What Are Health Sharing Ministries?
Health sharing ministries (sometimes called healthshare plans) are organizations where members contribute a monthly amount that gets pooled together to help pay other members’ medical bills. They’re typically faith-based, though some newer non-faith options have emerged. The big ones you’ll hear about are Medi-Share, Christian Healthcare Ministries (CHM), Samaritan Ministries, and Liberty HealthShare.
The concept has been around for decades, but it’s gotten more attention as health insurance premiums have climbed. Members are drawn by the lower monthly costs and the community-based model. There are now over 100 healthshare organizations in the U.S. with millions of members.
Here’s the critical thing to understand upfront: health sharing ministries are not insurance. They’re not regulated by state insurance departments, they’re not required to pay your claims, and they don’t count as minimum essential coverage under the ACA. That distinction matters a lot.
How They Work
Each month, you pay a set amount (called a “share” or “contribution”) that goes into a pool. When a member has a medical expense, eligible costs are paid from the pool. Some ministries send your monthly payment directly to another member who has a need, while others pool everything centrally.
Most plans have an “annual unshared amount” (similar to a deductible) that you’re responsible for before sharing kicks in. This might range from $1,000 to $10,000 depending on the plan you choose. Higher unshared amounts mean lower monthly contributions.
Monthly costs typically run $200 to $500 for an individual and $400 to $800 for a family, which is often significantly less than traditional health insurance premiums, especially if you don’t qualify for ACA subsidies.
The Pros
The cost advantage is real and it’s the main draw. For healthy individuals and families who don’t qualify for marketplace subsidies, the monthly savings can be substantial. Some long-time members report saving six figures over a decade compared to what they would have paid for traditional insurance.
Many members value the community aspect. There’s a sense of directly helping others with their medical needs rather than paying premiums to a faceless corporation.
Some ministries offer nationwide provider flexibility since they’re not tied to specific insurance networks. You can often see any provider and negotiate cash-pay rates, which are sometimes lower than insurance-negotiated rates for routine care.
The application process is generally simpler and faster than insurance enrollment, and there are no open enrollment windows. You can typically join any time of year.
The Cons
This is where you need to pay close attention.
Health sharing ministries are not legally obligated to pay your medical bills. Their plan documents typically include language saying that sharing is voluntary and not guaranteed. In practice, the larger established ministries do share most eligible expenses, but the legal protection you get with actual insurance doesn’t exist here.
Pre-existing conditions are usually not eligible for sharing, at least initially. Most ministries have waiting periods of 1 to 3 years before pre-existing conditions are shareable, and some never cover them. If you have diabetes, heart disease, or any chronic condition, this is a significant limitation.
Mental health coverage is often limited or excluded entirely. Substance abuse treatment, maternity care for pregnancies that began before membership, and certain lifestyle-related conditions may also be excluded depending on the ministry.
Because they’re not ACA-compliant plans, health sharing ministries don’t have to cover essential health benefits, can’t be purchased through the marketplace, and don’t qualify for premium tax credits.
Some members have reported slow payment processing, particularly for large claims. While many members have positive experiences, there’s no state insurance commissioner to appeal to if something goes wrong.
Faith Requirements
Most established health sharing ministries require members to affirm a statement of faith and agree to certain lifestyle guidelines. This might include abstaining from tobacco, limiting alcohol use, and maintaining certain moral standards. Some ministries verify church attendance.
If these requirements align with your beliefs, they may feel natural. If they don’t, there are a growing number of non-faith-based healthshare options, though these are newer and have less track record.
When Health Sharing Might Make Sense
Health sharing can work well for people who are generally healthy, don’t have significant pre-existing conditions, have the financial ability to handle unexpected large bills, and understand that they’re accepting more risk in exchange for lower monthly costs.
Self-employed individuals and small business owners who don’t qualify for ACA subsidies and find individual market premiums unaffordable are a common fit. Young, healthy families who primarily need coverage for unexpected emergencies also tend to do well with healthshare plans.
When It’s Probably Not the Right Fit
If you have chronic health conditions that require ongoing treatment, health sharing is risky. If you need mental health services or substance abuse treatment, coverage is often inadequate. If you can’t handle a potential $50,000+ medical bill without insurance backing, the lack of legal guarantee is a real concern.
If you qualify for significant ACA marketplace subsidies, a traditional plan might actually cost less than a healthshare after the subsidy, while providing much stronger protections.
And if you’re an employer looking to satisfy the ACA employer mandate, health sharing does not count as minimum essential coverage. You’d still be exposed to potential penalties.
What Employers Should Know
Some small employers have considered health sharing as a group benefit, but there are important limitations. Health sharing doesn’t satisfy ACA employer mandate requirements, can’t be offered through a Section 125 cafeteria plan for pre-tax treatment in most cases, and doesn’t provide the same legal protections for employees as actual insurance.
If employees are interested in healthshare plans individually, employers can potentially offer an ICHRA that reimburses employees for their healthshare contributions, though the tax treatment and compliance implications should be reviewed with a benefits advisor.
Bottom Line
Health sharing ministries offer a legitimate alternative for people who understand the tradeoffs. Lower monthly costs are real, but so are the risks. It’s not insurance, and it doesn’t come with the same protections. Do your research on the specific ministry, read member reviews, understand the exclusions, and make sure you have a financial safety net for worst-case scenarios.
For most people, traditional insurance or ACA marketplace plans with subsidies offer better protection. But if those options are genuinely unaffordable and you’re in good health, a well-established healthshare ministry is worth evaluating alongside your other choices.
