If you buy your own health insurance, you’ve probably felt overwhelmed. The options are confusing, the terminology is dense, and there’s no employer HR department to help you sort it out. This guide breaks down the three main paths, Marketplace health insurance, private health insurance, and health sharing memberships, so you can choose the right coverage with confidence and without overpaying.
Understanding the Three Main Types of Health Coverage
When you’re buying health insurance on your own, three main options exist. Each one works differently — and each fits a different kind of buyer. Understanding the basics helps you compare them clearly.
Marketplace health insurance (also called ACA plans or exchange plans) is sold through the federal or state Health Insurance Marketplace. These plans must cover a standard set of essential health benefits. They cannot deny you coverage or charge you more because of a pre-existing condition. And if your income qualifies, you may receive a premium tax credit to lower your monthly costs.
Private, non-marketplace health insurance includes both ACA-compliant plans sold outside the Marketplace and non-ACA-compliant options like short-term health coverage. These plans can be cheaper upfront. However, they may exclude pre-existing conditions, cap your benefits, or skip essential coverages entirely. Understanding what you’re getting (and what you’re not) is critical before you enroll.
Health sharing memberships are not insurance at all. They are community-based programs where members contribute monthly and share each other’s eligible medical costs. Membership programs like those available through Planstin typically cost 50–70% less than traditional insurance premiums. They offer no network restrictions — you choose your own providers. But they operate under a completely different framework than regulated insurance, and those differences matter.
Marketplace Health Insurance: Strong Protections and Possible Savings
If you qualify for financial help, the Marketplace may offer your best value. Premium tax credits reduce your monthly premium based on your household income relative to the federal poverty level (FPL).
For 2026, a single person earning around $31,300 (200% of FPL) pays no more than 6.60% of their income toward their premium after the credit applies. A family of four earning around $64,300 — also at 200% of FPL — has the same cap. At lower income levels, cost-sharing reductions on Silver plans can also slash your deductible and out-of-pocket costs significantly.
Marketplace plans also cap your total out-of-pocket spending each year. For 2026, that limit is $10,600 for an individual and $21,200 for a family. Once you hit that cap, your plan covers 100% of covered costs for the rest of the year. Or, on some silver, gold, or platinum plan, your out-of-pocket maximum will be lowered.
Marketplace plans are a strong fit if your income falls below 400% of FPL or if you have ongoing health needs. Explore your options on our Marketplace Health Insurance page.
Private Health Insurance: More Flexibility, More Trade-Offs
Not everyone qualifies for Marketplace subsidies. And not everyone wants an ACA plan. That’s where private health insurance comes in.
ACA-compliant plans sold outside the Marketplace offer similar protections — but without access to premium tax credits. If your income is too high to qualify for subsidies, buying directly from a carrier or working with an independent broker can sometimes offer more plan variety. For some buyers, this is the right move.
Non-ACA-compliant plans, like short-term health plans or fixed indemnity policies, cost less each month. That’s their main appeal. But the trade-offs are real. These plans may decline applicants with certain health conditions, exclude maternity or mental health benefits, and impose limits on how much they’ll pay for a single illness. They suit people who need a lower monthly cost and accept more risk in exchange.
Private plans can work well for someone in good health who understands exactly what their plan covers — and what it doesn’t. The key is reading the fine print before committing. Our Private Health Insurance page explains more about how these plans work and when they make sense.
Health Sharing Memberships: Affordable, Flexible, and Different
Health sharing memberships have grown quickly among self-employed individuals and families — and high premiums are a big reason why. When traditional coverage costs $800–$1,200 per month or more for a family, people naturally look for alternatives.
Here’s how they work. Members pay a monthly amount called a share or contribution. When a member faces a significant medical expense, the group pools resources to cover eligible costs. The experience feels similar to insurance in some ways. But the legal and regulatory framework is completely different.
Programs through Planstin Membership combine health sharing with telehealth, mental health support, and prescription savings. Membership tiers let you choose the level of coverage that fits your needs and budget. Monthly costs are typically 50–70% lower than comparable insurance premiums. And unlike network-restricted insurance, you can visit any provider you choose.
The trade-offs are worth understanding clearly. Health sharing memberships are not insurance. They are not regulated by state insurance departments. They don’t have to cover pre-existing conditions, and some programs impose waiting periods before sharing certain costs. Member contributions are shared (not legally guaranteed) so there’s an element of community trust involved. In some states, health sharing memberships do not satisfy the requirement to carry “minimum essential coverage.”
Health sharing works best for people who are generally healthy, want to reduce their monthly costs, and value the freedom to choose their own providers. Learn more on our Health Sharing Memberships page.
How to Choose the Right Coverage for Your Situation
There’s no single right answer — and that’s actually reassuring. The best plan depends on your income, health needs, budget, and comfort with risk. Here’s a clear way to think through it.
Start with income. If your household income falls below 400% of the federal poverty level, check Marketplace plans first. The premium tax credits and cost-sharing reductions may make them your most affordable and most protective option. If your income is higher or subsidies don’t apply, private insurance or a health sharing membership may deliver better value for your dollar.
Next, consider your health. If you have ongoing prescriptions, regular specialist visits, or a chronic condition, a plan with strong and predictable coverage matters more. Marketplace and ACA-compliant private plans offer those protections by law. If you’re generally healthy and rarely see a doctor, health sharing or a leaner private plan may meet your needs at a much lower monthly cost.
Finally, think about your priorities. Do you need guaranteed coverage for pre-existing conditions? Choose a Marketplace or ACA-compliant plan. Do you want the freedom to see any provider? Health sharing and some private plans offer that. Do you want to keep monthly costs as low as possible? Health sharing or short-term plans may fit (with a clear understanding of the trade-offs involved).
The worst option is no coverage at all. One unexpected hospitalization can easily cost $50,000 or more out of pocket. Even an imperfect plan provides meaningful financial protection.
Putting It All Together
Marketplace plans, private insurance, and health sharing memberships each serve a different kind of buyer. There’s no one-size-fits-all formula. What all three have in common: the more clearly you understand your options, the better your decision will be — for your health and your budget.
At Groberg Insurance Advisors, we help self-employed individuals, families, and small businesses find the right coverage at the right price. We educate first and recommend second — because you deserve to make an informed choice, not a pressured one.
Ready to find coverage that actually fits your life? Book an appointment with us today and let’s find the right plan for your situation — together.
