The health care sharing ministry landscape is dominated by five major players with the largest memberships and highest revenue, spread across the country and across Christian denominations. Samaritan Ministries (in Illinois), Christian Healthcare Ministries (in Ohio), and Medi-Share (in Florida) are the three large evangelical operations. (Dozens of similar ministries exist across the country, mostly smaller and more localized.) Ohio’s Liberty HealthShare is Mennonite, a denomination traditionally committed to pacifism and dialogue. Solidarity HealthShare, founded in 2015, is Catholic, and partnered with another Mennonite aid group in Ohio to be grandfathered into the ACA exemption for sharing ministries, which required that they exist before 1999. All ministries require members to sign statements of faith. Liberty’s is the broadest, and could theoretically be signed by people of varying religious backgrounds, but the others are fairly stringent. Many require regular church attendance, and Samaritan Ministries requires the signature of a pastor or church leader attesting that prospective members meet all requirements.

Each ministry operates slightly differently, but the basic premise remains the same: Every month, members pay a certain amount (their “share”) into the ministry. When a need arises — say you break your leg, or get diagnosed with lung cancer, or have a baby — you submit your bills to the ministry’s office and you receive payments for the total amount you owe, usually in the form of checks or direct deposits from various members. Some ministries hold the funds in an online escrow account; others have members mail their checks directly to the other members. Shares out are published by the ministries each month, so you can see that your $405 is going to, say, Irene in Idaho who recently had a hip replacement.

Most health care sharing ministries were born out of tragedy and frustration with the health care system in the US. Chris Faddis, the cofounder of Solidarity HealthShare, found himself at the end of his rope when his first wife was diagnosed with late-stage colon cancer in 2011. “She was so far into her diagnosis that there was not much that traditional chemo by itself would offer,” he told me. “So we found ourselves in a situation where we had to raise money.”