Healthcare sharing plans are growing in popularity — and the marketing often makes them sound like affordable health insurance. They are not insurance. Payment of your medical bills is not guaranteed. There is no state regulator to turn to if a claim is denied. Before you consider one, you deserve an honest picture of how they work, what can go wrong, and what your alternatives are.
Before choosing a sharing plan, explore your licensed insurance options. A broker compares ACA plans, short-term medical, and other alternatives at no cost to you — so you can make a fully informed decision.
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What Healthcare Sharing Actually Is
Understanding what a healthcare sharing ministry actually is — and what it isn't — is the essential starting point before evaluating any specific plan.
Healthcare sharing ministries (HCSMs) are organizations whose members agree to share each other's medical expenses. When a member has a qualifying medical expense, they submit it to the organization, which facilitates payment from the pooled contributions of other members. The model has existed for decades, primarily within faith communities, and has grown significantly as ACA premiums have risen.
The fundamental difference from insurance is legal and contractual: an insurance policy is a legally binding contract obligating the carrier to pay covered claims. A sharing plan membership is not. The organization's guidelines describe what expenses are eligible for sharing — but the actual sharing is voluntary among members, and the organization itself typically makes no legal guarantee of payment. If the pool runs short, if your expense doesn't meet the guidelines, or if the organization encounters financial difficulty, your bills may not be paid.
Sharing plans are specifically exempt from state insurance regulation under Arizona law and federal law. The Arizona Department of Insurance and Financial Institutions has no authority over them. There is no guaranty fund — the backstop that pays claims if a licensed insurer becomes insolvent — for sharing plan members. If the organization fails or refuses to share your expense, your recourse is limited.
None of this means sharing plans have never worked for anyone. Many members pay relatively modest monthly contributions and never have a significant medical event — for them, the plan functions adequately. The risk materializes when a member does have a serious medical event, submits a large claim, and discovers that the sharing guidelines exclude or limit the expense in ways the marketing materials didn't make clear.
Brokers who work with sharing plans are required in many states to carry a separate errors and omissions (E&O) policy specifically covering sharing plan recommendations — a reflection of the elevated liability risk associated with placing clients in products that lack the consumer protections of licensed insurance. We take that responsibility seriously, which is why this page leads with disclosure rather than promotion.
Arizona law requires sharing plan organizations to disclose that they are not insurance and that sharing is not guaranteed. If you have received materials from a sharing plan that did not prominently disclose these facts, that is a compliance concern worth raising with the organization before enrolling.
The following six risk categories represent the most common ways sharing plan members encounter unexpected financial exposure. We present them prominently because we believe you deserve to understand them fully before making a decision — not after you've received a bill the plan won't share.
The most fundamental risk: sharing plan organizations do not legally guarantee payment of your medical expenses. Sharing is described as a voluntary act of members supporting one another. If the pool has insufficient funds, if member contributions decline, or if the organization determines your expense doesn't qualify, your bills may not be paid — and you have no legal remedy equivalent to an insurance claim appeal.
Most sharing plans impose significant limitations on expenses related to pre-existing conditions — conditions you had before joining the plan. These limitations may apply for 1–3 years after enrollment, may permanently exclude certain conditions, or may apply reduced sharing limits. Unlike ACA-compliant insurance, sharing plans are under no legal obligation to cover pre-existing conditions at all.
Licensed insurance carriers in Arizona are regulated by DIFI, are required to maintain financial reserves, are subject to market conduct examinations, and are backed by the Arizona Life and Health Insurance Guaranty Association if they become insolvent. Sharing organizations have none of these protections. Several healthcare sharing organizations have failed or suspended operations in recent years, leaving members with unpaid bills and no recourse.
Sharing plans typically impose annual and/or lifetime limits on what they will share per member. ACA-compliant insurance is prohibited from imposing lifetime limits and is required to cap annual out-of-pocket costs. Sharing plans face no such restrictions. A member with a serious illness — cancer, a major accident, a chronic condition requiring ongoing treatment — may exhaust the plan's sharing limits and be left responsible for six- or seven-figure bills.
Sharing plans are not minimum essential coverage under the ACA. While there is currently no federal tax penalty for lacking ACA-compliant coverage, enrolling in a sharing plan rather than an ACA marketplace plan means you are ineligible for premium tax credits (subsidies) during the months you have sharing plan coverage. For self-employed Arizonans who would otherwise qualify for significant subsidies, this can represent a substantial financial cost that makes the lower sharing plan contribution illusory.
Sharing organizations vary dramatically in size, financial reserves, and operational transparency. Some are large and have operated for decades. Others are newer, smaller, or have limited financial disclosures. Unlike licensed insurers, sharing organizations are not required to file financial statements with state regulators or maintain specific reserve ratios. Evaluating an organization's financial health requires reviewing its own published reports — if it publishes them at all.
The Faith Requirement
Healthcare sharing ministries originated in faith communities and many retain explicit religious requirements. Understanding this distinction matters before you apply.
Many sharing organizations — particularly the larger, more established ones — require members to attest to a statement of faith as a condition of membership. This typically includes affirming belief in a specific religious tradition, commitment to attend religious services regularly, and agreement to live according to certain moral and lifestyle guidelines.
Expenses that conflict with the organization's stated values — certain reproductive health services, substance abuse treatment in some cases, injuries sustained under certain circumstances — may be excluded from sharing based on these guidelines.
A newer category of sharing organizations — sometimes called "health cost sharing" rather than "healthcare sharing ministries" — operates without religious requirements. Membership is open to anyone regardless of faith background. These organizations market primarily to self-employed individuals and ACA alternatives seekers.
Secular plans still carry all the same fundamental risks as faith-based plans: no guarantee of payment, no state regulation, pre-existing condition limitations, and annual sharing limits. The absence of a faith requirement does not change the underlying legal structure or risk profile.
Major Sharing Organizations
One of the larger secular health cost sharing organizations. Markets primarily to self-employed individuals and small businesses as an ACA alternative. Operates a membership model with an Initial Unshareable Amount (IUA) functioning similarly to a deductible.
A large faith-based sharing ministry with a Christian values statement of faith requirement. Members must affirm shared beliefs and lifestyle commitments. Has operated for several decades. Has experienced operational challenges in recent years — verify current status and member payment history directly before enrolling.
A faith-based sharing ministry with a Christian values framework. Smaller than some competitors. Requires members to affirm faith commitments and healthy lifestyle practices. As with all sharing organizations, independently verify financial health and current sharing practices before enrolling.
A faith-based sharing ministry offering tiered membership options with different sharing levels. Requires a Christian statement of faith. Has been subject to regulatory scrutiny in some states — verify current standing and member reviews before enrolling.
Side-by-Side Comparison
How healthcare sharing compares to ACA-compliant insurance and short-term medical across the dimensions that matter most when something goes wrong.
| ACA Marketplace Plan | Healthcare Sharing Plan | Short-Term Medical | |
|---|---|---|---|
| Payment guarantee | ✓ Legally guaranteed for covered services | ✗ Not guaranteed — voluntary sharing | ⚠ Guaranteed for covered services — many exclusions |
| State regulation | ✓ Regulated by DIFI | ✗ Exempt from state insurance regulation | ✓ Regulated by DIFI |
| Pre-existing conditions | ✓ Must cover — no exclusions allowed | ✗ Typically excluded or limited 1–3 years | ✗ Typically excluded entirely |
| Annual / lifetime limits | ✓ Lifetime limits prohibited; OOP cap required | ✗ Annual and/or lifetime sharing limits common | ✗ Benefit limits common; no OOP cap requirement |
| Essential health benefits | ✓ All 10 EHBs required | ✗ No requirement — varies by organization | ✗ Not required to cover EHBs |
| ACA subsidy eligible | ✓ Yes — potentially significant subsidy | ✗ No — ineligible for premium tax credits | ✗ No — ineligible for premium tax credits |
| State guaranty fund backup | ✓ Protected if insurer fails | ✗ No protection if organization fails | ✓ Protected if insurer fails |
| Appeals process | ✓ Formal appeals rights required by law | ✗ Internal process only — no independent review | ⚠ Carrier-determined process |
| Typical monthly cost (individual) | $0–$450+ (after subsidy, income-dependent) | $150–$400 (varies by organization and tier) | $100–$350 (varies by age and benefit level) |
| Best for | Most Arizonans — particularly those with subsidy eligibility, pre-existing conditions, or significant health utilization | Healthy individuals above subsidy eligibility who have fully understood and accepted the risks and have sufficient savings to self-fund potential uncovered costs | Short coverage gaps — transition between jobs, waiting for open enrollment. Not for ongoing primary coverage. |
Who Might Consider a Sharing Plan
We are not recommending sharing plans. We are presenting the circumstances under which some individuals determine — after fully understanding the risks and with the guidance of a licensed broker — that a sharing plan is an acceptable option for their situation. Even in these cases, we strongly recommend exploring all licensed insurance options first.
Self-employed Arizonans with income at or above 400% FPL (~$62,600 for an individual) receive no ACA subsidy and face full unsubsidized premiums. For someone in excellent health with no pre-existing conditions and no ongoing prescriptions, the premium differential between an ACA plan and a sharing plan is real and may be material. This is the narrowest possible justification — and it disappears entirely if the person has any significant health history.
For individuals whose faith tradition is central to their decision-making and who specifically want their healthcare costs shared within a community of shared values, faith-based sharing plans may align with personal priorities beyond just financial considerations. This is a legitimate personal choice — but it should be made with full awareness of the financial risks, not primarily because of lower monthly costs.
Some individuals use a sharing plan as a short-term bridge while evaluating permanent coverage options — for example, between jobs or during a period when ACA enrollment is not available and COBRA is prohibitively expensive. This is a legitimate transitional use, though short-term medical insurance should be evaluated alongside sharing plans for bridge coverage situations.
Individuals with substantial liquid savings — enough to self-fund a six-figure medical event if the sharing organization declines to share — are in a meaningfully different risk position than someone who would be financially devastated by an unpaid $80,000 claim. A sharing plan used as a supplement to self-insurance by someone with the financial resources to backstop it is different from someone relying on it as their sole financial protection against medical costs.
Before You Decide
If you've read this page and are still considering a sharing plan, these are the minimum steps a licensed broker recommends before you enroll.
Before comparing a sharing plan to anything else, get a formal quote from a licensed Arizona broker for ACA marketplace plans at your income level. Many people are surprised by how much the subsidy reduces ACA premiums — particularly below 400% FPL. You cannot make an informed comparison without knowing your actual licensed insurance cost.
Every sharing organization publishes member guidelines — a detailed document describing exactly what is and isn't eligible for sharing, how the sharing process works, what the appeal process is, and what the organization's obligations are to you. Read the full guidelines before enrolling. If an organization makes the guidelines difficult to obtain before enrollment, that is a warning sign.
Look for independent reviews from current and former members — not testimonials on the organization's own website. Search for state regulatory actions, Better Business Bureau complaints, and news coverage of the organization. For larger organizations, look for published financial statements. Ask the organization directly: what is your current membership size, what is your unshared liability, and what is your current sharing timeliness?
If you decide to proceed with a sharing plan, work with a licensed insurance broker who carries the additional errors and omissions coverage required for sharing plan recommendations. This is a signal the broker takes their professional responsibility seriously. Your broker should present the sharing plan alongside licensed alternatives — not in isolation — and should document that you received and understood the risk disclosures before enrolling.
Frequently Asked Questions
A licensed Arizona broker presents ACA plans, short-term medical, and sharing plan options side by side — with honest disclosure about the risks of each. Free consultation, no obligation, no pressure toward any particular product.
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