3 Alternative Health Plans Texans Can Use To Ditch The ACA Exchange

The gut-check moment for Sarah came when she opened her health insurance renewal notice and saw the new number. Sarah, like a lot of dedicated small business owners in Texas, has relied on the ACA Exchange to cover her family over the past few years. She was doing the best she could to balance premium costs with running her company in Austin.

Sarah is watching the news about the government shutdown fights and has heard the rumblings about federal subsidies expiring. But nothing prepared her for the reality of a massive, double-digit price increase that made her stomach drop.

She’s now looking at her budget, her business plan, and the well-being of her family near the Domain, and she’s forced to ask a question no one should have to. How can I still afford a health insurance plan for my family this year?

Sarah isn't the only one feeling this pain. What she experienced isn't just a rate increase; it's the financial fallout of the changes hitting the wallets of Texans. For years, the government helped keep these premiums artificially low for a huge swath of the middle class, but that is now set to disappear.

Why the Health Insurance Market is Shaking

Many Texans are just now realizing that their lower premiums were due to subsidies and cost-sharing reductions for qualifying health coverage through the Affordable Care Act exchange. Losing them means premium payments and health care costs could jump dramatically for Sarah and others.

The massive price hikes that Sarah and others are seeing are truly a "one-two punch" of rising Obamacare plan costs and the loss of those enhanced premium tax credits we call subsidies. This situation has created an urgent need to find a stable, cost-effective solution outside the volatile Federal Health Insurance Marketplace.

That uncertainty and the lackluster health care coverage has made what felt like an affordable plan turn into an inferior, expensive product. It is important to know that you don't have to choose between affordability and peace of mind.

The New Healthcare Playbook: Three Better Alternative Health Plans For Texans

Whether you're in Austin like Sarah or up in Amarillo, you do have choices for health benefits available to you that you may not realize. If you don't qualify for ACA subsidies and you're ready to stop dealing with the headaches and price increases of the ACA Exchange, you have excellent options. We've identified three strategies that offer better value, more stable coverage, and predictable pricing than the Federal Health Insurance Marketplace is currently providing.

1. Fully Underwritten Private Health Plans

For years, the gold standard of insurance has been a major medical policy that was fully vetted by the carrier. If you and your family are generally healthy, why should you have to pay the higher premiums required to offset the risk of a pool of people who may have issues? You shouldn't. This option is often the best fit for Texans who want a return to predictable rates and better benefits.

These private health insurance plans are the closest thing to the robust, traditional insurance policies that were common before the ACA. Since the insurer gets a clearer picture of your health upfront, they can offer a superior product at a better price.

Here's how fully underwritten private health plans work for Texans.

• Major Medical, Outside the Exchange: These are major medical policies sold directly by private insurance companies, and entirely outside the ACA Exchange. This means you are not subject to the same rules which can make coverage vary by company.
• Health Status Matters: These plans are fully underwritten, meaning your health status is considered during the application process. As a result, some Texans won't qualify due to pre-existing conditions. But this underwriting is what allows the carrier to offer more stable and favorable premiums for those who do.
• The Best Value for Healthy Texans: If you are relatively healthy and someone who doesn't get ACA subsidies, these plans will likely provide a lower premium for the same (or better) level of coverage. They also often have broader provider networks compared to an unsubsidized Marketplace Bronze or Silver plan.
• Long-Term Stability: Unlike short-term plans, these are designed to be stable and long-term, which is a big relief from the year-to-year chaos of Open Enrollment on the Marketplace.

2. Direct Primary Care (DPC) + Catastrophic Plans

Health insurance doesn't need to cover everything. It is meant to protect you from the financial fallout of major, unexpected events. Your routine visits, flu shots, and physicals are really small costs you can easily budget for, especially if you don't use them a lot. A Catastrophic Health Insurance Plan is a safety net for wipeout medical bills when they occur.

This strategy splits healthcare into two parts—routine care and major unexpected disasters—maximizing cost control while minimizing financial risk. This approach is great for Texans who prefer complete cost control over their everyday health while being shielded from financial disasters.

Here is how to structure this dual approach:

• Direct Primary Care (DPC): This is a membership model where you pay a fixed, affordable monthly fee (like a gym membership) directly to your doctor. You get unlimited access to your doctor for routine needs, often including appointments, preventative care, and basic labs. Did we mention no co-pays? It handles most of your typical medical needs, eliminating the hassle of deductibles and co-pays. And you have direct access to your doctor.
• Catastrophic Plans (Major Medical Coverage): These are major medical policies found outside the ACA Exchange. They typically have a very low monthly premium and cover the major events that involve hospitals and long term treatment plans. They are your financial fortress, priced with favorable terms and pricing because they are only designed to protect you from the big things.
• The Benefit of Pairing: This combination is a powerful way to manage your total cost of risk. You get predictable monthly primary care costs in a much better experience, and shield your assets from a "wipeout" medical bill. And it keeps your total expenses lower than many traditional, comprehensive plans.

3. Limited Benefit Plans (Hospital/Surgical, Critical Illness, Accident)

We understand that many Texans just do not go to the doctor very often. Sarah considered herself one of these people. They don't see the need to have routine care or a relationship with a primary care physician. But that doesn't mean you can just go without health insurance.

Limited benefit health plans can allow you to customize which type of major care is really important to you. These plans provide defined, specific coverage for major risks like accidents, critical illnesses or a surgery. They offer protection against large, condition-specific bills without the complexity of a major medical policy.

Unlike simple hospital indemnity plans, these policies can cover specific medical bills, rather than pay a lump sum.

Here is what these targeted coverage options can do for you:

• Targeted Coverage for Events: These are supplemental policies that offer specific coverage for medical bills related to clearly defined conditions or events. This includes hospital stays, a specific surgery, cancer treatment, or an accident.
• How They Pay: They function like highly specific insurance policies. They will pay for the expenses of covered events up to a set maximum amount when a covered event occurs. They are not major medical insurance, but they provide financial protection in the areas you deem most likely to occur.
• Essential Financial Shield: Sarah could see these plans working as hospital insurance for the entire family, or as accident insurance while her kids played sports. And since she had a history of cancer in the family, have critical Illness insurance to cover treatment seemed practical.

Don't Let the Chaos Define Your Coverage Options

You don't have to let political uncertainty force you into an expensive and inferior individual health insurance renewal. You don't have to wait for the open enrollment period since these three options are available today.

When you work with an independent health insurance agent to review your Total Cost of Risk, you can make decisions that can be long term solutions for your family.

That solution includes not just the monthly premium, but what you will owe for out-of-pocket costs for a major event. By evaluating your options, you can design a custom solution that actually protects your family and your future.

Don't guess which plan is right for your unique situation. Our local agents can help you navigate this changing market and find stability.

Click the button below to find the right health coverage for you and your family outside of the chaos.