Cheaper alternatives to expensive ACA health plans come with trade-offs: bullets

For millions of Americans who buy Affordable Care Act insurance, there is still time left to enroll in 2026. But premium increases and the expiration of enhanced tax subsidies have led to larger-than-expected costs.

Concerned shoppers, wondering if there’s anything they can do, consult insurance brokers or talk to representatives at ACA marketplace call centers.

“We hear from people with complex medical conditions who believe they can’t survive if they don’t get medical care,” said Audrey Morse-Gastere, executive director of the Massachusetts Insurance Marketplace, that state’s insurance market.

Some are considering moving out of the ACA to find more affordable options. But this requires caution.

Congress is unlikely to extend the enhanced support before the end of the year. Late Wednesday, the House passed a package of measures favored by conservatives that does not address subsidies and is largely viewed as dead on its way to the Senate. But earlier Wednesday, four GOP moderates joined Democrats to sign on Discharge solicitation To force a vote – likely in January – on a three-year extension. The Senate and President Trump would also have to approve the measure, but if the support is extended, it could Applies retrospectively.

Meanwhile, the deadline to choose a health plan is quickly approaching. The official end of open enrollment is set for January 15 for coverage beginning on February 1. In most states, it is already too late to sign up for coverage starting January 1.

Here are five considerations in the decision-making process:

1. Short-term plans: “You must be healthy”

Some ACA shoppers may find themselves considering short-term insurance plans sold outside government-run marketplaces — or being steered toward plans by insurance brokers. Be careful.

Short-term plans are just that: insurance originally designed as temporary coverage for situations such as changing jobs or starting school. It can look a lot like traditional coverage, with deductibles, copayments, and participating networks of hospitals and doctors. However, they are not ACA-compliant plans and are not available on the official ACA marketplaces.

They are often less expensive than ACA plans. But it covers less. For example, unlike ACA plans, they can impose annual and lifetime limits on benefits. The vast majority do not cover maternity care. Some may not cover prescription medications.

Short-term plans require applicants to complete a medical questionnaire, and insurance companies can do this Exclusion of coverage Or retroactively cancel the policy for those with pre-existing medical conditions. Also, depending on the specific plan terms, a person who develops a medical condition during the coverage period may not be accepted for renewal.

In addition, short-term plans are not needed to cover the costs of care ACA Checklist of Essential Benefitssuch as preventive care, hospitalization, or emergency services.

The shortcomings of the plans, which critics say are sometimes marketed in misleading ways, have led Democrats to label them “junk insurance.” The Trump administration says it is suitable for some people, and has sought to manufacture it More widely available.

“We recommend it when it makes sense,” said Joshua Brooker, an insurance broker in Pennsylvania. “But if you’re going to sign up for short-term coverage, you need to know which boxes aren’t checked.”

“It’s not for everyone. You have to be healthy,” said Ronnell Nolan, president and CEO of Health Agents of America, a trade group.

It is available in only 36 states, According to KFFa non-profit health information organization that includes KFF Health News. Some states, like California, ban it. Others put in place tight restrictions.

2. Beware of non-comprehensive coverage

There are other types of health coverage offered by sales brokers or other organizations.

one type, It is called a compensation planintended to supplement a traditional health insurance plan by paying for deductibles or copayments.

These plans don’t have to follow the ACA coverage rules either. Generally, they pay a fixed dollar amount — say a few hundred dollars a day — for a hospital stay or a smaller amount for a doctor’s office visit. These payments are usually less than the full costs and the policyholder pays the remainder. They also generally require consumers to fill out medical forms detailing any pre-existing conditions.

Another type, a religious participation plan, collects money from members to cover their medical bills. Plans are not required to hold any specific amount of financial reserves and members are not guaranteed that the plans will pay for their health expenses, according to the Commonwealth Fund, a foundation that supports health care research and health system improvements.

Participation plans expanded beyond religious communities after the adoption of the Affordable Care Act. Like short-term plans, they cost less than ACA plans but also don’t have to follow ACA rules.

It is not considered insurance, and some of it was Accused of fraud By state regulators.

“Yes, it’s cheaper, and yes, it’s good for some people,” Nolan said. “But you have to understand what this plan is doing. This will be my last resort.”

3. Consider a “bronze” or “catastrophic” plan, but be aware of the deductibles

For those who want to stay with ACA plans, the lowest premiums are generally in categories marked “catastrophic” or “bronze.”

Jessica Altman, executive director of the ACA Exchange in California, said her state has seen an uptick in enrollment in Bronze-level plans. They have lower premiums but high annual deductibles—the amount a customer must spend before most coverage kicks in. Discounts for Bronze plans The average is approximately $7,500 nationallyaccording to KFF.

Another option, new for 2026, is to expand eligibility for catastrophic plans, which were previously limited to people under 30. As the name suggests, they’re intended for people who want health insurance just in case they suffer a catastrophic health condition, such as cancer or injuries from a car accident, and the plans can have deductibles up to the ACA’s annual limit on out-of-pocket spending — $10,600 for an individual or $21,200 for a family.

But now People are losing benefits Because the enhanced tax credits have expired they could also be eligible for the plans. However, it may not be available in every region.

Lauren Jenkins, an Oklahoma broker, said some of her clients making less than $25,000 this year are eligible for very low-cost or free plans with enhanced support. However, next year, their costs could rise to $100 or more per month for a “silver” level plan, a step up from Bronze.

So it offers them bronze plans to reduce the monthly cost. “But they may have a deductible of $6,000, $7,000 or $10,000 that they now have to pay,” Jenkins said. “For people who only make $25,000 a year, that would be detrimental.”

Both Bronze and Catastrophic plans are eligible to link to health savings accounts, which can be used for this Save money tax free For medical expenses. It is more popular among high-income families.

4. Another plan may have lower premiums

It can pay for shopping. Some people may be able to find a lower premium by switching to a different plan, even one offered by the same insurance company. There are also different levels of cover, from bronze to ‘platinum’, where premiums also vary. In some locations, “gold”-level plans are less expensive than silver, although that seems counterintuitive, Brooker said.

Also, some people who run their own business but have only one employee may qualify for a group plan rather than an individual policy. Sometimes those can be less expensive.

“Not every state allows this,” Nolan said. But, for example, Nolan said, she has a client whose only employee is his wife, so she’ll see if he can get a group plan at lower rates.

“It might work for them,” she said.

ACA rates for small group plans (less than 50 employees) vary regionally and are not always less expensive than individual coverage, Brooker said.

“It’s nice across the board as to where the prices are better,” he said.

5. Other rules of the road

Insurance experts encourage people not to wait until the last minute to take at least initial steps. Shoppers can go to the official federal or state market website and fill out or update an application with the desired income and other information needed to determine what their 2026 plan holds for them.

For example, even without Congressional intervention, the subsidies would not disappear entirely. However, they will be smaller, and there is an upper income limit — a cap for families earning more than four times the poverty level, which amounts to $62,600 for an individual and $84,600 for a couple in 2026.

When shopping, consumers should make sure they land on an official ACA website, as there are look-alikes that may not offer ACA-compliant plans. Healthcare.gov is the official federal website. From there, people can find websites serving the 20 states, along with the District of Columbia, that operate their own ACA exchanges.

Government websites can also direct consumers to licensed brokers and other advisors who can assist in submitting an application.

And a reminder: Consumers also need to pay the first month’s premium for the coverage to take effect.

KFF Health News It is a national newsroom that produces in-depth journalism on health issues and is one of the core drivers of KFF.