If your job doesn't offer health insurance, you're probably stressed about what to do next. Take a breath—you have more options than you think, and most people qualify for help they don't know about.
You're far from alone: 64.7% of uninsured workers are employed by companies that simply don't offer benefits. Whether you're self-employed, working for a small business, or between jobs, this guide will walk you through your best options in about 15 minutes.
Source: Kaiser Family Foundation, December 2024
One important reminder: Any coverage beats no coverage. Medical debt remains the leading cause of bankruptcy, so the goal is to get protected first—you can always optimize your plan 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? Start with last year's tax return and adjust for any changes this year. Subsidies use your "Modified Adjusted Gross Income" (MAGI)—but don't let the jargon scare you. For most people, MAGI is simply your total household income before standard deductions. If you're unsure, estimate slightly high to avoid owing money back at tax time.
Path A: The Subsidized Path
Income under $62,600 individual / $128,600 family
Your Best Options (In Priority Order)
Medicaid Can Cover Bills From the Past 3 Months
Had an ER visit or hospitalization recently? This is the opportunity most people miss: Medicaid coverage is retroactive. If you qualify, it can pay for medical bills you've already received—potentially saving you $10,000 or more.
Income limits (2025):
- Expansion states: Up to $21,597 (individual) / $44,367 (family of 4)
- Non-expansion states: Limits vary widely—often much lower
- Pregnant women and children often have higher limits
What to do: Apply at Healthcare.gov or your state Medicaid office. It takes about 20 minutes, and even if you're not sure you qualify—apply anyway. There's no penalty for checking.
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
What is DPC? Direct Primary Care (DPC) is a membership model where you pay your doctor a flat monthly fee—typically $75-100—for visits included in your membership, longer appointments, and direct access via text or phone. Think of it like a gym membership for primary care. It's not insurance, so you still need a separate plan for hospitalizations and specialists.
Don't assume you can't afford it. 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 routine 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
Already Have a Medical Bill?
Even with the right coverage, billing errors happen. Our AI scans your itemized bill in seconds to find overcharges, duplicates, and coding mistakes.
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
Direct Primary Care (DPC) is a monthly membership with a doctor—flat fee, routine visits included, no insurance hassles. Pair it with a high-deductible plan for catastrophic coverage.
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 covers routine 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 events create special enrollment periods—but you only have 60 days to act
Did any of these happen to you recently?
- Lost job or employer coverage
- Turned 26 (or will soon)
- Moved to a new area
- Had a baby or got married/divorced
If so, count 60 days from that event—that's your deadline to enroll. Miss it and you'll wait until next November's Open Enrollment.
🎂 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)
DPC (Direct Primary Care) is a flat-fee doctor membership—typically $75-100/month for routine visits and direct text/phone access.
- 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
COBRA vs. Marketplace—which is right for you?
| Choose COBRA if... | Choose Marketplace if... |
|---|---|
| You're mid-treatment with specific doctors | Your income dropped (you may now qualify for subsidies) |
| You need to keep your current network | COBRA costs more than $500/month |
| You can afford $600-2,000/month | You're healthy and can switch networks |
| You expect to find new employer coverage soon | You want to explore DPC options |
Important: You can elect COBRA up to 60 days after losing coverage, and it's retroactive. This gives you a "safety net"—if you have a medical emergency before enrolling in a new plan, you can elect COBRA after the fact to cover it.
📦 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
Don't Overpay on Your Medical Bills
Up to 30% of medical bills contain errors. Whether you're newly insured or paying out-of-pocket, our AI spots overcharges and billing mistakes instantly.