If ACA marketplace premiums are too high and you don't qualify for much of a subsidy, the main alternatives are short-term health plans, health care sharing, direct primary care, and bundles that pair everyday copay benefits with health sharing. Bundles like MightyWELL's start around $315 a month for an individual and let you see any licensed doctor. They are not insurance, they are not built for people with a major health issue coming up, and they work best for healthy people under 65 who want predictable costs.
Why so many people are looking for an alternative
Open enrollment is when most people compare health plans, and it's also when the price shock lands. For a lot of self-employed people, early retirees and families who earn a little too much for a big subsidy, an unsubsidized marketplace plan can cost more than a mortgage payment and still come with a deductible in the thousands. Meanwhile, a plan you rarely use feels like paying twice: once for the premium, and again for the care.
There is no single right answer. The best choice depends on your health, your income, your state and how much risk you're comfortable carrying. Here is how the main options compare.
The options at a glance
| Option | Typical monthly cost | Pre-existing conditions | Best for |
|---|---|---|---|
| ACA marketplace plan | Varies widely; lower with a subsidy | Accepted, no extra cost | Ongoing conditions, subsidy-eligible households |
| Employer plan or COBRA | Employer-shared; COBRA is full price | Accepted | People with a good employer plan |
| Short-term health plan | Often lower than unsubsidized ACA | Usually excluded or declined | Short gaps between plans |
| Health sharing on its own | Often lower than unsubsidized ACA | Waiting periods, then phased in | Healthy people mainly worried about big bills |
| Copay + health sharing bundle (MightyWELL) | From $315 for an individual | Waiting periods, then phased in | Healthy people who want everyday care and big-bill protection |
| Direct primary care | A flat monthly membership | Accepted | Unlimited primary care; pair with something for big bills |
| Medicaid or CHIP | Free or very low cost | Accepted | Households under the income limits |
ACA marketplace plans
Marketplace plans are real insurance. They can't turn you down or charge you more for a health condition, and they cover the ACA's essential health benefits. If your income qualifies you for a premium tax credit, a marketplace plan is often the best value available, so check HealthCare.gov or your state's exchange first. You can usually only enroll during open enrollment, which starts November 1, or after a qualifying life event.
The trade-off shows up when you don't get much help with the premium. You pay the full price every month, and then most of your care up to a deductible that is often several thousand dollars.
Short-term health plans
Short-term plans are insurance, but they're built to bridge a gap, like a few months between jobs. They're medically underwritten, so they can decline you or exclude anything you've been treated for, and federal and state rules limit how long you can keep one. They can make sense for a short, healthy gap and much less sense as your long-term plan.
Health care sharing
In a health sharing community, members contribute each month and share one another's eligible medical bills. You choose an unshared amount (similar to a deductible); once a bill passes it, eligible costs are shared by the community. Sharing isn't insurance and isn't guaranteed, and most sharing programs phase in pre-existing conditions over time. The upside is a lower monthly cost and the freedom to see any provider. ShareWELL, the sharing community in every MightyWELL plan, has served more than 10,000 members.
Health sharing on its own is mainly there for big events: a hospital stay, a surgery, an ER visit. Everyday care like a sick visit or a prescription usually falls under your unshared amount, so you pay it yourself.
Copay bundles that include health sharing
This is the gap MightyWELL fills. A MightyWELL plan bundles everyday benefits, administered by an independent third party, with ShareWELL for the large bills:
- A Minimum Essential Coverage (MEC) plan with $0 ACA preventive care
- Set copays for primary, specialist, urgent and virtual care, with no big deductible first
- $0 virtual urgent care, 24/7
- ShareWELL health sharing for hospital stays, surgeries and other major medical events
- A concierge team that negotiates bills and helps you find fair prices
You can see any licensed provider nationwide. Partner networks (PHCS and Prime Health Services) give you the best rates, but they don't limit your choice (how the network works). The Concierge bundle runs from $315 to $1,042 a month depending on age, household and unshared amount. See the full price table.
Direct primary care
With direct primary care (DPC) you pay a doctor's office a flat monthly fee for unlimited primary care, often with cheap labs and medications. It's a good way to handle everyday care, but it doesn't help with a hospital bill, so most DPC members pair it with health sharing or an insurance plan.
Medicaid and CHIP
If your household income is low, check Medicaid and CHIP before anything else. They're free or close to it, and children often qualify even when parents don't.
How to choose
- You have a serious ongoing condition, a pregnancy underway, or surgery coming up: an ACA plan or employer plan is usually the safer choice.
- You qualify for a large subsidy: compare the marketplace first. It may be cheaper than anything else.
- You are healthy, under 65 and paying full price: a copay + health sharing bundle can cut your monthly cost substantially and keep everyday visits predictable.
- You only need a few months of protection: look at a short-term plan or a bundle you can cancel any time.
Read health sharing vs. ACA plans for a side-by-side, or who health sharing fits if you're unsure about pre-existing conditions. Self-employed? Start with options for the self-employed.
Common questions
What is the cheapest alternative to health insurance?
If you qualify, Medicaid or CHIP is the cheapest. If you don't qualify for a meaningful subsidy, health sharing and copay + health sharing bundles are usually the lowest-cost ongoing options; MightyWELL's Concierge bundle starts at $315 a month for an individual.
Is health sharing legal?
Yes. Health care sharing has operated in the U.S. for decades. It is not insurance, so it is not regulated as insurance and does not guarantee payment. Some states have their own rules, so availability can vary.
Can I join an alternative outside open enrollment?
Yes. Health sharing and MightyWELL plans accept members any month of the year. ACA marketplace plans generally require open enrollment or a qualifying life event.
Do these alternatives satisfy a state individual mandate?
Not automatically. A few states, including California, Massachusetts, New Jersey, Rhode Island and the District of Columbia, have their own coverage mandates. Check your state rules and whether an exemption applies before you choose.
MightyWELL plans are not insurance. ShareWELL is a health care sharing community, not insurance, and sharing is not guaranteed. Prices are monthly estimates for the Concierge bundle; final pricing is confirmed at enrollment.
