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.
I want to be careful here, because that's a sincere conviction and it deserves respect rather than a sales pitch.
So this page isn't going to tell you not to join one. It's going to explain exactly 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. Then you can decide.
A health sharing ministry is not insurance, and it does not guarantee payment of your medical bills.
That's not a technicality. It's the defining feature. Members contribute to a shared pool, and eligible medical costs are shared according to the ministry's guidelines. But there is 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. The question isn't what happens in a normal year. It's what happens in the year something goes badly wrong.
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 — 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 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.
Liberty HealthShare. Reporting has documented roughly $140 million of $300 million in member fees going toward a boutique airline, a marijuana farm, real estate, and carpet stores.
Here's the part worth holding onto: 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, none guarantees payment of your medical bills, none is minimum essential coverage, and your state insurance regulator generally can't step in if a bill goes unpaid.
That distinction matters. This is not an indictment of the whole category.
Health sharing memberships are not minimum essential coverage.
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 genuinely difficult spot. It's worth thinking through before you join rather than after.
A federal review found that at one ministry, 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.
If you're leaning toward a ministry, these are the ones that matter:
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. Know there's no guarantee of payment. Know 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.
And I'll be straight about my own side of it: the private under-65 coverage I work with is medically underwritten. Acceptance isn't guaranteed there either, and I'd be misleading you if I implied otherwise. What it does have is a contract, a regulator, and an appeals process.
Different tradeoffs. Neither is right for everybody.
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 want to know what you'd actually qualify for before you decide, that's a short conversation and it costs you nothing. If the honest answer is that your ministry is a fine fit and you should stay put, I'll tell you that.
A health sharing ministry is not insurance and does not guarantee payment of your medical bills. 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.
I'll walk your real options with you in plain English — no fee, no pressure, and no obligation to enroll.