What peer-to-peer insurance is
The National Association of Insurance Commissioners (NAIC) defines peer-to-peer insurance as a product that “allows a group of insureds to pool their capital, self-organize, and self-administer their own insurance.” The core idea is that a set of like-minded people with mutual interests group their policies together, introducing control, trust and transparency while reducing costs. In practice the model usually consists of a small group — family members, friends, or people with a common interest — who combine their premiums to insure against shared risks.
The mechanics are the point. In a traditional policy, premiums go to the insurer, claims are paid from the insurer's reserves, and the profit — the difference between premiums and claims — stays with the insurer. In a P2P model, the group's premiums go into a pool, claims are paid from the pool, and what is left over returns to the group, either as a refund or as lower premiums next year. The incentive flips: the group benefits when claims are low, rather than the insurer benefiting.
That is also why the model is sometimes described as a return to mutual insurance. A mutual insurer is owned by its policyholders, and profits return to them as dividends or lower premiums. P2P takes the same ownership idea and makes the group smaller and more visible — you can see, in principle, who you are sharing risk with, which is the trust argument the model makes for itself.
Peer-to-peer review is a different thing
Most search results for “peer to peer medical insurance” are about peer-to-peer review, and it is worth saying plainly that this page is not about that. Peer-to-peer review is a step in a health insurance appeal: when an insurer denies a treatment as not medically necessary, the treating doctor can request a call with the insurer's medical director — a peer, in the medical sense — to argue the case. It is a conversation between two doctors about one patient's treatment, and it happens inside ordinary health insurance.
The confusion is understandable: both phrases contain “peer to peer” and both live in health insurance, but one is a way of organising insurance and the other is a way of disputing a denial. If you arrived here looking for how to request a peer-to-peer review for a denied treatment, the relevant page is the site's guide to Medicare plan comparison for how Medicare cover is structured, and your insurer's appeals process — usually described in the denial letter itself — is the next step, not this page.
Where the model actually exists
The NAIC notes that Lemonade was the first U.S.-based P2P company to operate as an insurance carrier, in 2015, and that it now offers renters, homeowners, car, pet and term life insurance in more than 40 states and Washington, D.C. Lemonade's model pools premiums by group and donates unclaimed money to charity through its Giveback programme — a version of the P2P idea adapted to a conventional licensed carrier.
Outside the U.S., P2P startups such as Friendsurance in Germany and Guevara in the United Kingdom have operated since around 2010, and blockchain-based versions have also emerged: the NAIC describes a model in which every member puts premiums into an escrow-type digital wallet used for claims, with Teambrella the first P2P insurer to use Bitcoin in this way. None of these is a U.S. medical insurance product you can buy today.
That absence is the honest answer to the question this page exists for. There is no widely available peer-to-peer medical insurance product in the United States: health insurance in the U.S. is dominated by employer plans, marketplace plans and public programmes, and a P2P medical product would need to be licensed in each state, hold reserves under each state's rules, and meet the Affordable Care Act's requirements — a far heavier lift than P2P renters or pet insurance. The model is real, the medical version of it is not on sale.
Why it has spread slowly in the U.S.
The NAIC's own assessment is that P2P insurance should be regulated by state insurance departments like any other insurance company, and that each state is likely to have its own rules. With 50 states plus the District of Columbia and Puerto Rico each setting their own licensing, reserve and consumer-protection requirements, a new P2P company faces 52 separate approvals before it can operate nationally — the reason the NAIC expected a slow start in the United States.
There is also a structural tension. P2P works best in small, homogeneous groups where members trust each other and claims are visible — the conditions that make the pool feel fair. Medical care is the opposite: costs are large, unpredictable and unevenly distributed, and a small pool can be wiped out by one member's serious illness. That is why the models that have survived in the U.S. are in lines with smaller, more predictable claims, and why medical P2P remains an idea discussed by regulators rather than a product on the market. The comparison page at compare health insurance covers the products that are actually available.
Worked example
Consider two ILLUSTRATIVE groups. The first is ten friends who each put $100 a month into a pool for car repairs: in a year with one $2,000 claim, the pool holds $12,000, pays the claim, and returns most of the remainder — the model works, because the risk is small and visible. The second is ten friends pooling for medical care: one member develops a condition costing $80,000 in a year, the pool holds $12,000, and the model fails unless a reinsurer or a licensed carrier stands behind it. These are ILLUSTRATIVE contrasts to explain why P2P fits some lines of insurance and not others; they describe no real product, and no premium figure is asserted for either group.
Illustrative example only — not a fact about any real policy.