Jeff Janosick - Health Insurance Blog

Health Share Ministry Plans – An ACA Alternative

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Since the inception of the Affordable Care Act (ACA), consumers have seen increasing deductibles, higher out of pocket maximums and extremely high premiums. They are calling “uncle” and are looking for alternatives to the ACA. But what alternatives are available that will not cause an individual to pay a penalty for not having minimal essential coverage? The answer is Health Share Ministry Plans.


So what are Health Share Ministries and how do their plans compare to other health insurance plans?  A Health Share Ministry is an organization that facilitates sharing of healthcare costs between individual members who have common ethical or religious beliefs in the United States. They do not use actuaries, do not accept the risk or make guarantees, and do not purchase reinsurance policies on behalf of their members. Members are exempt from the individual responsibility requirements of the Patient Protection and Affordable Care Act, often referred to as Obamacare. This means they are not required to have insurance as outlined in the individual mandate.


Approximate thirty states have safe harbor laws that recognize Health Share Ministries as distinct from health insurance organizations.


Health Share Ministries are founded on the biblical principle of believers sharing each other’s needs. Ministries often cite the mandate of Galatians 6:2 to “Bear one another’s burdens and thus fulfill the law of Christ” as applicable to medical costs. Some see origins in the Book of Acts where early Christians "were together and had everything in common" and "gave to anyone as he had need", (Acts 2:44-45).


Some states have tried to block these ministries on the grounds that they are selling unauthorized insurance. However, a majority of states have enacted safe harbor laws specifying that the ministries are not insurance and do not need to be regulated as such.


The U.S. Department of Health and Human Services issues exemption letters to ministries that have met the criteria to operate independently of the Affordable Care Act.

The monthly cost of membership in a Health Share Ministry is generally lower than the cost of insurance rates.


Some of the larger Health Share Ministries are Christian Healthcare Ministries (established around 1981), Medi-Share, a program of Christian Care Ministry (1993), Samaritan Ministries (1994), Liberty HealthShare (1998), MCS Medical Cost Sharing and Altrua HealthShare (1999).


Most ministries are oriented toward practicing Christians, with restrictions like abstaining from sex outside of marriage, excessive drinking, tobacco, and illegal drugs. They usually require members to make a statement of belief as well. For instance, Samaritan Ministries requires a statement of Christian faith including belief in the triune God and divinity of Jesus; Altrua HealthShare and Liberty HealthShare is more inclusive, accepting members with a wide variety of religious and ethical beliefs. All such ministries require that members subscribe to the ethical principles of individual responsibility for health, and helping others in need.


In order for members to be exempt from the tax penalties outlined in the Affordable Care Act, ministries must meet the following qualifications:

  • Must be a 501(c)(3) organization
  • Members must share common ethical or religious beliefs
  • Must not discriminate membership based on state of residence or employment
  • Members cannot lose membership due to development of a medical condition
  • Must have existed and been in practice continually since December 31, 1999 (a grandfather clause)
  • Must be subject to an annual audit by an independent CPA which must be publicly available upon request

This carve out was intended to satisfy what, at the time, were relatively small religious groups that argued that their non-participation was a matter of religious freedom. Five ministries that meet these qualifications are Christian Healthcare Ministries, Liberty HealthShare, Samaritan Ministries, Medi-Share and Altrua HealthShare. Individuals who enroll in a one of these Health Share Ministries Plans will be exempt from any penalty under the ACA.


Here is what Health Share Ministry Plans are NOT:


They are not considered health insurance. They are considered memberships with health benefits. Since they are not considered health insurance, they are not regulated by the department of insurance, not part of any insurance guaranty fund and are typically not covered by most E&O carries. Since the Health Share Ministry Plans are not considered health insurance, they use a different set of terminology than traditional insurance. For example:

Member Responsibility Amount (MRA) - The equivalent to deductibles, copays, and out-of-pocket maximums.


Limitations - Deemed as waivers or exclusions.  Since Health Ministry Plans are underwritten, a member can be approved with a waiver or exclusion for certain medical conditions.


Contributions - Also known as premiums in the insurance world.


Needs – This is identical to a health insurance claim.


Height/Weight Chart - Under Health Ministry Plans, an individual can be rated up or declined based on where they fall on the height and weight chart.


How do Health Share Ministry Plans work compared to traditional insurance plans?


Individuals can enroll in a Health Share Ministry Plan all year long as opposed to ACA enrollments, where individuals are limited to the annual open enrollment period or outside this period if a qualifying event occurs. Individuals enrolling in a Health Sharing Ministry Plan are medically underwritten and can be denied coverage based on medical conditions. An ACA plan is guaranteed issue and cannot be denied regardless of any health condition. Unless an individual qualifies for a subsidy, the monthly contributions for a Health Sharing Ministry Plan are far less expensive than an ACA plan. Health Share Ministry Plans have limitations like lifetime maximums whereas an ACA plan does not. Health Share Ministry Plans are available across the country and are not limited to only one area. These plans can be taken across state borders, unlike many ACA plans.


Health Share Ministry Plans are not for everyone but definitely a fit for some. They have become increasingly popular by helping individuals offset their monthly premiums and lower their out of pocket expenses.  


Click here to check out all of your options!





Jeff Janosick

Health Insurance Consultant
National Producer Number | 10935898
Phone: 1-800-750-6530 | Direct: 1-859-414-0945 | Fax: 1-800-750-6530  |  |  My Facebook page