My goal is to provide the most affordable health insurance plan or health insurance alternative for freelance workers nationwide.

The Affordable Care Act made members of Health Care Sharing Ministries (HCSMs) exempt from the individual mandate, so they didn't have to pay a penalty if they didn't pay for an additional type of insurance.

Now that the individual mandate is being repealed, can I start a secular health care sharing organization that functions similarly to the HCSMs as a more affordable alternative to health insurance?

Are there any legal gotchas I need to be aware of?

  • The entity must have been around before 1999 Dec 28, 2017 at 20:18
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    @ClintEastwood I believe that's only true to qualify for the exemption from the individual mandate, which has now been "zeroed out" so there's no penalty. Do you think no more organizations of this kind can be formed at all? If so, got a source? Dec 28, 2017 at 23:04

1 Answer 1


Setting up any health insurance plan is subject to myriad state and federal regulations and is not something anyone should embark upon without a lawyer. There are private for profit and non-profit health care arrangements that exist now, and more can be created, but they must comply with all relevant laws.

A ballpark minimum legal cost to set something like this up would be in the several hundreds of thousands of dollars range at the low end.

  • Thanks. HCSMs are not insurance companies or insurance plans. This is certainly something I wouldn't take on without a lawyer. Dec 28, 2017 at 23:05
  • Despite not being insurance companies or insurance plans, some of the regulations that apply to those entities (e.g. HIPAA and the ACA) would also have some applicability to HCSMs, and part of the challenge from a legal point of view would be to avoid legal characteristics that would cause your entity to be classified as an insurance company. They look a lot like a "risk pool" similar to the Colorado Intergovernmental Risk Sharing Agency that I used to do legal work for (look it up), only that covers liability risks rather than health care risks.
    – ohwilleke
    Dec 29, 2017 at 4:02
  • Right on. I agree with everything you wrote above, and am trying to figure out how to figure out which regulations do and don't apply. Thank you for your feedback. Dec 29, 2017 at 20:59

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