The Hidden Cost of Health Sharing No One Talks About

The IUA: Your Real Deductible

Every health sharing plan has an Initial Unshareable Amount (IUA), sometimes called MRA, MCP, PRA, APA, or ISA depending on the ministry. This works like a deductible: you pay this amount out of pocket before the community shares any of your medical costs. And the range is enormous.

*True Annual Floor = (Monthly cost x 12) + lowest IUA. Actual costs will be higher with co-shares and uncovered services.

The lowest-advertised monthly cost often comes with the highest IUA. OneShare's Catastrophic 365 plan starts at $46/month but has a $5,000-$10,000 ISA. Impact Health Sharing starts at $73/month but has a $2,500-$10,000 PRA. Always look at the full annual cost picture. For more detail, see our guide on what an IUA is and how it works.

Co-Shares Add Up Fast

After you meet your IUA, most plans require you to pay a percentage of the remaining bill. This is the co-share (similar to co-insurance in traditional insurance). Co-shares range from 0% to 30% depending on the plan.

On a $50,000 hospital bill, a 20% co-share means $10,000 out of pocket on top of your IUA and monthly contributions. With traditional insurance, out-of-pocket maximums cap your annual exposure (typically $8,700 in 2026). Most health sharing plans do not have an equivalent out-of-pocket maximum, so co-shares on large bills can be substantial.

Notable exceptions: Liberty HealthShare's Unite plan has 0% co-share. Impact Health Sharing caps co-share exposure at $5,000 per household per year. United Refuah caps co-share at $1,000-$4,000 depending on household size. These caps provide more predictable worst-case costs.

Services That Are Not Covered

Every health sharing plan has exclusions. Some are expected (cosmetic surgery, elective procedures). Others are significant and easy to overlook.

Prescriptions. CHM, Medi-Share, Samaritan Ministries, Liberty HealthShare, OneShare, Altrua, and netWell do not cover prescription drugs. If you take a $200/month medication, that is $2,400/year out of pocket on top of your sharing costs. Only Zion HealthShare, Sedera, CrowdHealth, and HSA Secure include prescription sharing. See our prescription coverage guide.

Mental health. CHM, Medi-Share, Samaritan, netWell (Advantage plan), and JHS Community do not share mental health costs. Therapy at $150/session, weekly, is $7,800/year. Only Zion, Sedera, CrowdHealth, Solidarity (ONE plan), Liberty (premium plans), Impact, and Altrua include some level of mental health sharing.

Dental and vision. Almost no health sharing plan covers dental or vision. The only exceptions are United Refuah ($300/year dental, $50/year vision), JHS Community (Diverse and Dynamic plans), and Presidio Healthcare (insurance). Budget $20-$50/month for standalone dental and vision if needed.

Maternity. Not all plans cover maternity, and those that do often have restrictions. OneShare only covers maternity on its most expensive Classic Crown plan. JHS Community caps maternity at $8,000-$12,000 with a 9-month waiting period. Altrua requires the Diamond or Emerald plan with a $5,000 additional MRA. Check our maternity coverage guide before assuming your plan covers pregnancy.

The Pre-Existing Condition Tax

If you have any health condition that was diagnosed, treated, or medicated in the past 1-10 years (depending on the plan), you may face a waiting period during which those conditions are not shared at all. This is effectively a tax on your existing health.

Here is what this looks like in practice. Suppose you have Type 2 diabetes that costs $300/month to manage (medication, testing, doctor visits).

A plan that costs $73/month but does not share your pre-existing condition for 36 months can easily cost more than a plan at $185/month that shares it from day one. Always factor in the full cost of any waiting period when comparing plans. Our pre-existing conditions guide breaks this down in detail.

Coverage Caps and Catastrophic Risk

One of the biggest hidden risks in health sharing is the coverage cap. Several plans limit how much the community will share per incident, per year, or per lifetime. If you face a catastrophic medical event — cancer treatment, major surgery, extended hospitalization — these caps determine whether you face $0 or $100,000+ in uncovered bills.

Average cancer treatment costs $150,000-$300,000. A major surgery with complications can exceed $500,000. If your plan caps at $150,000 or $250,000, you could face six-figure bills that the community will not share. For maximum protection, choose plans with unlimited sharing (Zion, CHM, Sedera, Samaritan) or no per-event caps (CrowdHealth).

Three Real Cost Scenarios

To illustrate the true cost gap, here are three scenarios comparing Zion HealthShare ($185/month, $1,000 IUA, 10% co-share) with CHM ($115/month, $500 IUA, 20% co-share).

How to Minimize Hidden Costs

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