If you're shopping for health insurance on your own—maybe you're self-employed, between jobs, or your employer doesn't offer coverage—you've probably noticed the landscape has gotten complicated. The ACA marketplace isn't your only option anymore. In 2026, you can choose from traditional marketplace plans, short-term policies, health sharing ministries, and alternative models like direct primary care. Here's what you need to know to make the right choice for your situation.
The stakes are high. A record 24.2 million Americans enrolled in ACA marketplace plans for 2025, more than double the number from just four years ago. But enhanced subsidies that made those plans affordable are scheduled to expire at the end of 2025, which could leave millions facing higher premiums in 2026. Understanding all your options has never been more important.
ACA Marketplace Plans: Your Foundation for Comprehensive Coverage
Let's start with the most robust option. ACA marketplace plans remain the gold standard for individual health insurance because they guarantee coverage regardless of your health status. Have diabetes? High blood pressure? Cancer history? Doesn't matter—they cannot deny you or charge you more because of pre-existing conditions.
For 2026, marketplace plans are organized into metal tiers—Bronze, Silver, Gold, and Platinum—that help you balance monthly premiums against out-of-pocket costs. Bronze plans have the lowest premiums but the highest deductibles (averaging nearly $7,500 nationally). Platinum plans flip that equation with higher monthly costs but lower expenses when you actually need care. Most people land somewhere in the middle with Silver plans, which offer a reasonable compromise.
Here's what makes marketplace plans compelling: subsidies. If your income is between 100% and 400% of the federal poverty level (roughly $62,600 for an individual or $84,600 for a couple in 2026), you'll likely qualify for premium tax credits. Four out of five marketplace enrollees found plans for $10 or less per month in 2025 thanks to enhanced subsidies. However, those enhanced subsidies expire after 2025, and without Congressional action, costs could jump significantly in 2026. The average premium after tax credits is projected at $50 per month for the lowest-cost plan—a $13 increase from 2025.
The catch? You can only enroll during open enrollment (November 1 through January 15 for 2026 coverage) unless you experience a qualifying life event like losing other coverage, getting married, or having a baby. Miss that window, and you'll need to explore other options or wait.
Short-Term Health Insurance: Quick Coverage with Major Gaps
If you've missed open enrollment or need immediate coverage, short-term health insurance might seem tempting. These plans are exactly what they sound like—temporary coverage designed to bridge gaps between longer-term policies. They're typically cheaper than ACA plans because they cover less.
But here's what you need to understand: short-term plans don't play by ACA rules. They can deny you coverage if you have pre-existing conditions—and their definition of "pre-existing" is broad. Asthma? Diabetes? High blood pressure? Even conditions diagnosed or treated within the last two to five years (depending on your state) won't be covered. If you develop a serious condition while on a short-term plan and then try to renew, that condition becomes pre-existing for the next policy period.
Federal regulations attempted to limit short-term plans to four months total (three months initial plus one renewal), but enforcement has been delayed as of August 2025. Some states like Florida, Indiana, Missouri, Georgia, and Ohio allow plans up to 36 months. The regulatory landscape remains uncertain, so coverage duration varies significantly by where you live.
Short-term insurance makes sense if you're young, healthy, between jobs for a few months, and primarily worried about catastrophic accidents or sudden illness. It doesn't make sense if you have ongoing health needs or any medical history you want covered.
Health Sharing Ministries: Community Support, Not Insurance
Health sharing ministries represent a fundamentally different approach. Rather than insurance, these are faith-based organizations where members pool monthly contributions to help pay each other's medical bills. Think of it as organized mutual aid with religious requirements.
The appeal is clear: monthly contributions typically range from $115 to $299, significantly less than traditional insurance premiums. You can enroll any time—no waiting for open enrollment. And you choose your own healthcare providers without network restrictions. Organizations like Christian Healthcare Ministries (founded in 1981), Medi-Share, and Samaritan Ministries serve an estimated 1 to 1.5 million Americans.
But you need to understand what you're not getting. Health sharing ministries are not insurance. They're largely unregulated—at least 30 states exempt them from insurance rules. They typically don't cover pre-existing conditions or chronic illnesses. Many restrict maternity coverage. And crucially, they have no legal obligation to pay your bills. If the ministry decides your medical situation doesn't align with their guidelines, you could be stuck with the full cost.
Recent news reports have highlighted cases where members faced unexpected denials, particularly for maternity care. This isn't a guaranteed payment system—it's a shared belief community agreeing to help each other within certain parameters. If you share those beliefs, maintain generally good health, and understand the risks, a health sharing ministry might work for you. But it's not a replacement for comprehensive insurance if you have ongoing medical needs.
Direct Primary Care: Affordable Access to Your Doctor
Direct primary care offers something different: unlimited access to your primary care doctor for a flat monthly fee, typically $50 to $150 for adults. You pay your doctor directly, cutting out insurance middlemen. That membership fee covers office visits, annual physicals, basic lab work, and often telemedicine consultations—all without copays or surprise bills.
Here's the important part: DPC is not health insurance. It covers primary care—think routine checkups, minor illnesses, chronic disease management. It does not cover hospitalizations, specialist care, surgery, or emergency room visits. You still need insurance or another financial strategy for major medical expenses.
The good news for 2026: starting December 31, 2025, you can combine a DPC membership with an HSA-qualified high-deductible health plan and still contribute to your Health Savings Account, as long as your DPC fee doesn't exceed $150 per month for an individual or $300 for a family. This pairing is becoming increasingly popular—use an affordable catastrophic or Bronze plan for major medical coverage, add a DPC membership for routine care, and use your HSA to bridge the gap.
This strategy works particularly well if you're relatively healthy but want better access to a doctor who actually knows you. Many DPC physicians cap their patient panels at 600 or fewer (compared to 2,000+ in traditional practices), meaning you can often get same-day appointments and your doctor's cell phone number.
How to Choose the Right Option for You
Your best choice depends on your health status, budget, and risk tolerance. If you have any pre-existing conditions or ongoing medical needs, an ACA marketplace plan offers the strongest protection. Check if you qualify for subsidies—you might be surprised how affordable coverage can be. Use the Healthcare.gov calculator to estimate your actual out-of-pocket costs.
If you're young, healthy, and need temporary coverage between jobs, short-term insurance could fill the gap—but read the fine print carefully about what's excluded. If you share the faith-based values of a health sharing ministry, understand the limitations, and can handle potential unexpected costs, that community approach might resonate with you. And if you want better primary care access without copays, consider DPC paired with a high-deductible catastrophic plan for major medical protection.
Many people are combining these approaches creatively. A Bronze marketplace plan with a $7,500 deductible plus a $75 monthly DPC membership gives you comprehensive catastrophic coverage and unlimited primary care for less than a Gold plan alone. The key is understanding what each option actually covers and building a strategy that protects you from both routine costs and financial catastrophe.
The landscape of individual health insurance has expanded beyond the ACA marketplace, giving you more options but also more complexity. Take time to understand what you're actually buying. Compare real costs including premiums, deductibles, and out-of-pocket maximums. And don't wait until you need care to figure this out—the best time to secure coverage is before you need it.
