Health Share Plans: How They Work and Who They're Right For
Health care sharing programs are a different way to help with medical expenses. Instead of buying a health insurance policy, members contribute money that may be used to help pay eligible medical bills for other members.
They may have lower monthly costs than some insurance options, but health sharing is not health insurance, and the rules can be very different.
Before joining, it's important to understand what expenses are eligible for sharing, what isn't, and what protections you may be giving up.
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Important: Health Share Plans Are Not Insurance
This is the most important difference to understand before joining a health sharing program.
- Payment of medical bills is not guaranteed in the same way as covered claims under an insurance policy. Sharing depends on the program's member guidelines and eligibility rules.
- Health shares do not have to follow all ACA insurance requirements. They may limit or exclude pre-existing conditions and other types of care.
- They are not regulated in the same way as licensed health insurance. Consumer protections that apply to insurance may not apply to a sharing program.
- Marketplace premium tax credits cannot be used to pay a health sharing membership.
Many members may have eligible expenses shared successfully, but you should join only after understanding the program's rules and limitations.
How Health Sharing Programs Work
The exact terminology varies by program, but the basic idea often looks something like this.
You Pay a Monthly Share
Members contribute a monthly amount to participate in the sharing community.
You Pay an Initial Amount
Many programs require you to pay a certain amount of eligible medical expenses yourself before additional expenses become eligible for sharing.
Eligible Expenses May Be Shared
Medical expenses that meet the program's member guidelines may then be shared using contributions from other members.
When a Health Share May Be Worth Considering
You Want to Compare Monthly Costs
Some sharing programs may have lower monthly member contributions than certain traditional insurance options.
A lower monthly amount should still be weighed against exclusions, sharing limits, and your potential responsibility for medical bills.
You're Generally Healthy
Someone with few ongoing medical needs may find certain sharing arrangements worth comparing with insurance.
People with ongoing conditions or expensive prescriptions should pay especially close attention to eligibility rules.
You Need an Option Outside Open Enrollment
Many health sharing programs allow people to apply or join at different times during the year rather than using the Marketplace Open Enrollment schedule.
The Community Model Appeals to You
Some programs are faith-based and may require members to agree to specific religious or lifestyle standards.
Other sharing programs may have different membership requirements.
What About Maternity and Pregnancy?
Some health sharing programs include eligible maternity expenses, which can make them worth researching for people who expect to grow their family.
However, maternity rules vary significantly from one sharing program to another.
Join Before Pregnancy
Some programs may not share expenses related to a pregnancy that began before membership or before required eligibility periods were satisfied.
Waiting Periods May Apply
A program may require a certain amount of time in membership before maternity expenses become eligible for sharing.
Sharing Limits Can Apply
Programs may have specific rules about prenatal care, delivery, complications, newborn expenses, or the total amount eligible for sharing.
Already Pregnant?
Do not assume a health share will pay for an existing pregnancy. Review the program's current guidelines before joining.
ACA-compliant Marketplace plans cover pregnancy and childbirth according to the plan's benefits even when the pregnancy began before the policy started.
Planning for a Baby?
Talk with us before making a decision. We'll help you compare the actual maternity rules of a health sharing program with available health insurance options so you understand the tradeoffs.
When a Health Share May Not Be the Right Fit
You Have Ongoing Health Conditions
Health sharing programs may limit, delay, or exclude sharing for expenses related to pre-existing medical conditions.
You Take Expensive Prescriptions
Routine and ongoing prescription costs may not be treated the same way they are under comprehensive health insurance.
Check your medications and the program rules before joining.
You Qualify for Marketplace Financial Assistance
If you're eligible for significant Marketplace premium assistance, ACA-compliant insurance may be more affordable than you expect.
You Want Insurance Guarantees
If you want the contractual protections and regulatory framework of licensed health insurance, a sharing arrangement may not provide the level of certainty you're looking for.
You Expect Frequent Medical Care
Ongoing specialist visits, therapies, prescription treatment, or chronic-care needs should be reviewed carefully against the program's sharing rules.
You Want a Defined Out-of-Pocket Maximum
Health sharing programs are not required to follow the same ACA rules regarding annual out-of-pocket maximums.
Health Share vs. Health Insurance
| Feature | Health Sharing | Marketplace Plan | Other Private Coverage |
|---|---|---|---|
| Is it health insurance? | No | Yes | Depends on the product |
| Contractual insurance claim protections | No | Yes | Depends on the product |
| Pre-existing conditions | May be limited, excluded, or subject to waiting rules | Covered | Depends on the plan |
| Maternity | Depends on program rules and eligibility | Covered under ACA-compliant plans | Depends on the plan |
| Marketplace financial assistance | No | May be available if eligible | No |
| Enrollment timing | Often available outside Marketplace Open Enrollment | Open Enrollment or eligible Special Enrollment Period | Depends on the plan |
| ACA consumer protections | Do not apply in the same way | Yes | Depends on the type of coverage |
| Provider network | Varies by program | Depends on the insurance plan | Depends on the plan |
This is a general comparison. Health sharing programs and insurance products vary significantly. Always review the actual member guidelines, policy documents, benefits, exclusions, and eligibility rules.
Questions to Ask Before Joining a Health Share
Don't compare health sharing programs using the monthly price alone. Ask these questions first:
- What counts as a pre-existing condition?
- Are there waiting periods?
- How does the program handle maternity?
- Are prescriptions eligible for sharing?
- Are preventive visits eligible?
- Are mental health services eligible?
- Are there limits on how much can be shared for one medical event?
- Are there annual or lifetime sharing limits?
- How are large hospital bills handled?
- Does the program use a provider network or negotiated discounts?
- What happens if a medical expense is ruled ineligible?
- Is there an appeal or reconsideration process?
Common Questions About Health Sharing Plans
Are health share plans health insurance?
No. Health care sharing arrangements are membership programs in which members contribute toward eligible medical expenses. They are not health insurance policies.
Are my medical bills guaranteed to be paid?
No. Health sharing programs do not provide the same contractual guarantee of payment that applies to covered claims under licensed health insurance.
Medical expenses must meet the program's member guidelines to be considered eligible for sharing.
Do health sharing plans cover pre-existing conditions?
It depends on the program. Some may exclude expenses related to pre-existing conditions, impose waiting periods, or gradually make certain expenses eligible over time.
Review the specific program rules before joining.
Do health sharing programs cover maternity?
Some programs may share eligible maternity expenses, but the rules vary significantly.
Waiting periods, conception dates, membership requirements, maternity limits, and other conditions may apply.
Can I join if I'm already pregnant?
You may be able to join a program, but do not assume expenses related to an existing pregnancy will be eligible for sharing.
Review the current maternity guidelines before joining.
Do I have to be religious to join?
It depends on the organization. Some health care sharing ministries require members to agree to a statement of faith or certain lifestyle standards.
Other sharing arrangements may have different membership requirements.
Can I join a health share any time of year?
Many sharing programs do not use the same annual Open Enrollment period as the Marketplace, although their own application and membership requirements still apply.
Can I use any doctor?
That depends on the program.
Some sharing programs may allow broad provider choice, while others use networks, preferred providers, pricing arrangements, or other rules for obtaining care.
Always check the current program rules and ask important providers how they handle the specific sharing program before joining.
Can I use Marketplace subsidies for a health share?
No. Marketplace premium tax credits are used for eligible Marketplace health insurance coverage, not health sharing memberships.
Are health sharing programs regulated by the state?
Health sharing arrangements are not regulated as health insurance in the same way licensed insurance policies are.
State laws differ, so the legal and regulatory treatment can vary depending on where you live and the type of sharing organization.
How do I know whether a health share is right for me?
Compare your health history, prescriptions, expected medical care, family plans, budget, risk tolerance, and available insurance options.
Most importantly, read the actual member guidelines instead of choosing based only on the monthly contribution.
Understand the Rules Before You Join
Health sharing can work well for some people, but it is not a substitute for understanding what is and isn't eligible for sharing. We'll help you compare health sharing with available insurance options so you can make an informed decision.
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