Health Sharing and Pre-Existing Conditions: Complete Guide

What Counts as a Pre-Existing Condition?

A pre-existing condition is any health issue, illness, injury, or symptom that existed before you enrolled in the health sharing program. This includes:

Important: Even if you're not actively treating a condition, if you had symptoms or a diagnosis before enrolling, it's considered pre-existing. For example, if you were diagnosed with high blood pressure 5 years ago but stopped taking medication, it's still pre-existing.

How Health Sharing Programs Handle Pre-Existing Conditions

Health sharing programs use waiting periods to protect the community from members joining only when they need expensive care. Here's how it works:

Waiting Periods by Program

Key Takeaway: If you have pre-existing conditions and need flexibility, CrowdHealth, Solidarity, and Zion Health offer the shortest waiting periods (12 months). Traditional faith-based programs like Medi-Share and CHM have longer waits (36 months).

"Incident-Based" Sharing: A Critical Distinction

Many health sharing programs use incident-based sharing rather than covering ongoing treatment for chronic conditions. This matters a lot for pre-existing conditions.

Most faith-based programs (Medi-Share, CHM, Samaritan) use incident-based sharing. This means even after the waiting period, your ongoing treatment costs for chronic conditions are NOT shared. You'll still pay out-of-pocket for:

• Maintenance medications (insulin, blood pressure meds, cholesterol meds)
• Routine specialist visits (quarterly endocrinologist, cardiologist check-ins)
• Ongoing monitoring (lab work, imaging, A1C tests)

Exception: Programs like CrowdHealth and Zion Health are more flexible with ongoing costs after the waiting period. They may negotiate and share costs for chronic disease management, not just acute incidents.

Best Health Sharing Programs for Pre-Existing Conditions

If you have pre-existing conditions, here are the most lenient programs:

Tips for Joining Health Sharing with Pre-Existing Conditions

1. Be Honest on Your Application

Health sharing programs require complete medical history disclosure. If you hide a pre-existing condition and later submit a claim, they WILL deny it and may terminate your membership. Always disclose:

• Any diagnosis or treatment in the past 5-10 years
• All current medications (including OTC if taken regularly)
• Prior surgeries or hospitalizations
• Family history of genetic conditions (some programs ask)

2. Budget for Out-of-Pocket Costs During Waiting Period

During the 12-36 month waiting period, you'll pay 100% of costs related to your pre-existing condition. Plan for:

• Maintenance medications: Use GoodRx or CostPlus Drugs for discounts
• Specialist visits: Negotiate cash-pay rates (often 40-60% cheaper than insurance rates)
• Lab work: Use direct-to-consumer labs (Quest, LabCorp) for cheaper pricing
• Pair with DPC: Direct Primary Care ($50-150/mo) covers routine visits and basic lab work — perfect for chronic disease management

3. Consider Waiting Periods Before Canceling Insurance

DO NOT cancel health insurance until you understand the waiting period implications. If you need ongoing treatment for a chronic condition, you may want to:

• Keep insurance for 12-36 months while the health share waiting period passes
• Switch during open enrollment when both coverages can overlap briefly
• Use COBRA to bridge the gap if you're changing jobs

4. Ask Specific Questions Before Joining

Don't rely on marketing materials. Call the program and ask:

• "After the waiting period, will ongoing costs for my condition be shared, or only new incidents?"
• "Are my current medications eligible for sharing after the waiting period?"
• "If I have a complication from my pre-existing condition, is that shareable?"
• "Do you have any members with [your condition]? Can I speak with them?"

5. Pair Health Sharing with Direct Primary Care (DPC)

If you have chronic conditions, pairing health sharing with Direct Primary Care is incredibly effective:

• DPC ($50-150/mo): Covers unlimited primary care visits, basic lab work, care coordination, wholesale prescriptions
• Health Sharing ($100-400/mo): Covers major medical events (surgeries, hospital stays, emergencies)
• Combined: You get comprehensive care for $150-550/mo — less than most insurance premiums

Your DPC doctor manages your chronic condition day-to-day (checkups, medication adjustments, basic labs), while health sharing covers unexpected complications or hospitalizations.

When You Should Stick with Insurance

Health sharing isn't for everyone. You may be better off with traditional insurance if:

Health sharing works best for healthy or mostly-healthy people who want to save money and avoid insurance bureaucracy. If your medical costs exceed $10,000-15,000 per year, ACA insurance with an out-of-pocket max may be cheaper and more reliable.