Healthcare costs are a major concern for Americans, and health insurance premiums are a primary fuel for that anxiety.

Shrinking federal subsidies for Affordable Care Act plans led to large premium increases for millions of Americans in 2025, causing many people to drop coverage. With premiums expected to rise further and Medicaid work requirements set to begin in January 2027, many Americans are left scrambling for affordable options.

We are health economists who study public policies aimed at expanding health insurance coverage. When it comes to our own health insurance, we are fortunate: We are among the roughly 160 million Americans who receive coverage through their employers.

But if you don’t work for a large employer that provides health benefits, finding coverage for your family can be confusing and, increasingly, expensive.

People looking for low-cost alternatives have no doubt encountered several options. They may look appealing and, in some cases, may be appropriate, but they can also carry real risks.

Historically, people who didn’t have access to employer-sponsored coverage had limited health insurance options. Before the Affordable Care Act went into effect in 2014, insurers could charge you a higher premium based on your health status, exclude coverage for preexisting medical conditions, or deny you coverage altogether.

The ACA eliminated this kind of discrimination , established a minimum standard of 10 essential benefits that health insurance plans had to cover, and required plans to fully cover the cost of preventive care. It also introduced income-based subsidies that could be used to purchase coverage in newly established online marketplaces .

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