A health care sharing ministry (HCSM) is a nonprofit organization whose members pool money each month to pay one another’s medical bills, guided by shared religious or ethical beliefs. It looks similar to health insurance on the surface, but it operates under a fundamentally different legal framework: no HCSM is required to pay your medical expenses. Around 1.4 million Americans are currently enrolled in these programs nationwide.
How Sharing Ministries Work
Each month, members contribute a set amount called a “share.” The ministry matches those contributions with another member’s eligible medical bills. Many organizations publish a monthly newsletter listing members’ names and current medical needs so participants can support each other financially and through prayer.
When you have a medical expense, you submit it to the ministry for review. If it qualifies under the organization’s guidelines, your bill is divided among other members’ monthly shares. Some ministries route funds through a central account; others direct members to send payments straight to the person in need. Either way, the core concept is the same: members pay for each other’s care rather than an insurance company assuming the financial risk.
What Members Pay
Monthly shares vary by organization and depend on factors like your age, household size, and the level of coverage you choose. Plans often resemble the bronze/silver/gold tiers familiar from the insurance marketplace, with lower monthly costs meaning more out-of-pocket responsibility when you need care.
Before the ministry shares any of your expenses, you’re responsible for an “unshareable amount,” which functions like a deductible. These range widely. At Samaritan Ministries, the initial unshareable amount starts at $300 per medical need. At Medi-Share, the annual household amount can run as high as $10,500. Christian Healthcare Ministries sets personal responsibility between $500 and $5,000 per medical need depending on your plan level. The term “per need” is important: it means the threshold applies separately to each unrelated medical condition, not once per year.
Administrative fees add to the cost. Some ministries fold them into your monthly share. Others charge separately. Sedera Health, for example, retains 9.9% of cost-sharing dollars for administration and may keep up to 90 days of new members’ shares to cover startup costs. Samaritan Ministries asks each member to contribute one month’s share annually toward operations.
What’s Typically Not Covered
HCSMs exclude categories of care that standard health insurance is required to cover. Most do not share expenses for preventive care like cancer screenings or immunizations. Mental health services are commonly excluded. Maintenance prescription drugs for chronic conditions, such as daily medications for diabetes or high blood pressure, are often ineligible for sharing as well.
Pre-existing conditions are a gray area. Federal law requires that ministries retain members who develop a medical condition after joining, but many impose waiting periods of one to three years before sharing expenses related to conditions you had before enrollment. Some never share those costs at all.
Membership Requirements
Joining an HCSM isn’t just a financial decision. Most organizations require applicants to sign a statement of faith or attest to specific lifestyle commitments. Common requirements include regular church attendance, abstinence from tobacco and illegal drugs, limited or no alcohol use, and sexual activity only within a traditional biblical marriage. Some ministries ask members to agree to practice good health habits as a condition of eligibility.
If you don’t meet these standards, or if the ministry determines your medical need resulted from behavior outside its guidelines, your expenses may not be shared. A substance-related injury, for instance, could be denied.
How Members Handle Medical Bills
Because HCSMs are not insurance, members are technically self-pay patients. This changes how you interact with doctors and hospitals. You won’t hand over an insurance card and wait for an explanation of benefits. Instead, you receive the bill directly and either pay it yourself or work with the ministry to have it shared.
The upside is that self-pay patients can often negotiate significant discounts. Medical providers routinely offer 40% to 50% or more off their listed prices for patients paying out of pocket. Some ministries partner with negotiation firms to help members reduce bills. Karis Group, one of the largest such firms, reports negotiating roughly $200 million in savings for HCSM members since 1996. Members are generally encouraged to ask for the self-pay discount upfront and to push back if offered less than 50% off.
The downside is that you may need to pay the full bill first and wait for reimbursement, depending on how your ministry operates. And if your expense doesn’t qualify for sharing, you’re on the hook for the entire amount.
The Legal Distinction From Insurance
This is the most important thing to understand about HCSMs: they are not insurance, and they are not regulated as insurance. Federal law defines a health care sharing ministry as a tax-exempt 501(c)(3) organization that has been continuously operating since at least December 31, 1999, whose members share medical expenses according to common ethical or religious beliefs regardless of what state they live in, and which undergoes an annual independent audit made available to the public.
That legal definition originally mattered because it exempted HCSM members from the Affordable Care Act’s individual mandate penalty. The penalty was reduced to $0 starting in 2019, so the exemption is less relevant now, but the definition still determines which organizations qualify as legitimate ministries under federal law.
State insurance departments do not regulate HCSMs the way they regulate insurers. This means no state guarantee fund backs your claims if the ministry runs out of money. No regulator reviews whether your denial was fair. The California Department of Insurance puts it plainly: HCSMs don’t guarantee payment of claims, and while they may share funds with members who have health needs, they are not legally required to do so. Most ministries include similar disclaimers in their own materials.
How Much Actually Gets Shared
Colorado is one of the few states that requires HCSMs to report detailed financial data. In 2024, across roughly 20 reporting organizations, members in Colorado submitted $248.6 million in health care costs for sharing. Of that, $135.7 million was determined eligible. The amount actually paid out to providers or members came to $87.4 million. That means roughly 35 cents of every dollar submitted by members was ultimately shared, though the gap reflects a mix of unshareable amounts, ineligible expenses, and costs still being processed.
Christian Healthcare Ministries, the largest ministry with about 351,000 members nationally, collected $19.4 million from Colorado members alone while paying $5.1 million to Colorado providers. These numbers don’t tell the full story of any individual member’s experience, but they illustrate the gap between what members expect to receive and what ministries pay out.
Who HCSMs Work Best For
Health care sharing ministries tend to appeal to people who are relatively healthy, share the religious values of the organization, and want a lower monthly cost than traditional insurance. If you rarely need medical care beyond routine checkups, the savings on monthly shares can be substantial.
The risk increases if you develop a serious illness, need ongoing prescriptions, or require mental health treatment. Without the consumer protections built into regulated insurance, including guaranteed coverage of essential health benefits, annual out-of-pocket maximums, and prohibition on lifetime caps, a major health event could leave you with bills the ministry won’t share. Members who understand and accept that trade-off, and who have savings to cover gaps, are in the best position to use these programs without financial harm.