What is a health share, and could it be a good alternative to traditional health insurance? If you have been researching ways to lower your monthly health care costs, you have probably come across health sharing plans (also called health care sharing ministries) as an option. This post breaks down what a health share actually is, and whether it might be right for you.
As a family medicine physician who runs a membership-based primary care practice, I get this question a lot from patients who are trying to piece together an affordable, sustainable health care plan outside of traditional insurance. This post is the first in a series of posts where I will break down health shares in plain language, starting today with the basics.
What Is a Health Share?
A health share is a group of people who voluntarily agree to share each other’s health care costs. Instead of paying a premium to an insurance company, members pay a monthly contribution into a shared pool, and that pool is used to help cover eligible medical expenses when a member has a qualifying health event.
In some ways, health shares work similarly to insurance. You pay a monthly fee. You have an initial unshareable amount, which functions like a deductible, meaning you pay the first portion of an eligible expense out of pocket before the health share contributes.
But health shares are not insurance, and they do not carry the same legal protections and guarantees that traditional insurance does.
Why People Choose a Health Share
For most people, the biggest draw is straightforward: cost. A health share’s monthly contribution is often meaningfully lower than a comparable insurance premium, especially if you are paying full price without an employer subsidy or a marketplace tax credit. For healthy individuals and families who are not using much health care day to day, that gap can add up to real monthly savings.
The other major draw is flexibility. Since you are essentially a cash pay patient, there is no network to worry about, you can see any provider you want, and you can price shop before you go. I will go into this in more detail in the next post in this series, but it is worth knowing upfront: the same flexibility that saves you money each month also gives you more control over where and how you get care.
Who Is a Health Share a Good Fit For?
Health shares tend to work best for people who are generally healthy and do not have complex medical needs. If you rarely need to see a doctor, or if you manage a common, lower-cost chronic condition such as diabetes, hypertension, or hyperlipidemia without needing high-cost specialty medications, a health share can be a good fit.
Worth noting, whether a specific health share formally shares the cost of a common condition like this varies by company. But in practice, this often matters less than you would think. Basic, well-controlled diabetes managed with something like metformin, for example, is inexpensive enough to pay for directly, especially alongside a membership-based primary care relationship that already handles the ongoing management.
Health shares pair particularly well with a direct primary care practice like mine. Your direct primary care membership covers your everyday needs: same-day sick visits, chronic disease management, preventive care, and the ongoing relationship with your doctor. The health share is then there in reserve for the bigger, less predictable expenses, like a surgery or a hospitalization. Many major health share companies even offer a discount for members who already belong to a primary care membership practice, since it lowers their overall risk.
If you live in the Northern Shenandoah Valley and want to pair a health share with direct primary care, I offer DPC membership at my office near Stephens City.
Who Is a Health Share Not a Good Fit For?
Health shares are generally not a good fit if you have complex medical needs, see specialists frequently, have had recent or recurring hospitalizations, or rely on specialty medications you could not otherwise afford out of pocket.
This comes down mainly to two structural limitations: restrictions on sharing preexisting conditions, and limited or no coverage for specialty medications. If either of these applies to you, a health share may leave you exposed financially in a way that traditional insurance would not.
Limitations to Understand Before You Join
Beyond who it is and is not a good fit for, there are a few structural limitations worth understanding about health shares in general.
No contractual obligation to pay. This is the most important thing to understand about health shares. Because health shares are not regulated the same way insurance companies are, they are not legally required to pay your claims. Sharing happens on a voluntary basis.
That said, do not let this scare you off entirely. There are plenty of reputable, well-established health shares that have a long track record of sharing members’ expenses fairly and consistently. The key is doing your homework and choosing a company with a strong reputation, rather than assuming all health shares operate the same way. I will cover how to evaluate a reputable health share company in an upcoming post.
Preexisting conditions. Some health shares do not share costs related to preexisting conditions at all. Others have a waiting period. For example, some plans allow sharing on preexisting conditions after a certain number of months or years, but only up to a capped amount. Always check the specific terms before assuming a condition will be covered.
Maternity coverage timing. Most major health shares do share maternity related costs, but the waiting period requirements vary by company, and not all of them measure it the same way. Some require a certain amount of time to pass before conception, while others simply require a waiting period from your membership start date regardless of conception timing. If you are planning to grow your family, this timing detail is critical, varies company to company, and is easy to miss.
Read the member guidelines. This is worth repeating: before you sign up for any health share, read the member guidelines closely to understand the exclusions, waiting periods, and caps that apply to your specific plan. What one company covers, another may not.
The Bottom Line
Health shares are not insurance, but for the right person, they can be an affordable and workable piece of a health care plan, especially when paired with a membership-based direct primary care practice that handles your everyday care. They tend to work best for generally healthy people without complex medical needs, and they come with real tradeoffs around preexisting conditions, specialty medications, and the lack of a contractual guarantee to pay.
In the next post in this series, I will walk through how health shares actually compare to traditional health insurance, side by side. After that, I will cover how to find a reputable health share company, and break down typical health share pricing so you can see how the numbers actually stack up.
+ view comments . . .