Is Health Sharing Insurance?
No. Health sharing ministries are not insurance companies. They are exempt from Affordable Care Act requirements under Section 1402(d) and are not regulated by state insurance departments. There is no contractual guarantee that medical expenses will be shared. However, established ministries have reliably shared billions in medical expenses, and many members report comparable coverage at 30-60% lower cost than ACA marketplace plans.
Last updated: February 2026 | Data verified from official plan websites
Key Facts
| Legal Classification | 501(c)(3) nonprofit, not insurance |
| ACA Exemption | Section 1402(d) |
| State Regulation | Not regulated by insurance departments |
| Guaranteed Payment | No — voluntary sharing model |
| Mandated Benefits | No — each ministry sets own guidelines |
| Cost vs Insurance | 30-60% lower than ACA marketplace |
| Track Record | 40+ years (CHM founded 1981) |
What Are the Legal Differences Between Health Sharing and Insurance?
Insurance is a legally binding contract between you and an insurance company. The insurer is contractually obligated to pay covered claims according to the policy terms. Insurance companies are regulated by state departments of insurance, must maintain minimum financial reserves, and are subject to consumer protection laws. If an insurer wrongfully denies a claim, you can file a complaint with your state insurance commissioner or pursue legal action.
Health sharing is a voluntary arrangement between members. The ministry facilitates sharing but does not contractually guarantee that expenses will be paid. Health sharing ministries are organized as 501(c)(3) nonprofits and are exempt from insurance regulation. Members agree to sharing guidelines when they join, but these guidelines are not enforceable as insurance contracts. Every health sharing plan includes a disclaimer stating that sharing is voluntary and not insurance.
How Do Health Sharing and Insurance Compare on Coverage?
| Feature | Health Sharing | ACA Insurance |
|---|---|---|
| Monthly Cost (Individual) | $115 - $495 | $450 - $700 (unsubsidized) |
| Payment Guarantee | No — voluntary sharing | Yes — contractual obligation |
| State Regulation | Not regulated | Fully regulated |
| Pre-Existing Conditions | 0-12 month waiting period | Covered from day one |
| Essential Health Benefits | Not mandated | 10 categories mandated |
| Open Enrollment | Enroll anytime | Nov-Jan (special exceptions) |
| Dental & Vision | Not included (most plans) | Pediatric dental required |
| Mental Health | Some plans only | Required by law |
| Subsidies Available | No | Yes — income-based |
When Should You Choose Health Sharing Over Insurance?
Health sharing makes financial sense when you are generally healthy, do not qualify for ACA subsidies, and want lower monthly costs. A healthy 35-year-old earning $60,000 might pay $550/month for an unsubsidized ACA Silver plan or $215/month for Zion HealthShare — a savings of $4,020 per year. Over 5 years without major claims, that is $20,100 in savings.
Health sharing is not the right choice if you have significant pre-existing conditions requiring ongoing treatment, need guaranteed coverage by law (employer mandate in some states), want the regulatory protection of insurance, or qualify for substantial ACA subsidies that reduce your premium below health sharing costs. If you earn under 400% of the federal poverty level, check ACA subsidies first — they may make insurance cheaper than health sharing.
What Risks Come With Health Sharing vs Insurance?
The primary risk is that sharing is voluntary. If a ministry experiences financial difficulty, member contributions may not cover all eligible expenses. No major ministry has failed to share eligible expenses to date, but the possibility exists. Additionally, health sharing plans can change their sharing guidelines at any time, potentially reducing what is shareable.
Another risk is the lack of regulatory oversight. If a ministry denies sharing for an expense you believe should be covered, your only recourse is the ministry's internal appeals process. There is no state insurance commissioner to intervene. For members who want regulatory protection with lower costs than traditional ACA plans, Presidio Healthcare offers regulated insurance starting at $300/month with pre-existing conditions covered from day one.
The Bottom Line
Health sharing is not insurance. It is a voluntary cost-sharing arrangement that operates outside of insurance regulation. Members save 30-60% on monthly costs compared to ACA marketplace plans. The tradeoff is the absence of a contractual guarantee that expenses will be shared and the lack of regulatory oversight.
For over 1.5 million Americans, that tradeoff is worthwhile. Established ministries have shared billions in medical expenses over 30-40 years without failing to cover eligible expenses. If you are healthy, do not qualify for ACA subsidies, and understand that sharing is voluntary, health sharing is a legitimate and cost-effective alternative to insurance.
Frequently Asked Questions
Does health sharing count as insurance for tax purposes?
Health sharing contributions are not treated the same as insurance premiums for tax purposes. Self-employed individuals may be able to deduct contributions under certain circumstances. The federal individual mandate penalty is $0 as of 2019, so there is no federal tax penalty for having health sharing instead of insurance. State mandates in CA, MA, NJ, RI, DC, and VT may impose penalties for not having qualifying coverage.
Can a hospital refuse to treat me if I have health sharing instead of insurance?
Emergency rooms are required to treat all patients regardless of coverage under EMTALA (Emergency Medical Treatment and Labor Act). For non-emergency care, providers can choose whether to accept health sharing. Most providers accept health sharing members, especially when the plan uses a recognized network like Cigna PPO (Zion HealthShare). You may need to pay upfront and submit for sharing reimbursement with some providers.
Has any health sharing ministry ever gone bankrupt?
No major accredited health sharing ministry has gone bankrupt. CHM has operated continuously since 1981, Medi-Share since 1992, and Samaritan Ministries since 1994. Some smaller, unaccredited programs have had financial difficulties. This is why accreditation and track record matter when choosing a plan. We recommend choosing an established ministry with a minimum 5-year track record.
Do I still need insurance if I have health sharing?
There is no federal requirement to have insurance (the penalty is $0 since 2019). Some states (CA, MA, NJ, RI, DC, VT) have their own mandates where health sharing may not count as qualifying coverage. In those states, you may owe a state tax penalty. Many health sharing members use their plan as their sole coverage. Others combine health sharing with supplemental insurance or an HSA-compatible plan.
Are there hybrid options that combine sharing and insurance?
Yes. Presidio Healthcare offers regulated insurance (not health sharing) starting at $300/month with pre-existing conditions covered from day one. It provides the regulatory protection of insurance at a lower cost than standard ACA marketplace plans. Some members also pair a health sharing plan with a short-term health insurance policy for additional protection.
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