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Obamacare Too Expensive? Consider This Alternative

Our Exclusive Cost-Benefit Analysis Found Thousands in Savings for the Same Care at the Three Leading Healthcare Sharing Ministries

July 14, 2025

By Jeff Blyskal

If you don’t have traditional health insurance sponsored by your employer, you can buy Marketplace coverage under provisions of the Affordable Care Act of 2010—more commonly known as Obamacare. Some 24 million have done that this year. But Obamacare plans can cost policyholders a king’s ransom vs. employer plans: Hundreds of dollars more out-of-pocket in monthly premiums just to get a plan and thousands higher in annual deductibles if you actually use it.

Obamacare policyholders who are eligible for taxpayer-subsidies get an average premium reduction of $705 per year, according to KFF, a health information nonprofit. But they are about to be hit by a bipartisan one-two punch that the American Hospital Association says will make them considerably more expensive: President Joe Biden’s enhanced Obamacare tax subsidies expire at the end of 2025 and President Donald Trump’s newly enacted tax law doesn’t renew them. That and other policy changes are expected to increase premiums for subsidized enrollees.

Luckily, there is an enticing alternative for Christians: So-called healthcare sharing ministries (HSMs) are communities whose members profess their Christian faith, strive to maintain healthy lifestyles, and team up to share payment of each other’s medical bills—and they make seemingly miraculous promises:

  • “Save…up to 50 percent on your monthly [healthcare] cost.”
  • “Ninety-eight percent satisfaction.”
  • “No network restrictions…No fees…The…biblical solution to satisfying your medical costs.”

Hallelujah! But wait! Are these plans legit?

The short answer is Yes, according to Your Consumer Reporter’s assessment of the three largest HSMs—Christian Care Ministry (doing business as Medi-Share), Christian Healthcare Ministries, and Samaritan Ministries. Together, these plans, available in all 50 states, have delivered $23 billion in benefits to their members over the past four decades.

As important, our exclusive cost-benefit analysis shows these ministries can save an example California family $2,350 to $6,550 over one year vs. an equivalent-as-possible unsubsidized Obamacare plan, in dealing with three hypothetical medical care incidents costing a total $21,100.

But the devil is in the details.

For example, HSM membership is contingent on abiding by a Chrisitan lifestyle that includes only engaging in sexual relations within a marriage between one man and one woman. If that’s you, Great! Read on.

However, because 57 percent of Christians say sex between unmarried adults in a committed relationship is “sometimes” or “always” acceptable, according to a Pew Research Center survey, be sure to see our “Faith and Lifestyle Requirements” section below and scrutinize each HSM’s specific guidelines on this, which also cover LGBTQ consumers, use of pornography, alcohol and drug abuse, smoking, and other topics.

If you can’t abide by the faith and lifestyle requirements and join an HSM anyway, you risk important practical consequences: Your membership can be reviewed and cancelled, and your medical bills won’t be shareable.

HSMs’ Costs and Benefits Can Beat Obamacare

While Obamacare plans are insurance, HSMs are not insurance and they don’t cover all the same healthcare problems as health insurance (see below for more detail on the differences). In many ways, the differences make HSMs like a hamburger and Obamacare a four-course meal: You get more on your plate with Obamacare, but it costs more and may be more than you need. Nevertheless, we think it is legitimate to conduct a lunch-to-dinner comparison of insurance vs. not-insurance, because both work to accomplish the same goal—get your medical bills paid according to set rules—and real shoppers can, should, and do compare the two. We’re doing the same thing, but with a more precise methodology, and we’ll give you the tools to do your own comparison.

Let’s start with the big driver: Cost. To assess the all-important dollars and cents of HSMs vs. Obamacare, we created an example San Francisco Bay area family with a married husband and wife, both age 35, and one child. Their income is $150,000 a year, which would make them ineligible for Obamacare subsidies. We then obtained current price quotes for the Big Three HSMs’ monthly “share amounts” or “contributions” that our model family would pay, which is the equivalent of health insurance monthly premiums. These amounts are paid to an electronic account or directly to other members with a need, depending on the plan. We also got premium quotes for our family for a California Blue PPO plan that was as similar as possible to the HSM plans, and for a second not-so-similar Blue plan with a desirable zero deductible. We then toted up the monthly costs over a year.  

As shown below, almost all the HSM annual share costs for our model family were thousands of dollars lower than the two Obamacare annual plan premiums:

So far, so good. But premiums and shares are only part of the total insurance/HSM cost equation. They’re the price of admission that gets you into the tent; however, because they must be paid every month, providers have a competitive incentive to reduce that highly visible Ouch! and they can do that by shifting more of the total cost of coverage to less-obvious charges—via deductibles, household shares, co-payments and co-shares, and benefit limits—which don’t hit you until you use the coverage. So we applied each plan’s current benefit payment rules to three example medical care incidents.

That’s tough to do, which is why comparing plans is difficult for consumers. Every medical care incident is different, and the number of specific treatment billing items can range from one to 1,000 or more, depending on the complexity of the case. As it turns out, the federal Centers for Medicare and Medicaid Services mandates that Obamacare and other health insurance providers disclose coverage examples showing how much their plans and the policyholder would pay for three example incidents. CMS says this shopping tool can be used by consumers “to compare the portion of costs you might pay under different health plans.”

To put these cost calculations on a level playing field, CMS created standardized treatments for each medical case, right down to the insulin syringes, fiberglass leg cast, and prenatal vitamins. We obtained the underlying data for the specific treatment items, billing codes, and itemized prices based on an estimated national average for each case—from physician services, pharmaceuticals, and imaging to medical supplies, emergency room fees, and lab work. The three cases, which CMS labels as “Peg is having a baby,” “managing Joe’s Type 2 diabetes,” and “Mia’s simple fracture”—together involved 165 individual charges totaling $21,088 in cost and provided a robust example of the medical needs a family might realistically have over a year—not catastrophic, but also not minor.

We then applied each HSM plan’s rules to these treatment costs to estimate how each HSM plan would provide benefits to our example family over a year. The results allowed us to calculate and compare the total and net costs and benefits of the HSMs head-to-head with each other and with the Obamacare plans to reveal which provided the best to worst deal. We sent our calculations to Medi-Share and Samaritan and reached out to CHM, but all three declined to confirm, correct, or respond.

How The Plans Compared

This is what each plan cost our example family for the same health care:

If our example family had no insurance or HSM, it would have to pay $21,088 in medical bills for the three incidents in our model. By joining Samaritan Classic and making $7,980 in annual share payments plus $10,211 in out-of-pocket costs to providers—whose costs are not eligible for sharing under plan rules—the family pays a total of $18,191 for $21,088 in medical services. Our example family thus obtained a net benefit of $2,897.

Christian Healthcare Ministries’ Silver plan provided a similar net benefit. But note that the up-front annual contribution payments were lower, while the non-eligible costs ran higher. That’s one way providers can lower the visible fixed prices, while making up that savings by raising the less-appreciated variable costs. If you and your family are generally healthy, the sure thing of lower HSM share costs are a better deal for you, because you might incur little or no variable costs in a given year. Unfortunately, no one knows for sure what his health care needs will be in the coming year, which is why insurance and HSMs were created.

Of course, you don’t buy an HSM or insurance to make a profit, you buy it to protect against potential costly to catastrophic losses. Nevertheless, our cost-benefit analysis using the CSM shopping tool allows us to measure the two major kinds of costs associated with coverage and reveal marketing shell games.

Remember our hamburger/full-meal analogy from above? Here’s an example of that: The case involving managing Joe’s Type 2 diabetes was not covered by any of the HSMs, because it was a pre-existing condition. (The rules on pre-existing conditions vary among the top three HSMs, depending on length of membership and other factors, and in some cases, they are covered. So read those rules in detail.) CHM’s Bronze and Silver plans also don’t cover Mia’s fracture, because the $2,800 cost is below the $3,000 and $6,000 “Qualifying Amounts” that each incident must meet to be eligible for cost sharing.

On the other hand, our full-meal Obamacare plan—Blue of California Bronze 60 PPO, with a $5,800 deductible per individual and $11,600 per family—does cover Joe’s Type 2 diabetes and Mia’s fracture. But when all the costs and benefits were added up, our family would pay a total $24,741—highest among all 11 plans studied—for a net cost of $3,641—worst among the 11.

We also included Blue of California Silver 73 PPO, which was not like the HSMs, because it had no deductibles vs. the HSMs effective deductibles of $750 to $12,000. A zero deductible is a prized feature for consumers, but it comes with a price: This insurance ranked third-highest in total annual cost, $21,934, with a net cost of $834 for our example family’s year. That was worse than eight of the nine HSMs we compared.

Conduct Your Own Shopping Comparison Of course, our comparison is confined to one example family with one set of hypothetical health care needs in one ZIP code, designed to assess the differences between HSMs and Obamacare plans using the CMS-designed shopping tool. We believe the results are representative of how these two options compare generally, but you can and should do your own customized comparison. Here’s how:

Download our comparison tool here:

DIY Costs and BenefitsDownload
  1. Obtain your own monthly share costs from each of the plans offered by CHM, Medi-Share, and Samaritan serving your area;
  2. Multiply the monthly share costs from each plan and enter the result in the appropriate cells in the yellow-highlighted column for HSM shares;
  3. Start here to shop for the Obamacare plans available in your state that most fit your needs and have deductibles similar to the effective $750 to $12,000 deductibles of the HSMs;
  4. Get your monthly Obamacare premium quote, multiply it by 12, and enter the annual premium in the appropriate cell in the yellow-highlighted column for insurance premiums;
  5. Download the Obamacare plans’ Summary of Benefits and Coverage document, scroll down a few pages to the three Coverage Examples, and add up the totals that Peg, Joe, and Mia would pay. If the total deductibles shown exceed the plan’s applicable overall individual or family deductible, subtract the overage and enter the result in the appropriate cell in the yellow-highlighted column for insurance cost-sharing.
  6. The net (cost) or benefit column should show the best deal for the CMS shopping tool’s example.

Healthcare Sharing Ministries are NOT Health Insurance

A key thing to keep in mind is that HSMs are NOT health insurance. That’s important, because your natural inclination is to expect everything you’d get with insurance, when you don’t.

Insurance is a legally binding contract between you and an insurance company, overseen by state and federal regulators, to protect you from the potentially crushing cost of medical care. Most nonelderly people—almost 70 percent—are covered by private employer-sponsored health plans, which are the best deal for consumers, because the employer typically pays most of the considerable cost of annual premiums: 80 percent for individual plans and about 70 percent for family coverage.

The total premiums aim to cover most of the cost of your medical care needs, subject to plan rules and limits, and regulators work to ensure the insurers remain financially sound, so they can pay their share of its policyholders’ bills. When a medical need arises, you, the insurance policyholder, are also responsible for paying a certain portion of that cost in the form of deductibles, co-pays, and other out-of-pocket costs. Regulators also oversee and enforce consumer rights and protections, minimum coverage standards, access to insurance, complaint processes, and many other rules.

Employer-sponsored health insurance, also known as “group” coverage, is the Porsche of protection, and if you have it, you don’t need an alternative.

But if your employer does not offer health insurance, you’re self-employed, or you’re a gig worker, your second-best health insurance option is an Obamacare plan in your state’s individual or non-group marketplace. That IS insurance. But because Obamacare plans come with high costs and some coverage mandates you may not need or which conflict with your faith, an HSM is worth considering as another option.

What IS Healthcare Sharing?

Unlike health insurance, members of healthcare sharing plans voluntarily share each other’s medical cost burdens according to the rules each plan in what CHM explains is “a Biblical covenant, not a contract.” Our analysis covers 1) the three largest plans by national membership, according to the latest (2023) data collected by the Colorado Department of Regulatory Agencies, 2) which are also accredited by a credible standard-setting authority:

Before signing up, read each plan’s 43- to 90-page guidelines in detail, because, unlike health insurance, members are responsible for their own medical bills and the plan does not guarantee payment. However, the plans are a formal system for getting members’ medical bills paid. “We’ve shared and discounted $8 billion in medical bills since our founding,” says Marq James, a spokesman for Christian Care Ministry Medi-Share. Another $15 billion has been shared by Christian Healthcare Ministries and Samaritan since their founding.

According to Medi-Share’s Program Guidelines “Each Medi-Share Member is solely responsible for the payment of his or her own medical bills at all times. Neither CCM nor other Members guarantee or shall be liable for the payment of a Member’s medical bill. Further, no Member may or shall be compelled to make sharing contributions. If sharing occurs, the shared medical bills are paid by the Member that incurred the bill solely from voluntary contributions of Members, not from funds of CCM itself.”

Samaritan’s Guidelines for Healthcare Sharing warn, “Health care sharing is an arrangement where members share one another’s medical expenses through voluntary giving, not because of legal obligation. We are not licensed or registered by any insurance board or department, since we are not practicing the business of insurance. We do not assess applicants’ health risks, because neither the ministry nor the members are assuming financial liability for any other member’s risk.”

The Christian Healthcare Ministries Member Guidelines explain, “Based on New Testament principles, CHM helps Christian families, churches, and ministries join together as the Body of Christ to share healthcare costs such as medical tests, maternity, hospitalization, and surgery…

CHM is a non-profit health cost sharing ministry, not insurance. Participation is an expression of

Christian faith—it’s voluntary and doesn’t require a contract. Instead, CHM members join the

ministry as part of a biblical covenant through which each party desires to help the other.”

The key words here are voluntary and no guaranteed payments. That may be unnerving to consumers with an insurance mindset, but more than 1.2 million members have faith in the goodness of their fellow Christians to share their medical costs, HSM’s are an organized system to make that happen, and the top three HSMs have been doing this for 32 to 43 years.

Quality Without Regulation?

The National Association of Insurance Commissioners, which establishes standards and best practices, conducts peer reviews, and coordinates regulatory oversight of health insurers in all states, the District of Columbia, and five U.S. territories, warns that its member regulators do not supervise HSMs. “Healthcare Sharing Ministries may provide value to some, but they pose a risk to others because they often provide limited to minimal benefits,” the NAIC states on its website.

While lack of insurance regulatory oversight may give you pause, we think alternative authorities provide a credible substitute, and the three largest HSMs we assessed are accredited by legitimate private evaluating bodies. They’re also rated A+ by the Better Business Bureau.

There is government jurisdiction, too. As 501(c)(3) non-profits, “we come under the authority of any state’s attorney general and Internal Revenue Service regulations,” says Joel Noble, a spokesman for Samaritan. “If there is a bad actor, the AG will step in.”

Finally, 30 to 40 years in business and market dominance by the big three HSMs we studied are important free-market votes of confidence.

Christian Faith and Lifestyle Requirements

Another important requirement that distinguishes HSMs from health insurance is a profession of Christian faith, including the belief that the Holy Bible is the Word of God; there is only one God who eternally exists; and Jesus Christ is God. Members also agree to bear one another’s burdens, which is where the concept of healthcare sharing arises, and they should also regularly attend church services.

To keep medical costs down and treat the body as the temple of the Holy Spirit, members also agree to maintain a healthy lifestyle, which includes abstaining from use of tobacco, recreational marijuana, and illegal drugs; not abusing legal drugs or alcohol; and only engaging in sexual relations within a Biblical Christian Marriage between one man and one woman.

CHM’s faith profession also reminds and requires that members believe that God created all human beings in His image, and therefore, human life is sacred from conception to its natural end; that we must honor the physical and spiritual needs of all people; and, following Christ’s example, every person should be treated with love, dignity, and respect.

Consumers who don’t accept each plan’s faith and lifestyle requirements may not be interested in joining an HSM. However, if they do join and violate their commitments, or if violations lead to medical problems, their bills may not be sharable and their membership may be suspended.

In all cases, read your HSM’s guidelines to understand what you must agree to and whether you can comply.

How HSMs Work to Cut Costs

Your monthly share payments are deposited into an online account at Medi-Share and CHM. Samaritan also provides online access to their account, but members receive a monthly notification telling them who they should send their share to; that’s sent directly to the member in need along with a note of encouragement.

When you have a medical care need, you get treatment from the doctors and other providers of your choice. CHM and Samaritan have no networks, while Medi-Share does have a Preferred Provider Organization (PPO), whose members have agreed to discount their fees.

Ironically, experts say that one of the factors helping to skyrocket healthcare costs is the success and market dominance of employer-sponsored health insurance. Because employer and government plans like Medicare pay most of the costs and out-of-pocket costs for policyholders are limited, consumers have little incentive to price-shop for the lowest-cost care.

HSMs, on the other hand, expose members to more cost risk, which is ironically a good thing from a macroeconomic perspective: That gives members an incentive to plan better and shop for lower, more fair prices. When members have a need, they’re advised to negotiate directly with providers as “cash-pay” or “self-pay” patients, whenever possible. “Hospitals often extend discounts to self-pay patients and offer financial assistance programs,” says CHM. “The average discount varies by state, with potential discounts reaching up to 60-70%, depending on the location.”

“Physicians and other non-hospital services typically give cash-pay discounts of 20-40%,” says Samaritan. If the member can’t get a meaningful discount, they can contact CHM and Samaritan for help.

Our cost-benefit analysis cannot reliably quantify possible discounts, so they are not included in our HSM plan calculations, which means net benefits could be better than shown.

Limits on Sharing

Before Members can submit bills for sharing, they must first submit them to any other potentially responsible payers, including auto or home other insurance, Medicare, Worker’s Compensation, fraternal benefits, or other protections. “For example, if a Member is injured in a car accident, the Member’s automobile insurance may provide coverage and an at-fault third party may be liable for the Member’s medical expenses,” says Medi-Share. Members must report that effort when submitting their bills, and the amount of any third-party payments received are not shareable. Samaritan says, “If a bill is shared and later reimbursed by a third party, or liability is released as part of a settlement, the reimbursed amount must be sent on to meet other members’ needs.”

Depending on the plans we studied, bills eligible for sharing must be greater than the $3,000, $6,000, $9,000, or $12,000 Annual Household Portion (AHP) at Medi-Share, or the $750 or $1,500 Initial Unshareable Amount (IUA) per need at Samaritan. With CHM, the cost of treating a particular “incident” or medical condition is not eligible for sharing unless it’s greater than the “Qualifying Amount” of $1,250, $3,000, or $6,000 (or $2,000, 5,000, or $9,000 for maternity), depending on the plans we studied; those same amounts serve as the “Personal Responsibility” not shareable per year, per pregnancy, and per unit or participating individual within a membership, up to three. Once the QA and PR are met, remaining amounts are shareable according to plan rules.

Keep your eye on the balls above, which are the equivalent of insurance deductibles: In a family plan, Medi-Share’s Annual Household Portion is a better target to hit vs. the other HSMs’ per need, per incident, and per unit. At the same time, if you have only one need in a year, a $1,250 or $1,500 incident is easier to overcome vs. a $12,000 AHP. And, of course, the pricing can scramble that caveat, which is why you should look to our overall cost-benefit analysis, wherein Samaritan Classic (with the $750 IUA) and CHM Silver with the $3,000 QA/PR rose to the top of our assessment in net benefit.

Not all treatments are eligible for sharing, and some in this gap are biggies, including active pre-existing conditions, prescription medicines for maintenance treatment regimens, initial 60- or 90-day supply of pharmaceuticals for a new diagnosis, maternity expenses for pregnancies conceived prior to membership, abortions, alcohol and drug abuse (including injuries and illnesses relating from such abuse), and births from unwed mothers.

Because members are responsible for hundreds to thousands in cost-sharing and ineligible expenses, HSMs advise them to budget for those costs like any other expense, set up a savings account for these funds, price-shop, and research cost-saving strategies.

Membership requires members to deal with a great deal of bills, rules, timelines, medical-speak, and phone, online, and print mail communications. So we recommend you create a good recordkeeping system to keep scrupulous track of everything and which works best for your tolerance for bureaucracy. Once you get through the above gauntlet, you should receive the money you need to pay your medical bills according to the plan, along with prayers from your fellow members.

Sharing limits for the plans we studied range from $125,000 lifetime max per illness at CHM (with an optional extension to $1 million per incident with the CHM Plus add-on), to $247,000/$250,000 per non-maternity need under Samaritan Basic/Classic, respectively, to no limit at Medi-Share. The Blue of California Bronze plan has no annual or lifetime limit on what it will pay for covered services.

The Big Three HSM offer a couple of other plans and options, which we did not include. For specific further details, download and read the 43- to 90-page program rules from CHM, Medi-Share, and Samaritan.