Reviewed by Erik Osborne, PA-C, Co-Founder | October 6, 2026
The Quick Answer: A health sharing plan is a membership community where people contribute a set monthly amount and share one another’s eligible medical expenses. It is not insurance. At least 1.7 million Americans participate, according to data published by Colorado regulators [1], and roughly 30 states explicitly exempt these arrangements from insurance regulation [2]. Health sharing can cost far less than an unsubsidized marketplace plan, but it comes with real trade-offs: payment is not guaranteed, pre-existing conditions often have waiting periods, and rules vary by state.
Important: Health sharing plans are not insurance. Members voluntarily share costs for each other’s eligible medical expenses; payment is not guaranteed the way it is under an insurance contract. Health sharing is not regulated as insurance, and you remain responsible for your own medical bills.
If your 2027 marketplace renewal notice just arrived, the number on it may have stopped you cold. ACA Marketplace insurers proposed a median premium increase of 15% for 2027, the second double-digit jump in a row [5]. That comes after enhanced premium tax credits expired at the end of 2025, which raised what enrollees actually paid for premiums by an average of 58% in 2026 [6].
That is why so many families, freelancers, and small business owners are asking the same question this fall: what is health sharing, and is it a real option for us? This guide explains how it works in plain language, what it typically costs, where it falls short, and how to decide whether it fits your household.
What Is a Health Sharing Plan?
A health sharing plan (also called medical cost sharing or a health care sharing ministry) is a group of members who agree to help pay each other’s eligible medical bills. Each member contributes a fixed monthly amount. When a member has a large, eligible medical expense, the community’s contributions help cover it.
The model is older than the Affordable Care Act. The earliest ministries were founded in 1981, and the Alliance of Health Care Sharing Ministries reports that 107 groups have been certified by the U.S. Department of Health and Human Services as meeting the federal definition [3].
The key word is sharing. You are not buying a policy from a company that promises to pay. You are joining a community that has agreed to share costs under a published set of guidelines.
How Does Health Sharing Work, Step by Step?
Most health sharing programs follow a similar pattern, although the details vary by program:
- You pay a monthly contribution. This is the health sharing equivalent of a premium. It is usually set by age, household size, and the level of cost you agree to handle yourself.
- You choose an Initial Unshared Amount (IUA). The IUA is the portion of each medical event you pay before sharing begins, similar to a deductible. A higher IUA usually means a lower monthly contribution.
- You see the provider you choose. Many programs do not limit you to a network. You typically present yourself as a self-pay patient, which can open the door to cash-pay pricing.
- You submit an eligible medical need. After a large event, such as a hospitalization or surgery, you or the provider submit the bills for review against the program’s guidelines.
- Eligible costs above your IUA are shared. Depending on the program, the community pays the provider directly or reimburses you.
Many members pair health sharing with a Direct Primary Care (DPC) membership. DPC handles routine visits for a flat monthly fee, and health sharing focuses on the larger, unexpected events. Direct Primary Care is a membership arrangement with your doctor for primary care services; it is not insurance and does not replace it. We explain that layered approach in DPC Plus Health Sharing: The Layered Coverage Strategy.
Health Sharing Plan vs. Insurance: What Is the Difference?
The practical difference comes down to guarantees and regulation.
| Factor | ACA-Compliant Health Insurance | Health Sharing Plan |
|---|---|---|
| Legal status | Regulated insurance contract | Not insurance; exempt from insurance regulation in about 30 states [2] |
| Payment of eligible bills | Contractually required under the policy | Voluntary; not guaranteed [4] |
| Pre-existing conditions | Covered from day one | Often subject to waiting periods or limits |
| Consumer complaints | State insurance commissioner can step in | Insurance commissioners generally cannot intervene [3] |
| Provider choice | Usually a defined network | Often no network; self-pay model |
| Monthly cost | Varies widely; subsidies depend on income | Often lower than unsubsidized premiums |
| Enrollment timing | Open enrollment or a qualifying life event | Many programs accept members year-round |
That consumer protection point matters. As healthinsurance.org analyst Louise Norris has explained, if a marketplace insurer denies a claim, the state insurance commissioner can get involved; that same help is not available for a sharing arrangement, because it is not insurance [3].
Are Health Sharing Plans Legitimate?
Yes, health sharing is a legal, long-standing model, but “legitimate” does not mean “the same as insurance.” Health care sharing ministries are recognized in federal law, and roughly 30 states explicitly exempt them from insurance regulation [2]. Rules and exemption requirements vary from state to state, and a few states require programs to register or meet specific disclosure rules.
Because no program is required to pay the way an insurer is, reading the member guidelines matters more than it would with an insurance policy. Researchers reviewing ministry guidelines have found that some programs set monthly, annual, or lifetime sharing limits, and that no program guarantees payment, even for bills that qualify for sharing [4].
A practical test of legitimacy is transparency. A well-run program publishes its full guidelines, explains exactly which expenses are shareable, and tells you plainly what happens if needs exceed contributions in a given month.
Do You Have to Be Religious to Join a Health Sharing Plan?
Not always. Many ministries are faith-based and ask members to affirm a statement of beliefs. Other health sharing programs accept anyone who agrees to a set of shared ethical principles, such as a commitment to healthy living [2].
If you are searching for non religious health sharing, look for a program built on medical cost sharing rather than a statement of faith, and read its membership guidelines for any lifestyle requirements.
What Does Health Sharing Typically Cost?
Costs depend on age, household size, the IUA you choose, and the program. As one reference point, a 2026 Oklahoma fiscal analysis based on Alliance of Health Care Sharing Ministries membership data reported average annual required contributions of about $1,500 to $1,600 per member [3]. That works out to roughly $125 to $135 per member per month on average.
Compare that to the marketplace, where proposed 2027 premiums are up a median of 15% [5], and households above 400% of the federal poverty level no longer receive any premium tax credit [7]. For many healthy households paying full price, that gap is why health sharing is worth a look. It is also why the trade-offs below deserve an honest review.
These are averages, not quotes. Your actual cost will depend on your household and the program you choose.
Who Health Sharing Tends to Work For, and Who It Does Not
Health sharing is often a good fit if you:
- Are generally healthy and mainly want protection from large, unexpected medical bills
- Earn too much to qualify for ACA premium tax credits and are paying full price
- Are self-employed, a 1099 worker, or between employer plans
- Are comfortable with a self-pay model and reading program guidelines carefully
- Plan to pair it with Direct Primary Care for routine care
Health sharing may not be the right primary strategy if you:
- Have a significant pre-existing condition that needs ongoing specialist care or costly medications
- Are pregnant or planning a pregnancy soon, since maternity sharing rules and waiting periods vary widely
- Need the regulatory protections of ACA-compliant insurance
- Qualify for a large marketplace subsidy that brings a plan’s cost close to zero
For some households, the right answer is a marketplace plan. For others, it is health sharing paired with DPC. The goal is the right fit for your situation, not simply the lowest monthly number.
Questions to Ask Before You Join Any Health Sharing Program
- What is the monthly contribution for my household, and what IUA options are available?
- How are pre-existing conditions handled, and how long are the waiting periods?
- Are there annual or lifetime sharing limits?
- What happens in a month when members’ needs exceed contributions?
- Does the program pay providers directly, or do I pay and get reimbursed?
- Are maternity, mental health, and prescriptions shareable, and under what rules?
- Is the program available in my state, and does my state have registration or disclosure rules?
- Can I cancel easily, and how would I return to ACA coverage if I needed to?
Frequently Asked Questions About Health Sharing Plans
Is health sharing the same as health insurance? No. Health sharing plans are not insurance. Members voluntarily share eligible medical costs, and payment is not guaranteed the way it is under an insurance contract.
Is health sharing legal in my state? In most states, yes. About 30 states explicitly exempt health care sharing ministries from insurance regulation [2], but availability and rules vary by state. An advisor can help you confirm how it works where you live.
Can I join a health sharing plan outside of open enrollment? Many programs accept new members year-round. Returning to ACA coverage, however, generally requires open enrollment or a qualifying life event, so plan the timing carefully.
How much does health sharing cost per month? It varies by program, age, household size, and IUA. Alliance membership data suggests an average of about $1,500 to $1,600 per member per year [3], but your cost could be higher or lower.
Does health sharing cover pre-existing conditions? Often only after a waiting period, and sometimes with limits. This is one of the most important terms to read before joining.
Can I combine health sharing with Direct Primary Care? Yes, and many members do. DPC covers routine primary care for a flat monthly fee, while health sharing focuses on large, unexpected medical events.
Next Steps
Health sharing can be a smart, affordable option for the right household, and the wrong one for others. The difference is in the details: your health history, your income, your state, and the specific program’s guidelines.
At Journey Health Advisors, we help individuals, families, and self-employed professionals compare health sharing, Direct Primary Care, and ACA marketplace coverage side by side, with no carrier bias and no pressure. With 2027 open enrollment opening November 1, now is a good time to review your options.
Speak with an advisor at Journey Health Advisors: 1 (844) 580-6055 | journeyhealthadvisors.com/contact
Related Reading:
- Your Health Insurance Premium Went Up in 2026: Here Is What to Actually Do About It
- Health Coverage for Individuals and Families: Affordable Options Beyond Traditional Insurance
REFERENCES
[1] healthinsurance.org. “What is a health care sharing ministry?” healthinsurance.org, April 2026. https://www.healthinsurance.org/glossary/health-care-sharing-ministry/
[2] HSA for America. “How a Healthshare Ministry Works.” HSA for America, July 2026. https://hsaforamerica.com/blog/how-a-healthshare-ministry-works/
[3] Taylor, J. “Members of health care sharing ministries would get tax breaks under Oklahoma bill.” Oklahoma Voice / StateImpact Oklahoma, February 2026. https://oklahomavoice.com/2026/02/23/members-of-health-care-sharing-ministries-would-get-tax-breaks-under-oklahoma-bill/
[4] Volk, J., et al. “Health Care Sharing Ministries” issue brief. The Commonwealth Fund, August 2018. https://www.commonwealthfund.org/sites/default/files/2018-08/Volk_hlt_care_sharing_ministries.pdf
[5] KFF. “How Much and Why ACA Marketplace Premiums Are Going Up in 2027.” KFF, updated August 3, 2026. https://www.kff.org/affordable-care-act/how-much-and-why-aca-marketplace-premiums-are-going-up-in-2027/
[6] KFF. “In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase for 2027, Following a Steep Climb This Year.” KFF, July 2026. https://www.kff.org/affordable-care-act/in-preliminary-rate-filings-aca-marketplace-insurers-largely-propose-double-digit-premium-increase-for-2027-following-a-steep-climb-this-year/
[7] KFF. “Mapping the Uneven Burden of Rising ACA Marketplace Premium Payments due to Enhanced Tax Credit Expiration.” KFF, November 2025. https://www.kff.org/affordable-care-act/mapping-the-uneven-burden-of-rising-aca-marketplace-premium-payments-due-to-enhanced-tax-credit-expiration/
Journey Health Advisors | journeyhealthadvisors.com | 1 (844) 580-6055 | 8810 Blakeney Professional Drive, Suite 100, Charlotte, NC 28277
