Health Sharing in Texas: How It Works and How Programs Compare

What health sharing is

A health care sharing program is a group of members who agree to share each other's eligible medical bills under written guidelines. Each member pays a monthly share. When a member has a large eligible bill, money from the group helps pay it.

It isn't insurance. Nobody is legally required to pay your bills, so sharing is voluntary and not guaranteed. It isn't Minimum Essential Coverage under the ACA, and you can't get a tax credit for it. In exchange, monthly amounts are often well below the full price of an individual plan, and there's no provider network.

Health sharing and Texas law

Chapter 1681 of the Texas Insurance Code sets out when a health care sharing ministry isn't treated as insurance (source). Among the conditions: it's a tax-exempt, faith-based nonprofit; its participants share a similar faith; bills are paid by contributions from one participant to another, with no promise to pay; it sends every participant a monthly statement of the needs submitted; it discloses its administrative fees; and any card you show a provider must say you belong to a sharing ministry that isn't in the insurance business.

The law also requires a written notice on or with every application and set of guidelines. In short, it says the ministry isn't an insurance company, nobody is required by law to help with your bills, you're always personally responsible for them, and complaints may be reported to the Texas attorney general. We print the full notice at the bottom of every page on this site.

Some programs, including the one we recommend, call themselves medical cost sharing rather than a ministry and don't require a shared faith. Whichever kind you look at, it isn't insurance. Read its guidelines before you join, especially how it handles appeals. Texas has no state penalty for going without insurance.

How a big bill is handled

Here's how it works with the program we most often recommend (Sedera, under its current Membership Guidelines):

1. Call first. Contact a Member Advisor as soon as you know about planned care. For emergencies, notify the program within 48 hours.
2. Pay your Initial Unshareable Amount (IUA). You pay the provider up to your IUA for that Need, as a self-pay patient. The IUA applies per Need, not per year, and no more than three apply in a membership year.
3. Open a Needs case. Upload itemized bills within six months.
4. Bills are negotiated. The program negotiates bills over $1,000 on your behalf.
5. Shared money is paid to you, and you pay the provider.

What isn't shared

• Routine and preventive care, apart from some screenings. That's the job of direct primary care.
• Ongoing prescriptions beyond the first 120 days after a new diagnosis.
• Pre-existing conditions in year one. Conditions from the 36 months before joining are phased in: nothing in year one, up to $25,000 in year two, up to $50,000 in year three, then fully shareable.
• Maternity unless the due date is at least nine months after you join. The maternity IUA is twice your normal IUA, up to $5,000.
• Counseling above $750 a year, routine dental, glasses and contacts, and alternative medicine.

This list is why we pair sharing with a primary care membership and a dental savings plan.