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Is This a Health Share Ministry or Real Insurance? How To Tell What You Are Actually Buying
Written and reviewed by Dick Tracy, licensed health insurance broker (NPN 20414610) · Published September 14, 2026
Quick answer No. If I put it in front of you, it is real insurance: a named carrier, a licensed product, a true PPO network, and a contract that obligates somebody to pay your claim. A health care sharing ministry is none of that. It is not insurance, no state department of insurance supervises it, and it is not legally required to pay your bill. Here is the number that tells the story: when Colorado became the first state to make sharing ministries report their books, members submitted about $362 million in medical bills and the ministries deemed only about one third of that, roughly $132 million, eligible to be shared. Four questions below will tell you in ten minutes which one you are holding.
I'm Dick Tracy, an independent health insurance broker in Western New York, licensed in 25 states with 80+ carriers behind me. I get this question on almost every call now, usually phrased exactly like this: "This is not a health share, right? I don't want a health share ministry." Good. Ask me that. Ask everybody that. I came out of the healthcare side of this business, so there is no gag clause on me, and I will give you the tips, the tricks, and the traps. This one is a trap, and the people who fall into it are not careless. They are careful people who were shown something that looked like insurance.
The four-question test
You do not need to be an insurance person to sort this out. You need four answers, and you should get them in writing before you give anyone a dollar or a routing number.
Ask these four, in this order
- Who is the insurance carrier that underwrites this? Real coverage always has a named carrier. A sharing ministry cannot answer this, because there isn't one. If the answer is the name of the program itself, or a membership organization, or "we work with a network of providers," you have your answer.
- Is that carrier licensed in my state? Every state runs a free license lookup on its department of insurance website. Thirty seconds. If the carrier is not there, stop.
- Can I see the certificate of coverage or summary of benefits before I enroll? Insurance hands it over. A sharing ministry hands you "guidelines," which is a different word on purpose, because guidelines can be changed and are not a promise to pay.
- Are you a licensed agent, and what is your national producer number? Mine is NPN 20414610, licensed in 25 states. You can look me up. Sharing ministries are frequently sold by people with no insurance license at all, because no license is required to sell something that is not insurance.
Four for four means you are looking at insurance. Anything less than four for four means you are looking at something else, no matter how good the monthly number looks. And if asking those questions makes the person on the other end of the phone irritated, that is information too.
What a sharing ministry actually promises
A health care sharing ministry collects a monthly amount from members and, when a member has a medical bill, decides whether to share the cost among the membership. Notice the verb. Decides. The National Association of Insurance Commissioners, which is the organization of every state's insurance regulators, states it in plain language: sharing ministries are not insurance and cannot guarantee the payment of claims, and state insurance regulators do not supervise them. Read that twice. There is no rate filing, no reserve requirement, no claims appeal process backed by state law, and no guaranty fund if the thing runs out of money.
It is also not a fringe product. Membership has grown into the millions, and a lot of that growth came from people who thought they were buying insurance. That confusion is the point of the design: a monthly amount that looks like a premium, a card that looks like an insurance card, a member services phone number that sounds like a claims line. What is missing is the only feature that matters at two in the morning in an emergency room, which is a legal obligation.
I call them prayer policies. That is not me being cute about somebody's faith, and plenty of decent people run and join these things sincerely. It is a description of the coverage: you are praying the bill gets paid. I do not write them, I will not write them, and if that costs me a sale, fine. The math doesn't math on a product that can look at a $90,000 hospital bill and legally say no.
Side by side
| What you are checking | Health care sharing ministry | ERISA group plan or private medical plan |
|---|---|---|
| Is it insurance? | No. Explicitly not insurance. | Yes. A licensed, filed insurance product. |
| Who is behind it? | A membership organization. No carrier. | A named insurance carrier you can look up. |
| Who regulates it? | No state insurance regulator supervises it. | Your state department of insurance, plus federal law. |
| Is your claim guaranteed? | No. Sharing is discretionary. | Yes. Paid under contract terms you can read first. |
| Pre-existing conditions | Commonly excluded or limited for years. | Depends on the product, and it is in writing before you buy. |
| Network | Usually a discount arrangement, not a true network. | True PPO on PHCS or MultiPlan nationwide, or MagnaCare in NY and NJ. |
| If they refuse to pay | Internal review by the same organization. | Appeal rights, a broker in your corner, and a regulator to complain to. |
What I place instead
When somebody self-employed or on a 1099 tells me the marketplace number is brutal, the first door I open is a pre-established ERISA group plan. ERISA is federal law from 1974, and it beats state insurance rules, which is why it matters so much here in New York: federal ERISA overrides New York's community rating, so a healthy household can get group rates the state's own market will not give them. You get a true PPO network, PHCS or MultiPlan nationwide or MagnaCare across New York and New Jersey. You own the policy, not an employer, so it does not evaporate if you change who you work for. An employer can be the payer if there is one. Joining is a simple compliance step I walk you through.
Door two, in the states that allow medical underwriting, is a customized individual plan priced on your actual health instead of on the sickest people in a pool. Door three is the marketplace, and I will say the honest thing out loud: if your income is genuinely low and the premium tax credit is large, a marketplace plan may well be your best deal, and I will tell you so even though I do not get paid for it. It is one tool with real trade-offs, narrow county-by-county networks, community rating in New York, a subsidy that runs on an income guess and can be clawed back at tax time, and the 2026 cliff at 400% of the federal poverty level. If you want to see where you land on that, check the free 2026 subsidy cliff calculator before you renew anything. One more honest line: a serious diagnosis in the last five years belongs on a no-questions marketplace plan for now, and I will point you there rather than underwrite you into a decline.
What none of those three doors have in common with a sharing ministry is discretion. Every one of them is somebody's legal obligation. That is what you are actually buying when you buy insurance, and it is the entire reason the monthly number is different.
Why people end up in one by accident
Almost nobody goes shopping for a sharing ministry. They go shopping for a number. Somebody quotes them $2,100 a month for a family, they say that is impossible, and the next ad they see says $450 a month with a card and a network and a member portal. Nothing in that ad says "this is not insurance" in a font you would notice. By the time the distinction shows up, it is in a denial letter.
So here is the standing rule, and it costs me nothing to give it away: never accept the monthly number as the answer to the question. The monthly number is the last thing you look at, after you know who the carrier is and what happens when you get hurt. Anybody who leads with price and gets vague about carrier is selling you the wrong thing, and that includes anybody in my own business. I educate, you decide. If you decide something else is right for you, that is genuinely fine. Just decide it knowing what it is.
Common questions about health share ministries and real insurance
Is this a health share ministry or real insurance?
If I placed it, it is real insurance. A health care sharing ministry is not insurance, has no insurance carrier behind it, and is not licensed or supervised by any state department of insurance. The National Association of Insurance Commissioners puts it plainly: sharing ministries are not insurance and cannot guarantee the payment of claims, and state insurance regulators do not supervise them. What I place is a pre-established ERISA group plan or a private medical plan: a named carrier, a filed and licensed product, a real PPO network, and a contract that obligates somebody to pay your claim. You can check that in about ten minutes, and I will walk you through checking it.
Why not just use a health share instead of insurance?
Because a share does not owe you anything. The monthly amount looks like a premium and the card looks like an insurance card, but the organization is not legally required to pay your bill, and no state regulator is standing behind it if it does not. I call them prayer policies, and I do not write them. People also ask about HSA-compliant plans in the same breath, which is a different thing entirely: a health savings account is a tax-advantaged savings account that rides on top of a qualifying high-deductible medical plan. It is a tax feature, not coverage, and on its own it is not a health insurance strategy. The coverage question still has to be answered first.
Are health care sharing ministries a bad experience for members?
The numbers are not flattering. Colorado became the first state to require sharing ministries to report what they take in and what they pay out. In that first reporting period, members submitted roughly $362 million in medical bills for sharing, and the ministries deemed only about one third of that, roughly $132 million, eligible to be shared. That is reported by the Commonwealth Fund from Colorado's own data. The gap is not an accident: sharing guidelines commonly exclude pre-existing conditions, and the organization keeps broad discretion to decline a request even when it appears to meet the guidelines. Members find this out at the worst possible moment, which is after the hospital stay.
How do I verify a health plan is real insurance before I enroll?
Four checks, ten minutes. One: ask for the name of the insurance carrier that underwrites the plan, in writing. Real coverage always has one, and a plan that cannot name a carrier has told you what it is. Two: look that carrier up on your state department of insurance website and confirm it is licensed to do business in your state. Three: ask for the certificate of coverage or summary of benefits and read what it says about pre-existing conditions and claim payment. Four: ask whether the agent selling it holds a health insurance license and get their national producer number. Mine is NPN 20414610, licensed in 25 states. If anyone gets cagey on any of those four, walk away.
What is the difference between a health care sharing ministry and an ERISA group plan?
Everything that matters. A sharing ministry pools voluntary contributions and decides, at its own discretion, which member bills it will help with. A pre-established ERISA group plan is real insurance governed by federal law from 1974. It comes with an insurance carrier, a true PPO network on PHCS or MultiPlan nationwide or MagnaCare in New York and New Jersey, claims paid under contract terms you can read in advance, and a policy you own rather than one your employer owns. In New York it matters twice, because federal ERISA overrides New York community rating, so a healthy household can get group rates it cannot get anywhere else in the state. Joining is a simple compliance step I walk you through.
Forward me the brochure, the enrollment link, or just the name of the program. I will tell you straight whether there is a carrier behind it, and then show you what real coverage costs for your situation side by side. No hard sell, ever. I educate, you decide.
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