“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.”

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.

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.

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.

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