Christian Health Sharing Ministries: An Honest Look

Ryan Michalek, Licensed Health & Life Insurance Agent, NPN 21043091. Last updated November 8, 2026

A lot of the self-employed families I work with have looked at health sharing ministries, and many have joined one. The appeal is real and it isn't only about money. For a lot of people it's about wanting their health care dollars inside a community that shares their faith, rather than inside a system they have misgivings about.

That's a sincere conviction, and it deserves respect rather than a sales pitch.

This page isn't going to tell you not to join one. It explains how they work, what protections you do and don't have, and how to tell a well-run ministry from the ones that have hurt people, so you can decide for yourself.

How does health sharing work?

A health sharing ministry is not insurance, and it does not guarantee payment of your medical bills.

That's the defining feature, not a technicality. Members contribute to a shared pool, and eligible medical costs are shared according to the ministry's guidelines, but there's no contractual obligation to pay a claim.

With insurance, if a covered claim is denied you have a contract, an appeals process, and a state Department of Insurance that regulates the company. With a sharing ministry, you generally have the ministry's own guidelines and its own process. Most operate with minimal state oversight.

For most members in most years this works fine, so the real question is what happens in the year something goes badly wrong.

What has gone wrong with health sharing ministries?

I'm including this because it's public record and because people have been seriously hurt, not to scare you off the whole category.

Trinity HealthShare / Sharity, administered by Aliera. Regulators in multiple states found it wasn't a legitimate health sharing ministry at all. It went bankrupt in 2021, leaving roughly 10,000 remaining members with unpaid claims running into the hundreds of millions. In October 2025, California's Attorney General announced a $34 million settlement over what the state described as sham health plans sold to more than 14,000 Californians, and investigators found the operation kept nearly 84% of member payments while routinely denying claims. At least 14 states took action against Aliera.

Medical Cost Sharing, in Missouri. In 2023 and 2024 the co-founders pleaded guilty to an $8 million wire fraud conspiracy. They had collected $8 million and used about 3.1% of it to pay health care claims. Both were later sentenced to federal prison.

Liberty HealthShare. ProPublica reported that the ministry, which was taking in about $300 million a year, paid at least $140 million to businesses owned by its founders' family and friends, a network that included a boutique airline, a marijuana farm, real estate, and carpet stores. A 2021 settlement with Ohio's attorney general required it to cut ties with the family.

The legitimate ministries were among the loudest critics. The Alliance of Health Care Sharing Ministries publicly called Trinity a "sham front group." Long-standing ministries have been asking for more oversight precisely because bad actors used the model, and the religious exemptions carved out for it, as cover.

To name a few of the long-standing ones: Christian Healthcare Ministries has operated since 1981, Samaritan Ministries since 1994, and Medi-Share (Christian Care Ministry) since 1993. A longer operating history doesn't change the structure, though. Like every health sharing ministry, regardless of size or how long it has been around, none of these is insurance or guarantees payment of your medical bills, and none is minimum essential coverage. Your state insurance regulator generally can't step in if a bill goes unpaid, and that matters when you're choosing one.

The trap almost nobody mentions

Health sharing memberships are not minimum essential coverage, the ACA baseline that qualifies you for a special enrollment period.

Most Special Enrollment Periods require that you already had minimum essential coverage before your qualifying life event. A sharing membership doesn't count.

So if you're in a ministry and you get married, have a baby, or move, you may find you can't get onto a Marketplace plan and have to wait until the next Open Enrollment, with coverage starting the following January.

If your health changed in the meantime that's a hard spot to be in, so it's worth thinking through before you join rather than after.

The one that costs people the most money

In a 2023 federal review, one ministry reported that a survey of its members found 42% of members had household income under 200% of the federal poverty level.

At that income, most people qualify for substantial Marketplace cost assistance, often far more than they realize.

I've sat with families paying real monthly money into a sharing membership who would have paid less for an actual ACA plan with real consumer protections, because nobody ever ran their subsidy numbers.

If you take one thing from this page: find out what you'd actually pay on the Marketplace after cost assistance before you compare anything. It's free to check, it takes a few minutes, and for a lot of families it changes the whole picture.

What a medical bill looks like inside a ministry

This section isn't a recommendation. A health sharing ministry is not insurance, and I don't endorse any of them. What I can do is show you how a bill typically moves, because that's where members get surprised, and it's the part the brochures skip.

Most ministries ask for a monthly share amount. Many also set a portion of each medical need that the member pays before anything is shared, sometimes called an unshared amount. Those details live in the ministry's guidelines, not in a policy, and the ministry can change its guidelines.

The bigger surprise is at the front desk. The NAIC, the association of state insurance regulators, warns that sharing ministries usually don't have provider networks, so members may be charged full price by doctors and hospitals. In practice that can mean being handled like a self-pay patient: the bill comes to you, you may have to ask the hospital for its self-pay rate yourself, and then you submit the need and wait to learn what gets shared. An insured patient gets the plan's negotiated rate before the bill is ever printed. On a hospital stay, that difference is real money.

The same NAIC guidance (from 2022) notes that 30 states at that time explicitly exempted sharing ministries from insurance regulation, and that state insurance regulators don't supervise them. So if a need isn't shared, the disagreement generally stays inside the ministry's own process.

One question to take to your tax preparer, not to me: don't assume membership contributions are treated like insurance premiums at tax time. If you're self-employed and used to the premium deduction, that's worth a CPA's answer before you switch.

Source: NAIC, Not All Products Are Health Insurance, checked November 8, 2026.

Questions to ask before you join a health sharing ministry

If you're leaning toward a ministry, these are the ones that matter:

1. How long has it operated? The ministries with decades of history behave very differently from ones founded in the last few years.
2. Will they give you the annual audit? Many states require ministries claiming an exemption to make an audit available on request. If they won't provide one, that tells you something.
3. What percentage of contributions goes to administration versus sharing? One ministry reviewed by the GAO directed up to 40% to administrative costs.
4. How are pre-existing conditions handled, and for how long?
5. Is it a member of the Alliance of Health Care Sharing Ministries? Not a guarantee, but the trade group has publicly disavowed bad actors.
6. What exactly is excluded? Read the guidelines completely. Many exclude categories of care that people assume are covered.
7. What happens if the ministry can't pay? Ask directly. Get the answer in writing.

Health share vs. insurance: if you’re thinking about switching

Timing matters more than most members realize. Because sharing isn’t insurance, leaving a ministry generally doesn’t open a special enrollment window on the marketplace. That means marketplace coverage usually has to start through Open Enrollment, which runs from November 1 to January 15 in most states. A private under-65 plan can be applied for any time of year, but it’s medically underwritten, so approval isn’t automatic. Whichever way you go, keep your membership active until the new coverage is confirmed and in force.

Leaving a ministry for 2027: the order of steps

If you've decided to move to real insurance for 2027, the sequence matters more than the paperwork. Here's the order I'd walk a member family through:

1. Price both insured paths in November. A marketplace plan after any premium tax credit, and a private underwritten plan if everyone in the house is healthy.
2. Pick a marketplace plan by December 15 if you want it to start January 1. Enroll December 16 to January 15 and it starts February 1. Those are the HealthCare.gov dates for 2027 coverage; a few states run their own exchange with different deadlines.
3. Keep the membership paid until the new plan is approved, the first premium is paid, and the start date is confirmed in writing.
4. Then cancel the membership in writing and keep the confirmation, so there's no question later about which arrangement a bill belonged to.

Health sharing vs. insurance: five options side by side

People weighing a health share usually have four or five options on the table that can look alike on price and work very differently. Here’s the plain version, including the coverage I offer, with no product named. None of these is right for everybody, and price alone won’t tell you which one fits.

A general comparison, not a quote or a promise of coverage. Terms vary by state and by plan, so read the actual plan documents before you rely on any of this. I handle private plans; if a marketplace plan fits you better, I’ll say so and point you to a trusted partner for that enrollment.

Three households, three different answers

This is how the decision actually sorts out on a call, using the 2027 rules as of November 8, 2026. The faith side of the choice is yours; these are only the coverage facts.

A young family under the subsidy line. Families with children are the ones I most want to run this check for. A family of four earning under $132,000 is under the 2027 cliff, which is 400% of the 2026 federal poverty guidelines. Below that line, the premium tax credit generally holds the benchmark silver plan to no more than 10.22% of household income, and less at lower incomes. That's a contract-backed plan with a regulator behind it, and it's the number to set next to the monthly share before anything else. If the kids might qualify for Medicaid or CHIP, those programs take applications any time of year.

A self-employed couple over the line. Above 400% there's no credit for 2027 at all, so the comparison is a sharing membership against a full-price marketplace plan and a private underwritten plan. This is the household that searches for health care sharing ministries trusted by Christian entrepreneurs, and it's where the comparison is closest. Here's how I frame it: the full-price marketplace plan is guaranteed-issue and counts as minimum essential coverage; the private plan has a contract and a regulator but asks health questions; the ministry has neither a contract nor a guarantee.

A household with a diagnosis or a pregnancy already underway. Here the ministry's guidelines on pre-existing conditions and maternity decide most of the outcome, and many ministries limit both. A marketplace plan can't exclude either one. For that family I'd point toward the marketplace at Open Enrollment, and since I don't enroll marketplace plans myself, I'd connect you with a partner who does.

Sources: HHS 2026 poverty guidelines (Federal Register, Jan 15, 2026); IRS Rev. Proc. 2026-26 (2027 applicable percentage table); KFF, 9 things to watch for the 2027 ACA open enrollment period (Oct 30, 2026); CMS statement on 2027 open enrollment dates (July 31, 2026).

Where I land

If your convictions lead you to a ministry and you've picked a long-standing one with clean books, that's a legitimate choice and I'm not going to argue you out of it.

What I'd ask is that you make it as an informed choice rather than an assumption. Know that it isn't insurance, that there's no guarantee of payment, and that your state insurance regulator generally can't help you. And know what you would have paid on the Marketplace with cost assistance, so you're comparing real numbers.

The same goes for my side of it: the private under-65 coverage I work with is medically underwritten. Acceptance isn't guaranteed there either. What it does have is a contract, a regulator, and an appeals process, so they're different tradeoffs and neither is right for everybody.

Weighing other non-ACA routes people ask me about? Here's my take on Farm Bureau health plans.

And if you're a pastor or on church staff without a group plan (one of the most common reasons ministry families look at sharing in the first place), here's a guide built for your situation: health insurance for pastors and clergy.

Health sharing by state: Missouri and Indiana.

If you want the numbers run

I'm Ryan Michalek, an independent health insurance broker in Tampa, licensed in 31 states. I work with self-employed people, 1099 contractors, families, and small business owners under 65. If you’re weighing a health share against real insurance, my self-employed health insurance guide lays out the other paths.

If you want to know what you'd actually qualify for before you decide, that's a short conversation and it costs you nothing. If your ministry turns out to be a fine fit and you should stay put, I'll tell you that.

Sources

1. California Office of the Attorney General — Settlement over companies accused of selling sham health plans (Oct 2025)
2. Georgetown Center on Health Insurance Reforms — Health care sharing ministry data point to problems for consumers and regulators
3. ProPublica — The shadowy financial empire built around Liberty HealthShare
4. U.S. Department of Justice (W.D. Mo.) — Founder of St. Joseph medical charity pleads guilty in $8 million fraud scheme
5. Christianity Today — Health care sharing ministries and the Sharity/Trinity collapse
6. Commonwealth Fund — What consumers need to know about health coverage that doesn't comply with the ACA