While the federal health law includes an exemption for health sharing ministries, some states have sued to try to keep them out. The concern is that consumers shopping for insurance will be confused about what ministries really guarantee in the way of coverage. “We do not share in every medical need that a person has,” Miller of Medi-Share says. “Some of the things we don’t share in are related to lifestyle issues, such as an abortion. But others of them are related to things that the members have agreed that they would rather pay for themselves.”

The Affordable Care Act requires nearly every American to have health insurance or pay a penalty, beginning Jan. 1. The so-called “individual mandate” has been controversial ever since the law was passed.

But for people who fall into a few select categories, the mandate doesn’t apply. Like Native Americans who get health coverage through the Indian Health Service, or people who are incarcerated.

Another exception is for members of “health care sharing ministries,” a way for individuals with a “common set of ethical or religious beliefs” to share medical bills.

Sharing Health Burdens

The sharing ministries are not insurance: there’s no guarantee that a given bill will be covered. Instead, it’s like a co-op, where members decide what procedures to cover, and then all pitch in to cover the cost as group.

“It’s a group of people, in this case Christians, who band together and agree that they want to share one another’s burdens,” says Andrea Miller, medical director for the largest Christian health-insurance alternative, Medi-Share.

She says members put aside a certain amount of money every month, which then goes to other Christians who need help paying their medical bills. Medi-Share’s monthly fees vary, but its website advertises that family options “average less than $300 a month.”

There are a few requirements to fulfill before participating, Miller says. The first is that you have to be Christian. “Second, you need to agree to living a Christian lifestyle, including no smoking, including not abusing alcohol or drugs,” she says.

To constitute as a health care sharing ministry — and therefore be exempt from the Affordable Care Act requirements — the nonprofit has to have been in existence since 1999 (Medi-Share has existed since ’93). The ministries also have an independent accounting firm conduct a publicly available annual audit.

Footing The Bill

Tens of thousands of Americans belong to Christian health sharing ministries, including Fred Bennett of Chattanooga, Tenn.

Read More