What to know about healthcare sharing ministries, discount plans and risk-sharing plans

Contact: Jennifer Bowen
(334) 269-3550

12/14/2023

Consumer protection laws govern many types of health insurance coverage, like plans purchased through an employer or the health insurance marketplace. However, other plans are not insurance and are not required to protect consumers. 

Consumers who use health care sharing ministries (HCSMs), discount plans, or risk-sharing plans can best protect themselves by understanding the coverage they participate in. 

HCSMs, discount plans, and risk-sharing plans are not insurance products. Before signing, be sure to understand how the plan works and what benefits you or your family can count on. 

How Health Care Sharing Ministries Work  

HCSMs are organizations in which the members pay in and share the costs of health care. A member will typically contribute a monthly payment to cover the qualifying medical expenses of other members. The HCSM will match paying members who need the health care funds or pool all the monthly shares and administer payments to members directly. Some people look to HCSMs because of their typically lower up-front costs, compared to ACA plans. 

So far, there are 30 states where state law explicitly exempts HCSMs from insurance regulation. The remaining 20 states and Washington, DC, don't contain an explicit exemption for HCSMs under state law. 

Usually, HCSM members have common ethical or religious beliefs, but before you sign up for an HCSM, there are some things you should know. 

- HCSMs do not have to comply with the consumer protections of the federal Affordable Care Act (ACA), like covering treatments for pre-existing conditions or capping out-of-pocket costs. 

- HCSMs are not insurance and can't guarantee the payment of claims; i.e., while they may share funds with members who have health needs, they are not legally required to do so. 

- State insurance regulators don’t supervise HCSMs. 
 
-HCSMs usually don’t have provider networks, so members may be charged full price by doctors and hospitals, rather than the lower negotiated rates charged to consumers who have insurance coverage. 

- HCSMs may provide value to some, but they pose a risk to others because they often provide limited to minimal benefits. 

How Discount Plans Work 

You might receive advertisements from plans offering discounts on health care for a monthly fee. These are not health insurance plans, and participants do not have the same protections as under licensed health insurance plans. Insurance Commissioners strongly recommend that you thoroughly investigate any plan promising deep discounts for a “low” monthly fee and weigh the benefits against the cost carefully.  

How Non-Licensed Risk-Sharing Plans Work  

You may receive offers to join a group or association that will take your monthly payments, put them in a savings account, or trust, with other participants’ money, and help pay some of your health care costs, as needed. Such arrangements are not insurance, and the participants do not have the protections available to purchasers of licensed insurance plans. State insurance regulators strongly recommend that you thoroughly investigate such plans before joining. 

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