By Matthew Simone, FNP-BC, board-certified family nurse practitioner, 2025 Nurse Practitioner of the Year, and founder of Homesteady Health in Trumansburg, NY. Medically reviewed by Matthew Simone, FNP-BC.
This article is general education, not insurance or financial advice. With New York’s open enrollment for 2027 coverage running November 1, 2026 through January 31, 20271, it is a good time to compare a health share vs. health insurance, see how health care sharing works, and look at how either one can pair with direct primary care.
Key takeaways
- A health share is a different model from health insurance. Members contribute a monthly amount and share each other’s eligible medical costs. Sharing is a community commitment rather than a legal guarantee that any bill will be paid.
- Health shares are usually more affordable month to month than comparable insurance. In exchange, you take a more hands-on role in planning for your own costs.
- They are not licensed as insurance and they are not ACA-qualified plans, so it helps to know how consumer protections differ.
- Each program sets its own sharing guidelines, including how pre-existing conditions and certain services are handled (they are often phased in, limited, or excluded), and most programs have a statement of shared beliefs or ethics you agree to.
- A health share pairs well with a strong primary-care relationship. Pairing one with a direct primary care membership covers everyday care predictably while the share can help with larger, unexpected costs.
Is a health share the same as health insurance?
No, and the difference is worth understanding. With insurance, a regulated company is contractually obligated to pay covered claims. A health care sharing program works differently: members contribute a monthly amount into a community, and eligible medical costs are shared among members. Sharing rests on that community’s commitment to one another rather than an insurance contract, so no company is legally required to pay any particular bill. That single difference, a legal guarantee versus a shared commitment, shapes everything else about how the two compare.
A health share is a community-based alternative to insurance. Members share each other’s eligible medical costs under the program’s guidelines rather than through a legally binding insurance contract.
How does health care sharing work?
In a health share, members pay a monthly share amount, roughly comparable to a premium, into a program. When a member has an eligible medical need, they submit it, and the program coordinates sharing the cost among the membership, usually after the member pays an initial amount out of pocket (often called an unshared amount, similar in spirit to a deductible). Many programs are built around a community with shared values or faith, and members agree to a statement of beliefs or a healthy-living pledge when they join.
Because they are not insurance, health shares are typically not tied to the annual open enrollment window, so you can often join at other times of year. They also tend to cost less per month than comparable insurance. What gets shared is defined by the program’s guidelines rather than by state insurance law, so reading those guidelines before you join is the best way to know what to expect.
Health share vs. health insurance: a side-by-side comparison
| Health share | Health insurance | |
|---|---|---|
| Legally guaranteed to pay | No | Yes, for covered claims |
| Regulated as insurance | No | Yes |
| ACA-qualified | No | Marketplace plans are |
| Typical monthly cost | Often lower | Often higher |
| Pre-existing conditions | Often limited, phased in, or excluded | Covered on ACA plans |
| When you can join | Usually year-round | Open enrollment or a qualifying life event |
| Subsidies available | No | Yes, if income-eligible |
Neither option is automatically better. The right choice depends on your health, your budget, your tolerance for risk, and whether you qualify for marketplace subsidies that could make insurance more affordable than it first appears.
What to check in a health share’s guidelines
Because sharing is defined by program guidelines rather than insurance law, each health share decides what is eligible, and many share fewer categories of care than a typical insurance plan. A few questions are worth asking up front so you can tell whether a share is right for you.
- How are pre-existing conditions handled? Many programs phase them in gradually over the first few years, and some limit or exclude them.
- Is routine and preventive care shared? It depends on the program. Some share it partially or not at all, which is one reason a direct primary care membership pairs so well with a share.
- Which services fall outside the guidelines? Some programs exclude certain services based on their guidelines or statement of beliefs.
- How are declined needs reviewed? Health shares handle this through the program itself rather than a state insurance department, so it is worth asking how their review process works.
Every health share has its own guidelines. Reading them before you join tells you what is eligible to be shared, including how pre-existing conditions and routine care are handled.
Is health sharing worth it?
Health sharing can be a strong fit for people who are generally healthy, want a lower monthly cost, are comfortable with more personal responsibility, and do not qualify for meaningful insurance subsidies. It may be less of a fit for people with significant ongoing medical needs, those who prefer the certainty of guaranteed coverage, or those who qualify for subsidized marketplace plans that bring insurance within reach. As with any coverage decision, it depends on your situation, and it is worth comparing the real numbers for both before deciding.
One point that applies either way: a health share, like a high-deductible insurance plan, leaves the everyday cost of primary care and routine visits largely on you. That is exactly where pairing it with direct primary care changes the math.
How direct primary care fits with a health share (or insurance)
Direct primary care (DPC) is a flat monthly membership that covers your everyday primary care, with no per-visit fees and direct access to your provider. It is not insurance and is not a replacement for coverage against a major medical event. Instead, it handles the routine care that both health shares and high-deductible insurance tend to leave to you, which is why DPC pairs well with either one.
A common setup is a direct primary care membership for day-to-day care, plus a health share or an insurance plan to help with larger, unexpected costs. You get predictable, unhurried primary care at a known monthly price, while the share or plan can help with the big things. Our guide to direct primary care in the Ithaca area explains what membership includes, and our membership plans and pricing in Trumansburg page lays out the options. For more on why so many New Yorkers are rethinking traditional coverage, see how rising insurance prices are pushing New Yorkers toward direct primary care, and for businesses weighing options, our look at group health plans versus individual plans.
Homesteady Health and Zion HealthShare
Homesteady Health is an affiliate of Zion HealthShare, a health care sharing community, because a DPC membership plus a health share is one of the most practical, lower-cost ways our patients cover both everyday care and larger needs. If a health share sounds like a fit for your situation, you can explore Zion HealthShare membership options and read their guidelines directly. You can also see the full list of partners we work with on our network and affiliations page.
Disclosure: Homesteady Health may earn a commission if you join Zion HealthShare through the link above. It does not change our advice, and a health share is not the right fit for everyone, so read the guidelines and compare your options before you enroll.
Whether you pair our membership with a health share, a high-deductible plan, or a marketplace plan is entirely your choice. We are happy to help you think it through, with no pressure in either direction.
About the author
Matthew Simone, FNP-BC, is a board-certified family nurse practitioner and the founder of Homesteady Health Direct Primary Care in Trumansburg, NY, serving the greater Ithaca area. He was named 2025 Nurse Practitioner of the Year and serves as President of Region 2 of the Nurse Practitioner Association of New York State, with more than 25 years in healthcare. He works with individuals, families, and employers across the Finger Lakes to build practical, affordable approaches to care, often pairing direct primary care with a health share or a catastrophic plan. Outside the clinic, he lives the active Finger Lakes lifestyle, from running and grappling to coaching, hunting, fishing, and time on Cayuga Lake. His full background is on the Homesteady Health team page.
Not sure how a health share, insurance, and direct primary care fit together for you? You can book a free consultation at Homesteady Health in Trumansburg to talk it through, or call 607-882-6001. No sales pitch, just a clear explanation of your options.
Frequently asked questions
Is a health share cheaper than insurance?
Often, yes. The monthly cost of a health share is usually lower than a comparable insurance plan. Keep in mind that sharing is not a guarantee of payment and health shares are not ACA-qualified, and if you are eligible for marketplace subsidies, insurance may end up more affordable than it first looks. Compare the real numbers for your situation.
Does a health share count as insurance in New York?
No. A health care sharing program is not insurance, and New York does not license health shares as insurers. The state Department of Financial Services has penalized a program marketed as a health care sharing ministry for operating as unlicensed insurance, so it is worth checking how any program operates in New York before you join.2 A health share does not satisfy requirements that call specifically for health insurance, and consumer protections differ from a regulated plan.
Can I join a health share outside of open enrollment?
Usually, yes. Because health shares are not insurance, they are generally not limited to the annual open enrollment window and can often be joined year-round. New York’s open enrollment for 2027 insurance coverage runs November 1, 2026 through January 31, 2027.1
Can I use direct primary care with a health share?
Yes, and the two work well together. A direct primary care membership covers your everyday care at a flat monthly price, while a health share can help with larger, unexpected costs. This pairing is common because each covers what the other tends to leave out.
What are the risks of a health share, and what should I know before joining?
The main things to understand are that sharing is not guaranteed, so an eligible need might not be fully shared, and that pre-existing conditions and certain services are often limited or excluded. Declined needs are reviewed by the program rather than an insurance regulator. Reading the program guidelines and asking questions before you join will tell you what to expect.
Sources
- healthinsurance.org, ACA open enrollment guide: New York’s 2027 open enrollment dates (November 1, 2026 to January 31, 2027).
- New York State Department of Financial Services, Jericho Share to cease operations in New York for selling unlicensed health insurance plans: February 17, 2026 enforcement action against a program marketed as a health care sharing ministry.