Health sharing is not insurance

A health-sharing membership — sometimes called medical cost sharing or a health care sharing ministry — is an agreement among participants to share eligible medical expenses according to a set of published guidelines. It is not an insurance policy.

What that means in practice

• No legal obligation to pay. No participant and no organization is legally required to contribute toward your medical bills. Sharing is voluntary.
• You remain responsible for your bills. Regardless of whether an expense is shared, and regardless of whether the organization continues to operate, the debt is yours.
• Not regulated as insurance. In most states these programs are exempt from the insurance code, which means the consumer protections, reserve requirements, and guaranty funds that apply to insurers do not apply here.
• Not ACA coverage. A membership is not a qualified health plan. It is not required to cover essential health benefits, cannot be paired with a premium tax credit, and does not carry an out-of-pocket maximum in the ACA sense.
• Eligibility is defined by guidelines, not by a policy. Pre-existing conditions, waiting periods, maternity timing, and unshareable categories are set by the program and can be revised.
• Membership standards may apply. Some programs require agreement to a statement of faith or a lifestyle standard.

Vocabulary we use deliberately

We say monthly share rather than premium, member responsibility or initial unshareable amount rather than deductible, eligible for sharing rather than covered, and program guidelines rather than policy. The words are different because the legal reality is different. See the glossary.

Where to read more

The National Association of Insurance Commissioners publishes consumer guidance on health care sharing ministries: NAIC consumer guidance.

Several states require a specific statutory notice. Those notices are reproduced on state notices.

Who should not use health sharing

Some households should buy insurance instead. We keep that list on its own page: who should not choose health sharing.