What Is a Health Sharing Ministry?
A health sharing ministry (HSM) — sometimes called a healthcare sharing ministry — is a nonprofit organization in which members voluntarily pool money to help one another pay medical bills. Members are typically united by shared religious or ethical beliefs, though some newer organizations have broadened their membership criteria.
HSMs are explicitly exempt from ACA regulations under a provision in the law itself, meaning they are not classified as insurance under federal or most state definitions. This exemption is both their greatest strength and their most significant limitation.
How Health Sharing Ministries Work
The mechanics vary by organization, but the general model is:
- Members pay a monthly "share" (analogous to a premium) into the organization's pool.
- When a member has a qualifying medical need, they submit it to the ministry.
- The ministry facilitates payment from the pool to the member or provider.
- Members often also pay a fixed "annual unshared amount" — similar to a deductible — before the ministry covers costs.
Well-known HSMs include Samaritan Ministries, Medi-Share, and Liberty HealthShare. Some have operated for decades and have hundreds of thousands of members.
Advantages Over ACA Plans for Some Consumers
- Lower monthly costs: Monthly shares are often substantially lower than ACA marketplace premiums, particularly for individuals who don't qualify for subsidies.
- Flexibility: HSMs typically allow members to see any doctor or specialist without network restrictions.
- Aligned values: For members who share the ministry's ethical or religious framework, HSMs offer a community-based approach to cost-sharing.
- No mandate compliance issues: Though the individual mandate penalty is now zero, HSMs originally offered an exemption from it as well.
Critical Limitations and Risks
HSMs are not insurance, and that distinction carries real consequences. Consumers considering this option should understand the following risks:
- No legal guarantee of payment: Ministries can — and sometimes do — decline to share costs for claims they deem inconsistent with their guidelines. There is no regulatory backstop.
- Pre-existing condition exclusions: Most HSMs exclude or significantly limit coverage for pre-existing conditions, a protection the ACA guarantees in the insurance market.
- Lifestyle restrictions: Many ministries require members to abstain from tobacco, illegal drugs, and sometimes alcohol. Claims arising from non-compliant behavior may be denied.
- Limited mental health and prescription drug coverage: Many HSMs offer minimal or no sharing for mental health treatment or routine prescriptions.
- Regulatory complaints: Several state attorneys general have issued warnings or taken action against HSMs for misleading marketing or failure to pay claims.
Who Might Benefit from an HSM?
HSMs can be a reasonable option for:
- Generally healthy individuals or families with low expected medical utilization.
- Those whose income exceeds subsidy thresholds and who face high marketplace premiums.
- Consumers whose values align with the ministry's guidelines and who understand they are not purchasing regulated insurance.
They are likely a poor fit for people with chronic conditions, those who regularly use prescription medications, or anyone who needs the legal protections that come with regulated insurance coverage.
The Policy Debate
HSMs represent a genuine free-market alternative that has attracted millions of members. Their growth reflects real dissatisfaction with ACA marketplace pricing for unsubsidized consumers. However, their exemption from consumer protection regulation raises legitimate policy questions about what disclosures and solvency standards should be required. A balanced reform agenda would find ways to preserve this option for consumers while ensuring they can make fully informed choices.