Obamacare (ACA) Marketplace plans on HealthCare.gov are dependable and comprehensive, especially if you qualify for subsidies. But if your income disqualifies you from tax credits and you’re relatively healthy, there are legitimate alternatives that may cut costs while keeping strong benefits.
Why consider alternatives?
- You’re healthy and rarely use care beyond preventive visits.
- You want broader PPO networks or specific hospital access.
- You don’t qualify for subsidies and need a lower premium.
Common alternatives
1. Medically underwritten PPO plans (non-ACA)
- What they are: Health plans that review your medical history to determine eligibility and rates.
- Pros: Often lower premiums, strong networks, clear major-medical coverage.
- Cons: Not guaranteed issue; may have exclusions or waiting periods for certain conditions.
2. Level-funded small group plans
- Best for: Small employers (sometimes even owner + spouse qualifies depending on carrier rules).
- Pros: Potential savings if your group’s claims run lower; includes stop-loss protection.
- Cons: Requires group eligibility and participation; some admin responsibilities.
3. Short-Term Medical (STM)
- What it is: Temporary coverage that can often be renewed to bridge longer periods, depending on state rules.
- Pros: Fast to start, budget-friendly for healthy applicants, decent PPO options in some states.
- Cons: Not ACA-compliant; preexisting conditions typically not covered; benefits can be less comprehensive.
4. Direct Primary Care (DPC) + catastrophic wrap
- What it is: Subscription primary care with unlimited visits, paired with a high-deductible plan for big events.
- Pros: Great access to your doctor; transparent costs; strong for routine care.
- Cons: You must still solve for hospitalizations/imaging, usually via HDHP or STM.
5. Fixed indemnity + supplemental
- What it is: Plans that pay set dollar amounts per service (e.g., $X per day in hospital).
- Pros: Predictable payouts; can be layered with accident/critical illness plans.
- Cons: Not a substitute for major medical; best used as part of a strategy, not alone.
6. Health Care Sharing Ministries (HCSMs)
- What it is: Faith-based cost-sharing arrangements, not insurance.
- Pros: Lower monthly contributions; community-oriented.
- Cons: Not guaranteed payment; can exclude certain services; not ACA-compliant.
7. Association options
- What it is: Plans accessible via trade or professional groups (availability varies by state and association).
- Pros: Potential group pricing and networks.
- Cons: Eligibility and benefits differ widely.
How to compare fairly
- Total annual cost: Premiums + expected out-of-pocket + worst-case scenario.
- Networks: Are your doctors and hospitals covered?
- Underwriting impact: Know what’s excluded or rated.
- Renewal and stability: Can you keep the plan if health changes?
- Compliance and protections: Marketplace plans offer the strongest consumer protections.
Who’s a good fit for alternatives?
- Individuals and families with good health histories.
- Self-employed professionals seeking flexibility and PPO access.
- Small employers who can form a group (including owner-led teams).
Next step
Myers Health Insurance can show you a side-by-side comparison of Marketplace vs. alternative options tailored to your health, providers, and budget.
