A health care sharing ministry (HCSM) is an organization whose members share a common set of religious or ethical beliefs and voluntarily agree to cover each other’s medical expenses. It is not health insurance. Members pay a monthly amount, often called a “share,” which goes toward paying other members’ qualifying medical bills. As of 2024, roughly 1.4 million Americans were enrolled in these programs nationally.
How Health Care Sharing Ministries Work
The basic model is straightforward: you pay a monthly contribution, and that money goes toward the medical expenses of other members who have eligible needs. When you have a qualifying medical expense, the ministry either matches you directly with other paying members or pools all monthly contributions and pays your bills from that shared fund. The process resembles insurance on the surface, but the underlying structure is fundamentally different.
Most HCSMs set a “personal responsibility” amount, similar to a deductible, that you pay out of pocket before sharing kicks in. Monthly contributions typically range from $200 to $500 or more depending on age, family size, and the level of coverage you choose. That’s often less than a comparable health insurance premium, which is one of the main reasons people consider these programs.
What Makes Them Different From Insurance
The most important distinction is legal. Health insurance is a contract: the insurer is legally obligated to pay covered claims. An HCSM operates on a voluntary, faith-based agreement. There is no contractual guarantee that your medical bills will be paid. If the ministry runs short on funds or determines your expense doesn’t qualify, you have limited legal recourse compared to what you’d have with an insurance company.
Because HCSMs are not insurance, they are not regulated by state insurance departments in most states. That means they don’t have to comply with state consumer protection rules that apply to insurers, such as requirements around claims processing timelines, appeals processes, or minimum coverage standards. The National Association of Insurance Commissioners specifically flags this distinction for consumers considering these programs.
Eligibility and Membership Requirements
Most HCSMs require you to sign a statement of faith or agree to a set of religious or ethical beliefs. Many are rooted in Christianity and expect members to live according to specific lifestyle guidelines. Common requirements include regular church attendance, abstaining from tobacco and recreational drugs, and limiting alcohol use. Some ministries require that you were not using tobacco or drugs for a period before joining.
These lifestyle requirements aren’t just formalities. If the ministry determines that a medical condition resulted from behavior outside its guidelines, it can decline to share that expense. For example, a liver condition linked to heavy drinking, or injuries from drug use, would likely not be eligible for sharing.
What Expenses Are Typically Shared
HCSMs generally share costs for major medical events: surgeries, hospitalizations, emergency room visits, and some outpatient procedures. Beyond that, coverage varies significantly from one ministry to another. Some share costs for maternity care, though often with waiting periods of a year or more. Some cover prescription medications, while others don’t.
Services that are commonly excluded or limited include:
- Pre-existing conditions. Unlike health insurance under the Affordable Care Act, which cannot refuse coverage or charge more for pre-existing conditions, HCSMs routinely impose waiting periods of one to three years before sharing expenses related to conditions you had before joining. Some never share those costs at all.
- Mental health care. Many ministries exclude therapy, psychiatric medications, and substance abuse treatment entirely.
- Preventive care. Routine checkups, screenings, and vaccinations are often not eligible for sharing.
- Maternity for unmarried members. Pregnancies outside of marriage are typically excluded based on the ministry’s faith guidelines.
Each ministry publishes its own guidelines detailing what qualifies as a “shareable” expense. Reading these carefully before joining is essential, because the differences between programs can be dramatic.
The ACA Exemption (and Its Expiration)
When the Affordable Care Act’s individual mandate was in effect, membership in a qualifying HCSM counted as an exemption from the requirement to carry health insurance. You would not owe the tax penalty for being uninsured. To qualify, the ministry had to have been in continuous operation since December 31, 1999, and members had to share medical expenses in accordance with specific criteria.
This distinction matters less now. The federal tax penalty for not having insurance was reduced to $0 starting in 2019. However, a few states have their own individual mandates, so depending on where you live, HCSM membership may or may not satisfy your state’s requirement.
Financial Risks to Understand
The lower monthly cost is the primary draw, but it comes with tradeoffs that can be expensive if things go wrong. Because there is no legal guarantee of payment, members occasionally face large unpaid medical bills even after submitting them through the ministry. If the ministry decides a bill doesn’t meet its sharing guidelines, or if contributions from other members fall short, you are responsible for the balance.
HCSMs also typically set annual or per-incident caps on sharing. A serious illness or accident that generates hundreds of thousands of dollars in bills could exceed those limits, leaving you with substantial out-of-pocket costs. Traditional insurance plans sold under the ACA, by contrast, are prohibited from imposing annual or lifetime dollar limits on essential health benefits.
Regulatory oversight is another concern. Most states do not require HCSMs to undergo independent financial audits, maintain reserve funds, or publicly disclose their financial statements. Some ministries are well-run and transparent, publishing annual reports voluntarily. Others operate with little outside scrutiny. Colorado is one of the few states that has begun requiring HCSMs to report membership and financial data, with 20 organizations submitting data for 2024.
Who These Programs Work Best For
HCSMs tend to appeal to people who are relatively healthy, share the ministry’s faith commitments, and are comfortable accepting more financial risk in exchange for lower monthly costs. Self-employed individuals and families who don’t qualify for ACA subsidies are a common demographic, since unsubsidized insurance premiums can be very high.
They work less well for people with chronic conditions, those who need mental health services, or anyone who wants the certainty that comes with a legally binding insurance contract. If you’re considering an HCSM, the key questions to investigate are: what specific expenses does this ministry share, what are the caps and waiting periods, what happens if a bill is denied, and what is the ministry’s track record of actually paying members’ claims. Asking current and former members about their experiences can be more revealing than reading the ministry’s own marketing materials.