Medically reviewed by Jawad Arshad, MD, FACEP. Last reviewed: October 8, 2026.
Disclosure: Medical cost sharing plans, including the membership offered by Summit Health Benefits, are membership-based coverage. Membership-based coverage is not insurance, is not regulated as insurance, and does not guarantee payment of medical bills.
Medical cost sharing plans appeal to people who want a lower monthly bill than a marketplace plan. They can fit some households well. They also remove protections you may be counting on, so you need to see the trade before you join.
Key facts
- A health care sharing ministry "is not health insurance," and membership "does not guarantee that you will be reimbursed for your medical bills" (Georgetown University Health Policy Institute Navigator, 2026).
- Sharing programs are generally not required to follow Affordable Care Act consumer protections, and members cannot appeal to an independent reviewer the way they can with insurance (Georgetown Navigator, 2026).
- Federal law defines a health care sharing ministry as a 501(c)(3) nonprofit that has shared medical expenses continuously since December 31, 1999 and gets an annual independent audit (26 U.S.C. 5000A, 2026).
- The 2026 out-of-pocket limit on an ACA plan is $10,600 for an individual and $21,200 for a family, rising to $12,000 and $24,000 in 2027 (HealthCare.gov, 2026).
- The federal penalty for going without coverage is $0 (26 U.S.C. 5000A, 2026).
What are medical cost sharing plans?
Medical cost sharing plans are programs where members send a monthly share to a pool, and the program uses the pool to help pay approved medical bills of other members. Members join a community instead of buying a policy.
Two kinds exist. Faith-based programs, called health care sharing ministries, ask members to agree to a statement of beliefs. Non-religious programs do not. Our guides to non-religious health share plans and Christian health share plans compare them.
Table: Terms you will see for the same idea
| Term | What it usually means |
|---|---|
| Medical cost sharing | A program where members share eligible bills |
| Cost sharing solutions | Marketing name for the same programs |
| Health cost sharing program | Another name for the program |
| Monthly share | The monthly amount you pay, similar to a premium |
| Initial unshared amount or per-need amount | What you pay before sharing starts on each need |
How do medical cost sharing plans work?
Medical cost sharing plans work in four steps: you pay a monthly share, you get care, you submit the bill, and the program decides if the need is eligible and shares it. The program reviews every bill against its guidelines.
Here is a worked example. The numbers are hypothetical, so you can follow the math. A family has an eligible hospital bill of $18,000. One program asks the member to pay the first $2,500 of each need. A comparison ACA plan has a $6,000 deductible and 20% coinsurance.
Table: Same $18,000 bill, two designs (hypothetical)
| Step | Sharing program with $2,500 per need | ACA plan with $6,000 deductible and 20% coinsurance |
|---|---|---|
| You pay first | $2,500 | $6,000 |
| Remaining bill | $15,500 | $12,000 |
| Share you owe on the rest | $0 if approved and shared | $2,400 (20%) |
| Your total | $2,500 | $8,400 |
| Is payment guaranteed? | No | Yes, under the plan terms |
The ACA column stays below the 2026 out-of-pocket limit of $10,600 for an individual (HealthCare.gov, 2026). The sharing column looks cheaper only when the program approves the need. If it denies the bill as ineligible, you owe the full amount. Our HealthShare pros and cons guide covers where bills get denied.
Are medical cost sharing plans insurance?
No, medical cost sharing plans are not insurance. The Georgetown Navigator (2026) says a sharing ministry "is not health insurance and will not provide the kind of financial protection" a marketplace plan offers.
Three differences matter most. First, payment is not guaranteed. Second, ACA protections such as guaranteed coverage of essential health benefits do not apply. Third, if a dispute arises you cannot appeal to an independent reviewer. The Navigator also says many states have exempted these programs from state insurance laws, so state protections may not apply either.
What is a healthshare plan?
A healthshare plan is another name for a medical cost sharing plan. People search "healthshare plan" and "health share plan" for the same product: a membership program where members share eligible medical bills.
The word "ministry" comes from federal law. Under 26 U.S.C. 5000A (2026), a health care sharing ministry must be a 501(c)(3) nonprofit, its members must share ethical or religious beliefs, it must have existed since December 31, 1999, and it must get an annual independent audit made available on request. Many newer programs do not meet that definition and market themselves as non-religious. Our Best HealthShare Plans guide lists the options we track.
What do medical cost sharing plans cost?
Medical cost sharing plans cost a monthly share plus your per-need amount, and the monthly share varies by program, age, household size and the per-need amount you choose. No verified national average exists, so this guide does not quote one.
Do not compare a monthly share to a premium alone. Compare the full yearly picture: twelve monthly shares, the per-need amount for each need you might have, any annual enrollment fee, and what is excluded. Pre-existing conditions are often subject to waiting periods or limits, which our waiting periods guide explains.
Summit Health Benefits does not list a price on its Health Membership for Individuals and Families page. The page states a $2,500 out-of-pocket cap per need with no annual or lifetime limit on eligible expenses (Summit Health Benefits, 2026). A licensed professional quotes by age and household.
How do medical cost sharing plans compare with an ACA plan?
An ACA plan guarantees payment under its terms and caps your yearly out-of-pocket cost by law, while a cost sharing plan offers a different design with no guarantee and no federal cap.
Table: Medical cost sharing vs ACA marketplace plan
| Feature | Medical cost sharing plan | ACA marketplace plan |
|---|---|---|
| Is it insurance? | No | Yes |
| Payment guaranteed? | No | Yes, under plan terms |
| ACA consumer protections | Generally not required | Required |
| Yearly out-of-pocket limit set by law | No | Yes, $10,600 individual in 2026 |
| Independent appeal | No | Yes |
| Enrollment window | Often year-round, set by the program | Open enrollment or special enrollment period |
Sources for the table: Georgetown Navigator (2026), HealthCare.gov (2026). The same Georgetown source does not address pre-existing limits, so check each program's guidelines.
Who should consider medical cost sharing plans?
Medical cost sharing plans may fit healthy, self-paying households who can absorb a denied bill and who read the guidelines first. They are a poor fit for anyone who needs guaranteed payment or has an ongoing condition.
People we hear from most are freelancers and 1099 workers, early retirees, and families priced out of marketplace coverage. If you lost job coverage, also read our COBRA alternatives guide. If you are self-employed, see how health insurance for self-employed workers compares on cost and tax treatment.
What should I ask before joining a cost sharing plan?
Ask eight questions in writing before you join, and keep the answers. A program that will not answer them is telling you something.
Copy and paste this list:
- Is the program a 501(c)(3) health care sharing ministry, and can I see the latest independent audit?
- What is the per-need amount, and does it reset each need or each year?
- What are the annual and lifetime limits on eligible expenses?
- How are pre-existing conditions handled, and for how long?
- Which services are excluded entirely?
- How long does a bill take to be shared, and what happens if I disagree with a decision?
- What happens if the sharing pool runs short?
- Are there enrollment, administration or annual fees on top of the monthly share?
Compare Plans for Your State
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Frequently Asked Questions
What are the best medical cost sharing plans?
What is a healthshare plan?
Is a medical cost sharing plan the same as health insurance?
What are cost sharing solutions?
Do medical cost sharing programs cover pre-existing conditions?
Is there a penalty for not having health insurance?
Sources: Georgetown University Health Policy Institute, Navigator Guide, health care sharing ministries FAQ (2026); 26 U.S.C. 5000A, Requirement to maintain minimum essential coverage, via Cornell Legal Information Institute (2026); HealthCare.gov, Out-of-pocket maximum/limit (2026); HealthCare.gov, Dates and deadlines (2026); Summit Health Benefits, Health Membership for Individuals and Families (2026).