What Are My Other Options for Health Insurance if I Can’t Get Subsidies on the ACA Marketplace?

Health insurance can feel daunting to navigate, especially when you’re outside the subsidy eligibility requirements on the Affordable Care Act (ACA) marketplace for government aid. Subsidies are intended to offset health insurance costs for individuals and families based on income, but if you find yourself earning above the threshold, you might be wondering: what are your options? 2.5 million people will be paying for a marketplace plan at full price with no subsidies in 2025. Fortunately, there are alternatives, and understanding them can help you make an informed decision based on your unique health needs and budget.

1. My Private Health Insurance

Private health insurance can be an excellent option if you don’t qualify for ACA subsidies. These plans can often offer wider provider networks and varying levels of coverage to suit different healthcare needs. Unlike marketplace plans, private insurers may provide more flexibility regarding coverage, especially if you prefer PPO plans that allow you to see out-of-network providers without a referral.  Private Insurance with the United Health Care Choice Plus PPO offer the best rates for people that are healthy enough to get approved with the underwriting applications. Basically they are going to check your prescription records and medical information bureau records to make sure there are no major health conditions.

When shopping for private health insurance:

• Research the provider network to ensure you have access to preferred doctors and hospitals.
• Compare deductibles, premiums, and out-of-pocket maximums to find a plan that aligns with your healthcare usage and budget.
• Look into the policy benefits carefully, as some private plans may cover additional services like dental, vision, or telemedicine.

2. Short-Term Health Insurance Plans

Short-term health insurance, often referred to as “gap” coverage, is designed to provide temporary protection, typically for 30 days to a year. Though these plans do not have to comply with the ACA’s essential health benefit requirements, they can be a practical alternative if you need a stopgap solution for unforeseen medical expenses.

Benefits and considerations of short-term plans:

• Lower Premiums: Short-term plans often come with lower monthly premiums than traditional ACA-compliant plans, which can be ideal if you’re looking for budget-friendly coverage.
• Limited Coverage: These plans may not cover pre-existing conditions or preventative care, so review the benefits and exclusions.
• No Penalty for Gaps in Coverage: Short-term plans offer flexibility without financial penalties if you only need short-term protection.

Short-term plans were typically renewable for up to three years in some states, but starting September 1st of 2024, a new law required new terms to be no more than 3 months. Golden Rule short term plans are no only available in 3 month terms so we always recommend people get permanent private health insurance.

3. Health Sharing Ministries

Health sharing ministries are faith-based, nonprofit organizations where members contribute funds to cover each other’s medical costs. While not traditional insurance, these organizations facilitate sharing healthcare costs among members, which can be a good option for healthy individuals without complex medical needs.

Points to consider with health sharing ministries:

• Lower Monthly Contributions: The contributions or “shares” are generally more affordable than traditional health insurance premiums.
• Selective Coverage: Health sharing ministries often don’t cover procedures or treatments outside of their stated guidelines, such as elective procedures, birth control, or pre-existing conditions.
• No Guarantee of Payment: Since they’re not regulated like insurance companies, payments aren’t guaranteed, though most ministries have solid track records for paying members’ claims.

Health sharing ministries work best for those with a specific set of healthcare needs who align with the organization’s values.

4. Catastrophic Health Insurance

Catastrophic health insurance is another alternative for individuals under 30 or those facing financial hardships. These plans cover severe illnesses or injuries with high deductibles but provide coverage for essential health benefits after you meet the deductible. They’re best suited to healthy individuals who want to protect themselves from high medical costs in worst-case scenarios.

What to expect from catastrophic plans:

• Low Premiums but High Deductibles: The plans offer low monthly premiums, making them affordable if you don’t use medical services frequently, but they come with high deductibles.
• Three Primary Care Visits Per Year: Many catastrophic plans cover at least three primary care visits annually before you meet the deductible.
• Coverage for Essential Health Benefits After Deductible: After you meet your deductible, catastrophic plans cover all essential benefits required by the ACA.

Catastrophic plans offer peace of mind for those who rarely need medical care but want coverage for major accidents or illnesses.

5. Employer-Sponsored Health Insurance (COBRA)

If you recently lost a job with employer-sponsored health coverage, COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage allows you to extend your employer’s plan. Though COBRA can be costly, as you’re responsible for the full premium without employer contributions, it can be a temporary solution to maintain coverage until you find a permanent option.

Key aspects of COBRA:

• Full Premium Costs: COBRA coverage requires you to pay the entire premium plus an administrative fee, which can make it expensive.
• Limited Duration: COBRA typically lasts 18 months, though in certain cases, coverage may be extended up to 36 months.
• Same Coverage as Employer Plan: COBRA continues the same benefits you had while employed, which can be advantageous if you have ongoing health needs or specific provider relationships.

While COBRA is temporary, it provides a bridge of continuity for those who need time to evaluate other health insurance options.

6. Medicare and Medicaid Options

Medicare and Medicaid are federal programs that provide health coverage for specific groups, including those aged 65 or older (Medicare) and low-income individuals and families (Medicaid). If you meet eligibility requirements for either program, they can be valuable, subsidy-free coverage options.

• Medicare for Seniors or Disabled Individuals: Those over 65 or with certain disabilities can enroll in Medicare, which offers various plans to cover medical, hospital, and prescription drug costs.
• Medicaid for Low-Income Individuals and Families: Medicaid eligibility varies by state, and some states offer expanded coverage for low-income individuals. Even if you’re not eligible for ACA subsidies, you might qualify for Medicaid if your income and household size fall within state guidelines.

For those qualifying based on income or age, these programs offer reliable coverage options without the need for private health insurance.

7. Direct Primary Care (DPC) Memberships

Direct primary care (DPC) memberships are growing in popularity as an affordable healthcare option, especially for those without high medical needs. DPC operates on a membership basis, allowing you to pay a monthly fee for primary and preventive care services. While not a full health insurance replacement, DPC can cover basic healthcare needs.

Advantages and limitations of DPC:

• Flat Monthly Fee: DPC providers charge a flat fee, covering most routine visits, tests, and basic treatments.
• Limited to Primary Care: DPC covers primary care services only, so it’s recommended to pair DPC with a high-deductible health insurance plan if possible to cover major medical expenses.
• More Time with Providers: DPC allows providers to spend more time with patients, providing a higher level of personalized care.

DPC works well for healthy individuals who want reliable access to primary care without high insurance premiums.

8. Health Savings Accounts (HSAs)

If you’re considering a high-deductible health plan (HDHP), pairing it with a Health Savings Account (HSA) is a smart way to manage healthcare expenses. HSAs allow you to contribute pre-tax dollars, which you can use tax-free for qualified medical expenses. Unused funds roll over annually and can even serve as a savings vehicle for retirement.

Considerations for HSAs:

• Tax Advantages: Contributions are tax-deductible, and qualified withdrawals are tax-free, providing long-term savings potential.
• Flexibility: HSAs offer flexibility, as you can decide when and how to use funds, whether for current medical expenses or future healthcare costs.
• Investment Growth: Many HSA accounts allow investment options, potentially growing your funds over time.

Combining an HDHP with an HSA can give you more control over healthcare costs and offer significant tax benefits.

Choosing the Right Health Insurance for Your Needs

When subsidies aren’t an option, the health insurance market still provides several choices. Whether through private health insurance, short-term plans, COBRA, or alternative coverage methods, you can find a solution to match your healthcare needs and budget. Each option has unique benefits and drawbacks, so take time to research each thoroughly. Consulting a licensed health insurance advisor can also help you navigate your options to make the most informed decision for you and your family’s health and financial well-being.