaint with your state insurance commissioner, because Medishare is not an insurance company.

Do I need Medishare if I am already on Medicare?

No. Medicare covers a broad range of services, and you can add Medigap or Medicare Advantage for additional coverage. Medishare is an alternative to those products, not a supplement to Medicare alone. Most people on Medicare do not use Medishare.

Can I use Medishare for prescription drugs?

Medishare does not cover prescription drugs. You must enroll in Medicare Part D (prescription drug coverage) separately. Medishare will not reimburse your Part D premiums or copays.

What if I have a pre-existing condition and want to join Medishare?

Medishare may exclude your pre-existing condition entirely, or cover it only after a waiting period of 12 months or longer. Ask Medishare directly about their pre-existing condition policy before you join. If you are on Medicare, Medigap and Medicare Advantage cannot exclude pre-existing conditions.