No employer health insurance? You're not alone—64.7% of uninsured workers are employed by companies that don't offer health benefits. Whether you're self-employed, working for a small business, or between jobs, you need coverage now. This guide cuts through the confusion with specific action steps based on your situation.
Source: Kaiser Family Foundation, "Key Facts about the Uninsured Population," December 2024 (using 2023 data). https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/
Remember: Any coverage beats no coverage. Medical debt remains the leading cause of bankruptcy. Pick something, even if imperfect, then optimize next year.
Start Here: Find Your Path
Which describes you best? Choose the path that matches your situation:
Path A:
Qualify for help - income under $62,600 (single) or $128,600 (family)
Path B:
Income over $62,600 (single) or $128,600 (family)
Path C:
Qualifying events - Lost job, turning 26, moving, having a baby
Not sure about your income? Use last year's tax return as a starting point, then adjust for changes. For subsidies, it's your Modified Adjusted Gross Income (MAGI) that matters.
Path A: The Subsidized Path
Income under $62,600 individual / $128,600 family
Your Best Options (In Priority Order)
Check Medicaid First. It's Retroactive!
The opportunity everyone misses: Medicaid can cover medical bills from the past 3 months if you would have been eligible. This could save you thousands on recent emergency room visits or hospitalizations.
Income limits vary by state:
- Expansion states: Up to 138% of Federal Poverty Level ($21,597 individual / $44,367 family of 4)
- Non-expansion states: Varies widely, often much lower
- Some states have higher limits for pregnant women and children
Action step: Apply at Healthcare.gov or your state Medicaid office. It takes 20 minutes and could save you $10,000+ on recent bills.
Source: Code of Federal Regulations, Title 42, Section 435.915 - "Retroactive coverage." https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-435/subpart-J/subject-group-ECFR8fa41d2938b8fd6/section-435.915
Silver Plans With Subsidies—The Sweet Spot
If you earn between $20,000-$60,000 (individual), Silver plans offer the best value:
At $30,000 income (age 40):
- Silver plan: ~$49/month after subsidies
- Deductible: Often reduced to $500-$1,500 (vs $6,000+ standard)
- Maximum out-of-pocket: Reduced to ~$3,000
At $50,000 income:
- Silver plan: ~$200/month after subsidies
- Still includes cost-sharing reductions if under 250% FPL
Critical detail: You MUST choose a Silver plan to get cost-sharing reductions. Bronze and Gold don't qualify even if you're income-eligible.
Sources:
- Kaiser Family Foundation, "Health Insurance Marketplace Calculator," 2025. https://www.kff.org/interactive/subsidy-calculator/
- Centers for Medicare & Medicaid Services, "Cost-Sharing Reductions," 2025. https://www.healthcare.gov/lower-costs/save-on-out-of-pocket-costs/
DPC + Bronze HDHP—Better Care, Similar Cost
Don't assume you can't afford Direct Primary Care. Even with subsidy eligibility, the math can work:
The surprising math at $40,000 income:
- Subsidized Bronze plan: ~$120/month
- Add DPC: +$75-100/month
- Total: $195-220/month
- Compare to: Subsidized Silver at ~$150/month
What you get for the extra $45-70/month:
- 30-60 minute appointments (vs 7-15 minutes)
- Same-day or next-day access
- 24/7 doctor availability via text/phone
- Wholesale medications ($3 vs $30)
- No copays for unlimited visits
Starting January 2026: HSA tax benefits kick in, saving you another $40-80/month if you can contribute to an HSA, potentially making DPC + Bronze CHEAPER than Silver alone.
Sources:
- H.R.1 - "One Big Beautiful Bill Act," 119th Congress (2025), Section 71308. https://www.congress.gov/bill/119th-congress/house-bill/1
- IRS Revenue Procedure 2024-25, "2025 HSA Contribution Limits." https://www.irs.gov/publications/p969
Action boxes:
- Calculate your exact subsidy → Takes 2 minutes
- Find DPC practices near you → 2,600+ practices nationwide
Path B: The Optimization Path
Income over $62,600 individual / $128,600 family
When you don't qualify for subsidies, traditional insurance becomes expensive. Here's how to optimize.
Your Best Options (In Priority Order)
DPC + Bronze HDHP - The Clear Winner
The math without subsidies:
- Bronze HDHP: $380-420/month
- DPC membership: $75-100/month
- Total: $455-520/month
- After 2026 HSA tax savings: $350-415/month net cost
Compare to alternatives:
- Unsubsidized Silver: $497/month (with worse access)
- Unsubsidized Gold: $587/month
- COBRA: $600-2,000/month
Why this wins for healthy high earners:
- Better primary care than any insurance plan offers
- Protected against catastrophic events
- HSA triple tax advantage
- Predictable costs
- No insurance hassles for routine care
Real example: A 35-year-old software engineer in Austin pays $85/month for DPC + $395/month for Bronze HDHP = $480/month total. With HSA contributions in the 24% tax bracket, the effective cost drops to $367/month. His DPC includes unlimited visits, and he pays $4 for a 90-day supply of his allergy medication.
Sources:
- DPC Frontier Mapper, "Direct Primary Care Practice Mapper." https://mapper.dpcfrontier.com
- Healthcare.gov, "See 2025 health insurance plans & prices." https://www.healthcare.gov/see-plans/
- Example based on Texas DPC practices including Euphora Health (Austin). https://euphorahealth.com
Bronze Plan Alone—If You Never See Doctors
When this makes sense:
- You haven't seen a doctor in 2+ years
- No medications
- Just want catastrophic protection
- Saving every dollar possible
Cost: $380-420/month
Reality check: One primary care visit costs $150-200 applying to your deductible
Spouse/Partner Coverage—If Available
The math on adding to spouse's plan:
- Small employer: +$500-700/month
- Large employer: +$300-500/month
- Total family premium: ~$2,131/month average
When it's worth it:
- Employer covers most of the additional premium
- You need specific specialists in their network
- You have complex medical needs
Source: Kaiser Family Foundation, "2024 Employer Health Benefits Survey," October 2024. https://www.kff.org/health-costs/report/2024-employer-health-benefits-survey/
Path C: Special Timing Situations
These create special enrollment periods outside normal November-January window
🎂 Turning 26—Your Healthiest Years Need Smart Coverage
Your timeline:
- Employer-sponsored plans: Coverage ends on the last day of the month you turn 26
- Marketplace/ACA plans: Coverage lasts through December 31 of the year you turn 26
- 60 days before and after losing coverage to enroll in new Marketplace plan
- Can use parent's address for subsidy calculation if still dependent
Source: U.S. Department of Labor, "Young Adult Coverage Under the Affordable Care Act." https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/faqs/young-adult-and-aca
Your best options at 26:
Option 1: DPC + Catastrophic Plan (Under-30 exclusive)
- Catastrophic plans: ~$350-370/month average (only available under 30)
- Add DPC: $75/month
- Total: $425-445/month
- Perfect for healthy 26-year-olds who want doctor access via text
- Note: Premium subsidies cannot be used with catastrophic plans
*Sources:
- Healthcare.gov, "Catastrophic health insurance plans," 2025. https://www.healthcare.gov/choose-a-plan/catastrophic-health-plans/
- ValuePenguin, "Is Catastrophic Health Insurance Right for You?" 2025. Average cost $361/month.*
Option 2: Stay on Parent's Plan
- Costs them: $200-400/month extra
- Worth it if: They're willing to pay and you need specific specialists
Option 3: DPC + Bronze HDHP
- Total: ~$350-450/month depending on location
- Builds HSA savings early (huge benefit compounding over time)
Action: Start shopping 30 days before birthday. Don't wait until you age off.
🚨 Just Lost Your Job—You Have Options
Your critical timeline:
- 60 days to elect COBRA (can be retroactive)
- 60 days for Marketplace special enrollment
- Medicaid available immediately if income dropped
Source: U.S. Department of Labor, "FAQs on COBRA Continuation Health Coverage for Workers," 2025. https://www.dol.gov/sites/dolgov/files/ebsa/about-ebsa/our-activities/resource-center/faqs/cobra-continuation-health-coverage-for-workers.pdf
📦 Moving to New Area
Your opportunity: Moving triggers special enrollment + potential cost savings
Price variations to consider:
- Vermont Silver: $1,277/month
- New Hampshire Silver: $325/month
Action before moving:
- Check new area's Marketplace prices
- Research DPC availability
- Consider state Medicaid if moving to expansion state
Timeline: 60 days after move to enroll
Source: Healthcare.gov, "Qualifying Life Event (QLE) - Moving to a new home." https://www.healthcare.gov/glossary/qualifying-life-event/
👶 Pregnancy or Planning—Special Rules Apply
If pregnant:
- Immediate special enrollment in all states
- Medicaid income limits often higher (up to 200-300% FPL)
- Coverage can be retroactive
If planning:
- Enroll during Open Enrollment for January 1 coverage
- Choose Gold plan if possible (lower deductibles)
- DPC generally doesn't cover prenatal/delivery
Source: Healthcare.gov, "Having a baby? You can sign up for health insurance." https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/
How to Actually Enroll
Documents You Need Ready
For Healthcare.gov:
- Social Security Number
- Income documentation (pay stubs, tax return, or self-employment ledger)
- Current coverage information (if any)
- Employer coverage info (even if not taking it)
For DPC Enrollment:
- Insurance card (for your HDHP)
- Medication list
- Medical history summary
- Payment method for monthly membership
Estimating Income—The Most Critical Step
If employed:
- Use year-to-date pay stub
- Project forward including expected bonuses
- Include spouse's income
If self-employed:
- Use last year's Schedule C as baseline
- Adjust for known changes
- Can use bank statements if needed
Critical: Underestimating income means paying back subsidies. Overestimating means missing out on help. Update if income changes more than 10%.
When Coverage Actually Starts
Marketplace plans:
- Enroll by 15th of month → Coverage starts 1st of next month
- Enroll after 15th → Coverage starts 1st of month after next
Source: Healthcare.gov, "When coverage starts & ends," 2025. https://www.healthcare.gov/quick-guide/dates-and-deadlines/
DPC membership:
- Usually starts immediately upon payment
- Some practices prorate first month
COBRA:
- Retroactive to day after employment ended
- Must pay all back premiums
Source: Department of Labor, "COBRA General Notice," 2025. https://www.dol.gov/sites/dolgov/files/ebsa/laws-and-regulations/laws/cobra/model-general-notice.pdf
Payment Timing Gotchas
Common mistakes:
- Marketplace requires first payment before coverage starts
- Auto-pay sometimes fails first month—set reminder
- DPC bills separately from insurance
- HSA contributions can't exceed annual limit even if starting mid-year