For countless American families searching for a reprieve from the crushing weight of health insurance premiums, the promise of an affordable, faith-based alternative can seem like a long-awaited answer to their financial prayers. Health care sharing ministries have positioned themselves as a community-focused solution, offering seemingly comprehensive coverage for a fraction of the cost of traditional plans. However, beneath this appealing veneer lies a high-stakes gamble, particularly for those planning to start or expand their families. The experience of individuals like Alycin Berry, who was drawn in by promises of robust maternity benefits, serves as a stark warning. When faced first with a miscarriage and later a full-term pregnancy, she discovered the devastating gap between marketing claims and reality, finding herself buried under thousands of dollars in unpaid medical bills, a mountain of invasive paperwork, and the crushing realization that her family’s health was not protected by a guarantee but by the discretionary whim of an unregulated organization.
The Lure and the Lie
The Affordability Trap
The primary driver pushing families toward health care sharing ministries is the prohibitive cost of traditional health insurance, a problem that is only expected to worsen. As enhanced tax credits for Affordable Care Act (ACA) marketplace plans are set to expire, many families will face skyrocketing premiums, with some projected to more than double. This impending financial cliff creates what health policy experts at Georgetown University have termed a “golden marketing opportunity” for sellers of alternative plans. Preliminary government data already indicates a significant drop in health insurance enrollment, and a recent KFF survey found that one in four marketplace enrollees would likely forgo insurance entirely if their premiums doubled. This economic desperation creates fertile ground for ministries to attract new members, who are often so focused on the immediate relief of lower monthly payments that they overlook the fine print that could lead to financial catastrophe down the road. The appeal is understandable, but the risks are profound and often hidden until a medical crisis strikes, at which point it is too late.
Deceptive Marketing and False Promises
The marketing of these plans often blurs the line between a voluntary cost-sharing arrangement and genuine health insurance, creating a dangerous misconception for consumers. Alycin Berry and her husband, for instance, were led to believe their chosen ministry was “comparable to health insurance if not better,” with specific advertisements highlighting its generous maternity benefits. This is a common tactic, as some insurance brokers also sell ministry plans, further confusing consumers who believe they are purchasing a regulated product. Georgetown University expert Katie Keith emphasizes that because of these advertising strategies, “people don’t realize what they’re getting.” The reality is that these organizations are not insurance. They operate on a theoretical “sharing” model where the ministry has the ultimate discretion to decide which medical expenses to share among its members. There is no legal obligation to pay for any claim, a fact often buried in membership agreements that members may not fully read or comprehend until they are denied payment for a critical medical need, leaving them with unexpected and often insurmountable debt.
The Unregulated Reality
A System Without Safeguards
The structural differences between ACA-compliant insurance plans and health share ministries are stark, revealing a system devoid of the consumer protections that most Americans take for granted. Under the Affordable Care Act, insurance plans are legally mandated to cover a comprehensive set of essential health benefits, which includes everything from preventive care and mental health services to prescription drugs and, crucially, maternity care. Furthermore, insurers are explicitly forbidden from discriminating against individuals with preexisting conditions and cannot impose lifetime or annual limits on coverage. These regulations were designed to ensure that insurance serves as a reliable safety net. In stark contrast, health care sharing ministries operate without any of these obligations. They are free to exclude coverage for preexisting conditions, impose strict caps on payments, and deny claims for services they deem outside their scope of sharing, leaving members exposed to catastrophic out-of-pocket costs with virtually no legal recourse.
The Absence of Oversight
This lack of protection is compounded by an almost complete absence of government oversight. While the insurance industry is governed by a robust regulatory framework at both the state and federal levels, no federal body is tasked with tracking or regulating health care sharing ministries. The industry has grown from serving approximately 200,000 members before the ACA to over 1.7 million people today, all while operating in a regulatory gray area. In a move that further insulates them from accountability, around thirty states have passed laws that explicitly state that ministries are not insurance. This legal classification effectively exempts them from scrutiny by state insurance departments, meaning there are no requirements for financial transparency, no mandated medical loss ratios ensuring funds are spent on member care, and no formal process for members to appeal denied claims. Members who are wronged have little recourse beyond filing lawsuits, a costly and time-consuming process against organizations that have legally shielded themselves from the responsibilities of an insurer.
Ideology Over Health
As faith-based organizations, health care sharing ministries frequently build their coverage rules around a specific set of religious and lifestyle values, leading to significant and often discriminatory exclusions. Membership typically requires adherence to a statement of faith and a commitment to certain behaviors, and coverage can be denied for medical needs that are deemed the result of “immoral choices.” This ideological foundation directly translates into policy, with common restrictions on reproductive health care. Coverage for contraception is almost universally denied. Furthermore, pregnancies conceived outside of a heterosexual marriage or through advanced reproductive technologies like in vitro fertilization (IVF) are often explicitly excluded from sharing. These rules mean that a member’s eligibility for care is not based solely on medical necessity but is instead filtered through a lens of moral judgment, creating significant coverage gaps that disproportionately affect women and LGBTQ+ individuals who may not conform to the organization’s narrow definition of an acceptable lifestyle.
The impact of these ideologically driven policies extends beyond reproductive health, often leaving members without coverage for critical mental and behavioral health services. While the ACA mandates that insurance plans cover mental health and substance use disorder services as essential benefits, ministries are under no such obligation and frequently exclude them. This is a particularly dangerous gap, as women and LGBTQ+ individuals often require more care in these areas and face systemic barriers to accessing it. A ministry may refuse to cover treatment for depression, anxiety, or addiction if it is perceived to be linked to behavior that violates their code of conduct. This practice puts personal beliefs ahead of established medical needs, forcing members to either pay entirely out-of-pocket for essential care or forgo it altogether. The result is a two-tiered system where a member’s adherence to a prescribed lifestyle becomes a prerequisite for receiving financial assistance for their health, a stark departure from the principles of modern health insurance.
Pregnancy and childbirth represent an area of exceptional risk for members of health share plans, where the potential for financial devastation is particularly high. A comprehensive review by the Government Accountability Office (GAO) discovered that every single ministry it examined imposed a waiting period, often many months, before a new member could become eligible for pregnancy-related coverage. This effectively penalizes any woman who becomes pregnant shortly after joining a plan. Furthermore, a separate analysis by The Commonwealth Fund found that many ministries will only cover maternity costs under a very specific set of circumstances, such as requiring conception to occur within wedlock or mandating enrollment in more expensive, premium-tier plans. Given that the average cost for a privately insured birth can easily exceed $20,000—with typical out-of-pocket costs around $2,700 even with good insurance—being denied reimbursement for these substantial bills can be a catastrophic financial blow for a young family at a uniquely vulnerable time.
The reimbursement process itself adds another layer of hardship, shifting a significant administrative and financial burden onto the members. Unlike traditional insurance where healthcare providers bill the insurance company directly, the ministry model often requires members to pay for medical services upfront and then submit a labyrinth of documentation to seek reimbursement. Alycin Berry’s experience serves as a powerful illustration of this arduous system. Following a miscarriage, she was forced to provide invasive proof that her pregnancy was conceived without fertility treatments and then waited several months for payment, all while grieving her loss. Her subsequent effort to get reimbursed for a $4,000 global fee from her birth center took over a year of relentless emails and phone calls. This process places a heavy burden on members when they are least equipped to handle it—coping with medical issues, caring for a newborn, or recovering from a procedure—with no guarantee that their persistence will ever result in payment.
As the stories of denied claims and financial hardship have mounted, a slow but steady movement toward accountability and regulation has begun to take shape across the country. Recognizing the potential for consumer harm, a handful of states have started to take action. States like Massachusetts and Colorado have implemented new rules requiring ministries to provide data and be more transparent about their operations and the limitations of their coverage. More aggressive legal actions have been taken in Washington and California, where state attorneys general have sued specific ministries, accusing them of operating as “sham insurance” and engaging in deceptive and fraudulent business practices. These lawsuits argue that by mimicking the language and structure of insurance without providing any of the guaranteed protections, these organizations are misleading consumers and leaving them dangerously exposed. These state-level efforts represent the first significant pushback against an industry that has flourished in a regulatory void.
Beyond government action, members themselves have started fighting back through the legal system. A number of class-action lawsuits have been filed by groups of members who were denied promised coverage for essential medical care, from cancer treatments to maternity bills. These lawsuits collectively challenge the fundamental business model of the ministries, alleging that they collect monthly payments under the guise of being a reliable alternative to insurance while arbitrarily denying claims and retaining excessive amounts of member contributions for administrative costs and executive salaries. While the outcomes of these legal battles are still pending, they signal a growing awareness among consumers and a rising demand for transparency and accountability. The combination of regulatory scrutiny and member-led litigation has put the health care sharing ministry industry on the defensive, forcing a long-overdue public conversation about whether these unregulated entities are a viable solution or a dangerous predator in the American healthcare landscape.
A Concluding Reflection
The rise of health care sharing ministries tells a compelling story about the profound affordability crisis in American healthcare, yet the experiences of countless families reveal a deeply flawed and hazardous alternative. The initial allure of lower monthly payments consistently masks a system that lacks the fundamental protections and guarantees of regulated insurance. For individuals like Alycin Berry, the journey from an optimistic new member to a disillusioned cautionary voice encapsulates the core problem: the perceived savings are not worth the catastrophic risk of being denied coverage for essential medical care. Her definitive conclusion, that she would “never recommend the health share to anyone else,” echoes the sentiments of many who found themselves abandoned at their most vulnerable moments. The synthesis of these personal stories with expert analysis and policy reviews builds a unified and powerful argument that these ministries are an unreliable and often dangerous solution, especially for those planning to grow their families.
