DES MOINES, Iowa (AP) — Some Iowa residents who face steep health insurance bills are turning to faith-based ministries in which religious Americans help each other pay medical bills. The Des Moines Register reports that the arrangements count as coverage under the Affordable Care Act, even though they aren’t exactly insurance.

Some of the groups’ monthly costs are much lower than what insurance would run, but there are limits on the types of bills they will cover. Outside health policy experts warn that the “health sharing ministries” have little oversight, and plans are not required to cover pre-existing health problems, such as diabetes or cancer. And unlike health insurers, the groups are not regulated by state officials.