What are your health coverage options
if you don’t have employer insurance?

ACA plans

ACA plans are regulated health insurance that can be purchased through the official marketplace (healthcare.gov or a state exchange) or directly from a carrier off-exchange. Both channels offer the same ACA protections — guaranteed coverage of pre-existing conditions, ten essential health benefits including mental health and maternity, and guaranteed issue regardless of health status. The key difference is that subsidies (premium tax credits and cost-sharing reductions) are only available through the official exchange. Off-exchange ACA plans follow the same rules but are paid at full price — and in some counties, carriers offer plan designs exclusively off-exchange that are not available through the marketplace at all. In 2026, ACA plans also come with real trade-offs: premiums up an average of 26%, record-high average deductibles of $3,786, shrinking networks in many states, and a subsidy system with a hard income cliff at $62,600 for a single adult.

For people with incomes below the subsidy cliff, ACA plans are almost always the best financial choice. Above it, the math changes significantly — unsubsidized premiums now average around $8,500/year nationally.

Health Shares

Health Sharing Ministries are membership organizations where members pool funds to pay each other’s eligible medical bills. They are not insurance and are not regulated under state insurance law — but they are governed by contract law and subject to state consumer protection statutes and Attorney General oversight.

Being less regulated does not mean bills are less likely to be paid. Both Health Shares and insurance have situations where bills are not covered — insurance through networks and prior authorizations, Health Shares through sharing guidelines. What matters most is understanding what your membership covers before you need it.

Health Shares are most compelling for people above the ACA subsidy cliff who are generally healthy with no significant pre-existing conditions. In 2026, with unsubsidized ACA premiums up 26%, the cost gap is the widest it has been in years.

Direct primary care

Direct primary care (DPC) is a membership model where you pay a flat monthly fee directly to a primary care physician — no insurance billing, no copays, no per-visit charges, no surprise bills after the fact. The national average DPC membership costs $92/month in 2026 (median $80/month), based on data from 2,780+ providers nationwide. What you’re buying is a fundamentally different relationship with a primary care doctor.

The most important distinction between DPC and traditional insurance-based primary care is incentive alignment. In a traditional fee-for-service practice, a physician earns revenue by seeing more patients and ordering more services. In a DPC practice, the physician earns a flat monthly fee regardless of how many visits you make or how many tests are ordered. This means the DPC physician’s financial interest is aligned with keeping you healthy and out of the hospital — not with generating billable encounters. Patients with chronic conditions who manage well mean less work for the physician, not less revenue.

This incentive structure produces measurable practical differences. DPC physicians maintain panels of approximately 400–600 patients — compared to 2,000–2,500 patients in a typical insurance-based primary care practice. Smaller panels mean same-day or next-day appointments as the norm rather than the exception, visits that run 30–60 minutes rather than 12 minutes, and a physician who actually knows your history without scrolling through a chart. Most DPC physicians provide direct access by phone, text, or secure message — responses in hours, not days. Routine labs and basic in-office procedures are typically included at no additional cost, or available at near-wholesale pricing.

2026 HSA update: Starting January 1, 2026, DPC fees are payable with tax-free HSA funds — up to $150/month for individuals and $300/month for families per IRS Notice 2026-05. A significant change that makes DPC meaningfully more affordable for people with HSA-eligible health plans.

DPC does not include major medical coverage — hospitalizations, specialist care, surgery, or emergency care are not part of the membership. Most DPC members pair it with a Health Share, a high-deductible ACA plan, or short-term medical coverage for those events. What DPC eliminates is the most common and frustrating part of the traditional healthcare experience: the inability to reach your doctor, the rushed visit, the copay for a three-minute conversation, and the bill that arrives six weeks later for something you thought was covered.

MEC plans

MEC (Minimum Essential Coverage) plans satisfy the ACA’s minimum coverage requirement and come in more variety than most people expect. While all MEC plans cover preventive care at 100% with no cost-sharing — annual exams, immunizations, and preventive screenings are always included — the similarities end there. Some MEC plans are structured as high-deductible health plans (HDHPs) that qualify for HSA contributions, making them a tax-advantaged option for healthy individuals who primarily want catastrophic protection and preventive coverage. Others include copays for office visits, urgent care, labs, and imaging — meaning some non-preventive care is covered, just at a fixed per-visit cost rather than subject to a full deductible.

What no MEC plan covers, without exception, is inpatient hospital care. Hospitalizations, inpatient surgery, inpatient rehabilitation, and any care requiring an overnight admission fall entirely outside the MEC benefit structure. This is the hard line — and the most important thing to understand before enrolling in any MEC plan. A single inpatient stay without major medical coverage behind it creates significant financial exposure regardless of how well the MEC plan handles office visits and labs.

MEC plans work best as one layer in a broader coverage strategy — most commonly paired with DPC (which handles primary care with no per-visit cost) and a Health Share or short-term medical plan (which handles major medical events). Together these three layers can cover the full spectrum of care at a significantly lower total monthly cost than a comparable unsubsidized ACA plan — without the gaps that exist when any one of the layers is used alone.

Virtual medicine memberships

Virtual medicine memberships provide on-demand access to physicians, mental health providers, and specialists via video, phone, or text — for a flat monthly fee ranging from as little as $5/month for basic urgent care platforms to $80/month for full-service options with mental health providers included. Virtual medicine is a complement to more comprehensive coverage, not a replacement for it. It fills a specific gap that nearly every other coverage type leaves open: the ability to reach a clinician quickly, without an appointment, for conditions that don’t require an in-person visit. That gap — a respiratory infection at 9pm, a prescription refill, a follow-up on lab results, an urgent mental health visit — is where virtual medicine earns its place in a coverage strategy. Paired with an ACA plan, Health Share, or DPC membership, a virtual medicine layer adds accessibility without meaningfully adding cost.

Indemnity benefit plans

Indemnity benefit plans pay a fixed dollar amount per medical event — per hospital day, per surgery, per ER visit — regardless of what the actual bill is. They are a complement to more comprehensive coverage, not a substitute for it, and they pair with virtually any primary coverage type. Added to an ACA plan, indemnity benefits help offset deductible and coinsurance exposure when a hospitalization or surgery hits. Added to a Health Share, they function as a bridge during the Annual Unshared Amount period — reducing out-of-pocket exposure while the Health Share processes the claim. Added to short-term medical or a MEC plan, they fill the significant coverage gaps those products leave for major events. The benefit is straightforward: when a covered event occurs, the plan pays the stated amount directly to you, regardless of what the actual bill is or what your primary coverage pays. The gap between the benefit and the real bill remains your responsibility — which is why indemnity benefits work best as a layer on top of meaningful primary coverage rather than as a primary product on their own.

Short-term medical insurance

Short-term medical (STM) is licensed insurance designed for temporary coverage gaps — between jobs, before employer coverage starts, or after missing open enrollment. It is not ACA-compliant and excludes pre-existing conditions, but it provides major medical coverage for new conditions at significantly lower premiums than ACA benchmark plans.

STM premiums typically run $70–$165/month for a 40-year-old depending on age, deductible, and state. Terms are capped by federal and state rules — most policies run 3–4 months, though some states allow longer. Following the August 2025 DOL tri-agency enforcement suspension, duration rules are in flux; state law controls in most cases.

COBRA continuation coverage

COBRA (Consolidated Omnibus Budget Reconciliation Act) lets you keep your employer’s group health plan after leaving a job — but you pay the full premium yourself, plus a 2% administrative fee. It is not a standalone coverage type in the individual market, but it is a common bridge option people consider when they lose employer coverage.

The cost shock is real: if your employer was paying $800/month toward your family plan, your COBRA bill will be your share plus that $800 plus 2% — often $1,200–$2,000/month for coverage that cost you $300–$400 as an employee. You have 60 days to elect COBRA after losing coverage; if elected, coverage is retroactive.

Farm Bureau health plans

Farm Bureau health plans are offered through state Farm Bureau membership organizations in select states. They are not ACA-compliant and not Health Shares — they occupy a separate regulatory category that varies by state. Because Farm Bureau organizations are exempt from certain ACA requirements, their plans can exclude pre-existing conditions, use health underwriting, and deny coverage based on health history.

In exchange, premiums are often significantly lower than ACA benchmark plans for healthy individuals — typically $200–$450/month for a single adult depending on age, state, and plan. Farm Bureau plans are only available in states that have enacted specific exemptions: Texas, Iowa, Kansas, Indiana, Tennessee, North Carolina, Mississippi, Alabama, and Nebraska. You must be a Farm Bureau member (typically $40–$100/year) to enroll.