Health Sharing Health Sharing Programs: How They Work and Who They Fit
An independent look at health sharing, what it does and doesn't do, and how it can pair with Direct Primary Care for predictable monthly costs.
The Quick Answer: A health sharing program is a membership community where members contribute a set amount each month and share one another's eligible medical expenses. Health sharing is not insurance. It often costs less each month than an unsubsidized insurance plan, but sharing is not guaranteed, pre-existing conditions are often limited, and availability varies by state. Journey Health Advisors helps you compare health sharing, Direct Primary Care, and traditional coverage side by side so you can decide what fits.
Important: Health sharing plans are not insurance. Sharing of medical costs among members is voluntary and is not guaranteed the way payment is under an insurance contract.
What Is Health Sharing?
Health sharing, also called medical cost sharing, is a way for a group of people to help pay each other's large medical bills. Instead of buying a policy from an insurance company, you join a community and agree to share eligible costs under a published set of guidelines.
Health care sharing ministries, one well-known type of health sharing program, serve at least 1.7 million people in the U.S. [1]. Other programs are built around shared health principles rather than a statement of faith.
Because health sharing isn't insurance, it isn't regulated by state insurance departments, and it doesn't count as minimum essential coverage under the Affordable Care Act [1]. That's why understanding a program's guidelines matters before you join.
How Health Sharing Works
Details vary by program, but most follow the same basic pattern:
You make a monthly contribution.
The amount usually depends on your age, household size, and the share amount you choose.
You choose an Initial Unshared Amount (IUA).
This is the portion of each medical event you pay yourself before sharing begins. A higher IUA usually means a lower monthly contribution.
You see the providers you choose.
Many programs don't use a provider network. You typically present yourself as a self-pay patient.
You submit an eligible medical need.
After a large event such as a hospital stay or surgery, the bills are reviewed 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.
Health Sharing vs. Health Insurance
Health sharing and insurance can look similar, but the guarantees and protections are different.
| Feature | Health Sharing | ACA-Compliant Insurance |
|---|---|---|
| What it is | A membership community that shares eligible costs | A regulated insurance contract |
| Payment of eligible bills | Voluntary; not guaranteed | Required under the policy terms |
| Pre-existing conditions | Often waiting periods or limits | Covered from day one |
| If you have a complaint | Handled under the program's own process | State insurance department can step in |
| Provider choice | Often no network | Usually a defined network |
| When you can join | Many programs accept members year-round | Open enrollment or a qualifying life event |
For a fuller side-by-side, see Health Share vs. Traditional Insurance.
Pairing Health Sharing with Direct Primary Care
Many members pair health sharing with a Direct Primary Care (DPC) membership. The two layers do different jobs:
Direct Primary Care
- Sick visits and checkups
- Ongoing condition management
- Direct access to your doctor by phone, text, or telehealth
- A flat monthly membership fee
Health Sharing
- Large, unexpected medical events
- Hospital stays and surgery
- Emergency room visits
- Eligible costs above your IUA, under the program's guidelines
Direct Primary Care is a membership arrangement with your doctor for primary care services. It is not insurance and doesn't meet ACA minimum coverage requirements on its own.
Employers can use a similar layered approach for their teams, often alongside a CHOICE Arrangement (formerly ICHRA). Learn more on our Employers page.
Who Health Sharing Tends to Fit
Often a good fit if you:
- Are generally healthy and mainly want protection from large, unexpected bills
- Pay full price for coverage because you don't qualify for marketplace subsidies
- Are self-employed, a 1099 worker, or between jobs
- Are comfortable reading program guidelines and paying as a self-pay patient
- Plan to pair it with Direct Primary Care for everyday care
May not be the right primary choice if you:
- Have a significant pre-existing condition that needs ongoing specialist care or costly medications
- Are pregnant or planning a pregnancy soon
- Want the regulatory protections of ACA-compliant insurance
- Qualify for a marketplace subsidy that brings a plan's cost close to zero
- Live in a state with its own coverage requirement
How Health Sharing Programs Differ
No two programs are the same. These are the details we compare with you before you choose one:
- Monthly contribution and IUA options: how the monthly amount changes with the share amount you choose.
- Pre-existing conditions: how long the waiting periods are and whether some conditions are never shared.
- Sharing limits: whether there are annual or lifetime caps.
- Maternity, prescriptions, and mental health: what's shareable and under which rules.
- Membership requirements: whether a statement of faith or lifestyle commitment is required.
- How bills are handled: whether the program pays providers directly or reimburses you.
- State availability: whether the program accepts members where you live.
State availability: Health sharing programs are not available in every state. The program we most often recommend to individuals and families, which may pay us a referral fee, is not currently accepting new members in California, New Mexico, Pennsylvania, Vermont, or Washington. Ask an advisor about options where you live.
How Journey Health Advisors Helps
We're an independent health benefits advisory firm, not an insurance company or agency, and we aren't tied to any single program. We help you:
- Compare health sharing, Direct Primary Care, and marketplace coverage side by side
- Read a program's guidelines with you, including pre-existing condition and maternity rules
- Check availability in your state
- Decide whether health sharing fits your household at all
How we're paid: Journey Health receives referral compensation from some of the programs and partners we refer clients to, including the health sharing program we most often recommend to individuals and families. The amount varies by program, and some programs don't pay referral fees in every state. Our compensation doesn't change the price you pay. We'll tell you whether a program pays us before you decide. See our Licensing & Disclosures for details.
Health Sharing FAQ
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.
Does health sharing count as minimum essential coverage?
No. Health sharing doesn’t count as minimum essential coverage under the ACA. There’s no federal penalty for going without it, but a few states have their own coverage requirements, so ask an advisor how this applies where you live.
Can I join a health sharing program outside open enrollment?
Many programs accept new members year-round. Returning to ACA marketplace coverage, however, generally requires open enrollment or a qualifying life event, so plan the timing carefully.
Does health sharing cover pre-existing conditions?
Often only after a waiting period, and sometimes with limits. Rules vary by program, so this is one of the first things we review with you before you join.
Do I have to be religious to join?
Not always. Some programs ask members to affirm a statement of faith. Others are open to anyone who agrees to a set of shared health principles.
Can I combine health sharing with Direct Primary Care?
Yes, and many members do. Direct Primary Care handles routine primary care for a flat monthly fee, while health sharing focuses on large, unexpected medical events.
Is health sharing available in my state?
It depends on the program. The program we most often recommend to individuals and families, which may pay us a referral fee, is not currently accepting new members in California, New Mexico, Pennsylvania, Vermont, or Washington. Ask an advisor about options where you live.
See Whether Health Sharing Fits Your Household
Talk with an independent advisor. No pressure. We'll compare options with you.
Speak with an AdvisorHealth sharing is not insurance. Availability varies by state. Licensing & Disclosures
REFERENCES
[1] healthinsurance.org. "What is a health care sharing ministry?" healthinsurance.org, April 2026. https://www.healthinsurance.org/glossary/health-care-sharing-ministry/