Jun 1, 2026
When Melanie Miller of Michigan learned her Affordable Care Act (ACA) marketplace premium would be almost tripling to $914 a month, the 59-year-old retired teacher stopped shopping on the exchange altogether.
Instead, she now pays $341 a month for two plans that together don’t meet federal standards for comprehensive coverage — one for routine care, another that pays flat amounts for hospital stays. If she winds up there, her plan pays $2,000 toward what can easily be a $30,000 bill.
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“I don’t gamble,” Miller told KFF Health News. “But I may as well. This is gambling.”
Miller is far from alone. As enhanced ACA premium tax credits expired at the end of 2025, millions of Americans have faced sharply higher costs — and many are turning to cheaper alternatives that carry serious financial risks.
The numbers tell the story
A recent KFF analysis found that the average ACA marketplace deductible grew 37% in a single year — from $2,759 in 2025 to $3,786 in 2026 — the largest increase in the program’s 12-year history.
Monthly premium payments climbed 58% on average, from $113 to $178. To cope, millions of enrollees downgraded from silver to bronze plans; bronze plan enrollment jumped from 30% to 40% of all marketplace sign-ups in one year. Meanwhile, silver plan enrollment, which offers lower out-of-pocket costs for lower-income enrollees, hit 43%, its lowest level on record.
Total marketplace enrollment dropped by more than a million people during the 2026 open enrollment period. KFF projects that effectuated enrollment could ultimately fall by 21.5% — from 22.3 million people in 2025 to roughly 17.5 million — as more enrollees fail to keep up with premium payments.
And a KFF survey found that 67% of marketplace enrollees said they would likely reduce spending on basic household needs if their annual health costs rose by $1,000.
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Alternatives Americans are turning to
Into that gap have stepped plans that offer lower premiums but far weaker protections.
These plans come in several forms: short-term policies, originally designed to cover temporary coverage gaps and typically excluding pre-existing conditions; fixed-indemnity plans, which pay flat amounts per service regardless of actual costs; and healthcare sharing ministries, faith-based arrangements where members pool funds to cover each other’s bills and which are not legally classified as insurance under federal or state law.
The growth is measurable. Zion HealthShare, a healthcare sharing ministry, reported more than 75,000 members in February — a 50% increase since last June, according to KFF Health News. Off-market marketing of fixed-indemnity plans also intensified ahead of this year’s enrollment period.
What can go wrong
The stakes couldn’t be higher.
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Jade Ramsey was 24 when she declined employer insurance because of cost and enrolled in a fixed-indemnity-style plan. Two weeks later, she was hospitalized for six days after being unable to walk. She was diagnosed with acute lymphoblastic leukemia, and her insurer denied $143,823 in bills, classifying her cancer as a pre-existing condition. She had no meaningful avenue post-appeal, the debt went to collections and her credit score collapsed.
Critics say situations like Ramsey’s are precisely what these plans are designed, inadvertently or not, to create.
According to a 2023 study, after reading a summary of a sample short-term policy and a disclosure that it wasn’t ACA-compliant, only half of participants understood that prescription drugs weren’t covered.
Read More: Dave Ramsey says this 7-step plan ‘works every single time’ to kill debt, get rich in America — and that ‘anyone’ can do it
Who’s regulating what
The regulatory picture varies enormously by state. The Trump administration stopped enforcing Biden-administration rules on short-term plan duration and marketing, and offered states a competitive edge in rural health funding if they did the same.
Kansas lawmakers overrode a governor’s veto in March to pass a tax break for healthcare sharing ministry enrollees; Florida, Arizona and Indiana have each given more time for short-term plan renewals.
On the other side, California and Massachusetts ban short-term plans outright and impose a tax on adults who refuse comprehensive coverage.
Making the insurance decision
Proponents argue that limiting these options pushes people toward being fully uninsured. “People should be able to spend their own money financing healthcare the way that works best for them,” Brian Blase, president of the Paragon Health Institute, told KFF Health News.
But for Ramsey, now in remission and still fielding calls from collection agencies, the message is simple: do your research and read the fine print.
“Make sure it’s covering what you need to be covered,” she warned. “It could be too good to be true.”
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With a writing and editing career spanning over 15 years, Emma creates and refines content across a broad spectrum of industries, including personal finance, lifestyle, travel, health & wellness, real estate, beauty & fitness and B2B/SaaS/tech.
