Health Care Sharing Ministries: How They Work and What to Know

Health care sharing ministries have grown from a niche faith-based movement to a mainstream alternative to health insurance, with over 1.5 million Americans now participating. These organizations allow members to share each other’s medical costs according to shared religious beliefs — and their monthly costs are typically far lower than traditional insurance premiums.

But health care sharing ministries are not insurance, and the distinction matters in ways that can cost you thousands of dollars if you do not understand the fine print. This guide explains how they work, profiles the major ministries, and offers a balanced assessment of the benefits and risks.

How Health Care Sharing Ministries Work

At their core, health care sharing ministries (HCSMs) are voluntary arrangements among people who share common religious convictions. Members pay a monthly “share” amount — not a premium — into a collective pool. When a member has a medical need that meets the ministry’s guidelines, other members’ contributions are directed toward that need.

The operating model varies by ministry, but the general process looks like this:

You enroll as a member and attest to shared religious beliefs and lifestyle commitments (no tobacco, limited alcohol, regular church attendance, etc.).
You pay a monthly share amount, typically $100 to $500+ depending on coverage level and family size.
When you have a qualifying medical expense, you submit it to the ministry.
The ministry reviews the need against its sharing guidelines.
If approved, the cost is shared by other members — either through the central fund or directly member-to-member, depending on the ministry.
You pay a personal responsibility amount (similar to a deductible) before sharing begins.

The critical legal distinction: HCSMs are not insurance companies. They are not regulated by state insurance departments, not required to maintain financial reserves, and not legally obligated to pay any specific claim. Every major HCSM includes a disclosure stating that sharing is voluntary and not guaranteed. They were explicitly exempted from the ACA’s individual mandate under 26 U.S.C. Section 5000A.

The Major Health Care Sharing Ministries

Four organizations dominate the HCSM landscape. Each operates differently, so understanding the distinctions is important.

Christian Healthcare Ministries (CHM)

Founded in 1981, CHM is one of the oldest and most established HCSMs. It operates as a 501(c)(3) nonprofit based in Barberton, Ohio.

Monthly shares: $90 (Bronze — bills over $500 per incident), $135 (Silver — bills over $500), $175 (Gold — all eligible bills).
Family pricing: Approximately $270 to $525 per month for families.
Personal responsibility: $500 per incident on most programs.
Notable features: No network restrictions — use any provider. Optional “Brother’s Keeper” add-on covers bills exceeding $125,000. Shares medical bills up to 36 months old.
Requirements: Members must attest to living a biblical lifestyle, including attending a fellowship of believers.

Medi-Share

Operated by Christian Care Ministry, Medi-Share is one of the largest HCSMs with over 400,000 members. It functions more like traditional insurance than other ministries.

Monthly shares: Vary by age, family size, and Annual Household Portion (AHP) chosen. Individual shares range from approximately $130 to $400+; family shares from $350 to $700+.
Annual Household Portion: Functions like a deductible. Options range from $1,000 to $10,500.
Notable features: Uses a Preferred Provider Organization (PPO) network for discounted rates. Online member portal for bill tracking. Pre-notification required for non-emergency services.
Requirements: Statement of faith, regular church attendance, no tobacco, no illegal drugs, no unmarried sexual activity.

Samaritan Ministries

Samaritan uses a direct member-to-member sharing model — your monthly share is sent directly to another member in need, along with a personal note of encouragement.

Monthly shares: Approximately $440 for a family, $185 for individuals (amounts adjust periodically based on membership needs).
Personal responsibility: Members pay the first $300 of each medical need before sharing.
Notable features: “Save to Share” program for needs exceeding $250,000. Members choose their own providers. Emphasis on personal relationships between members.
Requirements: Regular church attendance, pastoral verification, agreement with Samaritan’s statement of faith.

Liberty HealthShare

Liberty has positioned itself as a more inclusive HCSM, accepting members from a broader range of faith backgrounds.

Monthly shares: Starting at approximately $199 for individuals, $449+ for families.
Annual Unshared Amount: Ranges from $1,000 to $2,250 depending on the program.
Notable features: Accepts members from various Christian traditions. Offers a wider range of shareable expenses than some other ministries.
Requirements: Agreement with Liberty’s Statement of Shared Beliefs, which is broader than some other ministries’ requirements.

Note: Liberty HealthShare has faced legal challenges and regulatory scrutiny in several states. Research its current standing before enrolling.

What Health Care Sharing Ministries Cover

Shareable expenses vary by ministry, but most cover:

Hospitalization and surgery
Emergency room visits
Doctor office visits (often after the personal responsibility amount)
Diagnostic testing and lab work
Maternity care (often with a waiting period of 10 to 12 months)
Cancer treatment
Prescription drugs related to a shareable need

What most HCSMs do NOT share

Pre-existing conditions: Most ministries exclude or limit sharing for conditions diagnosed before enrollment. Waiting periods of one to three years are common before pre-existing conditions become shareable.
Mental health care: Many HCSMs do not share costs for mental health treatment, counseling, or psychiatric medications.
Preventive care: Routine physicals, annual screenings, and vaccinations are generally not shareable.
Substance abuse treatment: Typically excluded.
Conditions resulting from “unbiblical” lifestyle choices: Medical needs arising from drug use, extramarital sexual activity, or other behaviors violating the ministry’s guidelines may not be shared.
Ongoing prescription maintenance medications: Coverage for long-term medications (cholesterol, blood pressure, diabetes) varies significantly by ministry.

Pros of Health Care Sharing Ministries

HCSMs offer genuine advantages for the right members:

Lower monthly costs: Average HCSM shares are 30 to 60 percent lower than ACA marketplace premiums for comparable coverage levels, particularly for families.
No network restrictions (most ministries): CHM and Samaritan allow members to see any provider, which can be valuable in rural areas or for patients who prefer specific specialists.
Faith-based community: Members value the spiritual dimension — praying for each other’s needs, sending personal notes, and participating in a community of shared values.
Lower administrative overhead: HCSMs spend a higher percentage of member contributions on actual medical sharing compared to the administrative and profit margins of insurance companies.
Negotiating leverage: Many HCSMs negotiate directly with providers for cash-pay discounts, often reducing bills by 40 to 70 percent.

Cons and Risks of Health Care Sharing Ministries

The risks are real and should not be minimized:

No legal guarantee of payment. Every HCSM states clearly that sharing is voluntary. If the ministry faces financial difficulty, decides your need does not qualify, or interprets its guidelines differently than you expected, you have limited recourse. Unlike insurance, there is no state insurance commissioner to file a complaint with.
Pre-existing condition exclusions. Under the ACA, insurers must cover pre-existing conditions at the same price. HCSMs have no such requirement. If you develop a condition before joining, you may wait years before those expenses are shareable — or they may never qualify.
No coverage for preventive care. The ACA requires insurers to cover preventive services at no cost. HCSMs generally do not share preventive care expenses, meaning annual physicals, screenings, and vaccinations come entirely out of pocket.
Mental health gaps. With 21 percent of U.S. adults experiencing mental illness annually per the National Institute of Mental Health, the exclusion of mental health care is a significant concern.
Regulatory uncertainty. Several states have investigated HCSMs for operating like unlicensed insurance companies. Legal challenges have resulted in fines and operational restrictions for some ministries. The regulatory landscape continues to evolve.
Lifestyle requirements. Members who fail to adhere to the ministry’s lifestyle standards — or whose medical needs arise from prohibited behaviors — risk having their expenses denied.

Health Care Sharing Ministries vs. Health Insurance

Here is a direct comparison of the key differences:

Legal obligation to pay claims: Insurance — yes (contractual). HCSM — no (voluntary).
Regulated by state insurance departments: Insurance — yes. HCSM — no.
Pre-existing conditions: Insurance (ACA) — must cover. HCSM — may exclude.
Preventive care: Insurance (ACA) — free. HCSM — typically not shared.
Mental health coverage: Insurance (ACA) — required. HCSM — often excluded.
Annual/lifetime benefit caps: Insurance (ACA) — prohibited. HCSM — may apply.
Monthly cost: Insurance — higher premiums (before subsidies). HCSM — lower share amounts.
Provider network: Insurance — varies (HMO, PPO). HCSM — typically any provider.

For a deeper understanding of insurance plan types, see our guides on HMO vs. PPO, deductibles, and copays.

Frequently Asked Questions

Are health care sharing ministries considered insurance?

No. HCSMs are explicitly not insurance under federal and state law. They are voluntary cost-sharing arrangements organized around shared religious beliefs. They do not provide guaranteed benefits, are not regulated by insurance commissioners, and are exempt from ACA requirements.

Do I need to be religious to join an HCSM?

Most HCSMs require members to affirm a statement of faith and adhere to lifestyle guidelines rooted in Christian teachings. Some ministries, like Liberty HealthShare, have broader faith requirements than others. If you do not hold these beliefs, an HCSM is likely not an appropriate fit.

What happens if my HCSM goes out of business?

If an HCSM ceases operations, members lose their cost-sharing arrangement and are responsible for any unpaid medical bills. Because HCSMs are not insurance, there is no state guaranty fund to cover losses — unlike regulated insurers, which are backed by state guaranty associations in the event of insolvency.

Can I have an HCSM and health insurance at the same time?

Yes. Some people maintain an HCSM for routine and moderate medical needs while also carrying a high-deductible health plan or short-term insurance for catastrophic protection. This approach combines lower monthly costs with a legal safety net. However, coordination between the HCSM and insurer may be complex.

Do employers offer HCSMs as a benefit?

Some small businesses offer HCSM memberships as an alternative to traditional group health insurance, often through Section 105 HRAs (Health Reimbursement Arrangements) or Individual Coverage HRAs (ICHRAs). This is more common among small, faith-aligned employers. However, HCSMs do not satisfy the ACA’s employer mandate for applicable large employers.

Make an Informed Choice

Health care sharing ministries fill a real need in the American healthcare landscape, offering significantly lower monthly costs and a community-driven approach to medical expense sharing. For healthy, faith-aligned individuals and families who understand the limitations and are comfortable with the lack of legal guarantees, they can be a viable alternative to traditional insurance.

But they are not for everyone. If you have pre-existing conditions, need mental health care, want guaranteed coverage, or are uncomfortable with faith-based lifestyle requirements, a traditional ACA marketplace plan — especially with premium subsidies — provides stronger protections. The best approach is to read the sharing guidelines of any ministry you are considering, calculate your total annual cost under both options, and assess your risk tolerance honestly.

For more on navigating the complex world of healthcare coverage, explore our healthcare policy guide and compare options like COBRA, short-term insurance, and urgent care costs to find the coverage strategy that works for your situation.