What is a Healthcare Sharing Ministry?

Healthcare sharing ministries are organizations that help members to share medical costs. The healthcare sharing organization focuses on members who have shared religious or moral beliefs, which has led to the term “ministry” being used in organizational names. Health care sharing ministries are not health insurance and do not use actuarial tables or other calculations of risk that are used by insurance companies. Members of a health care sharing ministry have not had to meet the requirement for proof of health insurance under the U.S. Affordable Care Act (ACA), also called “Obamacare.”

Healthcare Ministries and Religious Status

Most healthcare ministries have members who share religious beliefs, and the majority are associated with Christian churches. The Orange County Register reported that most healthcare ministries were founded in Biblical principles, including the letter of the Apostle Paul to the Galatians, which states, “bear each other’s burdens and fulfill Christ’s instructions.” Several other New Testament passages also encourage mutual assistance and sharing of burdens. Although the organizations have shared religious membership, more than 30 states have laws which authorize the associations to operate. Some states, including Washington, Kentucky, and Oklahoma, have tried to block healthcare sharing ministries stating they are selling unauthorized health insurance, but state legislatures have not agreed.

How Healthcare Sharing Ministries Work

Each health cost sharing ministry works slightly differently, but members usually pay a monthly membership fee. Frequently, members will be responsible for paying for all of their own routine medical appointments and preventive care. Most ministries ask that members attend church regularly and refrain from harmful health practices. Prohibited harmful practices usually include alcohol and drug abuse and unsafe sexual activity. Members may also have the responsibility to pay a minimum amount of medical bills before they receive any financial assistance. Some associations ask members to pay for other members’ medical bills as reimbursements to members in need, while others make payments on behalf of members to providers. Coverage amounts can be limited, but many of the ministries have negotiated affordable rates with providers.

Ministry Size and Membership

Over 1 million people belonged to a health care sharing ministry as of 2017, the Alliance of Healthcare Sharing Ministries reported. More than 100 health care sharing organizations are operating in the United States. Many of the organizations are small and focused on individual churches. The three largest organizations are Samaritan Ministries International, with 227,000 members, along with Christian Healthcare Ministries, and Medi-Share. Medi-Share reports about 300,000 members. Texas and California are the states with the largest number of healthcare sharing organization members.

Legal Requirements for Medical Cost Sharing Ministries

Healthcare sharing ministries are required to meet legal standards in order to be recognized as an alternative to health insurance plans established under the Affordable Care Act. The ministries must be federally tax-exempt organizations qualified under the Internal Revenue Code 501(c)3. They also cannot discriminate in allowing membership depending upon a member’s state of residence or form of employment. They must also have been established before December 31, 1999, unless they agree to pay tax penalties that members are required to pay under the Affordable Care Act.

A healthcare sharing ministry can be an affordable alternative for rising health insurance costs for members who are qualified to join. Because of their strong Christian and moral basis and exemption from federal insurance law, the ministries can be more flexible and help to control health costs for qualified members than for-profit health insurers.