The Principles and Practices of Health Sharing Ministries

Health sharing ministries have been around for decades, but recently received national attention when they convinced Congress to exclude them from the ACA’s individual mandate. These faith-based cooperatives are not insurance and are not regulated by the government.

Some experts are concerned that these groups could negatively impact the overall health insurance market. Others say it’s too early to tell.

1. They are not insurance

Membership in health-sharing ministries has been on the rise since Obamacare, partly because they offer a low-cost alternative to traditional major medical insurance. In addition, members of qualified ministries don’t have to pay the ACA penalty for not having traditional insurance.

HCSMs are national groups of people who follow religious or ethical beliefs to share the cost of their members’ medical expenses. They avoid operations central to the business of insurance, such as a guarantee of payment for claims and use of actuarial methods.

HCSMs are largely faith-based, and most have guidelines for what they will cover or not. For example, they typically do not cover abortions or maternity costs from out-of-wedlock pregnancies and generally decline to share in the cost of drug abuse treatment.

2. They are not regulated by the government

Health sharing ministries operate like a cross between GoFundMe, a mutual aid society and a lending circle. Membership requirements vary but usually include a commitment to a code of behavior including avoidance of tobacco and drugs. Those who violate the rules are often expelled.

Members of a health-sharing ministry deposit a fixed dollar amount into their savings account and share expenses with other members who need help paying medical bills. The ministries also typically promote themselves as a way to stay true to scripture like Galatians 6:2 that calls Christians to bear one another’s burdens.

While the popularity of these groups has increased since passage of Obamacare, they are still not regulated by state insurance commissioners or federal agencies and do not qualify as health insurance under the ACA’s exchanges. That means that if you have problems with a health sharing ministry, your only option for recourse is an internal appeals process and not a federal court like with commercial insurance.

3. They are not a social contract

Many healthcare sharing ministries have strict membership rules, including adherence to certain faith doctrines and abstaining from drugs or tobacco. These rules can make it difficult to obtain supplemental health insurance coverage.

Unlike medical insurance, healthcare sharing ministries do not disclose their reimbursement rates to providers. This can be problematic because members may not know the full cost of a treatment before receiving it.

In addition, healthcare sharing ministries do not offer any legal protection if the ministry fails to pay claims or goes bankrupt. This risk is often more significant than the risks posed by unregulated insurance companies. This may have a negative impact on the overall health insurance market. Nevertheless, it has not stopped thousands of people from joining these groups. Some even find these groups more affordable than ACA-compliant plans.

4. They are not a charity

Despite their claims, most health sharing ministries do not qualify as charities. They are non-profit, membership-based organizations. They are often associated with Christian biblical beliefs or principles and are frequently referred to as “Christian health insurance.” Some of the largest sharing ministries include Christian Healthcare Ministries, Liberty HealthShare, Medi-Share, Samaritan Ministries, and OneShare.

Members make monthly payments into a pool that is then used to share medical expenses. The programs typically have strict membership requirements, such as a statement of faith and pledge to abstain from tobacco, alcohol, or drugs. Members are also required to agree to certain rules and codes of conduct, which may limit participation or lead to membership termination. Members pay a monthly fee for their share and can be reimbursed for medical expenses according to established procedures.

5. They are not a church

Health Sharing Ministries occupy a niche in the American health care market, two years after the implementation of the Affordable Care Act. They avoid operations central to the business of insurance, including a guarantee for payment of medical bills and the assumption and distribution of risk using actuarial methods.

The health-sharing groups, whose strict membership rules vary by organization, require members to attest that they adhere to specific faith doctrines and to live lifestyle behaviors that comply with those principles. Most also impose additional restrictions, such as abstaining from tobacco and drugs and attending church services regularly.

Beers and Fabris traveled to churches, fraternal organizations like the Loyal Order of Moose and conservative political groups like CPAC to pitch their ministry. They argued that any crackdown on the industry would amount to religious persecution.