SAN ANTONIO — When Chris Doyle learned that his health insurancedeductible 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.
Samaritan Ministries International, which Mr. Doyle and his wife, Sarah, joined last winter, plays matchmaker, assigning member families to help pay the medical bills of other members. The money is mailed directly to the families in need, often with handwritten prayers or notes of support — or in the case of one family here, strawberry stickers and a drawing of an elephant for their 5-year-old as she recovered from ear tube surgery.
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. More participants live in Texas than in any other state, according to Samaritan and the two other largest ministries,Medi-Share, based in Florida, and Christian Healthcare Ministries, based in Ohio. Under the federal health law, only members of ministries that have operated continuously since December 1999 are exempt from the requirement to have health insurance.
The growth seems to have come largely through word of mouth, at churches, schools and workplaces. Mr. Doyle, a machinist, heard about Samaritan Ministries at Grace Point Church in San Antonio, whose pastors and employees are members and whose congregants post about it on Facebook.
He and Sarah, who stays home with their two toddlers, mail a flat $405 payment to a fellow member every month, the standard rate for families of three or more. Had they stuck with the insurance he was offered through work, the Doyles said, their share of the premium would have been about $600 a month, and they would have had to pay the first $5,000 in individual medical costs, $10,000 for the family, other than preventive care.
Under the ministry, they also have to pay the first $300 of any medical expense they incur. They have not yet had a doctor’s bill exceed that amount, though they are waiting somewhat nervously for that day to come. Samaritan limits spending on each injury or illness to $250,000, with exceptions for people who agree to pay extra each year toward others’ bills above that amount.
“There’s a little bit of fear going into it,” said Mrs. Doyle, 33, adding that she suspected she had a hernia that would need to be repaired soon. “What if people don’t pay their share and what if the money doesn’t come in? But that’s where the faith-based part comes in — I’m really going to rely on God.”
Mr. Lansberry said Samaritan members’ eligible medical bills averaged, cumulatively, over $16 million a month. Its membership has grown by about 50,000 over the last year, to nearly 200,000 people in 58,000 paying households.
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.”
Before members can be reimbursed, they sometimes must pay upfront for their medical care — potentially a sizable outlay, because hospitals increasingly require at least partial prepayment. It then takes at least two months for Samaritan to process their requests for help and for checks from other members to arrive in the mail.
The most harrowing part of health care sharing so far for Kyle Burkholder, the teaching pastor at Grace Point, and his wife, Stefani, was paying $6,500 upfront for their daughter’s ear tube surgery, they said. They waited for what seemed like forever for other members’ checks to come.
“About 90 days after her surgery, sure enough, the money did start showing up,” Mrs. Burkholder said. “And it was with handwritten notes — every day it was one, two, three notes, and she was reading them aloud, and I found myself just crying.”
Members with “special prayer needs” — conditions that are not eligible under the ministry’s rules — can also ask for financial help. Last month, for example, Samaritan’s newsletter highlighted the case of a woman withuterine cancer diagnosed before she became a member, and a teenager who tore a knee ligament in a dirt bike race.
Upon joining, members waive their right to sue, and in the case of Samaritan, appeals panels of randomly selected members are supposed to settle disputes. Mr. Lansberry said that such panels had been convened only four times since Samaritan’s founding in 1994, and that the group had never been the subject of complaints to state attorneys general or insurance commissioners.
The insurance commissioner in Washington State did try to stop Samaritan from operating in 2011, saying it was selling “unauthorized insurance,” but the state Legislature passed a law explicitly exempting health care sharing ministries from regulations.
Insurance commissioners in Kentucky and Oklahoma had tried to block Medi-Share, the Florida-based ministry, but were thwarted when their legislatures also passed protection laws.
In 2001, Ohio’s attorney general sued one ministry — known then as the Christian Brotherhood Newsletter, and now as Christian Healthcare Ministries — ultimately forcing its leaders to repay $15 million they had spent on homes, vehicles and excessive salaries out of the fund where members had sent payments.
Members have filed a handful of lawsuits against Medi-Share after bills they had expected to be covered were not. The cases were settled out of court. While the health law requires the ministries to submit to annual independent audits, critics question whether that safeguard is sufficient.
“Our message has consistently been that this is not a health insurance product that we regulate, so buyer beware,” said Nick Gerhart, the insurance commissioner in Iowa. “A premature baby could cost $1 million pretty easily, so it wouldn’t take very many of those to put a significant strain on any group, let alone an unregulated group like this.”
Lee and Amy Jebson of Chesapeake, Va., were not expecting any major medical costs when they signed up for Medi-Share in 2014 after being priced out of the plans available through HealthCare.gov, the federally run insurance marketplace. Then their 8-year-old son was found to have acute lymphoblastic leukemia, leading to several hundred thousand dollars’ worth of medical bills in just the first few months of his treatment.
“One single fever is a $10,000-a-night hospital cost,” said Mrs. Jebson, adding that her family pays a $500 monthly share toward other members’ medical costs, and $2,500 a year toward their own. But so far, she added, their bills are being covered, with the exception of a few thousand dollars.
They, like others interviewed, said joining the ministries allowed them to live by their religious beliefs rather than follow a government mandate to buy insurance that may cover things they do not want to pay for, likeabortion (though half the states do not allow plans sold through the Affordable Care Act marketplaces, at least, to pay for abortions) or birth control.
“It’s really a model of wanting to take care of someone else — not being told, ‘You have to,’ or ‘I’m forcing you to do this,’ ” Mr. Jebson said.
The Doyles said that their impression might change if they incurred big medical bills, but that for now they appreciated the personal nature of their monthly transactions.
“There’s something different about writing my check to someone who needs it,” Mrs. Doyle said. “I feel like I’m loving on somebody instead of just paying my premiums.”