Health Sharing Ministry Plans: How They Work, What They Cost, and What to Watch Out For

What Is a Health Sharing Ministry?

A health care sharing ministry (HCSM) is an organization whose members agree to share each other's medical expenses. Members make monthly contributions — called "shares" rather than premiums — and when someone has an eligible medical need, funds from other members help cover the cost. It is voluntary, faith-based mutual aid, not a contractual insurance obligation.

HCSMs have existed since the late 1980s, when small groups of Christians began pooling money for hospital bills. Enrollment surged after the ACA took effect in 2014 because the individual mandate included a specific exemption for HCSM members under Section 5000A(d)(2)(B)(ii) of the Internal Revenue Code. Although the federal mandate penalty dropped to $0 in 2019, some states — California, Massachusetts, New Jersey, Rhode Island, and D.C. — maintain their own mandates, and HCSM membership may not satisfy them.

Today, an estimated 1.5 to 2 million Americans participate in health sharing ministries. These organizations are not insurance companies, are not regulated as insurance, and do not guarantee that your medical bills will be paid.

How Health Sharing Ministries Work

While each ministry operates differently, the basic process follows a consistent pattern.

1. Apply and affirm beliefs. Most HCSMs require a Christian faith statement and lifestyle guidelines including church attendance, abstinence from tobacco, and limited alcohol use.
2. Pay a monthly share. Monthly shares range from $150 to $600 depending on plan level, family size, and the annual household portion (their term for a deductible-like amount).
3. Receive care and pay the provider. You typically pay the provider directly. Ministries encourage negotiating cash-pay discounts to reduce bills.
4. Submit the bill. After meeting your annual household portion, you submit eligible bills to the ministry for review.
5. Receive reimbursement from the shared pool. If approved, funds from the shared pool — or directly from assigned members — are sent to you or the provider.

The language is deliberate. Payments are "shares," not premiums. Your initial responsibility is an "annual household portion," not a deductible. Expenses are "shared," not "covered." This reflects the legal reality that these are voluntary sharing arrangements, not insurance contracts.

Major Health Sharing Ministries

Medi-Share

The largest HCSM with over 400,000 members, operated by Christian Care Ministry. It functions the most like traditional insurance, using the PHCS/Multiplan provider network. Annual household portions range from $1,000 to $10,500. Family shares run $300 to $600 per month. Uses a centralized pooled fund.

Christian Healthcare Ministries (CHM)

One of the oldest HCSMs, founded in 1981. Offers Bronze, Silver, and Gold levels starting at $90 per person per month. Gold members can add the Brother's Keeper program for sharing on bills exceeding $125,000 per incident, up to $1 million. No provider network — members see any provider. Personal responsibility ranges from $500 to $5,000 per incident.

Samaritan Ministries

Operates a unique direct-sharing model. Rather than pooling funds, Samaritan assigns each member a specific need to share with monthly. You send your share ($495 to $605 for a family) directly to another member, often with a note of encouragement. The initial unpublished amount is $300 per incident. Approximately 200,000 members.

Liberty HealthShare

Liberty grew to over 200,000 members but faced significant legal trouble. Multiple state attorneys general and class-action lawsuits alleged Liberty failed to pay hundreds of millions in member medical bills. Texas issued a cease-and-desist in 2020, and a $67.5 million Ohio class-action settlement was reached in 2023. Its history is a cautionary tale about the lack of HCSM oversight.

What Is Typically Shared

• Hospitalization, including inpatient surgery and related services
• Emergency room visits for injuries and acute medical events
• Outpatient surgery and diagnostic procedures
• Doctor office visits (after the annual household portion is met)
• Maternity care including prenatal visits, delivery, and newborn care (often with a 10- to 12-month waiting period)
• Lab work, X-rays, MRIs, and other imaging
• Prescription medications related to an eligible medical need
• Cancer treatment including chemotherapy and radiation (if not pre-existing)
• Physical therapy and rehabilitation following an eligible incident

What Is NOT Shared

The exclusion list is where HCSMs diverge most sharply from insurance. Some of these exclusions would be illegal for an ACA-compliant plan.

• Pre-existing conditions. Most HCSMs impose waiting periods of 1 to 3 years, and some conditions may never become eligible. ACA plans cannot exclude pre-existing conditions.
• Mental health and substance abuse. Many ministries exclude psychiatric care, therapy, and substance abuse treatment entirely. ACA plans must cover these as essential health benefits.
• Lifestyle-related conditions. Injuries from drug use, alcohol abuse, extramarital sexual activity, or extreme sports are typically excluded.
• Preventive care. Annual physicals, routine screenings, and wellness visits are generally not eligible. Some ministries offer optional add-ons.
• Contraception and fertility treatments. Birth control, IVF, and fertility treatments are excluded consistent with religious foundations.
• Dental, vision, and long-term care. None of the major HCSMs share these costs.

Cost Comparison vs. Traditional Insurance

Cost is the primary reason people consider HCSMs. Here is a rough side-by-side for a family of four in 2026.

ACA Bronze plan (unsubsidized): $1,200 to $1,800 per month. Deductible of $7,000 to $9,200 individual. Out-of-pocket max of $18,400. Covers all 10 essential health benefits.

ACA Silver plan (unsubsidized): $1,400 to $2,200 per month. Deductible of $3,500 to $6,000 individual. Out-of-pocket max of $18,400. Eligible for cost-sharing reductions if income qualifies.

Health sharing ministry (mid-tier): $400 to $600 per month. Annual household portion of $1,500 to $5,000. No guaranteed out-of-pocket max. Excludes pre-existing conditions, mental health, and preventive care.

The savings can reach $600 to $1,400 per month — $7,200 to $16,800 annually. But if you qualify for ACA premium tax credits, the gap narrows considerably or disappears entirely.

Key Differences Between Health Sharing and Insurance

Regulation: Insurance is regulated by state departments of insurance and federal law. HCSMs are exempt from insurance regulation in most states — no insurance commissioner oversight, no solvency requirements, no required financial reserves.

Payment guarantees: Insurance is a contract — the insurer is legally obligated to pay covered claims. HCSMs have no legal obligation to pay. Their guidelines state that sharing is voluntary and the ministry is not responsible for unpaid bills.

ACA protections: ACA plans must cover essential health benefits, accept pre-existing conditions, ban lifetime limits, cover preventive care at no cost, and provide an appeals process. None of these apply to HCSMs.

Provider networks: Insurance plans maintain negotiated rates with in-network providers. Most HCSMs (except Medi-Share) have no network, meaning members pay cash and negotiate their own rates.

Out-of-pocket maximum: ACA plans cap annual costs at $9,200 individual and $18,400 family in 2025. HCSMs have no mandated cap. Some set per-incident limits of $250,000 to $1 million, but there is no guaranteed annual ceiling.

Pros of Health Sharing Ministries

• Significantly lower monthly costs. Families without ACA subsidies can save 40% to 70% monthly — potentially $12,000 or more per year.
• Community and shared values. Members value knowing fellow believers voluntarily contribute to their care and vice versa.
• Provider freedom. Most HCSMs let you see any doctor or hospital with no network restrictions, referrals, or prior authorization.
• Transparent guidelines. Ministry sharing guidelines are generally straightforward documents that clearly spell out what qualifies.
• Healthcare consumerism. Paying providers directly and negotiating prices makes members more engaged and often leads to lower per-service costs.

Cons of Health Sharing Ministries

• No legal guarantee your bills will be paid. Sharing is voluntary. If the ministry declines your need or lacks funds, you owe the full amount with limited recourse.
• Pre-existing conditions excluded. Diabetes, heart disease, asthma, and other chronic conditions may face 1- to 3-year waiting periods or permanent exclusion.
• No mental health coverage. Depression, anxiety, ADHD, substance abuse — if you or a family member needs psychiatric care or therapy, an HCSM will likely not help.
• Religious and lifestyle requirements. If your beliefs or lifestyle do not conform to the ministry's guidelines, you may be denied membership or have needs rejected.
• No regulatory oversight. No required financial reserves, no solvency audits, no state guaranty fund. When Liberty HealthShare collapsed, members were left with hundreds of thousands in unpaid bills.
• Slow reimbursement. You often pay providers first, then wait 30 days to 6 months for reimbursement. Large unpaid balances during that period are your responsibility.

Who Health Sharing Works For

You may be a good candidate if you are generally healthy with no pre-existing conditions, do not need mental health services, share the ministry's religious beliefs, earn too much to qualify for ACA subsidies, have savings to cover a major bill if the ministry declines to share, and accept the risk that sharing is not guaranteed. The ideal member is a financially stable, healthy family that values the faith community and does not need the broader protections insurance provides.

Who Should NOT Use Health Sharing

Choose traditional insurance instead if you have pre-existing conditions requiring ongoing treatment, need mental health or psychiatric care, are pregnant or planning pregnancy soon, take expensive ongoing prescriptions, lack savings to absorb a large unexpected bill, qualify for ACA subsidies, or want a legally enforceable guarantee that your bills will be paid.

A serious medical event without adequate coverage can lead to years of medical debt or bankruptcy. The NAIC has issued multiple consumer alerts warning that HCSM members may believe they have coverage when they actually do not.

Legal Status and Regulatory Concerns

At the federal level, HCSMs in continuous operation since December 31, 1999 qualified for the ACA exemption. At the state level, more than 30 states explicitly exempt HCSMs from insurance regulation, provided they are 501(c)(3) nonprofits, have operated continuously, and include disclaimers stating they are not insurance.

This regulatory gap has attracted both legitimate ministries and questionable operators. State attorneys general in Washington, Texas, Colorado, and New Hampshire have taken enforcement actions against organizations they allege were selling unlicensed insurance disguised as health sharing. The NAIC recommends states strengthen oversight through financial reporting requirements and consumer complaint processes. The Alliance of Health Care Sharing Ministries argues regulation would undermine religious freedom principles.

Before joining, verify the ministry is an Alliance member or has operated since at least 1999. Check for lawsuits, attorney general complaints, and BBB ratings. Read the full guidelines — not just marketing materials — and understand you have fewer protections than with insurance.

The Bottom Line

Health sharing ministries offer a genuinely lower-cost alternative for healthy people who share the ministry's religious values and understand the risks. Monthly savings of $600 to $1,400 for a family are real and meaningful.

But health sharing is not insurance. There are no coverage guarantees, no regulatory oversight, and no legal obligation for the ministry to pay. If you have chronic conditions, need mental health care, or cannot absorb a large medical bill, the savings are not worth the risk.

Before joining, take three steps. First, check if you qualify for ACA premium tax credits — many families earning well into six figures qualify for subsidies that make marketplace plans affordable. Second, read the ministry's full guidelines, focusing on exclusions, waiting periods, and voluntary-sharing disclaimers. Third, make sure you have a financial safety net to cover a major expense on your own — because that is exactly what you might need to do.

Frequently Asked Questions

Are health sharing ministry payments tax-deductible? No. Monthly shares are not deductible as health insurance premiums, and you cannot use HSA or FSA funds to pay them. You may be able to deduct qualifying out-of-pocket medical expenses exceeding 7.5% of adjusted gross income, but shares themselves are not deductible.

Does HCSM membership count as health insurance under the ACA? Not exactly. Qualifying HCSM membership provided an exemption from the individual mandate penalty — not compliance. The federal penalty is now $0, but states with their own mandates (California, New Jersey, etc.) may not accept HCSM membership, potentially triggering a state penalty.

What happens if the ministry denies my medical need? You are responsible for the full cost. There is no legally binding appeals process. Some ministries have internal reviews, but their decision is generally final. You cannot file a complaint with your state insurance department because HCSMs are not regulated as insurance.

Can I join if I am not Christian? Most major HCSMs require a Christian statement of faith and agreement to live by biblical principles. Some newer, non-faith-based sharing organizations exist but may not qualify for the same legal exemptions. Options among established, reputable HCSMs for non-Christians are very limited.

How long does reimbursement take? Simple needs may be processed in 30 to 60 days. Complex cases involving large bills or eligibility questions can take 90 days to 6 months or longer. You are responsible for the outstanding balance with the provider during that time.

Can I have both health insurance and an HCSM? Yes, but it rarely makes financial sense since it doubles your monthly payments. Some people pair a high-deductible ACA plan for catastrophic protection with an HCSM, but most choose one or the other based on needs, risk tolerance, and budget.