Rapidly rising health insurance costs and, for the last several years, the penalty tax provisions of the Affordable Healthcare Act (ACA) have generated considerable interest in alternatives to health insurance. One alternative that is exempt from penalty under the ACA is participating in a religious healthcare cost sharing ministry (HCSM). Even though the ACA may soon be repealed, HCSMs may still remain of broad interest for legal, strategic, and cost reasons.
Many people, including some who are not Christians at all, are interested in the qualification requirements for participating in HCSMs so they may participate honestly. Below, I provide a comparison of the major points of these qualifications to help people decide which of them (if any) are suitable candidates.
There four most prominent HCSMs are: Christian Helathcare Ministries (CHM), Samaritan Ministries, Medi-share, and Liberty Health Share. All four expect their members to be Christians. In summarizing and providing commentary on the specific points below, I do not intend to suggest that people who aren’t truly Christians join any of these organizations, or that anyone intentionally stretch the rules merely to avoid the ACA penalty or achieve some other advantage. Of course, anyone can, at any time, become a Christian and thereby (potentially) qualify to participate in these ministries.
There are significant differences in views on these issues that are sincerely held by Christians of various stripes. I will not compare the general theological requirements of the four organizations I mention below, because there are too many complex differences to create a table of use to many people. However, there are numerous specific qualifications (behavior issues, etc.) that lend themselves to tabular comparison. I provide that comparison here to help anyone who is considering HCSMs as a method for managing healthcare costs.
In the interest of disclosure, I am a member of Christian Healthcare Ministries.
Specific Qualifications Summary Table
|Christian Healthcare Ministries||Samaritan Ministries||Medi-Share||Liberty HealthShare|
|Tobacco||Abstain from the use of tobacco||Abstain from tobacco use (a rare celebratory cigar or pipe, e.g. at the birth of a baby, is an allowed exception)||Strive to maintain a healthy lifestyle. Examples of unhealthy lifestyles include: Use of tobacco. …Have abstained from the use of tobacco for at least the 12 months prior to application.||Abstain from tobacco use in any form. You must cease use of tobacco products within 6 months of enrollment. Testing for nicotine is required.|
|Drug abuse / illegal drugs||Abstain from the illegal use of drugs.||Agree to: not abuse any legal or prescribed substance, abstain totally from illegal drugs and recreational use of marijuana.||Strive to maintain a healthy lifestyle. Examples of unhealthy lifestyles include: Use of illegal drugs. …Have abstained from the use of illegal drugs for at least the 12 months prior to application. Applicants attest that they have not abused legal drugs, such as prescriptions or over-the-counter medication, for at least the 12 months prior to application.||Avoid abuse of prescription drugs, which means consuming prescription medications in a manner not intended by the prescriber that would likely result in bodily harm or dependency. Abstain from the use of illegal drugs. Illegal drugs includes, but is not limited to, any hallucinogenic substance, barbiturates, amphetamines, cocaine, heroin, marijuana, illegal intravenous drugs, or narcotics.|
|Alcohol||Follow biblical principles regarding the use of alcohol.||Choose one option regarding the use of alcohol. 1: Abstain totally from all beverages containing alcohol (wine used for communion only is an approved exception). 2: Limit consumption of alcohol to moderate amounts so as never to drink to drunkenness.||Applicants attest that they have not abused alcohol for at least the 12 months prior to application.||Follow biblical teachings on the use or abuse of alcohol.|
|Sex||No specific requirement||Abstain from any sexual activity outside of traditional Biblical marriage as designed by God between one man and one woman.||Members must only engage in sexual relations within a Biblical Christian Marriage.||No specific requirement.|
|Diet||No specific requirement||Diet not specifically mentioned. Agree to practice good health measures in accordance with the principle that your body is the temple of the Holy Spirit.||Diet not specifically mentioned. Value the biblical principle that our physical bodies are temples of the Holy Spirit.||Eat healthy foods that do not harm the body.|
|Exercise||No specific requirement||Exercise not specifically mentioned. Agree to practice good health measures in accordance with the principle that your body is the temple of the Holy Spirit.||Exercise not specifically mentioned. Value the biblical principle that our physical bodies are temples of the Holy Spirit.||Exercise regularly.|
|Worship / church attendance||Attend group worship regularly as health permits.||Attend a Christian church regularly (at least three out of four weeks per month that your health or weather permits). If it is not possible for you to attend a Christian church, please submit a letter giving the details.||Attend and actively support a fellowship of believers regularly.||No specific requirement|
|Certification / oversight||No specific requirement (Note: they do ask for church and pastor information)||Sign and send to us your Membership Continuation Form each year confirming that you are meeting the above requirements. Have your pastor or Christian church leader sign a statement confirming that you meet the above requirements.||Must attest to a personal relationship with the Lord Jesus Christ. A church leader may be interviewed to verify their testimony.||No specific requirement|
As you can see from the above table, CHM and Liberty HealthShare have the shortest and simplest specific qualification requirements by far.
For those who do not completely abstain from tobacco use, only Samaritan and Medi-Share are options: Samaritan gives specific exceptions, while Medi-Share’s language might be interpreted as something less than absolute (striving to maintain a healthy lifestyle may not mean achieving perfection).
All four have requirements regarding alcohol and drug use (both illegal drugs and abuse of legal drugs). Three things are noteworthy to me. First, none of them prohibit alcohol consumption outright. Second, if a successful argument can be made (to a particular HCSM) that all federal drug laws are unconstitutional per se (this is conceivable to me), then non-abusive use of marijuana would not necessarily be disqualifying for members of CHM and Medi-Share in states where such use is legal. Third, it appears that Liberty HealthShare’s wording prohibits marijuana use even if prescribed by a doctor in a state where such use is legal (the other three appear to not make such a specific prohibition).
Only Samaritan and Medi-Share explicitly mandate sexual monogamy within marriage and only Samaritan mandates heterosexual monogamy. Neither CHM nor Liberty HealthShare have explicit requirements regarding sexual behavior.
It is worth noting that even though risky / reckless behavior is not specifically listed as disqualifying for membership in any of the four listed organizations, there are specific exclusions for sharing bills in some cases involving risky / reckless behavior (eg. riding certain motorized vehicles without a helmet). If this is a concern, it would be best to read the specific rules for a particular organization.
Qualifications are only one matter of interest to prospective participants in HCSMs. Other important considerations are the differences in the plans (coverage), how the plans are administered, and real world experiences regarding sharing of expenses. The websites for each HCSM describe their plans adequately, so I will not write my own post about that. However, I have had personal experience now with the sharing of expenses, which I will relate in a separate blog post.
I hope you find this information helpful. If there are any questions, please don’t hesitate to ask.