A health care sharing ministry is an organization that facilitates sharing of health care costs among individual members, in the United States, who have common ethical or religious beliefs. A health care sharing ministry does not use actuaries, does not accept risk or make guarantees, and does not purchase reinsurance polices on behalf of its members. Members of health care sharing ministries are exempt from the individual responsibility requirements of the Patient Protection and Affordable Care Act, often referred to as Obamacare. This means members of health care sharing ministries are not required to have insurance as outlined in the individual mandate.
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Approximately 30 states have safe harbor laws that distinguish healthcare ministries from health insurance organizations.
History
Health care sharing 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 2:44-45, which states that early Christians "were together and had everything in common" and "gave to anyone as he had need".
Some states have tried to block health care sharing ministries on the grounds that they are selling unauthorized insurance. A majority of states, however, have enacted safe harbor laws specifying that the ministries are not insurance and do not need to be regulated as such. However, 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.
Membership
According to Healthcaresharing.org, an alliance of the two largest ministries in the US, over 400,000 Americans participate in health care sharing in 2015, sharing more than $340 million in medical bills annually. A January 2015 op-ed in The New York Times stated that the four main healthcare ministries in the US have a total combined membership of about 340,000, that membership has grown recently because of the healthcare ministries' exemption to the insurance mandate of the Affordable Care Act, and that monthly cost of membership in a health care sharing ministry is generally lower than the cost of insurance rates. The Seattle Times also reported that membership has grown significantly in recent years.
Some of the larger health care sharing 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.
Most ministries are oriented toward practicing Christians, with restrictions like abstaining from extramarital sex, excessive drinking, and use of tobacco or 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; 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 individually responsibility for health and helping others in need.
Requirements under the Affordable Care Act
In order for members to be exempt from the tax penalties outlined in the Affordable Care Act, ministries must meet the following qualifications:
Four ministries that meet these qualifications are: Christian Healthcare Ministries, Liberty HealthShare, Medi-Share, and Samaritan Ministries. MCS Medical Cost Sharing, founded after 1999, does not meet the qualifications, but offers to pay the tax penalties incurred by members. Altrua HealthShare has also been recognized as an qualifying health care sharing ministry, due to its merger with Blessed Assurance Bulletin.
Tax deductibility
Monthly share payments are not deductible from US federal income tax as either a medical expense (because it is not a payment for insurance) or a charitable deduction (because it is a payment for goods and services). Member payment in excess of their required monthly minimum, however, may be deductible as a charitable contribution.