Health sharing ministries: how they work and what members pay in 2027

A health sharing ministry is a faith-based nonprofit whose members pay a monthly share and use it to pay one another's eligible medical bills. It is not insurance. Tennessee's insurance regulator says whether anyone helps with your bills "will be entirely voluntary," and that you stay "responsible for the payment of your own medical bills" (Tennessee Department of Commerce and Insurance). What it costs: half of the 1,153 health-sharing applications our advisors submitted from July 1 to October 13, 2026 were $241 a month or less, and the middle half ran $145 to $450 (America First Healthcare sales records, read October 14, 2026).

America First Healthcare is an independent licensed insurance agency. Our advisors place health sharing programs, Marketplace plans and private plans, and compare them side by side on a free 15-minute call. This page is educational. It names no program and recommends no plan.

What is a health sharing ministry?

Federal law defines one in the Affordable Care Act's coverage section, 26 U.S.C. 5000A(d)(2)(B) (Cornell Law School, Legal Information Institute). A "health care sharing ministry" is an organization that:

1. Is a 501(c)(3) nonprofit, exempt from federal income tax.
2. Has members who "share a common set of ethical or religious beliefs and share medical expenses among members in accordance with those beliefs," wherever a member lives.
3. Lets members "retain membership even after they develop a medical condition."
4. Has existed, and shared its members' medical expenses without a break, since at least December 31, 1999.
5. Has an annual audit by an independent certified public accounting firm, "made available to the public upon request."

A program that started after 1999, with no predecessor sharing bills since then, does not meet that federal definition, even if it works the same way. Ask which one you are joining.

Is a health sharing ministry insurance?

No. Michigan's insurance department puts it plainly: ministries "are not considered health insurance because they do not assume any risk, and because the ministries are not legally or contractually obligated to pay health care costs" (Michigan Department of Insurance and Financial Services, January 23, 2024). The same notice says they do not have to cover pre-existing conditions or essential health benefits, and that they "are not regulated as insurance under state or federal law."

That changes four things for you.

• Paying the bill. A health plan pays covered claims under its contract. With a ministry, sharing is voluntary under its guidelines, and the bill is yours if it is not shared (Tennessee).
• Pre-existing conditions. Every Marketplace plan "must cover treatment for pre-existing medical conditions" (HealthCare.gov). A ministry does not have to cover them, so ask for its rules on conditions you had before you joined (Michigan DIFS).
• Tax credits. The premium tax credit is available "only through the Marketplace" (HealthCare.gov). Sharing never gets one.
• Complaints. In Tennessee and Michigan, a complaint about a ministry goes to the Attorney General, not the insurance department. Both regulators say so on the pages above.

What do health sharing ministries cost?

Each program sets its own monthly share. Here is what our clients' applications actually showed, next to the other plan types our advisors placed in the same months.

How to read it: these are submitted applications, not issued policies, and the price is the monthly amount of the primary plan as the advisor recorded it. A quarter of health-sharing applications came in under $145 and a quarter over $450. The Marketplace figure is before any premium tax credit the household received. For prices by state and age, see how much health insurance costs per month.

How health sharing works, step by step

1. You join and agree to the guidelines. That usually includes a statement of faith or of ethical beliefs, as the federal definition describes.
2. You pay a monthly share. It goes toward other members' eligible bills, not into an account of your own.
3. You get care and send in the bill. Ask whether you pay a set amount yourself before sharing starts, and how much.
4. The program reviews the bill against its guidelines. The guidelines decide what is eligible. Read the exclusions before you join.
5. Eligible amounts are shared. Members' shares pay the bill, or reimburse you. Nothing obliges anyone to pay (Michigan DIFS).

Who a health share fits, and who should compare a plan first

A health share can fit a household that holds the program's beliefs, has no ongoing condition to manage, and could pay a large bill for a while if sharing is slow or a bill is not eligible.

Compare a Marketplace plan first if any of these is true:

• Someone on the plan has an ongoing condition or takes a regular prescription. Marketplace plans cannot refuse to pay for a condition you had before coverage started (HealthCare.gov).
• Your income could qualify for a tax credit. The credit applies when household income is between 100% and 400% of the federal poverty level (HealthCare.gov), and only on Marketplace plans.
• You need a guaranteed cap on what you pay. A 2027 Marketplace plan caps your share of covered in-network care at $12,000 for one person and $24,000 for a family (HealthCare.gov).

On HealthCare.gov, Open Enrollment for 2027 runs November 1, 2026 to January 15, 2027. Enroll by December 15 for coverage that starts January 1 (HealthCare.gov). Your state's dates are in our Open Enrollment 2027 guide.

Questions to ask before you join

1. Are you a health care sharing ministry under 26 U.S.C. 5000A, or a newer sharing program? The answer tells you which rules it says it follows.
2. May I see your latest independent audit? The federal definition requires one, made available on request (26 U.S.C. 5000A).
3. How do you treat conditions I have today? Ask for the waiting period and any dollar limit in writing.
4. What do I pay myself before a bill is shared, and is there a yearly or lifetime sharing limit?
5. What is not eligible? Ask about maternity, prescriptions, mental health and care outside the United States.
6. How long does sharing take, and who pays the provider in the meantime?
7. Which beliefs and lifestyle rules do I agree to, and what happens if I break one?

Taxes and state coverage rules

The federal fee for having no health coverage "no longer applies" (HealthCare.gov). A few states run their own requirement. New Jersey residents "must have minimum essential health coverage, qualify for an exemption, or remit a Shared Responsibility Payment" (New Jersey Treasury). If you live in a state with its own rule, check its exemption list before you rely on a sharing program.

FAQ

Is a health sharing ministry the same as health insurance?

No. A ministry is not legally or contractually obligated to pay medical costs and is not regulated as insurance, according to Michigan's insurance department. A health plan pays covered claims under a contract.

How much does a health share cost a month?

Half of the 1,153 health-sharing applications our advisors submitted from July 1 to October 13, 2026 were $241 a month or less. The middle half ran from $145 to $450. Your price depends on the program you join and who is on it.

Do health sharing ministries cover pre-existing conditions?

They do not have to, according to Michigan's insurance department. Each program sets its own rules, so ask for them in writing. Every Marketplace plan must cover pre-existing conditions.

Can I use a premium tax credit for a health share?

No. The premium tax credit is available only for Marketplace plans bought through HealthCare.gov or your state's exchange.

Is there a tax penalty for using a health share instead of insurance?

Not at the federal level: the federal fee no longer applies. Some states, such as New Jersey, run their own coverage requirement with its own exemptions.

Can I join a health share at any time of year?

Each program sets its own enrollment rules. Marketplace plans follow Open Enrollment, November 1 to January 15 on HealthCare.gov, or a Special Enrollment Period after a qualifying life event.

References

1. 26 U.S.C. 5000A, Requirement to maintain minimum essential coverage, Cornell Law School, Legal Information Institute. Checked November 8, 2026.
2. Healthcare Sharing Ministries, Tennessee Department of Commerce and Insurance. Checked November 8, 2026.
3. DIFS Reminds Consumers That Health Care Sharing Ministries Are Not Health Insurance, Michigan Department of Insurance and Financial Services, January 23, 2024. Checked November 8, 2026.
4. Coverage for pre-existing conditions, HealthCare.gov. Checked November 8, 2026.
5. Premium tax credit, HealthCare.gov glossary.
6. Out-of-pocket maximum/limit, HealthCare.gov glossary.
7. Dates and deadlines, HealthCare.gov.
8. Fee for not being covered, HealthCare.gov. Checked November 8, 2026.
9. New Jersey Health Insurance Mandate, New Jersey Department of the Treasury.
10. America First Healthcare sales records: 2,582 priced health applications submitted July 1 to October 13, 2026, read October 14, 2026 (aggregates only; method in how much health insurance costs per month).

Next step

Want the numbers for your household? A licensed advisor will put a health share, a Marketplace plan and a private plan side by side on a free 15-minute call, and tell you if what you have already fits.