Sarah Barazza doesn’t have health insurance, but all her costs were recouped for her 15-month-old son’s emergency room trip last year, including the ambulance ride.

The Barazza family belongs to a health care sharing ministry, a religious nonprofit in which members pay for one another’s health care needs.

“Wow, I’m so grateful I don’t have to worry about finances,” the Plainfield, Ill., woman said. “I’m just focused on taking care of my child.”

Compared with traditional health insurance premiums, ministries’ monthly member costs are often much lower, and the option was an exception to mandated insurance coverage under the Affordable Care Act.

Members must often commit to religious principles to join the cooperative groups. The ministries generally won’t pay for services that don’t align with those principles, including abortion and substance-abuse treatment. They also often limit coverage of pre-existing conditions and prescriptions.

It’s hard to say exactly how many people take part in the ministries, but the IRS estimates that in 2016, more than 330,000 people claimed the exemption to the health insurance mandate.

Although participation in and the number of ministries have grown since the ACA, some of the ministries have been around for decades. Beyond restrictions on the type of care covered, they also are not regulated and subject to the standards of health insurance.

“They’re not insurance,” said Karen Pollitz, a senior fellow with the Kaiser Family Foundation. “There’s no contract. This is just a group of people who say God wants us to pay for each other’s medical bills, and then they either will or won’t send money.”

For Michael and Sarah Johnson of Carol Stream, Ill., joining Samaritan Ministries about five years ago allowed the couple to avoid further debt after Michael decided to change careers and entered the seminary.

They pay a little more than $500 a month.

When it comes to their own medical needs, the Johnsons generally pay out of pocket for services and incidents that cost less than $300.

Samaritan also doesn’t cover their preventive care. But as relatively healthy people in their 30s, they estimate they are saving thousands of dollars a year over a traditional plan’s premiums and co-payment costs.

“At first you think, ‘Is this really going to work? Will people actually send us money, or are we going to be left high and dry?’ ” Sarah Johnson said.

So far, so good, though. When she gave birth to the couple’s second child in 2014, Samaritan members sent them about $18,000 that covered her bills. Many of the checks, from Samaritan members across the country, came with prayers and notes with well wishes.

Samaritan, based in Peoria, Ill., has about 80,000 member families nationwide. Members often get “self-pay” discounts that doctors offer to people without insurance.

Other large ministries have doctor networks so patients can get discounts.

Another ministry, Florida-based Medi-Share, asks members to pay an “annual household portion” of their medical expenses before kicking in money — similar to a deductible in traditional insurance. That portion can range from $1,000 to $10,500, depending on how much members contribute, or share with others, each month.

Medi-Share generally doesn’t get help with prescription drug costs for more than six months. “It’s not the best fit for everyone,” said Michael Gardner, a spokesman for Medi-Share. “[For] someone who has really high recurring monthly prescription costs, it’s probably not going to be the most affordable.”

Another large ministry, Liberty HealthShare, with 98,000 families across the country, has members pay $199 to $579 a month, depending on which program they choose and their age and family size. They pay $2,250 a year for medical expenses before Liberty members will start sharing costs.

The buyer beware part of health care sharing ministries is that they are under no legal obligation to pay for members’ health costs, said Pollitz with the Kaiser Family Foundation.

Samaritan spokesman Anthony Hopp said that some months, there’s not quite enough money to pay for everyone’s medical needs, though that’s not the case most of the time. During those lean months, members may get 80 or 90 percent of their bills covered.

When that does happen, Samaritan typically will make it up through an overage the next month, extra giving from members or discounts from providers. If it happens three months in a row, members can vote to raise the monthly share fee. The last increase, however, was more than two years ago.

Read more at Frustrated with health insurance costs, some turn to religious ‘sharing ministry’.