Lost Your ACA Subsidy? 6 Alternatives to Marketplace Insurance in 2026

Published March 18, 2026 · Updated for latest policy changes

If your health insurance premiums doubled overnight on January 1, you're not imagining it. The enhanced ACA premium tax credits that kept marketplace coverage affordable for more than 20 million Americans expired at the end of 2025, and Congress failed to extend them despite months of political wrangling — including the longest government shutdown in U.S. history.

The numbers are stark. Subsidized enrollees are paying an average of 114 percent more for the same coverage in 2026, according to KFF. That translates to roughly $1,016 more per year on average. For a 40-year-old earning $50,000, the increase can be closer to $2,000 annually. For older adults approaching Medicare eligibility, the jump is even steeper because ACA premiums rise sharply with age.

Some states have stepped in with their own money — Massachusetts invested $250 million to shield roughly 270,000 ConnectorCare members, California allocated $190 million for enrollees earning up to 150 percent of the federal poverty level, and Maryland is fully replacing the lost enhanced subsidies for people below 200 percent FPL and partially replacing them up to 400 percent FPL — but for the majority of marketplace enrollees, the federal safety net just got a lot thinner.

So what are your options? Here are six alternatives worth considering, along with an honest look at what each one actually covers and where the gaps are.

1. Downshift to a Bronze or Catastrophic Marketplace Plan

Before you leave the marketplace entirely, look at what's available at the bottom of the metal tier ladder. Many people who had affordable silver or gold plans with enhanced subsidies are finding that a bronze or catastrophic plan — while less generous — is at least manageable on the budget.

Bronze plans typically cover about 60 percent of your expected medical costs, compared to 70 percent for silver and 80 percent for gold. You'll pay less each month but face higher deductibles and copays when you actually use care. Catastrophic plans go further in that direction: very low premiums, very high deductibles ($10,600 for an individual in 2026, which equals the annual out-of-pocket maximum), and coverage kicks in mainly for serious events. You do get three primary care visits per year and preventive services before the deductible, though.

There's an important new development for 2026: CMS has expanded eligibility for catastrophic plans. Previously, they were mostly limited to people under 30 or those with a hardship exemption. Now, anyone who isn't eligible for marketplace premium savings due to their income can also purchase a catastrophic plan — which means if you earn above 400 percent of the federal poverty level and don't qualify for subsidies, this option is newly available to you.

Another big change: starting in 2026, both bronze and catastrophic plans purchased through the ACA marketplace are automatically treated as HSA-qualified high-deductible health plans under the One Big Beautiful Bill Act — even if they don't meet the traditional HDHP deductible or out-of-pocket thresholds. That means you can pair them with a Health Savings Account and contribute pre-tax dollars — up to $4,400 for an individual or $8,750 for a family in 2026, plus an extra $1,000 if you're 55 or older — to cover out-of-pocket costs. If you're relatively healthy and primarily need protection against a major medical event, this combination can be significantly cheaper than an unsubsidized silver plan.

Use our subsidy calculator to see exactly what you'd pay at each metal tier in your county, and check whether you still qualify for any remaining (non-enhanced) subsidies if your income is between 100 and 400 percent of the federal poverty level. You can also use our True Cost calculator to compare plans based on your actual expected healthcare usage — not just the monthly premium.

Best for: Healthy individuals and families who rarely use medical services beyond annual checkups and want catastrophic protection at the lowest premium.

Watch out for: High deductibles mean you'll pay the full cost of most care out of pocket until you hit the $10,600 threshold (individual). If you have ongoing prescriptions or regular specialist visits, the out-of-pocket costs could exceed what you save on premiums.

2. Direct Primary Care + Catastrophic Coverage

This combination is gaining serious traction in 2026, and for good reason. Direct Primary Care is a membership model where you pay your doctor a flat monthly fee — typically $50 to $150 per person — for unlimited primary care visits. No insurance claims, no copays, no surprise bills for routine care. Your doctor knows you, sees you the same week you call, and spends 30 to 60 minutes per visit instead of 7.

There are now more than 2,800 DPC practices across every state in the country, though availability varies by area. Most DPC memberships include office visits (in person and virtual), basic lab work, and sometimes discounted imaging and prescriptions at wholesale pricing. What they don't cover is anything beyond primary care — no hospitalizations, no surgeries, no specialist referrals, no emergency room visits.

That's where the catastrophic plan comes in. You pair your DPC membership with a low-premium catastrophic or bronze plan that protects you from the big, unpredictable expenses. Your DPC handles the day-to-day care that would otherwise hit your deductible, and the insurance handles the rest.

A major policy change makes this combination even more attractive in 2026: the One Big Beautiful Bill Act eliminated the old IRS rule that prevented people with DPC memberships from contributing to a Health Savings Account. Starting this year, you can have a DPC membership and still contribute to and use your HSA — as long as the monthly DPC fee doesn't exceed $150 per individual or $300 per family (these limits will adjust annually for inflation). You can even pay your DPC fees directly from your HSA with pre-tax dollars, since DPC membership fees now count as a qualified medical expense. If your DPC fees exceed these caps, you can still use existing HSA funds to pay DPC fees, but you won't be eligible to make new HSA contributions.

Best for: People who value a strong relationship with their doctor, want unlimited access to primary care without worrying about copays, and are comfortable pairing it with a high-deductible plan for major events.

Watch out for: DPC is not insurance. If you need a specialist, surgery, or hospital care, you're relying entirely on your catastrophic plan — which means paying the full deductible first. Also, not every area has a DPC practice, and you'll need to research what's included in the membership carefully since services vary by practice.

3. Short-Term Health Insurance

Short-term health plans provide temporary coverage and were originally designed to bridge gaps between jobs. In the post-subsidy world, some people are using them as a longer-term solution.

The appeal is the price. Premiums for short-term plans can run 50 to 80 percent less than comparable ACA plans because these plans aren't subject to ACA regulations. That means they can (and do) underwrite applicants based on health status, exclude pre-existing conditions, impose annual and lifetime coverage caps, and skip many of the essential health benefits that ACA plans are required to cover.

The duration rules have shifted. The Biden administration finalized a rule in 2024 limiting short-term plans to three months initially, with a maximum total of four months including renewals. However, in August 2025, the Trump administration announced it would not enforce these limits. As a result, short-term plans with durations up to 12 months (and total durations up to 36 months including renewals) are once again available for purchase in many states. The actual duration available to you depends heavily on your state — several states including California, New York, Massachusetts, New Jersey, and the District of Columbia have banned or severely restricted short-term plans regardless of federal policy.

Best for: Healthy individuals who need temporary coverage while waiting for employer insurance, Medicare eligibility, or an upcoming open enrollment period. Could work for someone between jobs who just needs something to prevent a catastrophic medical bill.

Watch out for: Short-term plans are not ACA-compliant insurance. They can deny coverage for pre-existing conditions — and some use post-claims underwriting, which means they may review your medical history after you file a claim and retroactively deny it if they discover an undisclosed condition. They don't count as minimum essential coverage, and they typically don't cover maternity, mental health, or prescription drugs. If you have any ongoing health needs, this is a risky choice.

4. Health Sharing Ministries

Health sharing ministries are member-based organizations where participants contribute a monthly amount to a shared pool, which is then used to pay other members' medical bills. Monthly contributions typically range from $100 to $500 per individual, depending on the plan and the level of coverage — significantly less than unsubsidized ACA premiums.

The concept has been around for decades within religious communities, but membership has grown substantially in recent years. Over one million Americans now participate in health sharing programs. Well-known organizations include Samaritan Ministries, Medi-Share, Christian Healthcare Ministries, and Liberty HealthShare. Some newer programs, like Knew Health and Sedera, are secular and don't require a religious affiliation.

Here's the critical thing to understand: health sharing ministries are not insurance. They are not regulated by state insurance departments. There is no legal guarantee that your medical bills will be shared. If the ministry declines to share a particular expense, you have no legal recourse through your state's department of insurance. Members typically must agree to a statement of beliefs (religious or ethical) and may be subject to lifestyle requirements.

Most programs exclude pre-existing conditions for a waiting period (commonly 12 to 24 months), may not cover maternity for a certain period after joining, and have per-incident or annual limits on what they'll share. Some also exclude mental health services, substance use treatment, and preventive care — all of which ACA plans are required to cover.

Best for: People who are comfortable with the community-based model, understand the risks, don't have significant pre-existing conditions, and are looking for a lower monthly cost than unsubsidized ACA premiums.

Watch out for: No legal protection if your claim is denied. Pre-existing condition exclusions. No coverage guarantees. Some programs have faced state enforcement actions. Read the membership guidelines (not just the marketing materials) before joining, and check whether your state has any consumer protections or restrictions on health sharing ministries.

5. Employer-Sponsored Coverage (Including ICHRA)

This might seem obvious, but the subsidy expiration is making many people reconsider employer coverage they previously turned down. If your employer (or a spouse's or parent's employer) offers group health insurance, now is the time to take another look. Employer plans cover roughly half the premium on average, and you can't get that benefit from the marketplace.

If you're under 26, you can remain on a parent's employer-sponsored plan regardless of your own employment status, marital status, or income. That provision of the ACA is still fully in effect.

There's also a newer option that's growing quickly: the Individual Coverage Health Reimbursement Arrangement, or ICHRA. Instead of offering a traditional group health plan, some employers (particularly small businesses) set a monthly budget and reimburse employees tax-free for individual health insurance premiums they purchase on their own. The employee picks the plan, the employer reimburses up to their set amount, and both parties get tax benefits.

About 450,000 people were enrolled in ICHRAs as of 2025, and that number is growing as more small businesses discover the model. If your employer doesn't currently offer health benefits, it might be worth suggesting an ICHRA — it's simpler and cheaper for them to administer than a group plan, and several states are considering tax credits to encourage small employers to offer them.

One important rule: if your employer offers an ICHRA that's considered "affordable" (meaning the employee's share for a silver plan after the ICHRA reimbursement is less than 9.96 percent of household income in 2026), you cannot receive marketplace premium tax credits. So if you're offered an ICHRA, compare the reimbursement amount against what you'd get from marketplace subsidies before deciding.

Best for: Anyone with access to employer coverage who previously opted out. Small business owners and employees who want to explore ICHRA as a flexible benefits solution.

Watch out for: Employer coverage isn't always cheaper than a subsidized marketplace plan — but with enhanced subsidies gone, the math has shifted significantly for most people. If your employer offers an ICHRA, run the numbers carefully on affordability.

6. Medicaid (If You Qualify — and Can Navigate the Changes)

If your income has dropped — or if the loss of your subsidy makes you realize you might be closer to the Medicaid threshold than you thought — check whether you qualify for Medicaid in your state. In the 40 states (plus Washington, D.C.) that expanded Medicaid under the ACA, adults earning up to 138 percent of the federal poverty level (about $21,597 for an individual in 2026) are eligible.

Use our Medicaid calculator to check your eligibility based on your household size and income.

Medicaid has no premiums and minimal cost-sharing, making it the most affordable option available. If you qualify, there's no reason not to enroll. You can apply at any time — there's no open enrollment period for Medicaid.

However, Medicaid is also undergoing major changes. The One Big Beautiful Bill Act, signed in July 2025, cut roughly $900 billion in federal Medicaid funding over the next decade. Starting in 2027, expansion adults ages 19 to 64 will face new work requirements (80 hours per month of work, school, volunteering, or other qualifying activity). Six-month eligibility redeterminations begin in late 2026 or early 2027, doubling the paperwork compared to the previous annual check. And immigrant eligibility is being narrowed significantly starting in October 2026.

If you're already on Medicaid, the most important thing you can do right now is keep your contact information current and respond promptly to any renewal notices. During the post-pandemic Medicaid unwinding, millions of eligible people lost coverage simply because they didn't return paperwork or their state agency had outdated addresses.

For a deeper dive on the Medicaid work requirements, see our recent article: Medicaid Work Requirements Are Coming in 2027: How to Prepare Now.

Best for: Anyone whose income qualifies — especially people who lost marketplace subsidies and whose income is now below the Medicaid threshold. Also worth checking if you've had a recent job loss, reduction in hours, or other income change.

Watch out for: New work requirements and more frequent eligibility checks are coming. Not all states expanded Medicaid, so if you live in one of the 10 non-expansion states (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, or Wyoming), the income threshold is much lower and many adults without dependents don't qualify at all.

Before You Choose: A Decision Framework

The right alternative depends entirely on your situation. Here are the key questions to ask yourself:

How healthy are you? If you're generally healthy with no ongoing conditions, lower-cost options like catastrophic plans, DPC pairings, or even short-term plans may work. If you have chronic conditions, pre-existing diagnoses, or take regular medications, you need ACA-compliant coverage (marketplace or employer) that can't deny you or exclude your conditions.

How much financial risk can you absorb? A $10,600 deductible might be fine if you have an emergency fund. If a surprise $5,000 bill would derail you, a higher-premium plan with lower out-of-pocket costs might actually be cheaper in the long run. Use our True Cost calculator to model different scenarios based on how much care you actually expect to use.

Does your state offer additional help? Several states have created their own subsidy programs to soften the blow — Massachusetts, California, Maryland, Colorado, New Mexico, and others. Check your state's marketplace or our state pages for details.

Are you in a "coverage gap" state? In states that didn't expand Medicaid, people earning below 100 percent of the federal poverty level may not qualify for either Medicaid or marketplace subsidies — a situation known as the coverage gap. If this applies to you, community health centers that charge on a sliding scale may be your most practical option.

Have you actually priced out your 2026 marketplace options? Even without enhanced subsidies, the original ACA subsidies still exist for people earning between 100 and 400 percent of FPL. You may still qualify for some help — just not as much as before. Don't assume you're ineligible without checking. Use our subsidy calculator to find out.

The Bottom Line

There's no perfect replacement for the enhanced subsidies that expired in 2025. Every alternative involves tradeoffs — lower premiums come with higher risk, more flexibility comes with fewer protections. The worst decision is making no decision at all and going uninsured, which puts you one accident or diagnosis away from medical debt that can take years to recover from.

Start by checking what you qualify for. Then compare your real costs — not just premiums, but deductibles, out-of-pocket maximums, and the specific services you actually use. And if you're overwhelmed, reach out to a licensed navigator or insurance broker in your state. They can walk you through your options at no cost.

Your coverage situation may have changed, but your options haven't disappeared. They've just shifted.

This article is for informational purposes only and does not constitute insurance advice. Plans and availability vary by state. For personalized help, contact a licensed insurance agent or navigator in your area, or visit HealthCare.gov. Find plans available in your county on our county pages.

Sources: KFF, Centers for Medicare & Medicaid Services, Congressional Research Service, Internal Revenue Service, HealthInsurance.org, American Academy of Family Physicians, PeopleKeep, Peterson-KFF Health System Tracker