Got ACA Sticker Shock? Here Are Some Cheaper Health Insurance Options to Consider Before Jan. 15

As the end of open enrollment for Obamacare plans approaches, some individuals facing significant premium increases are seeking alternatives to the Health Insurance Marketplace.

Boulder, Colorado, resident Rebecca Rush spent much of the 2026 Affordable Care Act (ACA) open enrollment season in sticker shock.

The premiums for her 2025 health insurance—a Bronze plan with a $9,500 deductible—were increasing from an already pricey $760 to $1,001 a month, and it was one of her more affordable marketplace options.

“I was stressed financially,” she said.“The last few years, I’ve had to get worse insurance to stay in my budget, and I was still paying tons of money [out-of-pocket] for everything.”

So, when a private health insurance broker contacted her, Rush was happy to hear his pitch. For the first time since the ACA marketplaces opened in 2013, she chose an off-market plan.

“My premiums are $565 a month, and my deductibles are very reasonable,” she said, though the new plan doesn’t cover maternity care, mental health services, or prescription drugs. “I’m a little apprehensive because I don’t know how things are really gonna shake out.”

Rush, an independent contractor, isn’t the only ACA shopper facing a tough decision this year. In fact, many enrollees could easily find themselves in the same predicament as Jan. 15, the final deadline for 2026 open enrollment, approaches.

Research from the nonprofit organization KFF finds ACA insurers are raising 2026 premiums by an average of 26%—and that shoppers benefiting from the now-expired enhanced premium tax credits will see monthly premium payments more than double. 

ACA Plans: The Consumer Protection Baseline

The good news for anyone squeezed by sky-high ACA premiums is that there are cheaper alternatives to consider. The bad news is that these alternatives come with significant trade-offs. That’s because the ACA didn’t just create health insurance marketplaces‒it also introduced baseline consumer protections for the plans sold on them. 

Under the federal law, all ACA marketplace plans must:

• Cover 10 essential health benefits, including preventative care, pregnancy, mental health services, and prescription drugs 
• Not exclude treatment or deny coverage for pre-existing conditions 
• Adhere to federal caps on annual out-of-pocket maximums (MOOPs) (set in 2026 to $10,600 for individuals and $21,200 for families)

Off-market plans or alternative health care solutions, which also don’t qualify for health insurance subsidies, aren’t subject to these rules. As a result, they can offer cheaper but decidedly less comprehensive coverage.

“Lower premiums usually come with less protection,” said Brandy Thompson, CEO of benefitbay, a Kansas City-based insurtech company. “It is especially important not to rush into a decision based solely on price without fully understanding the coverage trade-offs.”

4 Obamacare Alternatives

To help you make a final health insurance decision ahead of Jan. 15, here are the most common ACA health insurance alternatives, along with their costs and potential downsides.

1. Private Health Insurance That Isn’t ACA-Compliant

What it is: Health care plans sold outside of the ACA marketplaces by insurers, agents, or independent brokers during or outside of open enrollment. They can carry restrictions and aren’t eligible for health insurance subsidies. 

Pros

• Potentially lower premiums
• You can typically sign up at any time
• Can have broad provider networks

Cons

• Often won’t cover the 10 essential health benefits named as ACA standards
• Can require underwriting, including medical questionnaire
• Can exclude or charge more for pre-existing conditions

2. Short-Term Health Insurance Plans

What it is: Private plans that provide coverage for a short period of time, usually from one to 12 months; Short-term health insurance is generally best used as a temporary stop-gap if you’re healthy and can’t otherwise get coverage, as it excludes pre-existing conditions and carries significant coverage caps.

“If someone experiences a major medical event, short-term plans may deny claims, limit payouts, or exclude follow-up care related to the initial issue,” Thompson says.

Pros

• Low monthly premiums
• Fast application process
• Can serve as a short-term safety net

Cons

• Extremely high deductibles 
• Excludes people with pre-existing conditions
• Limited coverage for almost all services

3. Health Care Sharing Ministries

What it is: Organizations, usually faith-based, collect monthly payments from members to cover qualified medical expenses. Also known as health cost-sharing ministries (HCSMs), this coverage isn’t technically insurance and, so, comes with limited benefits and little government oversight.

Pros

• Lower monthly payments
• Year-round enrollment
• You can join quickly

Cons

• Faith-based requirements 
• No coverage guarantees
• Lack of consumer protections

4. Fixed Indemnity Insurance

What it is: Supplemental health insurance that pays a set amount for qualified medical events, like hospitalization or doctor visits, regardless of your total cost of care. Indemnity plans usually pay you directly, allowing you to control what the funds are put toward, albeit in exchange for less comprehensive benefits.  

Pros

• Costs less than traditional health insurance
• You can apply year-round
• Lets you control funds and where you seek care

Cons

• Low coverage limits
• Reimbursement hassles 
• Can deny coverage or payouts for pre-existing conditions 

Who Should—and Shouldn’t—Consider Alternatives

Given the common tradeoffs, Obamacare alternatives aren’t a great option if you or your family has chronic or unpredictable health conditions, relies on regular medications, or has special medical needs.

“Most non-ACA options work best for people with predictable health needs and a higher tolerance for risk,” Thompson said.

Rush, for instance, felt comfortable purchasing her off-market plan from Freedom Life Insurance Company of America, a subsidiary of USHEALTH Group, Inc., a United Healthcare company, given she’s on an individual plan, has no chronic conditions, and maintained a relatively clean health history, which helped mitigate exclusions that could have come up during the underwriting.

“I don’t think it’s for everyone,” she said, “[but] I know what I’m getting into. I know the limitations.”

What You Should Do Before Jan. 15

The following steps can help you assess your options ahead of the upcoming open enrollment deadline.

• Double-check your subsidy eligibility: Shoppers with a household income of at least 100% and no more than 400% of the federal poverty line (FPL) can still qualify for premium tax credits, and those with household incomes from 100% to 250% of FPL can also receive cost-sharing reductions to help with other out-of-pocket costs. Remember, you’ll need to purchase a marketplace plan to receive this assistance.
• Check local laws: Some states have their own rules for ACA alternatives. New York, for instance, prohibits short-term health insurance entirely, while 30 states explicitly exempt health care sharing ministries from insurance regulations. Know what you can—or can’t—apply for in your state, and what protections you might have at your disposal.
• Compare all costs: Low premiums are enticing, on paper, but you can easily lose any savings if you’re continually paying out-of-pocket for care. Be sure to compare plan deductibles, copays, coinsurance, and MOOPs when assessing which option is truly your most affordable.   
• Read all documents: Don’t just read marketing materials or a plan summary. “Pay close attention to exclusions, benefit caps, and provider access,” Thompson said. “It can also be helpful to ask how the plan would respond to a worst-case scenario, not just routine care.”