An increasing number of Iowans who face steep health insurance bills are looking at an alternative: faith-based “health sharing ministries,” in which religious Americans help each other pay medical bills.

The arrangements aren’t exactly insurance, but they count as coverage under the federal Affordable Care Act. That means people who join the cost-sharing ministries don’t have to pay a federal penalty for going uninsured.

The sharing ministries are national Christian organizations whose members help each other pay medical bills. Anthony Hopp, a vice president of Samaritan Ministries, said the plans are “for people looking to live out their faith in a practical way. … We realize this is not a silver bullet, and it’s not for everyone.”

Hopp’s organization, based in Illinois, includes about 1,150 families participating in Iowa and about 71,000 participating nationally. Its monthly costs tend to be much lower than what insurance would run, but there are limits on what types of bills it will help cover.

Outside experts warn that the sharing ministries have little oversight, and the plans are not required to cover pre-existing health problems, such as diabetes or cancer. “There’s a fair amount of risk to the individual. … It’s a little bit of a black box,” said Sabrina Corlette, a Georgetown University health-policy researcher.

Corlette noted that unlike insurance companies, sharing-ministry organizations are not regulated by state officials. “If you have a problem, there’s really no one to complain to except the company or the organization itself,” she said.

The organizations have differing rules. But the gist is that members agree to “share” specific amounts of money each month, similar to paying an insurance premium. That money is then used to cover the medical bills of other members.

Participants also have to pay parts of their own medical bills before other members will help them shoulder costs — similar to a deductible arrangement in standard health insurance.

Members of the sharing ministries generally must declare their religious faith and promise not to smoke, drink alcohol to excess or engage in sex outside marriage. Health care costs stemming from such behaviors can be deemed unqualified for payments.

Most of the organizations are Christian-based. “You can’t use tobacco, you have to believe in Jesus as the savior and you have to go to church on a regular basis,” is how Iowa insurance broker Lynn Schreder explains the basics to potential applicants for Medi-Share, the sharing ministry she represents.

Schreder, who has offices in Fort Dodge and West Des Moines, mainly sells traditional insurance, including individual policies and employer-based policies. She advises consumers to look into those insurance options first. But, she said, the health sharing ministries have become more attractive alternatives in the past couple of years, as premiums for traditional insurance have shot up.

The sharing ministry arrangements are most likely to attract people who lack access to health insurance through an employer or a government program, such as Medicare or Medicaid. Such consumers often buy their own health insurance, and it’s become increasingly pricey. That’s partly because under the Affordable Care Act, insurers are no longer allowed to deny coverage to applicants with pre-existing health issues, such as diabetes, cancer or heart problems.

Just one insurance carrier, Medica, is selling individual health policies in Iowa for 2018. Its premiums are roughly double what many Iowa consumers are paying for 2017. Most Iowans who face such premium increases qualify for public subsidies under the Affordable Care Act to pay some or all of the difference. But consumers who make too much money to qualify for the subsidies are facing sticker shock and could be seeking alternatives.

The Iowa Insurance Division is aware of six “sharing ministries” offering memberships in the state. Insurance Commissioner Doug Ommen said he understands why increasing numbers of Iowans are looking into the sharing ministries as “an island of refuge” if their other choices are paying impossible premiums or going uninsured.

Ommen said that before signing on with a sharing ministry, consumers should go online to healthcare.gov, which can show them options for individual health insurance. The federal website can also show people whether they’ll qualify for subsidies toward their premiums. But the sign-up deadline is Dec. 15, so consumers who want insurance need to act soon.

People interested in the sharing ministry option should study the rules of how the organizations work, Ommen said. “They should read everything and consider what’s right for them and their families,” he said.

Mike and Ruth Brauer of Urbandale did so, and say they’re happy with their membership in Medi-Share, one of the national sharing ministries. Mike Brauer said they paid $1,200 per month in 2016 for a traditional insurance policy from Aetna, with a $10,000 deductible. When that premium was set to jump past $1,600 per month for 2017, the couple looked into the sharing ministry. Their Medi-Share membership costs $299 per month, and they generally would have to spend $10,000 of their own money on medical bills before qualifying for assistance.

They see the Medi-Share plan as a way to protect against large medical bills if they become seriously ill. “We’re healthy as all get-out, but you never know,” Ruth Brauer said.

Every month, the Brauers receive “share notices” from the Florida-based organization, listing other members whose medical costs the couple’s account has been tapped to help cover. The organization doesn’t specify what the other members are being treated for, but it offers a way to pass along well-wishes and prayers for their health.

The Brauers haven’t had to use the plan for many of their own expenses, and they hope to keep it that way.

The Brauers lost access to employer-provided insurance after they retired in their early 60s; she as a barber, he as a co-owner of a small business. They see the Medi-Share plan as a temporary measure. “We were just trying to find something to get us by until we turned 65 and could get on Medicare,” Mike Brauer said. That will happen next year.

Such arrangements have been around for more than 20 years, but they’ve gained prominence recently because of a quirk in the Affordable Care Act: People who participate in sharing ministries are exempt from the law’s requirement that most Americans obtain health insurance.

Michael Gardner, marketing director for Medi-Share, said his company has nearly 3,000 members in Iowa and about 320,000 nationally. He and other leaders of such groups emphasize that they’re not selling standard health insurance. “We’re not the best solution for everyone,” he said. “There definitely are times people should look at health insurance.”

For example, Medi-Share doesn’t cover routine care, such as doctors’ check-ups. It also doesn’t cover medications for chronic issues, such as blood pressure or diabetes, beyond a six month supply. The organization checks for pre-existing health conditions, and it doesn’t cover many of them until after a member has belonged to the organization for at least three years. The sharing ministry also doesn’t cover birth control, abortions or mental health counseling.

Gardner acknowledged such rules mean the organizations tend to attract pools of relatively healthy members, reducing the risk of expensive medical problems. But he said he didn’t believe that would substantially worsen the risk pool for Americans who buy standard health insurance because the number of participants in sharing ministries is still relatively small.

Read more at More Iowans opting for ‘health sharing ministries’ as alternative to increasingly pricey insurance.