Hidden Costs of Health Sharing Plans Nobody Talks About

Hidden Cost #1: Initial Unshareable Amount (IUA)

The IUA is health sharing's equivalent of a deductible — the amount you pay before the community starts sharing your medical expenses. Unlike insurance deductibles, the IUA typically resets per incident, not per year. If you have three separate medical events in one year, you pay the IUA three times.

The impact depends on your plan choice:

The per-incident reset is one of the most misunderstood aspects of health sharing. A member with a $1,000 IUA who has an ER visit ($1,000 IUA), a separate surgery ($1,000 IUA), and a subsequent hospitalization ($1,000 IUA) pays $3,000 in IUAs before any sharing begins — on top of their monthly contributions. With ACA insurance, the same person's deductible applies once per year.

Hidden Cost #2: Pre-Existing Condition Waiting Periods

If you have any pre-existing condition — diabetes, hypertension, asthma, anxiety, a previous surgery — most health sharing plans will not share expenses related to that condition for 6 to 12 months after you join. During the waiting period, you are responsible for 100% of those costs.

For someone with a manageable pre-existing condition, the waiting period can cost more in year one than the savings from lower monthly contributions. A Medi-Share member with diabetes paying $405/month ($4,860/year) plus $4,000–$8,000 in uncovered pre-existing costs during year one faces a total cost of $8,860–$12,860 — close to what ACA insurance would cost with full coverage from day one.

Zion HealthShare is the only major plan that accepts pre-existing conditions with no waiting period. If you have pre-existing conditions, this single factor should heavily influence your plan choice. Learn more in our pre-existing conditions guide.

Hidden Cost #3: Co-Shares and Member Responsibility Percentages

After you meet your IUA, most health sharing plans do not cover 100% of the remaining bill. You pay a “co-share” — typically 10–20% of eligible expenses. Unlike insurance, there is no annual out-of-pocket maximum that caps your total spending.

Here is what a $50,000 surgery actually costs you at each plan (assuming $1,000 IUA):

Notice the difference: with ACA insurance, your cost is capped at $9,200 regardless of the bill size. With health sharing, there is no ceiling. A $200,000 hospital bill with a 20% co-share could leave you responsible for $40,000+ on top of your IUA. This is the single biggest financial risk of health sharing compared to insurance.

Hidden Cost #4: Coverage Exclusions and Gaps

Unlike ACA insurance, health sharing plans are not required to cover essential health benefits. Common exclusions that can result in significant out-of-pocket costs include:

• Prescription drugs: CHM, Medi-Share, and Samaritan Ministries do not share prescription costs. If you take a $200/month medication, that is $2,400/year out of pocket on top of your monthly contribution. Read our prescription coverage guide.
• Mental health: CHM, Medi-Share, and Samaritan Ministries do not share mental health expenses. Therapy at $150/session weekly costs $7,800/year.
• Telehealth: CHM and Samaritan do not cover telehealth visits, which typically cost $50–$75 each.
• Dental and vision: No health sharing plan includes dental or vision as standard benefits. Budget $500–$2,000/year if you need routine dental work or glasses.
• Lifestyle-related conditions: Conditions resulting from tobacco use, alcohol abuse, or risky activities may not be shareable. Guidelines vary by plan.

Plans like Zion HealthShare and Sedera cover prescriptions, mental health, and telehealth — but they cost more per month. The cheapest plans almost always have the most exclusions.

Hidden Cost #5: Claim Processing Delays

Health sharing ministries are not insurance companies and do not process claims at insurance speed. Processing times range from 30 to 180 days depending on the plan. During that time, you may need to pay bills upfront and wait for reimbursement — or negotiate payment plans with providers.

Processing delays create a hidden cash flow cost. If you pay a $5,000 ER bill upfront and wait 60 days for sharing reimbursement, you are floating that money interest-free to the ministry. For larger bills, some members have reported difficulty getting providers to wait for sharing processing, leading to collections activity or credit impact.

CrowdHealth is the fastest, with community-funded processing happening within days in most cases. Traditional ministries average 30–60 days for straightforward claims.

True Cost Comparison: Plan by Plan

Here is a realistic annual cost breakdown for an individual with 2 medical events (one ER visit, one specialist procedure) and one ongoing prescription ($150/month):

Even with hidden costs factored in, Zion HealthShare saves roughly $4,580/year compared to ACA insurance in this moderate-use scenario. CHM saves $2,540/year but does not cover prescriptions. Medi-Share's savings shrink to $876/year once hidden costs are included — far less than the monthly contribution alone would suggest.

The lesson: advertised monthly costs can be misleading. Always calculate total annual cost including IUA, co-shares, exclusions, and prescription costs before choosing a plan. Use our side-by-side comparison tool to see these numbers for your specific situation.

How to Minimize Hidden Costs