Health sharing ministries have been around for 40 years, and are an alternative to traditional health insurance. With the escalating cost of health insurance and medical care, they have provided a more cost-effective method for Christians to pay for medical care.
As they are not insurance, this is an important decision that needs to be weighed carefully.
This post is not an exhaustive look at these ministries, but rather focused on providing an overview of what they are and the issues you need to be careful to examine. It is not meant as an endorsement of this option, but rather to help those who are considering a health sharing ministry weigh the important issues prior to any decision.
With that said, I hope you find this informative.
A Brief History
For much of US history, patients paid the entire cost of medical care from their own pocket. In the 1920’s the precursor of modern health insurance began, but health insurance (as we currently know it) became more commonplace after World War II.
As medical costs have skyrocketed over the past few decades, health insurance was viewed as the main method to share medical costs over a larger group. This helps everyone by keeping overall costs lower, while providing funds for very expensive treatments.
The Amish and Mennonites started the health sharing concept over a century ago and still use it today. Members of their respective communities would help share in the larger medical costs of others in the community.
In the 1980’s, the idea was broadened to include the greater Christian community. Health sharing ministries take a similar approach of pooling the resources of a group of people to pay for care of its members. Health sharing members are connected by their faith, not by their employer (which is the basis for traditional health insurance).
In 2010 it was estimated that there were about 100,000 Americans who were active members of a health sharing ministry, yet by June 2021, that number had grown to more than 1.5 million Americans. The growth stemmed from the passage of the Affordable Care Act (ACA) in 2010, that required health insurance coverage or pay a penalty (the penalty ended January 1, 2019). Since people were required to have health insurance with certain coverages, the cost of health insurance increased dramatically, causing people to look for more affordable options. The ACA allowed health sharing ministry enrollment to comply with the individual mandate, thereby providing an alternative for some Christians.
What is a Health Sharing Ministry?
This is not health insurance, but rather families and individuals who come together because of their faith, to share costs for certain medical expenses. Though not all health sharing ministries are faith based, the main ones are (and they are the focus of this post). Each ministry handles things differently or have different terminology, but in general the members agree to live a “Christian” lifestyle (that is defined a little differently by each ministry) and pay a monthly sharing amount (similar to a health insurance premium).
When a medical event happens, the bill is submitted to the ministry and it is shared with the other members (paid by the other member’s monthly sharing amount). Some or all of the cost is paid by the ministry, but the member may also have some responsibility, depending on the terms of their sharing plan.
Members are generally considered cash pay patients by the medical community, which normally results in lower costs than the original quoted price for the medical treatment (traditional health insurance pays discounted rates as well). Some ministries require members to request discounts to help lower the costs for the group. In reality, many providers will give the discounts without asking because they tend to get paid quicker and at a higher amount than pursuing an insurance company for payment.
Most ministries take between 60-90 days (though sometimes longer) from receipt of a sharing request until the member or medical provider is paid out for approved expenses. Some ministries have the members send their monthly share amount to a central office and they distribute funds to other members, while others will have members send their monthly share amount to different people each month to reimburse them for their medical expenses.
Health sharing ministries are non-profit 501(c)3 organizations who also give back to their communities. The ministries view Galatians 6:2 as their Biblical mandate: “Bear one another’s burdens, and so fulfill the law of Christ.” By sharing the medical expenses across the broader pool of members, it allows Christians to share the medical expenses of other Christians.
The advantages are:
1. Lower Cost – Generally, they cost less than traditional insurance. Since they are not for profit businesses (like insurance), there is no profit motive or need to satisfy shareholders.
2. Principled Care – You aren’t paying for medical care that you don’t agree with. Traditional health insurance pays for abortions and gender reassignment surgery, but health sharing ministries do not pay for such care.
3. Spiritual Support – Rather than deal with the impersonal bureaucracy found in health insurance, these ministries also provide spiritual support to their members via prayer, encouraging notes and prayer requests shared with other members.
What Are the Options?
One of the requirements of the ACA exemption is that a health sharing ministry (or its predecessor) had to be in operation as of 12/31/1999. This limits the number of ministries to select from.
According to the Alliance of Health Care Sharing Ministries the Department of Health and Human Services (HHS) certifies there are 108 ministries that meet the federal definition of a health sharing ministry. Of the 108, only about 9 have a large and open membership.
The main evangelical Christian faith-based options are:
Christian Healthcare Ministries (CHM) – founded in 1981, it is the oldest and largest health sharing ministry. They have no network of medical providers, and monthly share amounts are sent to CHM’s office for them to distribute to other members. Each member is responsible to submit medical bills to CHM for potential reimbursement.
Medishare – founded in 1993, is one of the larger ministries. Their plan is more similar to traditional health insurance, as members have a defined network of care providers and pay the equivalent of copay’s and/or have a deductible.
Samaritan Ministries – founded in 1994. The do not have a defined network of medical providers, and each month members will send their monthly share amount to another member to help them meet their approved medical expenses.
Liberty Healthshare – founded in 1998 by the Mennonites. There is no network of medical providers, and is more similar to traditional health insurance as medical professionals send their bills to Liberty for processing.
Altrua HealthShare – traces its roots back to 1996. They are more similar to traditional health insurance with a network of medical providers who send their bills to Altrua directly for them to process.
Factors to Consider
As you weigh your options, here are important points to consider:
1. Minimal Oversight
Health insurers are regulated by each individual state insurance commissioner they operate in. They are required to have enough financial resources to meet claims, and are legally required to pay out on certain claims. Health sharing ministries do not have such oversight or legal requirements.
2. Limited Ability To Appeal
If the health sharing ministry refuses to pay for medical expenses, the appeal is through the organization. As there is no government oversight, there is limited ability to appeal a decision.
3. Financial Strength
Due to not being regulated, there is no financial reserve requirement for these ministries. Though they are required to have an outside firm audit them annually and provide the report to members, they may not have the financial resources available to meet all their members medical expenses. If too many members file large claims, it could potentially bankrupt the ministry.
4. Medical Bills Sharing History
Some health sharing ministries have struggled to pay the members medical expenses. Particularly more recently, many ministries have experienced significant growth and their systems haven’t been able to keep up with the influx of new members and sharing requests. However, some health sharing ministries struggled with this prior to their uptick in growth. This has left some members with bills they have had to pay themselves. Be sure to do your research on this because it is important to find a ministry that has a good track record of sharing medical bills.
5. Pricing Increases
Some ministries have a track record of rarely increasing their share amounts, while others raise them frequently. For example, CHM just raised their monthly share amount in 2020 for the first time in 12 years. Understanding the frequency and magnitude of increases is important.
6. Pre-existing Conditions
Each ministry has a different method of covering (or not covering) pre-existing conditions. Some allow other members to give towards those medical expenses, while others the ministry will cover. If you have pre-existing conditions, be sure to understand how this is handled.
7. What Do They Cover, And How Much?
Each ministry handles this differently. Some have networks of medical providers that they encourage you to use, while others allow you to see any medical professional. Some plans will have limits on how much they share, while others offer unlimited sharing. Traditional health insurance doesn’t cover everything, neither do health sharing ministries, so it is essential to understand their coverage.
8. No Tax Deduction
Though the monthly share amount is sent to a 501(c)3 charity, it is not tax deductible. If the member decides to gift an additional amount to the ministry, that amount may be tax deductible. As of 2021, if you are part of a health sharing ministry, you cannot contribute to a Health Savings Account (HSA).
9. Lifestyle Restrictions
Signing up for a health sharing ministry normally includes signing a statement that you agree to live a “Christian lifestyle.” Some of these lifestyle agreements are more restrictive than others, and may require you to be an active member of a local church. The terms of this agreement are very important to understand and abide by, as the other members are counting on all members to fulfill their commitment to the group.
My wife and I joined a health sharing ministry in late 2016. Being self-employed, our health insurance premiums were quite high, and we didn’t agree with some of the procedures that were being paid for by our provider. Though I was aware of health sharing ministries for some time, I didn’t think they were a viable option. However, after doing much research, we selected one, but were a bit cynical if they would work as promised.
Early in 2017 I had a medical situation develop. For the first time in my life, I was a cash pay patient, which was a little unnerving. I quickly realized how insulated I was from the true cost of medical care. The medical field is the only one that I know of where prices aren’t published, making it very difficult to compare costs.
I needed to go for a test, but did not comparison shop at all (as I was new to this). When the provider learned I was a cash pay patient, they gave me an immediate discount of over 40% (without me asking for it).
After the bills were submitted to the health sharing ministry, the expenses were shared about 90 days later. I did not pay anything for my medical care. My wife and I were shocked (and thankful) that it worked.
Over the past few years, we have had other medical expenses, and they were all handled the same way with no issues. It has been a blessing to know that we are part of a community of believers who are helping one another with medical expenses. We may never meet them, but it is encouraging to be a member.
There are a few things that we learned through this process:
1. It Can Be Time Consuming
You may need to shop around for lower cost providers which can be a challenge. After our initial research, we know which lab to go to, what facility charges the best rate for scans etc, It is a bit easier once the research is done, but can be time consuming on the front end.
2. More Responsibility
Some ministries require their members to be more involved as intermediaries between them and the medical professionals (than under traditional health insurance). This can mean extra steps to get them what they need to process a sharing request. It can be tedious particularly if you have several medical conditions at the same time.
3. It Works
At least in our case, the ministry has worked as advertised. We have saved money, received coverage for larger expenses, and become a part of a community of believers helping one another.
How To Decide
Each health sharing ministry helps people in different circumstances. There is no one ministry that is good for everyone. Here are some questions/points to consider to help you find the one that is the best fit for you:
1. What Does It Cover?
It is essential to understand whether the ministry covers pre-existing conditions, your current medicines, transport to the hospital etc so that you know your financial responsibility. Each ministry provides their coverage details on their website. Yes, it will be uninteresting reading, but is the most important step in the process.
2. Check Their Financials
Your eyes may be glazing over, but stick with me here. You can either ask your Christian financial advisor to review their finances, or you can do a basic comparison on your own:
Call each ministry and have them send you their most recent audited financial statement, and ask them how many members are currently with the ministry. You will want to look for either total current assets or unrestricted net assets on the financial statement, and then divide that number by the number of members. This will tell you how much cash they have on hand per member to meet medical needs.
If you calculate this across the different ministries, you can compare the amount they have per member to share for member medical expenses. This is very rudimentary, but can be helpful.
3. Sharing History
Google the different sharing ministries and read reviews from actual members. You can get a feel for which ones consistently share expenses and those who may not. No ministry is perfect, but you should be able to get a feel for their track record.
4. Provider Choice
Do you want to only select from a roster of providers in your area, or go see who you want?
5. Amount of Work
Do you have the time or interest to shop around for lower cost medical providers, submit bills, request discounts for medical services, etc or not?
6. Medical Expense Payments
Do you have to pay medical providers directly out of your own pocket and then be reimbursed, or does the ministry pay them directly? Some medical providers require full payment prior to service, while others may put a patient on a payment plan. Due to the potential cost, this is an important point to weigh.
7. Lifestyle Commitment
Can you abide by it? Having a more restrictive commitment can help keep costs lower as members aren’t involved in a lifestyle that may entail higher medical expenses. But once you sign it, the other members are counting on you to live by it.
This is listed last because though cost is important, the other factors listed above are more important. If you go for the cheapest plan but it doesn’t cover what you need, that isn’t a good solution for you.
Since the financial penalty for not having health coverage under the ACA was removed, many people have considered not carrying any insurance as a way to save money. Unfortunately, medical costs are one of the leading causes of bankruptcy, so I would encourage you to consider all your options as that is not a wise stewardship decision.
A health sharing ministry is not for everyone. If you are considering it, you really need to do your research and understand what is involved. This is a very large decision with potentially long-lasting consequences, but I hope this post helps you weigh your options wisely.
Points to Consider
1. You need to be willing to do your research and potentially take a more active role in the medical billing side of things if you want to join a health sharing ministry.
2. If you have children, you will want to understand what you are getting yourself into. As children normally have more medical needs, this may not be an option (unless you are fairly well organized).
3. There are no guarantees that health insurance or health sharing ministries will cover your medical expenses.