Payments to Christian Healthcare Ministries are generally not tax deductible. The IRS does not treat CHM monthly shares as health insurance premiums, so they don’t qualify for the medical expense deduction on Schedule A, and they don’t qualify for the self-employed health insurance deduction either. They also don’t count as charitable contributions, because you receive something of value in exchange. A proposed IRS rule could change this treatment someday, but as of 2026 it has not been finalized.
Why Monthly Shares Don’t Qualify as Medical Expenses
The medical expense deduction requires you to itemize on Schedule A, and only the portion of qualifying medical costs above 7.5% of your adjusted gross income counts.1Internal Revenue Service. Topic No. 502, Medical and Dental Expenses Health insurance premiums count toward that total. CHM shares do not.
The reason sits in the statute. Section 213 allows a deduction for amounts paid for “medical care,” including insurance covering medical treatment.2Office of the Law Revision Counsel. 26 U.S. Code 213 – Medical, Dental, Etc., Expenses CHM is a health care sharing ministry, not an insurance company. Its monthly shares are contributions to a shared pool, not premiums under an insurance contract. Because the IRS draws that line, shares don’t get folded into the medical expense calculation.
For most members, this doesn’t change how they file. With the 2026 standard deduction at $16,100 for single filers and $32,200 for married couples filing jointly, most taxpayers don’t itemize anyway.3Internal Revenue Service. IRS Releases Tax Inflation Adjustments for Tax Year 2026 But for members with high medical costs who do itemize, the exclusion is a real disadvantage compared with someone paying premiums on traditional coverage.
Why Shares Don’t Count as Charitable Donations
CHM is a 501(c)(3) nonprofit, and members often assume that makes their monthly payments deductible as charitable gifts. It doesn’t. A payment to a charity is not deductible to the extent the donor receives something of value in return.4Internal Revenue Service. Substantiating Charitable Contributions Your monthly share buys you the right to have your future medical bills shared by other members. That’s a tangible benefit, and it disqualifies the share from being treated as a donation.
One narrow exception exists. If you voluntarily give money above your required share to a designated benevolent fund at CHM, and the extra payment doesn’t entitle you to any additional sharing benefit, that excess may qualify as a deductible charitable contribution. Keep those payments documented separately from your regular share so it’s clear the amount was a voluntary gift rather than part of your membership obligation.
Self-Employed Members Don’t Get a Break Either
Self-employed taxpayers can normally deduct health insurance premiums above the line on Schedule 1, which reduces AGI without any itemizing. This deduction under Section 162(l) is limited to amounts paid for “insurance” covering medical care for you, your spouse, and your dependents. Because CHM is not insurance, monthly shares don’t qualify.
This one stings more than the Schedule A gap. The self-employed health insurance deduction is one of the more valuable tax benefits available to freelancers and small business owners, and CHM members simply don’t get it.
The Proposed IRS Rule That Could Change This
In June 2020, the Treasury Department and IRS published a proposed regulation, REG-109755-19, that would classify health care sharing ministry payments as amounts paid for medical insurance under Section 213(d).5Federal Register. Certain Medical Care Arrangements If finalized, CHM shares could be included as deductible medical expenses on Schedule A, subject to the same 7.5% AGI floor that applies to premiums. It could also potentially open the door to the self-employed health insurance deduction.
As of 2026, the rule remains in proposed form. It has not been finalized, withdrawn, or replaced. Until the IRS takes final action, the current treatment holds. Don’t rely on the proposed rule when preparing your return, but it’s worth watching.
Reimbursements Aren’t Taxable Income
When CHM shares your medical expenses, the money you receive is generally not taxable. These payments work like insurance reimbursements for tax purposes: you’re being compensated for a medical cost you paid, not earning income. CHM does not issue Form 1099 for reimbursements, which is consistent with that treatment. You also won’t receive Form 1095-B or 1095-C, since those come from insurers and employers offering coverage, and CHM is neither.
There is one narrow scenario where a reimbursement can become taxable. If you deducted a medical bill on Schedule A in one year, then received a CHM reimbursement for that same bill in a later year, the tax benefit rule requires you to include the reimbursement in gross income, but only up to the amount the earlier deduction actually reduced your tax. This rarely happens in practice. It requires you to have itemized, to have cleared the 7.5% AGI floor, and to have received an actual tax benefit from the deduction.
CHM Membership and Health Savings Accounts
CHM membership by itself does not make you eligible to contribute to an HSA. HSA eligibility requires coverage under a qualifying high deductible health plan as of the first day of the month.6Office of the Law Revision Counsel. 26 U.S. Code 223 – Health Savings Accounts A health care sharing ministry is not an HDHP.
Some CHM members work around this by separately buying a low-cost HDHP alongside their CHM membership to gain HSA eligibility. If you do that, verify the standalone plan actually meets the IRS definition of an HDHP, including the current-year minimum deductible and maximum out-of-pocket limits.
State Mandates and What to Keep on File
A handful of states and the District of Columbia have their own individual health insurance mandates with financial penalties. As of 2026, that group includes Massachusetts, New Jersey, California, Rhode Island, and D.C. Most of these jurisdictions specifically exempt members of qualifying health care sharing ministries, using the same federal definition set out in the ACA.7Office of the Law Revision Counsel. 26 U.S. Code 5000A – Requirement to Maintain Minimum Essential Coverage The exemption is not automatic. You typically need to claim it on your state return using a specific code or supplemental schedule, so check your state tax authority’s current-year instructions.
Because CHM doesn’t send the tax forms an insurer would, record keeping falls on you. Save your monthly share payment records, whether that’s a bank statement, credit card receipt, or CHM confirmation. Keep copies of the medical bills you submit for sharing and the reimbursement statements you get back. If you live in a mandate state, hold a CHM membership letter confirming coverage for each month of the year. If you make voluntary contributions above your required share, file those receipts separately so they can support a charitable deduction. Retain everything for at least three years after filing, which lines up with the general IRS assessment period.8Internal Revenue Service. Time IRS Can Assess Tax
One last boundary worth naming: CHM does not count as minimum essential coverage. That means members are not eligible for the Premium Tax Credit that subsidizes marketplace insurance. If you’d otherwise qualify for marketplace subsidies, factor that lost credit into any cost comparison between CHM and traditional coverage.