What a health care sharing ministry is
A health care sharing ministry is an organisation whose members pool monthly contributions to pay one another's medical bills, united by shared religious or ethical beliefs. Members pay a monthly share, and when a member has an eligible medical need, the ministry directs other members' shares to that bill — in Samaritan Ministries' case, members send their share directly to another member, with a note of encouragement. The model is explicitly faith-based: members share one another's burdens, in the words of Galatians 6:2, which the ministries cite as their foundation.
The legal distinction matters more than the mechanics. Sharing ministries are not health insurance: they are not legally required to pay claims, are largely exempt from state insurance regulation, and do not have to follow the consumer protections built into the Affordable Care Act. Most states have safe-harbour laws stating that ministries are not insurance and need not be regulated as such. That means a ministry's promise to share a bill is a matter of its own guidelines and its members' good faith, not a contract enforceable in the way an insurance policy is.
The scale is substantial but small beside insurance. The Alliance of Health Care Sharing Ministries reported about 692,000 Americans enrolled in its member organisations as of January 2025, with $1.1 billion in medical expenses shared during 2024, and Medi-Share alone claims more than 350,000 members. By comparison, more than 300 million Americans hold health insurance — sharing is a niche, and its members have chosen it knowingly.
The three large Christian ministries
Medi-Share, run by Christian Care Ministry, is the largest. Members pay a monthly share and an Annual Household Portion — the amount a household pays out of pocket before sharing begins, functioning like a deductible, with options commonly from $3,000 to $12,000. Medi-Share has a provider network for discounts, which the other two largely do not, and members must sign a statement of faith and meet lifestyle standards, including abstaining from tobacco and illegal drugs.
Samaritan Ministries, based in Peoria, Illinois, is the direct-sharing model: each month members send their share straight to another member with a medical need. Its Classic programme has a $1,000 Initial Unshareable Amount per need with 100% sharing after that, and Basic has a $2,000 Initial Unshareable Amount with 90% sharing. Samaritan requires a statement of Christian faith, regular church attendance and lifestyle standards, and states that it has no network restrictions — members act as cash-pay patients.
Christian Healthcare Ministries offers Gold, Silver and Bronze programmes, and caps sharing at $125,000 per illness on those programmes without an add-on programme. Its out-of-pocket amount is called Personal Responsibility. All three ministries require a statement of faith; all three exclude or restrict some categories of care that Affordable Care Act plans must cover, and all three limit or exclude pre-existing conditions in ways an ACA plan may not. The right comparison is not between the three ministries alone — it is between a ministry and an ACA plan, on the same medical history.
What ministries do not cover
Because ministries are exempt from the Affordable Care Act's requirements, they do not have to cover the ten categories of essential health benefits, accept enrollees regardless of pre-existing conditions, or cap annual out-of-pocket costs. In practice that means maternity care, mental health care, substance-use treatment and prescription drugs are commonly excluded or sharply limited, and pre-existing conditions are often subject to waiting periods or caps. A ministry's guidelines, not a regulator, decide what is eligible — and guidelines change.
There is also no guarantee of payment. An insurer that denies a covered claim can be sued for breach of contract and, in many states, for bad faith; a ministry that declines to share a bill has made a decision under its own guidelines, and the member's remedy is the ministry's own appeal process. That is not a criticism of the model — its members accept it as part of the faith commitment — but it is a fact a buyer must weigh with open eyes, especially for a large or ongoing condition.
One more practical point: a ministry membership may not satisfy a state requirement to hold health insurance. Check your state's rules before assuming a ministry replaces insurance for a loan, a visa, an employer requirement or a court order.
The federal exemption, and what it does and does not mean
The Affordable Care Act's individual mandate, when it carried a tax penalty, exempted members of a qualifying health care sharing ministry. To qualify, a ministry had to be a 501(c)(3) nonprofit, have members sharing common ethical or religious beliefs, share expenses regardless of the member's state, retain members who develop medical conditions, have existed continuously since 31 December 1999, and conduct an annual independent audit available to the public (26 U.S.C. § 5000A(d)(2)(B)). The federal tax penalty for not having insurance was reduced to zero from 2019, so the exemption now matters mainly as a marker of which ministries meet the federal definition — the five that do are Christian Healthcare Ministries, Liberty HealthShare, Medi-Share, Samaritan Ministries and OneShare.
That federal recognition is not an endorsement of a ministry's finances or a guarantee of its bills: the Department of Health and Human Services issues exemption letters but does not regulate ministries as insurers, audit their ability to pay, or back their obligations.
The alternatives that are insurance
For Christians who want the faith community without giving up insurance protections, the alternatives are the ordinary ones: a marketplace plan bought during open enrollment, with a premium tax credit if income qualifies; employer cover, which is still how most working Americans are insured; or a catastrophic plan for younger buyers. The site's guide to employer health insurance explains how group cover works, and the health insurance comparison page sets out the products that are actually insurance.
Short-term health insurance is sometimes offered as a cheaper alternative, but it is not Affordable Care Act cover either: it can exclude pre-existing conditions, cap benefits and deny renewal, and it is not sold in some states, including New York. Direct primary care — a monthly fee to a doctor for primary care, without insurance — is a further option for routine care, but it does not cover hospitalisation, and it is usually paired with a high-deductible plan or a ministry rather than replacing cover entirely. The honest way to choose is to price the ministry and the marketplace plan on the same medical history, read the ministry's guidelines in full, and ask what happens to a $100,000 bill under each.
Worked example
Consider two ILLUSTRATIVE households, both a married couple in their forties with two children. The first joins a ministry: they pay a monthly share, meet a $1,000 Initial Unshareable Amount when a child breaks an arm, and the rest is shared by other members. The second buys a marketplace plan: they pay a monthly premium, meet a deductible, and the plan pays the rest under its contract. If the child later needs ongoing treatment for a chronic condition, the first household's sharing depends on the ministry's guidelines and any caps; the second household's plan must cover it, subject to its cost-sharing and out-of-pocket maximum. These are ILLUSTRATIVE contrasts to explain the legal difference between sharing and insurance; they predict no real household's costs, and no premium or share figure is asserted for either household.
Illustrative example only — not a fact about any real policy.