What does Medi-Share not cover?

This review concerns Medi-Share Complete guidelines marked updated September 29, 2026, not every sharing program or Medi-Share 65+ rule. Medi-Share is not insurance and does not guarantee payment of every medical bill. Read both the excluded-services section and its specific exceptions, together with your actual program and membership conditions.

Routine care exclusions and specific exceptions

The general routine-care exclusion has important exceptions. Complete guidelines allow eligible annual physicals for members who join or change AHP levels on or after September 1, 2020, with limited recommended A1c and lipid-panel tests. Routine well-child checkups and associated labs can be eligible before age six, excluding vaccinations or immunizations. The selected Direct Primary Care option has separate arrangements; these provisions do not mean all preventive bills are shared.

Build a budget from actual provider prices and the applicable sharing rules rather than assuming one annual cost for every family. Comprehensive insurance may provide eligible in-network preventive services under different rules; a fixed-benefit schedule is another distinct design. See how preventive care works on a fixed benefit plan.

Prescriptions are time-limited, not ongoing

The Complete prescription provision considers eligible medications for 6 months from diagnosis of each new condition that is not preexisting, subject to the guidelines. A new medication for an existing condition does not restart that timeline. Eligibility is not a guarantee that every prescription or bill will be shared.

Budget for medication beyond the applicable sharing period, but do not describe every maintenance prescription as permanently excluded in all circumstances. The guidelines allow consideration of exceptions for cancer and transplant medications, with patient-assistance applications and specialty-pharmacy or formulary requirements when applicable. Confirm the actual determination.

Mental health is largely outside

Complete guidelines describe eligible psychiatric or primary-care evaluation, associated tests and medication for mental illness related to an eligible medical condition for 6 months per new condition. Counseling and psychotherapy bills are generally ineligible under that provision; access to phone or video counseling through the Member Center is a separate service, not proof that every counseling bill is shared.

Psychological care, special education charges, and counselling for learning deficiencies or behavioural problems including attention deficit disorders and autism are excluded.

Dental, vision and hearing

Routine dental and related services are generally excluded under the Complete rules, which include a stated trauma exception for certain orthodontic or oral-surgery care within one year of diagnosis. Confirm the exact service and conditions rather than saying every dental expense is excluded without exception. See dental and vision alongside limited medical. Wisdom teeth, dentures, bridges, TMJ services and complications of dental procedures require review under the actual exclusions.

Vision services and routine optometry are out, including anything for nearsightedness, farsightedness or astigmatism, contacts and eyeglasses. Hearing aids are excluded.

Therapy and equipment carry hard caps

For eligible ordered treatment under the Complete guidelines, physical, occupational and osteopathic manipulation therapy have a 20 visits combined provision; additional referrals for the same diagnosis require review. Outpatient speech therapy is limited to 10 visits under the specified post-stroke, post-surgery or post-trauma conditions. Chiropractic may be considered in lieu of an offered surgical option, with approval and documentation, for up to 20 visits within a six-week period. These are separate provisions, not one universal cap on every therapy.

Eligible ordered home care for a member homebound by the need is limited to 60 calendar days from first service. The specified non-hospital inpatient provision allows 30 days when ordered for an eligible condition requiring care otherwise provided in an acute setting. Eligible DME rental is limited to 6 months; a one-time purchase may be considered under its separate provider and need requirements. Confirm approval rather than treating these limits as automatic benefits.

Lifestyle-linked exclusions

Expenses related to what the guidelines call non-Biblical lifestyles and choices are excluded. That includes alcohol and drug related injuries and illnesses, sexually transmitted diseases including HIV other than innocent transmission, intentionally self-inflicted injuries, illegal acts, and maternity for children conceived outside marriage other than pregnancy resulting from rape.

Weight control and management is excluded, as is care for symptoms not related to a specifically diagnosable disease or injury, such as ongoing fatigue and malaise.

Maternity has its own gate

Maternity sharing requires a married member at an annual portion of $3,000 or higher, who has shared faithfully from the month of conception through the month of delivery. Sharing is limited to $125,000 per pregnancy event, and multiple births count as one event.

A newborn must be added within 30 days of delivery or preexisting and congenital condition limitations apply. If the mother was not a member from conception through delivery, maternity bills are not shared.

The billing rules that quietly exclude

Complete guidelines require bills within 12 months of service and have further rules for requested information and proper coding. Ask promptly how an incorrect submission can be corrected or reviewed; do not assume a rejected bill is irreparable. Their excessive-charge provision retains 200% of Medicare for professional services excluding anesthesia and 300% for facility bills and anesthesia. These eligibility thresholds are distinct from separate PPO or out-of-network responsibility rules and do not guarantee a provider accepts them as full payment.

Where no Medicare rate exists, charges above the 70th percentile of usual and customary are excluded. After-hours, holiday and weekend fees that are not CMS approved are excluded too.

There is also a conflict-of-interest rule. Bills are ineligible if the provider or ordering provider is related to the member by blood, marriage or adoption, or if the member has a financial interest in the provider.

Alternative and elective care is treated the same way. Acupuncture, vitamins and supplements without a diagnosed deficiency, experimental or investigational treatment, integrative medicine, functional medicine and regenerative medicine are all outside the guidelines.

So are cosmetic procedures, gender reassignment surgery and related treatment, fertility and infertility care including birth control procedures and sterilisation, embryo donation and adoption, and medication or treatment for sexual health or dysfunction.

Compare actual routine care, prescriptions, provider charges and potential ineligible services for your household. Include the annual-physical, well-child and medication exceptions where applicable rather than repeating that preventive care is never shared or predicting several thousand dollars for every family. Review both eligible sharing and amounts you remain responsible to pay.

Everyday items people assume are covered

Over-the-counter drugs and disposable medical supplies are excluded, which the guidelines define to include diabetic supplies, wound care supplies, ostomy supplies and custodial care supplies. Motorised locomotion equipment and home modifications are excluded. So are podiatric orthotics, missed appointment fees and Veterans Administration care.

Genetic testing is generally not eligible unless it is required for personal treatment of a diagnosed condition and not available through a patient assistance programme. Sleep studies are excluded where they relate to insomnia or hypersomnia rather than a specific disorder. Custodial and long-term care is excluded, which matters more with age, as we cover in when supplemental coverage ends.

How The Jordan Insurance Agency helps

We are an independent agency based in Charlotte, licensed in 23 states, and we have helped families choose coverage since 2006. We place sharing memberships as well as insurance, so this is not an argument against one of them. It is the list a household should price before choosing either.

Our licensed agents can help compare the actual membership guidelines with represented insurance options and identify questions for the program or insurer. An agency review cannot guarantee a sharing decision, insurance claim or a particular annual saving.

This page summarizes named Medi-Share Complete provisions reviewed in the guidelines marked September 29, 2026. Confirm the actual program, applicable version, membership dates and written eligibility decision. Generic hospital, ICU, ambulance or unlimited-maximum insurance figures do not establish Medi-Share sharing benefits. Guidelines and exceptions can change, and members remain responsible for their medical bills.