Cheaper alternatives to pricy ACA health plans come with trade-offs : Shots

For the millions of Americans who buy Affordable Care Act insurance, there’s still time left to enroll for 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, are consulting insurance brokers or talking to representatives at ACA marketplace call centers.

“We’re hearing from people with complex medical conditions who don’t think they can survive if they don’t have access to medical care,” said Audrey Morse Gasteier, executive director of the Massachusetts Health Connector, that state’s insurance marketplace.

And some are considering going outside the ACA to find more affordable options. But that requires caution.

Congress is unlikely to extend the enhanced subsidies before the year’s end. Late Wednesday, the House passed a package of measures favored by conservatives that does not address the subsidies and is largely viewed as dead on arrival in the Senate. Earlier Wednesday, however, four GOP moderates joined with Democrats to sign a discharge petition 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 extended the subsidies could be applied retroactively.

Meanwhile, the deadline for choosing a health plan is quickly approaching. The official end of open enrollment is set for Jan. 15 for coverage starting Feb. 1. In most states, it’s already too late to enroll for coverage starting Jan. 1.

Here are five considerations in the decision-making process:

1. Short-term plans: ‘You have to be healthy’

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

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

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

Short-term plans require applicants to complete a medical questionnaire, and insurers can exclude coverage or cancel a policy retroactively for those with preexisting medical conditions. Also, depending on the terms of the particular plan, a person who develops a medical condition during the coverage period might not be accepted for renewal.

In addition, short-term plans are not required to cover care on the ACA’s checklist of essential benefits, such 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 argues they’re suitable for some people and has sought to make them more widely available.

“We recommend it when it makes sense,” said Joshua Brooker, a Pennsylvania insurance broker. “But if you’re going to enroll in short-term coverage, you need to know which boxes are unchecked.”

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

And they’re available in only 36 states, according to KFF, a health information nonprofit that includes KFF Health News. Some states, such as California, prohibit them. Others set tight restrictions.

2. Beware of coverage that’s not comprehensive

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

One kind, called an indemnity plan, is meant to supplement a traditional health insurance plan by paying toward deductibles or copayments.

Those plans do not have to follow ACA coverage rules, either. Generally, they pay a fixed dollar amount — say a few hundred dollars a day — toward a hospital stay or a smaller amount for a doctor’s office visit. Typically those payments fall short of the full costs and the policyholder pays the rest. They generally also require consumers to fill out medical forms stating any preexisting conditions.

Another type, a faith-based sharing plan, pools money from members to cover their medical bills. The plans are not required to keep any specific amount of financial reserves and members are not guaranteed that the plans will pay their health expenses, according to the Commonwealth Fund, a foundation that supports health care research and improvements to the health system.

Sharing plans expanded beyond faith communities after the ACA was adopted. Like short-term plans, they cost less than ACA plans but also don’t have to follow ACA rules.

They are not considered insurance, and some have been accused of fraud by state regulators.

“Yes, it is cheaper, and yes, it does work for some people,” Nolan said. “But you need to understand what that plan does. It would be my last resort.”

3. Consider a ‘Bronze’ or ‘Catastrophic’ plan, but be aware of deductibles

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

Jessica Altman, executive director of California’s ACA exchange, said her state has noticed an uptick in enrollments in bronze-level plans. They have lower premiums but high annual deductibles — the amount a customer must spend before most coverage kicks in. Deductibles for bronze plans average nearly $7,500 nationally, according to KFF.

Another option, new for 2026, is expanded