ACA Alternatives for 1099 Workers: 5 Real Options Compared

Before reading any of this, get your actual subsidised marketplace price. Every option below is only interesting if the marketplace comes back expensive for you.

1. A spouse's employer plan

If your partner has employer coverage, joining it is almost always the cheapest option available, because their employer is subsidising it. Check this before anything else. Losing your own coverage is usually a qualifying event that lets you join mid-year.

2. A flat-priced group plan

Priced by household size rather than age, sold outside open enrollment, from $269 a month. The trade-offs are a twelve-month commitment, a twenty-four month wait if you cancel early, and a narrower network than a large marketplace carrier. Not a marketplace plan and not subsidised.

3. A short-term medical plan

Cheap and genuinely temporary. These can decline you for pre-existing conditions, may exclude prescriptions and maternity entirely, and are restricted or banned in several states. Reasonable for a two-month gap, dangerous as a long-term plan.

4. A health care sharing ministry

Members contribute to each other's bills. It is not insurance, there is no legal obligation to pay your claim, and most require agreement with a statement of faith. Some people are very happy with them. Understand that there is no regulator behind the promise.

5. Virtual-only care

Around $60 a month for unlimited video visits. Genuinely useful for prescriptions, minor illness and mental health, and genuinely not a substitute for hospital coverage. Best used alongside something that covers a serious event, not instead of it.

The honest summary

If you qualify for a subsidy, take it. If you do not, the flat-priced group route is the most conventional of the alternatives. Everything else on this list involves giving up a protection you may not realise you have.