6 Healthcare Coverage Options When Your Job Doesn't Offer Insurance

COBRA Continuation Coverage

Monthly Cost: $600-$2,000+ (102% of your former employer's full premium)

What It Is

COBRA lets you keep your exact employer health plan for up to 18 months after leaving your job (36 months for certain qualifying events). You pay the full premium plus a 2% administrative fee.

The Sticker Shock Reality

The average employer-sponsored health insurance costs:

• Individual coverage: $8,951/year ($745/month)
• Family coverage: $25,572/year ($2,131/month)

Under COBRA, you pay 102% of these amounts. That $50/month employee contribution suddenly becomes $760/month for individual coverage or $2,174/month for family coverage.

Source: Kaiser Family Foundation, "2024 Employer Health Benefits Survey" https://www.kff.org/health-costs/report/2024-employer-health-benefits-survey/

Pros

• Keep your exact same coverage and doctors
• No waiting periods or new deductibles if mid-year
• Coverage starts immediately (retroactive to separation date)
• No medical underwriting

Cons

• Extremely expensive (you see the true cost of healthcare)
• Maximum 18-month duration in most cases
• Must elect within 60 days of qualifying event
• Ends if you miss a single payment

Best For

• Short gaps (1-3 months) with sufficient savings
• Mid-year job changes when you've met your deductible
• Complex medical situations requiring continuity of care
• High earners who value keeping their exact providers

Action Step

Before leaving your job, get the exact COBRA cost from HR. Compare it to Marketplace options—you might be shocked at the difference.

Short-Term Health Insurance

Monthly Cost: $100-$200 (but barely qualifies as insurance)

What It Is

Short-term plans provide temporary coverage for 3-12 months (varies by state). They're medically underwritten and can deny coverage for pre-existing conditions.

Coverage Gaps—The Devil in the Details

Short-term plans typically exclude:

• Pre-existing conditions
• Maternity care
• Mental health services
• Substance abuse treatment
• Prescription drugs (or very limited)
• Preventive care

Fourteen states plus DC prohibit or severely restrict these plans: California, Colorado, Connecticut, Hawaii, Illinois, Maine, Massachusetts, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, and Washington.

Source: Commonwealth Fund, "State Regulation of Short-Term Health Plans" https://www.commonwealthfund.org/publications/maps-and-interactives/state-regulation-short-term-health-plans

Pros

• Cheap monthly premiums
• Quick approval (often same day)
• Some coverage better than none
• Can choose coverage periods

Cons

• Doesn't cover anything important
• Can deny claims for "pre-existing conditions" discovered after enrollment
• No out-of-pocket maximum requirements
• Doesn't satisfy ACA requirements
• Banned or restricted in 14 states

Best For

• Young, healthy individuals with no health conditions
• Very temporary gaps (1-3 months maximum)
• People who literally cannot afford anything else
• Bridge coverage while waiting for other insurance to start

Red Flag Warning

Some short-term insurers retroactively cancel coverage if you get sick, claiming you had an undisclosed pre-existing condition. Read exclusions extremely carefully.

Action Step

If considering short-term coverage, read the entire policy exclusions list. If you have ANY health conditions, these plans likely won't cover related care.

Health Sharing Ministries

Monthly Cost: $200-$500 ("sharing amounts," not premiums)

What It Is

Faith-based organizations where members share medical costs. This is not insurance—it's a voluntary agreement to help pay each other's medical bills. No guarantees, no regulatory oversight, no legal obligation to pay claims.

Major Health Sharing Ministries

• Medi-Share: ~400,000 members, requires statement of faith
• Samaritan Ministries: $200-$596/month depending on plan
• Christian Healthcare Ministries: $150-$450/month per unit
• Liberty HealthShare: Entered bankruptcy proceedings in 2021

Source: Alliance of Health Care Sharing Ministries Data and Statistics, 2024. Total membership across Alliance ministries: 692,251 Americans as of 2024.

How Sharing Works

1. You pay monthly "share amount" to ministry
2. When you have medical needs, you submit bills
3. Ministry decides if it's "shareable" based on their guidelines
4. If approved, they direct other members' payments to you
5. Many exclude "non-Biblical lifestyles," require church attendance

What's Often Not Shareable

• Pre-existing conditions (usually 12-36 month waiting periods)
• Mental health care
• Preventive care
• Injuries from "hazardous activities"
• Pregnancies outside marriage
• Alcohol-related injuries

Pros

• 30-50% cheaper than traditional insurance
• Some offer negotiation help with providers
• Faith-based community support
• Exempt from ACA individual mandate (when it existed)

Cons

• Zero guarantee of payment—ever
• Can change sharing guidelines anytime
• No state insurance department protection
• Several have gone bankrupt, leaving members with unpaid bills
• Discriminatory membership requirements
• Long waiting periods for pre-existing conditions

Best For

• Religious families with strong emergency funds
• Healthy individuals who rarely need care
• People philosophically opposed to traditional insurance
• Those who understand and accept the risks

Critical Warning

Multiple health sharing ministries have failed to pay members' bills or gone bankrupt. In 2021, Sharity Ministries (formerly Trinity HealthShare) shut down, leaving approximately 10,000 families with an estimated $50-300 million in unpaid medical bills according to court documents. Liberty HealthShare faces multiple class-action lawsuits for unpaid claims.

Sources: Christianity Today, "Health Care Sharing Ministry Sharity Leaves 10K Families with Millions in Unpaid Bills," April 2022 • Denver Post, "Liberty HealthShare bankruptcy leaves members with millions in medical bills" https://www.denverpost.com/2021/07/01/liberty-healthshare-bankruptcy/

Action Step

If considering health sharing, verify the ministry's payment history, read complaints with state attorneys general, and maintain an emergency fund equal to your annual maximum.

Spouse or Parent Coverage

Monthly Cost: $200-$600 (additional premium for adding you)

What It Is

Getting coverage through a family member's employer-sponsored or individual health plan. The ACA requires plans to cover children up to age 26, regardless of student status, marital status, or financial dependency.

Under 26? Your Parents' Plan

• Must be offered if parent has family coverage
• Employer-sponsored plans: Coverage ends last day of month you turn 26
• Marketplace/ACA plans: Coverage through December 31 of year you turn 26
• Costs your parents approximately $200-$400/month extra
• Works even if you're married, not in school, or not claimed as dependent

Source: U.S. Department of Labor, "Young Adult Coverage" https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/faqs/young-adult-and-aca

Spouse's Employer Plan

Adding a spouse to employer coverage typically costs:

• Small employers: +$500-$700/month
• Large employers: +$300-$500/month
• Total family premium averages $25,572/year (2024)

Source: Kaiser Family Foundation, "2024 Employer Health Benefits Survey"

Domestic Partner Coverage

Some employers offer coverage for domestic partners. Requirements vary but often include:

• Shared residence for 6-12 months
• Financial interdependence
• Affidavit of domestic partnership
• Note: Domestic partner benefits are taxable income (unlike spouse coverage)

Pros

• Group rates typically better than individual
• Employer often subsidizes portion
• No medical underwriting
• Comprehensive benefits
• Simple enrollment process

Cons

• Tied to family member's employment
• Must wait for their open enrollment period (unless qualifying event)
• Adds to their premium costs
• May lose if relationship status changes

Best For

• Anyone under 26 with insured parents
• Married couples where one has employer coverage
• Domestic partners with progressive employers

Action Step

Check during your family member's open enrollment (typically November-December). Adding you mid-year requires a qualifying life event like marriage, birth, or loss of other coverage.

Direct Primary Care + Bronze HDHP

Monthly Cost: $455-$550 before tax benefits ($349-$374 after HSA savings starting 2026)

What It Is

A two-part strategy that splits your healthcare needs:

1. Direct Primary Care (DPC): $75-$100/month membership for unlimited primary care
2. Bronze High-Deductible Health Plan: $380-$420/month for catastrophic protection

This combination provides better primary care access than traditional insurance while protecting against financial catastrophe—and starting January 2026, becomes fully tax-advantaged.

The 2026 Game-Changer Nobody's Talking About

The "One Big Beautiful Bill Act" (signed July 4, 2025) includes a provision that revolutionizes this strategy. Starting January 1, 2026:

• DPC membership fees become HSA-eligible expenses (up to $150/month individual, $300/month family)
• You can contribute to an HSA while having both DPC and HDHP
• All Bronze and Catastrophic Marketplace plans automatically become HSA-qualified

This eliminates the current "DPC tax penalty" that disqualifies DPC members from HSA contributions, potentially saving you $1,275/year in taxes.

Source: H.R.1, 119th Congress, Section 71308, "One Big Beautiful Bill Act of 2025"

What DPC Includes

Based on analysis of 2,649 DPC practices nationwide:

• Unlimited office visits (no copays)
• 30-60 minute appointments (vs. 7-20 minutes traditional)
• Same-day/next-day access (92% of practices)
• 24/7 doctor access via phone/text/email
• Wholesale medications (50-90% below retail—metformin for $0.36/month)
• Basic procedures (EKGs, sutures, joint injections)
• Chronic disease management without deductible barriers

Source: DPC Frontier Mapper, https://mapper.dpcfrontier.com (2,649 practices listed as of 2025)

Real Cost Breakdown

Without tax benefits (current 2025 rules):

• DPC membership: $75-$100/month
• Bronze HDHP: $380-$420/month
• Total: $455-$520/month

With HSA tax benefits (starting January 2026):

• Gross cost: $455-$520/month
• HSA tax savings (22% bracket): -$106/month
• Net cost: $349-$414/month

For someone in the 22% federal tax bracket maximizing HSA contributions ($4,300 individual, $8,550 family), annual tax savings reach $1,275—more than covering the entire year of DPC membership.

Source: IRS Revenue Procedure 2024-25 (HSA contribution limits)

What Each Component Covers

Your DPC Membership Handles:

• Diabetes, hypertension, thyroid management
• Acute illnesses (strep, flu, UTIs)
• Minor injuries and procedures
• Preventive care and wellness
• Medication management
• Mental health support (basic)

Your Bronze HDHP Handles:

• Emergency room visits
• Hospitalizations
• Specialist care
• Surgery
• Cancer treatment
• Advanced imaging (MRI, CT)
• Catastrophic events (capped at $8,300 out-of-pocket maximum)

The Evidence Is Compelling

Studies show DPC delivers:

• 25% fewer hospitalizations (unadjusted basis)
• Reduced emergency department usage
• Decreased specialist and diagnostic utilization
• 95th percentile patient satisfaction (vs 90th traditional)
• 45-minute average appointments in real-world practices

Source: Society of Actuaries/Milliman, "Direct Primary Care: Evaluating a New Model of Delivery and Financing," May 2020. https://www.soa.org/resources/research-reports/2020/direct-primary-care/

Pros

• Best primary care access available
• Predictable costs
• No insurance hassles for routine care
• Catastrophic protection included
• Tax-advantaged starting 2026
• Actually develops relationship with your doctor

Cons

• High deductible for specialist/hospital care ($6,650-$8,300)
• Must coordinate two separate systems
• Specialist referrals can be complicated
• Not available in all areas (though reaching all 50 states)
• Requires financial cushion for potential deductible

Best For

• Healthy individuals earning above subsidy thresholds (400% FPL = $62,600)
• People with chronic conditions manageable by primary care
• Self-employed/entrepreneurs who value time and health
• Anyone frustrated with 7-minute doctor visits
• Those who can afford potential $8,300 out-of-pocket maximum

Geographic Availability

DPC has expanded to all 50 states with 2,600+ practices, though density varies:

• Well-served: Texas (9+ networks), Florida, Colorado, Kansas
• Growing: California, Washington, North Carolina
• Limited but present: Vermont, Wyoming, Alaska

Find practices near you at: https://mapper.dpcfrontier.com

Action Steps

1. Find a DPC practice: Use DPC Frontier Mapper to locate nearby practices
2. Compare Bronze HDHPs: Check Healthcare.gov during open enrollment (Nov 1 - Jan 15)
3. Calculate your tax savings: Factor in your tax bracket and HSA contributions
4. Schedule a DPC consultation: Most offer meet-and-greets to explain their model
5. Open an HSA: Choose a provider like Fidelity or HSA Bank (can contribute until April 15 for prior year)