Back with the third installment of the Alternative Health Plans: Scam or Bargain? series to discuss Health Care Sharing Ministries (HCSMs), a popular option that must be thoroughly understood before making a commitment. I'll give you an in-depth look at the pros and cons of this "alternative" to health insurance (with links to sources/further reading and text of searches used to gather info) but first, the definition!
What are health sharing ministries?
Health care sharing ministries (HCSMs) are organizations where members pool their money to help cover each other's medical expenses, based on shared religious or ethical beliefs.
CAVEAT EMPTOR (buyer beware)
These ministries are NOT INSURANCE COMPANIES and are not subject to the same regulations, including those of the ACA (like policies in the Health Insurance Marketplace®). They do not offer any guarantees of coverage, can restrict due to pre-existing conditions, and should NOT be viewed as a substitute for traditional health insurance.
Health sharing ministries have a rich history rooted in faith based mutual aid societies, particularly among Amish and Mennonite communities, stemming from religious tenets such as sharing one another's burdens and providing mutual support.
Members pooled resources to help with each other's medical expenses under informal arrangements which later evolved into the more formalized health sharing ministries we see today. They expanded into broader Christian communities and rapidly grew in 2010 due to the individual mandate of the Affordable Care Act and HCSMs being exempt from the mandate if they met certain criteria.
"At the time of the law’s passage, an estimated 200,000 Americans participated in health care sharing ministries. Today, a little more than a decade later, that number has swelled to roughly 1.5 million, a more than sevenfold increase — even though Congress ultimately repealed the ACA fine." Health Care Sharing Ministries: A Christian Alternative to Health Insurance
I expect they're about to (if they haven't already) experience another boom due to the massive number of people about to lose coverage due to the Big Stupid Bill that was pushed through by the Trump administration. They can sound appealing, especially to those who are vulnerable and confused, so it's important to have a thorough understanding of their risks as well as benefits before making any choices, not just to protect ourselves but for our loved ones as well.
Older adults in particular can easily get tangled up in something like this just due to lack of information and fear of lack of coverage while facing increasing health issues due to age. Please share your knowledge on this and similar topics as much as you can because it can make a real difference.
Key Characteristics of HCSMs
Shared Religious/Ethical Beliefs
Most HCSMs are faith-based and require members to share a common set of beliefs. Some even include requirements/restrictions surrounding lifestyle choices.
Cost sharing
Members contribute monthly payments ("shares") to a pool that is used to pay for the medical expenses of other members.
No guaranteed coverage
HCSMs do NOT guarantee that all medical expenses will be covered and they ARE allowed to include restrictions based on pre-existing conditions, as well as other limitations.
What appeals to people about health sharing ministries?
It's important to understand what appeals to people about these organizations. A simple internet search will quickly demonstrate how popular they are so obviously something draws people in.
Let's take a look:
Cost/affordability
First and foremost, lower monthly costs/affordability versus that of traditional health insurance. The monthly contributions made by members are typically less than what they'd be paying in insurance premiums.
Sense of community 
People often say that they are comforted and reassured by the sense of community they get from the emphasis on shared religious/ethical beliefs. This also leads to a more personal approach to healthcare needs and they enjoy finding support and encouragement from other members. Being able to pool funds to cover each other's expenses creates a sense of shared responsibility to ease the feeling of having to carry the weight all on their own.
Extra benefits and customized coverage
Some ministries allow coverage to be customized based on the member's specific needs and beliefs, and some offer additional benefits like dental, vision, free telehealth, disability, etc. that aren't commonly included with traditional individual health insurance.
Independent audits
Most ministries undergo independent audits to ensure financial stability and transparency.
Pros and Cons & "Lifestyle Guidelines": A Closer Look
Let's go ahead and get an in-depth view of the pros and cons of HCSMs. They all vary depending on who is offering them, where they're located, and the shared beliefs of the members on which they are founded. Since they aren't subject to the same standards and regulations as health insurance, it's critical that you do your due diligence and learn about each one specifically before making any decisions about enrollment.
Health care sharing ministries (HCSMs) often consider lifestyle choices as part of their membership requirements and eligibility for medical expense sharing. I had never heard of this before researching HCSMs and was curious about the details.
I took some time to browse around some of the well known HCSMs and looked over their requirements for participation. In general, something that stands out to me is their readiness to let you know that they can deny coverage of your expenses if you're found to be in violation of their "guidelines" yet don't specify how that determination is made. When dealing with something like this that can quite literally be a matter of life and death under grim circumstances, I'd expect more clarity on the process. Even Medicare and the private insurers selling in the Marketplace detail the appeals/grievance process clearly in all of their literature for transparency.
In the tabbed section below, in addition to the pros and cons, you'll find general information about "lifestyle guidelines" as they relate to HCSMs, as well as the details of the requirements from some of the popular HCSMs operating at the moment. I've also provided links in case you want to go check it out and see how it strikes you. There's even a link to a guide comparing the "statements of faith" and/or other required commitments from different HCSMs all in one place!
Lower Monthly Costs
Health sharing ministries generally have lower monthly contributions than the monthly premiums paid for traditional health insurance plans because they don't have the overhead costs associated with insurance companies, such as marketing and administrative expenses.
Wider Choice of Providers
Members can often see any healthcare provider without the restrictions of a network.
Sense of Community
Many members appreciate the sense of belonging and shared faith within the ministry due to HCSMs often being rooted in a shared religious or ethical belief system.
Additional Benefits
Some ministries offer additional perks like dental and vision discounts, disability sharing, or telehealth.
Flexible Enrollment
Some ministries allow enrollment outside of open enrollment periods.
Pre-existing Conditions
This appears as a pro and a con of HCSMs. While some HCSMs do have limitations or exclusions on coverage based on pre-existing conditions, there are also some that do not exclude members based on their medical history, thus increasing their appeal to those with chronic, ongoing conditions.
Not Regulated Like Insurance
Health sharing ministries are not subject to the same regulations as insurance companies, potentially leading to fewer consumer protections.
Limited Coverage
Coverage for specific medical expenses or procedures may be limited or excluded, especially those deemed against the ministry's religious beliefs.
Potential for Higher Out-of-Pocket Costs
If a member experiences a significant medical event, the cost of care may be higher than with insurance, especially if the ministry cannot meet its financial obligations.
Limited Legal Protections
Consumers have little to no legal recourse if a claim is denied or the ministry goes bankrupt.
Pre-existing Conditions
Some ministries may limit or exclude coverage for pre-existing conditions.
Risk of Financial Instability
If a ministry experiences financial difficulties, it could impact its ability to pay claims, potentially leaving members with substantial out-of-pocket costs. Furthermore, HCSMs often require members to negotiate discounts or seek charity care, adding another layer of complexity and potential frustration.
Potential for Unintentional Neglect
If a ministry primarily attracts healthy individuals, it may create a smaller, sicker risk pool in the broader insurance market, leading to higher premiums and fewer choices.
Health care sharing ministries (HCSMs) often consider lifestyle choices as part of their membership requirements and eligibility for medical expense sharing. Here are some details of how lifestyle choices relate to HCSMs:
Faith-Based Principles
Many HCSMs are founded on shared religious and ethical beliefs and require members to adhere to specific lifestyle guidelines.
"Godly Lifestyle" Rules
These guidelines often include tenets like refraining from tobacco use, avoiding alcohol abuse, and abstaining from certain sexual practices.
Focus on Health and Wellbeing
HCSMs may emphasize maintaining a healthy lifestyle, such as eating healthy foods and exercising regularly, according to Liberty HealthShare.
Christian Health Share Ministries: What Is A Christian Lifestyle?
Impact on Sharing Eligibility
Certain medical expenses related to what an HCSM considers unhealthy lifestyle choices might not be eligible for sharing. For example, some ministries may exclude expenses related to alcohol/substance use, addiction, or illnesses caused by smoking or obesity.
Statements of Faith
Some HCSMs require members to sign a statement of shared faith and principles, which includes a commitment to healthy life choices.
Membership Continuation
Members may need to reconfirm their adherence to these requirements annually to maintain membership.
I've said it before and it bears repeating: HCSMs are NOT health insurance and are NOT subject to the same regulations as traditional insurance plans. Membership and the sharing of costs are often based on voluntary contributions among members, guided by the ministry's specific rules and guidelines. Therefore, it's imperative for individuals considering joining an HCSM to carefully review the ministry's guidelines and statement of faith to understand how lifestyle choices might affect their membership and eligibility.
HSA for America (a very clearly pro-HCSM organization) offers a comparison of statements of faith from various HCSMs. While they state that there are secular HCSMs without statements of faith or other required commitments based on religion, I had trouble finding any featured in their blog other than Sedera, who claims no affiliation with any religious group. While their guidelines are neutral, the language used is so close to that of the others that I had difficulty viewing them any differently. Check this out and see what you think:
Healthshare Statements of Faith: 2025 Comparison Guide
You can also browse the 2025 HealthShare Guide. It offers information about HCSMs in general and also ranks some of the current ones operating in 2025 on different features. Interestingly, I wasn't able to establish who provides this guide and the information and assessments in it but give it a look. What's your take on it?
https://healthshareguide.org/healthshares/
Medi-Share is a HCSM offering an education center on their website to share information about what they provide with "tools and insights for individuals, families, seniors, and the self employed."
Medi-Share® Education Hub | Health Care Sharing Resources
When searching Google for information on this, their AI summary had this to say:
"Information related to secular HCSMs in 2025 is limited, and it appears that no explicitly secular HCSMs existed when research was being conducted for a publication that will be released in April 2025. However, there is mention of a secular health care cost-sharing company called CrowdHealth that was founded around the time data was being collected for the research mentioned above and has recently gained national attention."
Full article: Religion facilitates cooperation in health care sharing ministries
Conclusion
This is my personal opinion/overall takeaway from my own research into HCSMs. Your opinion after doing your research may very well be different and even in complete opposition to mine. In no way am I suggesting that all HCSMs are the same or offer the same things to their members. I am speaking purely from the information that I found and how I feel about it. Please don't just take my word for it. Dive in and see what you can find and how it resonates with you.
I have learned quite a bit I didn't know about health care sharing ministries from researching this piece and my personal conclusion, had I been considering joining one, would have to be a solid no after being informed of all the facts. I have no doubt that HCSMs are a great option for others out there but they're not something I'd feel particularly comfortable with if I had other, more secure options.
Not everyone has a lot of confidence in financial endeavors entered into by churches and the literature provided by the ministries themselves didn't provide nearly enough insight into their workings to ease my concerns. Add to that the lack of government oversight of their practices (because they're not considered insurance and therefore not held to the standards set in place to protect consumers) and I've got the coldest feet you could get when it comes to giving them my money and trusting that they'll come through when needed.
I hope that this has been informative, helpful, and easy to understand. Thank you for your interest! I hope you'll bookmark the blog and check back for the next installment where we'll explore Direct Primary Care (DPC). In short, it's a healthcare model where patients pay a monthly membership fee to a physician or practice for access to comprehensive primary care services, bypassing traditional insurance-based billing. (AKA subscription health plans, concierge care plans)
Sources/Links for further information:
⇒ What is a health care sharing ministry? | healthinsurance.org⇒ Alternative health plans (from TX Department of Insurance)
⇒ Health Care Sharing Ministries - The Actuary Magazine
⇒ What You Should Know About Health Care Sharing Ministries, Discount Plans, and Risk-Sharing Plans (from NAIC National Association of Insurance Commissioners)
Searches used in topic research:
⇒ Top pros and cons of health sharing ministries⇒ Drawbacks of HCSMs
⇒ What appeals to people about HCSMs
⇒ History of health care sharing ministries
⇒ Health care sharing ministries and lifestyle choices
⇒ Secular HCSMs in 2025
What's next?
To keep up-to-date on news and information regarding the ACA & the Marketplace, you can check out my blog!
Go take a look at my Resources page for helpful links from the entire website, my upcoming e-book, and social media series PLUS a glossary of key terms and gallery of infographics!
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