2025 Average Unsubsidized Premiums (40-Year-Old):

• Bronze: $381–$488/month
  
  

• Silver: $486–$621/month
  
  

• Gold: $507–$676/month
  
  

• Platinum: ~$913/month

Key Benefits of ACA Plans:

• Guaranteed coverage — No one is denied for pre-existing conditions
  
  

• Comprehensive benefits — Includes 10 essential services like hospitalization, prescriptions, maternity, mental health, and preventive care
  
  

• No lifetime or annual limits
  
  

• Subsidies available — Enrollees may qualify for premium tax credits, 70% pay $10 or less/month after subsidies
  
  

• Cost-sharing reductions — Lower deductibles and out-of-pocket costs for low- to moderate-income individuals

Medically Underwritten Major Medical Plans

• Full-featured health insurance, typically PPO-style
  
  

• Lower premiums for healthy individuals
  
  

• Often include nationwide provider networks
  
  

• Requires health screening; can deny coverage or charge more based on health history
  
  

• Offers strong benefits, often with lower deductibles than ACA plans
  
  

Short-Term Health Insurance

• Temporary coverage lasting 30 days up to 364 days (varies by state)
  
  

• Intended for gaps between major coverage (job change, missed open enrollment, etc.)
  
  

• Covers unexpected medical events
  
  

• Limited benefits: usually excludes maternity, pre-existing conditions, mental health, and prescriptions
  
  

Fixed Indemnity Plans

• Pays set cash amounts per medical service (e.g., $75 per doctor visit, $1,000 per hospital day)
  
  

• No deductibles; you get paid regardless of your provider’s billed charges
  
  

• Best used to supplement other plans or as a budget-friendly option for low users of care
  
  

• Does not meet minimum coverage standards under the ACA
  
  

Limited Benefit & Supplemental Health Programs

• Offers cash payouts for specific conditions or services (e.g., hospital stays, surgeries, cancer, accidents)
  
  

• Often includes bundled extras like dental, vision, or telemedicine
  
  

• Does not offer comprehensive major medical coverage, but helps cover unexpected out-of-pocket costs
  
  

Catastrophic Health Plans (Non-ACA)

• Designed for emergency-only coverage
  
  

• High deductible, low monthly premium
  
  

• Intended to protect against financial ruin from serious medical events
  
  

• May not meet ACA essential coverage standards
  
  

Health-Sharing Ministries

• Non-insurance, faith-based programs where members share each other’s medical bills
  
  

• Lower monthly costs
  
  

• No legal guarantee that claims will be paid
  
  

• Typically excludes coverage for pre-existing conditions, prescriptions, mental health, or services that don’t align with the organization’s values
  
  

Direct Primary Care (DPC) Memberships

• Monthly subscription to a primary care provider or clinic
  
  

• Covers unlimited office visits, basic labs, and sometimes urgent care
  
  

• Does not cover hospitalization, specialists, or major medical services
  
  

• Often used in combination with indemnity or catastrophic plans
  
  

Telemedicine + Discount Benefit Programs

• Not insurance, but provides discounted rates on doctor visits, prescriptions, lab work, imaging, and more
  
  

• Typically includes unlimited 24/7 virtual care access
  
  

• Useful for people who want low-cost access to basic care but do not need full insurance
  
  

• May be bundled with dental, vision, or lifestyle benefits

📅 When Can You Enroll?

• ACA Open Enrollment: Nov 1 – Jan 15 (some states extend beyond Jan 15)
  
  

• ACA Special Enrollment Period (SEP): Available year-round if you experience a qualifying life event, such as:
  
  

  • Loss of job-based insurance
    
    

  • Marriage, divorce, or birth of a child
    
    

  • Moving to a new state
    
    

  • Loss of Medicaid or CHIP
    
    

  • Becoming a U.S. citizen

⚠️ Important: You must have had previous ACA coverage to qualify. 

• Private/non-ACA plan Enrollment: Most plans are available year-round, especially if medically underwritten or short-term.

🧭 How to Choose the Right Plan

Before choosing, consider the following:

• Your income – Do you qualify for ACA subsidies?
  
  

• Your health – Do you have pre-existing conditions or take regular prescriptions?
  
  

• Your preferred doctors and hospitals – Are they in-network?
  
  

• Your risk tolerance – Can you handle a higher deductible in exchange for lower premiums?
  
  

• Flexibility needs – PPOs offer broader access but typically cost more; HMOs are more affordable but have limited networks.