What Health Sharing Does NOT Cover
An honest look at the limitations, exclusions, and legal differences between health sharing and insurance.
⚠️ This is NOT Insurance
Health sharing ministries and programs are not insurance. They are not regulated by state insurance departments, and members have no legal guarantee that their medical bills will be paid. Understanding what health sharing doesn't cover is critical before you join.
1. No Guarantee of Payment
This is the most important thing to understand: health sharing programs do NOT guarantee they will pay your medical bills.
What this means:
- Even if you follow all the rules, your claim can be denied
- There's no state insurance regulator you can appeal to
- If the ministry runs out of funds, your bills may not get paid
- You are ultimately responsible for all medical bills incurred
Traditional insurance is legally required to pay covered claims. Health sharing ministries are not. They operate on voluntary sharing principles, not contractual guarantees.
2. Pre-Existing Conditions Are Excluded (or Have Long Waiting Periods)
Unlike ACA marketplace insurance, health sharing programs can — and do — exclude pre-existing conditions.
Common exclusions:
- Heart disease, diabetes, cancer: Often 36-month waiting periods (sometimes never covered)
- Chronic conditions: Asthma, COPD, arthritis may have 12-36 month waits
- "Incident-based" sharing: Ongoing treatments may not qualify as new "incidents"
- Prescription coverage: Maintenance meds for pre-existing conditions often excluded
If you have significant pre-existing conditions, health sharing may not be a viable option. Do not cancel insurance coverage until you understand the waiting periods.
3. Limited or No Mental Health Coverage
Most health sharing ministries exclude or severely limit mental health services.
What's typically NOT covered:
- Therapy and counseling sessions (outpatient)
- Long-term psychiatric treatment
- Substance abuse treatment and rehab
- Mental health medications (antidepressants, anxiety meds)
Some programs cover "acute mental health crises" (e.g., hospitalization for suicidal ideation), but ongoing therapy is rarely shared. If mental health coverage is important to you, see our guide to programs with mental health benefits.
4. Limited Prescription Drug Coverage
Prescription coverage in health sharing is limited and inconsistent.
Common limitations:
- Incident-based only: Prescriptions only covered if directly related to a shareable medical incident (e.g., antibiotics after surgery)
- No maintenance meds: Ongoing prescriptions for chronic conditions often excluded
- No pharmacy discount programs: Unlike insurance, no built-in Rx discounts (though some programs offer third-party discount cards)
- High out-of-pocket costs: Members often pay full retail price for prescriptions
If you take regular medications, budget for paying full retail prices or use discount programs like GoodRx independently.
5. State Mandate Penalties (in Some States)
A few states impose tax penalties if you don't have "minimum essential coverage" — and health sharing does not qualify.
States with individual mandates:
- California: Penalty for not having qualifying insurance (~$850/year for individuals)
- Massachusetts: Penalty of ~50% of the cost of the lowest-priced plan available
- New Jersey: Penalty (~$695-$3,012 depending on income)
- Rhode Island: Penalty (~$695+ per adult)
- Vermont: Penalty enforced via state income tax
- District of Columbia: Penalty (~$695+)
If you live in one of these states, budget for the penalty on top of your health sharing costs.
6. What Happens If a Claim Is Denied?
Unlike insurance, you have limited recourse if a health sharing program denies your claim.
Your options:
- Internal appeal: Most programs have an appeals process, but it's not legally binding
- No state insurance regulator: You can't escalate to a government agency like you can with insurance
- Legal action: Possible, but expensive and uncertain — health sharing guidelines are not insurance contracts
- You're still liable: Even if the ministry denies the claim, you're responsible for paying the provider
Read member testimonials and reviews carefully. Some programs have excellent reputations for paying claims fairly; others have concerning patterns of denials.
7. Other Common Exclusions
Most health sharing programs exclude:
- Routine dental and vision care (unless purchased as add-on)
- Cosmetic procedures and elective surgeries
- Injuries from high-risk activities (skydiving, racing, etc.)
- Self-inflicted injuries
- Experimental or investigational treatments
- Workers' compensation claims
- Care eligible for payment by other parties (auto insurance, liability claims)
- Long-term care and nursing home costs
The Bottom Line
Health sharing can be a valuable, affordable alternative to traditional insurance — but it's not for everyone, and it's not a perfect replacement for insurance.
Health sharing works best if you:
- Are relatively healthy with no major pre-existing conditions
- Understand and accept the risk that claims may not be paid
- Can afford to pay out-of-pocket if a claim is denied
- Primarily need coverage for catastrophic, unexpected medical events
- Don't rely heavily on prescriptions, mental health services, or ongoing treatments
Before joining a health sharing program, read the guidelines carefully, understand what's excluded, and have a financial backup plan.
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