What is the difference between insurance and a healthshare?

Health insurance is a regulated contract that guarantees payment of covered claims. A healthshare (healthcare sharing ministry) like Liberty HealthShare is a voluntary, faith-based community where members share each other's medical expenses—and at Liberty HealthShare, monthly contributions start as low as $87 a month. The average ACA individual premium exceeded $500 a month in 2024 (KFF Health Insurance Marketplace Calculator, 2024).

Healthcare sharing ministries like Liberty HealthShare operate on fundamentally different principles than health insurance, with distinctions that affect legal structure, cost, and member experience. Understanding these differences helps individuals make informed decisions about their healthcare financing options.

Legal and Structural Differences

The most important distinction is that Liberty HealthShare is not an insurance company and does not offer insurance products. Healthcare sharing ministries are faith-based organizations where members voluntarily share each other's eligible medical expenses based on shared Christian values. Liberty HealthShare's sharing programs do not guarantee or promise that a member's medical bills will be paid or assigned to others for payment—whether anyone chooses to contribute toward a member's medical bills is entirely voluntary. Members remain personally liable for any unpaid bills.

In contrast, insurance companies are legally bound by contractual obligations to pay covered claims according to policy terms. Insurance operates as a regulated financial product with guaranteed benefits, while the medical cost-sharing model operates as a voluntary community support system with no guarantee for the sharing of eligible medical bills.

Philosophy and Approach

The operational philosophy differs significantly between these two models. As Liberty HealthShare Chief Executive Officer Dorsey Morrow explains, insurance involves multiple profit-seeking entities: "You've got to deal with providers, you've got to deal with third party administrators, just so many people with their fingers in the pie and everybody is trying to make a profit." The medical cost-sharing model simplifies this structure by focusing purely on facilitation rather than profit generation.

Insurance companies typically aim to minimize their financial exposure, with limited personal interaction during claims processes. Liberty HealthShare, by contrast, emphasizes collaboration with members facing medical situations. "Our focus is on the member—what can we do to help you and what are you going through? Let's talk about it and let's see what the options are," Morrow notes. 

Cost Structure: AUA vs. Deductible

One practical difference that often surprises people is how annual cost thresholds work. Insurance uses a deductible—the amount you pay out-of-pocket before your insurer begins covering costs. Liberty HealthShare uses an Annual Unshared Amount (AUA), which is the amount of an eligible need that that the member is responsible for before sharing begins.

Beyond the AUA, Liberty HealthShare also uses medical bill repricing—a process that negotiates eligible medical bills down before sharing occurs, which can significantly reduce what members actually pay. This is one of the tools Liberty HealthShare uses to help its medical cost-sharing community get the best care at the best value.

Pre-Existing Conditions

One meaningful difference between insurance and medical cost-sharing involves pre-existing conditions. Under the ACA, insurance plans cannot deny coverage or charge more based on health history. Healthcare sharing ministries operate differently: Liberty HealthShare's programs have defined guidelines for pre-existing conditions, which include waiting periods before certain expenses become fully eligible for sharing. Members are encouraged to review the full Sharing Guidelines to understand how their specific health history may be affected.

Member Engagement and Stewardship

Healthcare sharing requires more active member participation than insurance. Morrow draws a comparison to how Americans maintain their vehicles: "We as Americans will buy a car and maintain that car because you're sinking a lot of money into it. You put the tires on, you get the oil changed." He notes that while people carefully steward other investments, "healthcare is that one area where we tend to just sign up for it and then you're not engaged with it."

The medical cost-sharing model represents a mindset shift toward proactive engagement, encouraging members to understand their options, practice better stewardship of shared resources, and take an active role in their health decisions. This participation model is a defining characteristic of how healthcare sharing ministries differ from insurance.