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

Health care sharing ministries have grown from a niche faith-based movement into a widely marketed alternative to health insurance, with well over a million Americans now participating. These organizations let members share one another’s medical costs according to shared religious beliefs, and their monthly costs are often far lower than traditional insurance premiums.

But here is the single most important thing to understand before you read another word: health care sharing ministries are not health insurance. That distinction is not a technicality – it changes what you are legally owed, what happens when a big bill arrives, and what recourse you have if a payment is denied. This guide explains how HCSMs work, profiles the major ministries, and gives you an honest assessment of the benefits and the 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 or, in some cases, directly to another member. 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:

1. You enroll as a member and attest to shared religious beliefs and lifestyle commitments (for example, no tobacco, limited alcohol, and regular church attendance).
2. You pay a monthly share amount, which varies widely by ministry, coverage level, age, and family size.
3. When you have a qualifying medical expense, you submit it to the ministry.
4. The ministry reviews the need against its sharing guidelines.
5. If the need is approved, the cost is shared by other members – either through a central fund or directly member-to-member, depending on the ministry.
6. You pay a personal responsibility amount (loosely similar to a deductible) before sharing begins.

The critical legal distinction bears repeating: HCSMs are not insurance companies. They are generally not regulated by state insurance departments, not required to maintain the financial reserves that insurers must hold, and not legally obligated to pay any specific claim. Every major HCSM publishes a disclosure stating in plain language that sharing is voluntary and not guaranteed. Congress explicitly exempted qualifying ministries from the ACA’s former individual mandate under 26 U.S.C. Section 5000A. Because of that exempt status, the consumer protections that come with ACA-compliant plans simply do not apply.

The Major Health Care Sharing Ministries

A handful of organizations dominate the HCSM landscape. Each operates differently, so understanding the distinctions matters. The figures below are illustrative of how these programs have been structured; share amounts, personal-responsibility amounts, and program tiers change frequently, so confirm current numbers directly with each ministry before relying on them.

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: Historically offered in tiered levels (often described as Bronze, Silver, and Gold) with different per-incident thresholds before bills become shareable. Verify current pricing.
• Personal responsibility: A set amount per incident on most programs.
• Notable features: No provider network – members may use any provider. An optional add-on has been offered to help with bills exceeding the program’s standard limits. Historically shares eligible bills up to a set age (for example, bills within the past few years).
• Requirements: Members attest to living a biblical lifestyle, including participating in a fellowship of believers.

Medi-Share

Operated by Christian Care Ministry, Medi-Share is one of the largest HCSMs and functions more like traditional insurance than some other ministries.

• Monthly shares: Vary by age, family size, and the Annual Household Portion (AHP) you choose. Confirm current amounts.
• Annual Household Portion: Functions loosely like a deductible, with a range of options.
• Notable features: Uses a Preferred Provider Organization (PPO) network for discounted rates, an online member portal for tracking bills, and pre-notification requirements for many non-emergency services.
• Requirements: Statement of faith, regular church attendance, and lifestyle commitments (for example, no tobacco, no illegal drugs, and no sexual activity outside of marriage).

Samaritan Ministries

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

• Monthly shares: Vary by household type and adjust periodically based on the ministry’s overall needs. Verify current amounts.
• Personal responsibility: Members typically pay an initial amount for each medical need before sharing applies.
• Notable features: A separate program has been offered for very large needs above the standard limit. Members choose their own providers, and the ministry emphasizes personal relationships between members.
• Requirements: Regular church attendance, pastoral verification, and agreement with Samaritan’s statement of faith.

Liberty HealthShare

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

• Monthly shares: Vary by program and household. Confirm current pricing.
• Annual Unshared Amount: Varies depending on the program selected.
• Notable features: Broader faith eligibility than some ministries and a range of shareable expenses that differs by program.
• Requirements: Agreement with Liberty’s Statement of Shared Beliefs.

Important: Some ministries, including Liberty HealthShare, have faced legal challenges, class-action litigation, and regulatory scrutiny in various states over how needs were shared and marketed. Research any ministry’s current legal and financial standing – not just its marketing – before enrolling.

What Health Care Sharing Ministries Cover

Shareable expenses vary by ministry, but many programs share costs for:

• Hospitalization and surgery
• Emergency room visits
• Doctor office visits (often after the personal responsibility amount)
• Diagnostic testing and lab work
• Maternity care (frequently subject to a waiting period, commonly around 10 to 12 months)
• Cancer treatment (sometimes with limits or caps)
• Prescription drugs tied 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 several years are common before pre-existing conditions become shareable – if they ever do.
• 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 use treatment: Typically excluded.
• Conditions tied to “unbiblical” lifestyle choices: Needs arising from drug use, sexual activity outside of marriage, or other behaviors that violate the ministry’s guidelines may not be shared.
• Ongoing maintenance medications: Coverage for long-term prescriptions (for cholesterol, blood pressure, or diabetes, for example) varies significantly by ministry and may be excluded.

Pros of Health Care Sharing Ministries

HCSMs offer genuine advantages for the right members:

• Lower monthly costs: Share amounts are frequently lower than unsubsidized ACA marketplace premiums, particularly for larger families. The size of that gap depends heavily on your income and whether you qualify for premium subsidies, so compare your own numbers.
• No network restrictions (most ministries): Programs like CHM and Samaritan let members see any provider, which can help in rural areas or for people who want a specific specialist.
• Faith-based community: Many members value the spiritual dimension – praying for one another, sending notes, and participating in a community of shared values.
• Lower administrative overhead: Some ministries direct a high share of member contributions toward actual medical sharing.
• Cash-pay negotiating leverage: Many HCSMs negotiate directly with providers for cash-pay discounts, which can meaningfully reduce bills.

Cons and Risks of Health Care Sharing Ministries

• No legal guarantee of payment. Every HCSM states clearly that sharing is voluntary. If the ministry runs into financial trouble, decides your need does not qualify, or interprets its guidelines differently than you expected, your recourse is limited. Unlike insurance, there is generally no state insurance commissioner with authority to force payment.
• Pre-existing condition exclusions. Under the ACA, insurers must cover pre-existing conditions at the same price. HCSMs have no such requirement. If you developed a condition before joining, you may wait years before those expenses are shareable – or they may never qualify at all.
• No guaranteed preventive care. ACA plans must cover recommended preventive services at no cost. HCSMs generally do not share preventive care, so annual physicals, screenings, and vaccinations often come entirely out of pocket.
• Mental health gaps. Mental illness is common – the National Institute of Mental Health reports that a large share of U.S. adults experience a mental illness in a given year – so the frequent exclusion of mental health care is a significant limitation.
• Benefit caps. Many ministries cap what they will share per incident or per lifetime. ACA plans cannot impose annual or lifetime dollar limits on essential health benefits; HCSMs can and often do.
• Regulatory uncertainty. Several states have investigated HCSMs for operating like unlicensed insurers, and some have imposed fines, disclosure requirements, or operating restrictions. The regulatory landscape continues to evolve, so a ministry’s status can change.
• Lifestyle requirements. Members who fall short of a ministry’s lifestyle standards – or whose needs arise from prohibited behaviors – risk having 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 – generally no.
• Backed by a state guaranty fund if it fails: Insurance – yes. HCSM – no.
• Pre-existing conditions: Insurance (ACA) – must cover. HCSM – may exclude or delay.
• Preventive care: Insurance (ACA) – covered at no cost. HCSM – typically not shared.
• Mental health coverage: Insurance (ACA) – required. HCSM – often excluded.
• Annual/lifetime benefit caps: Insurance (ACA) – prohibited on essential benefits. HCSM – may apply.
• Monthly cost: Insurance – higher premiums (before subsidies). HCSM – often lower share amounts.
• Provider network: Insurance – varies (HMO, PPO). HCSM – typically any provider.

One caveat on the cost comparison: the value of an ACA plan depends heavily on premium subsidies, and the level and future of enhanced marketplace subsidies has been the subject of ongoing policy debate. Before assuming an HCSM is cheaper, check what a subsidized marketplace plan would actually cost you this year at HealthCare.gov or your state exchange. 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 generally not regulated by insurance commissioners, and were exempted from the ACA’s former individual mandate. Marketing that makes an HCSM sound like insurance does not change its legal status.

Do I need to be religious to join an HCSM?

Most HCSMs require members to affirm a statement of faith and follow lifestyle guidelines rooted in Christian teachings. Some ministries have broader faith requirements than others. If you do not share these beliefs or are unwilling to follow the lifestyle rules, an HCSM is likely not an appropriate fit.

What happens if my HCSM goes out of business or won’t share my bill?

If an HCSM ceases operations or declines to share a need, you are responsible for the 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 if they become insolvent. This is one of the most important risks to weigh before enrolling.

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

Yes. Some people keep an HCSM for routine and moderate needs while also carrying a comprehensive plan or catastrophic coverage as a legal safety net. This can combine lower monthly costs with real protection, though coordinating between an HCSM and an insurer can be complex, and the HCSM may reduce what it shares if another payer is involved.

Do employers offer HCSMs as a benefit?

Some small businesses offer HCSM memberships as an alternative to traditional group coverage, sometimes paired with a Health Reimbursement Arrangement such as an ICHRA. This is more common among small, faith-aligned employers. However, HCSMs do not satisfy the ACA’s employer mandate for applicable large employers, and employees give up ACA protections.

Make an Informed Choice

Health care sharing ministries fill a real niche in the American healthcare landscape, offering lower monthly costs and a community-driven approach to sharing medical expenses. For healthy, faith-aligned individuals and families who fully understand the limitations and are comfortable with the lack of any legal guarantee, they can be a workable option.

But they are not for everyone, and they are not a substitute for insurance if you need certainty. 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 far stronger protections. The safest approach is to read the sharing guidelines of any ministry in full, calculate your total realistic annual cost under both options (including what you would owe if a big claim were denied), and assess your risk tolerance honestly.

For more on navigating healthcare coverage, explore our healthcare policy guide and compare options like COBRA, short-term insurance, and urgent care costs to find a strategy that fits your situation.

Sources

• 26 U.S.C. Section 5000A – ACA exemption for health care sharing ministries (Cornell Legal Information Institute)
• HealthCare.gov (Centers for Medicare & Medicaid Services) – health coverage options and marketplace plans
• National Association of Insurance Commissioners (NAIC) – consumer guidance on health care sharing arrangements
• The Commonwealth Fund – research on health care sharing ministries and consumer protections
• National Institute of Mental Health – Mental Illness Statistics