If you're self-employed and looking at alternatives to ACA insurance, you've probably come across two options: health sharing plans and short-term health insurance. They look similar on the surface — both are cheaper than ACA, both are unregulated alternatives — but they work very differently. Picking the wrong one could leave you with a $50,000 uncovered bill.

Here's a straight comparison.

The Core Difference

Short-term insurance is exactly what the name says: temporary. Federal rules cap it at 12 months (some states cap it shorter). When it ends, you're uninsured again. It typically excludes pre-existing conditions entirely — not a waiting period, but a permanent exclusion.

Health sharing is ongoing membership with no expiration. It's not insurance, but it's designed as a long-term coverage alternative. Pre-existing conditions usually have a waiting period (12-24 months for most plans, none for Zion as of January 2026), after which they can be shared.

Side-by-Side Comparison

| Feature | Health Sharing | Short-Term Insurance | |---------|---------------|---------------------| | Monthly cost | $140–$405 | $100–$200 | | Coverage duration | Ongoing, no limit | 1–12 months max | | Pre-existing conditions | Waiting period (0–24 months) | Permanently excluded | | Benefit cap | $250K–$350K per incident | $250K–$1M per policy | | Preventive care | Not typically covered | Sometimes included | | Prescription drugs | Covered by Zion; not most others | Sometimes covered | | Provider network | Zion: Cigna PPO; others: any provider | Varies by insurer | | Renewable | Yes, indefinitely | Limited renewals in many states | | ACA-compliant | No | No | | Tax deductible (self-employed) | No (check your state) | Sometimes |

Monthly Cost Comparison

For a 35-year-old self-employed individual:

Short-term insurance (typical options):

• Lowest tier: $100–$130/month (high deductible, low benefit cap)
• Mid-tier: $150–$200/month ($5,000 deductible, $500K cap)
• Note: These plans exclude pre-existing conditions permanently

Health sharing:

• CrowdHealth: ~$140/month
• Zion Basic: $185/month (no pre-existing wait, Cigna PPO)
• Zion Standard: $215/month ($2,500 IUA)
• Medi-Share Bronze: $227/month (12-month pre-existing wait)

The cheapest short-term plan is cheaper than health sharing. But the coverage is fundamentally different — and often worse — when you need it.

When Short-Term Insurance Actually Makes Sense

Short-term insurance has legitimate uses. It makes sense if:

• You're between jobs for 2–4 months and just need a bridge until your new employer's coverage kicks in
• You missed ACA open enrollment and need something until the next enrollment period
• You're turning 26 and aging off your parents' plan, with another option lined up in a few months
• You're healthy with zero pre-existing conditions and only need catastrophic coverage for a few months

What it's not good for: being your primary long-term health coverage as a self-employed person. The 12-month limit means you're shopping for a new plan every year, and if you develop a health condition during the policy, it becomes a pre-existing exclusion on your next policy.

When Health Sharing Makes Sense for the Self-Employed

Health sharing is designed for long-term coverage. It's the better fit if:

• You've been self-employed for more than a year and need ongoing coverage with no expiration
• You're healthy and the savings ($100–$200/month vs ACA Silver) are meaningful to your cash flow
• You have a manageable pre-existing condition and can wait out the waiting period (or choose Zion, which has no pre-existing wait)
• You want a PPO network — Zion gives you access to 950,000+ Cigna providers

The main restrictions to know: health sharing isn't insurance, plans have sharing caps, and coverage decisions are made by the ministry's guidelines rather than state insurance regulators.

Real Cost Scenario: Freelance Designer, Age 38

Situation: Healthy freelance designer. No pre-existing conditions. Income: $75,000/year (too high for ACA subsidies).

ACA Silver: ~$430/month unsubsidized = $5,160/year Short-term (12 months): $160/month = $1,920/year — then what? Zion Standard: $215/month = $2,580/year, indefinitely

If she's healthy all year, Zion saves her $2,580 vs ACA with no coverage cliff after 12 months. Short-term saves $660 more than Zion but expires.

If she gets injured mid-year: Short-term covers it (assuming no pre-existing condition). Zion covers it after her IUA ($2,500). ACA covers it after her deductible ($4,500).

For long-term coverage, Zion wins on cost and continuity.

The Tax Deduction Question

Self-employed people can deduct health insurance premiums on Schedule 1 of their federal taxes. Health sharing plan contributions and short-term insurance premiums are typically not deductible in the same way — though some states allow deductions for health sharing.

If tax deductibility matters to you, an HSA-eligible ACA plan might be worth running the numbers on. The deduction can meaningfully offset the higher premium.

Bottom Line

Choose short-term insurance if: You're in a genuine transition (between jobs, waiting for open enrollment) and need coverage for 2-6 months.

Choose health sharing if: You're self-employed long-term and need ongoing coverage without ACA's price tag. Zion is the best starting point — no faith requirement, Cigna PPO, and no pre-existing waiting period.

Choose ACA if: You qualify for subsidies, you have serious pre-existing conditions, or you need full mental health and prescription coverage with no gaps.

Not sure which fits your situation? Take our 2-minute quiz — we'll account for your health history, budget, and how long you need coverage.

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