When Chris Doyle learned that his health insurance deductible would climb to $10,000 last year, he and his wife, both evangelical Christians, “spent a couple weeks just praying,” he said.

Then they opted out of insurance altogether, joining something called a health care sharing ministry, which requires members to help cover one another’s major medical costs as they come up.

While such nonprofit ministries have been around for decades, interest in them has grown since the Affordable Care Act passed in 2010, largely because the law exempts members from the requirement to have health insurance or pay a yearly fine.

Because they are not insurance companies, sharing ministries provide no guarantee that members’ medical debts will be paid; members are advised to trust that God will provide. The ministries say the payment system is helping Christians fulfill a biblical mandate to share one another’s burdens.

“Our only assets are the good will and continued participation of our members,” said James Lansberry, executive vice president of Samaritan, which is based in Peoria, Ill.

Some ministries operate differently, requiring members to pay monthly into accounts from which funds are disbursed to those with eligible medical bills. Pre-existing medical conditions are often not covered, nor are preventive care, mental health and injuries resulting from behavior the ministry considers immoral or reckless. Members who acquire a sexually transmitted disease from an extramarital affair are out of luck, for instance, as are those injured while driving drunk or during a melee.

Still, membership in sharing ministries has more than doubled over the last six years, to 535,000 from about 200,000, according to the Alliance of Health Care Sharing Ministries.
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Acknowledging that many families can qualify for subsidized insurance policies with free preventive care through the Affordable Care Act, Mr. Lansberry said that most new members were not “joining primarily on price; they are joining primarily on principle.”