Most churches want to take care of their staff. Health benefits are one of the most meaningful things you can offer a pastor or ministry employee — but the cost of traditional group plans has made that harder and harder for small and mid-size churches.
The good news: there are more good options in 2026 than there have ever been. The hard part is knowing which one fits your church. This guide walks you through the decision process step by step — from assessing your situation to comparing your real options to actually getting something set up.
Church pastors, administrators, and elders responsible for staff benefits decisions — especially at churches with 1–50 full-time employees who don't have a dedicated HR team. If you're starting from scratch or trying to improve what you currently offer, this is your roadmap.
Step 1: Know Your Church's Legal Situation
Before exploring options, understand where your church stands under federal law:
- Fewer than 50 FTEs: You are not required by the ACA to offer health coverage. You have maximum flexibility to choose any approach.
- 50+ FTEs: You are an Applicable Large Employer (ALE) and must offer ACA-qualified health coverage to full-time employees or face penalties. Health sharing ministries alone won't satisfy this requirement.
- Denominational affiliation: Some denominations have their own group plans that are exempt from certain ACA requirements ("church plans"). If your denomination offers one, compare it carefully — it may be a significantly better deal.
Step 2: Assess Your Priorities and Budget
Not every church needs the same thing. Before comparing options, answer these questions:
- How many full-time employees need coverage? (Just the pastor? Entire staff team?)
- What's the church's realistic monthly budget per employee?
- Do any staff members have significant pre-existing conditions?
- Is faith alignment in the coverage model important to your congregation?
- Do you want to offer a uniform plan, or give employees choice?
These answers will immediately narrow the options significantly.
Answer these questions in our comparison tool
3 minutes, free. We'll show you the real options available for your church's size and situation.
⛪ Start My Comparison →Step 3: Match Your Church Size to the Right Strategy
Just the Pastor (Solo or Bi-Vocational)
If you're a solo pastor — whether the church covers you or you're purchasing coverage yourself — you have the most flexibility. The main options:
Health Sharing Ministry
CHM, Medi-Share, or Samaritan. Lower cost, faith-aligned, works well if you're generally healthy.
ACA Marketplace Plan
Check your subsidy eligibility first. If your income qualifies, this can be an excellent deal.
Small Church: 2–10 Staff
This is the most common scenario — and historically the most underserved. The best approach: set up a Health Reimbursement Arrangement (HRA) rather than selecting a single group plan.
Set up a QSEHRA
A Qualified Small Employer HRA allows your church to reimburse employees tax-free for individual health insurance premiums and medical expenses. In 2026, the limit is $6,350/year for individuals ($12,800/family). Employees buy their own plan — ACA marketplace, health sharing, or otherwise. Simple to administer, no group plan required.
Or consider an ICHRA
The Individual Coverage HRA has no size limits and more flexibility than QSEHRA. Churches of any size can use it. Employees must purchase an individual health insurance plan (ACA-qualified) to use ICHRA funds. More administrative setup than QSEHRA but more scalable.
Or offer a taxable stipend
The simplest option: add a fixed dollar amount to each employee's paycheck designated for health coverage. It's taxable income (unlike HRA reimbursements), but it's easy to set up and gives employees maximum flexibility. Works best when employees can find very affordable coverage on their own (health sharing or subsidized ACA plans).
Mid-Size Church: 10–50 Staff
At this size, a group plan becomes more viable — and potentially more cost-effective when the church negotiates employer contributions. Three paths worth exploring:
- ICHRA: Still often the most flexible and cost-effective. Employees get reimbursed for individual plans they choose.
- Denomination group plan: If available, denomination-specific plans (GuideStone, Servant Solutions, etc.) often offer better rates and faith-aligned plan design compared to commercial carriers.
- Commercial group plan: Get quotes from a licensed agent. Expect $600–$1,200/employee in employer contributions for meaningful coverage. Compare this against ICHRA to see which is more efficient for your specific staff demographics.
Step 4: Common Mistakes to Avoid
Mistake 1: Offering nothing because "we can't afford a group plan." HRAs and stipends mean you can offer meaningful benefits at almost any budget level. Even $150/month per employee toward individual coverage is valuable — and many pastors can pair it with a health sharing ministry for complete coverage well under that amount.
Mistake 2: Assuming health sharing ministries work for everyone. If a staff member has significant ongoing health conditions, the pre-existing exclusions in most HSMs can leave them with uncovered costs in the first few years. Know your staff's health situations before recommending a path.
Mistake 3: Choosing a plan without checking ACA subsidy eligibility. If staff members are purchasing individual coverage, check whether their income qualifies for premium tax credits. Subsidized ACA plans can be extraordinary value — sometimes $0/month for solid coverage.
Step 5: Use a Comparison Tool
The fastest way to navigate this is to use a tool that asks about your church's specific situation and surfaces real options — not generic advice. Key variables that affect your best path:
- Location (state/zip): State marketplaces vary significantly, and some states have expanded Medicaid or state-based subsidies that change the math.
- Staff ages: Health sharing ministry costs are often flat-rate regardless of age (especially CHM), while ACA marketplace premiums scale with age. For older staff, HSMs can be dramatically cheaper.
- Staff family situations: CHM's family cap ($765/month for 3+ people) is exceptional for larger families.
- Staff health history: Pre-existing condition exclusions in HSMs are deal-breakers for some — know before you commit.
What It Actually Looks Like: A Real Scenario
Riverside Community Church: 8 staff members, pastor + 7 part-time. Budget constraint: can contribute $200/employee/month toward health coverage.
Approach taken: Set up a QSEHRA at $200/month contribution. Pastor (age 52, healthy) enrolled in CHM Gold at $287/month (Gold + CHM+), with the church covering $200 and the pastor contributing $87 out-of-pocket. Part-time staff used the $200 reimbursement toward their spouse's employer plan or Medicaid. No group plan selected. Total church cost: $1,600/month for 8 employees. No HR overhead, no minimum participation requirements, no renewal negotiations.
You don't need a big budget or a complex group plan to offer meaningful health benefits to your church staff. The combination of HRAs (QSEHRA or ICHRA) and the right individual coverage — whether that's a health sharing ministry, an ACA plan, or both — can get most church staff covered for $150–$400/month in church contribution per employee. Start with a comparison tool to see what's available for your specific situation.
Find the right coverage for your church staff
Use our free comparison tool — see health sharing ministries, ACA plans, and group plan options side-by-side for your church's size and zip code.
⛪ Compare Plans for My Church →