Somehow, at some point, Amy Killelea’s name must have ended up on a list — they get texts all the time now from brokers selling health insurance. 

Texts that often start out something like this: “Are you looking for cheap coverage with an unlimited provider network?” 

And because Killelea is a research professor at Georgetown University’s Center on Health Insurance Reforms, and a consumer advocate to the National Association of Insurance Commissioners, they almost always answer, “Of course I am. I would love to learn more.” 

For research. 

Killelea’s first question is always: “Can you tell me, is this an ACA [Affordable Care Act] regulated marketplace plan?” 

To which they said brokers often respond, “I can tell you about marketplace plans, but I also want to talk to you about plans that we have that are on our private exchange.” 

That is a red flag — there is no such thing as a private exchange. 

“That’s a made-up term,” Killelea said. “And they’re using the term ‘exchange’ because that is another term for the marketplace. So right away, you’re confusing the consumer.”

It is a confusing and stressful time for many consumers who are trying to make decisions about their health insurance plans for next year. There is now virtually no chance Congress will extend the enhanced subsidies millions of people have been getting for the last few years to buy insurance through Affordable Care Act marketplaces, which for many means their premiums are set to double, triple or quadruple for 2026. 

That has left some people looking for cheaper alternatives to ACA insurance. And if you spend some time on social media platforms, search engines, or on the phone with certain brokers, it might seem like such alternatives exist. 

Killelea has had phone calls where brokers are telling them about ACA plans, and said, “they lift it up as like, ‘wow, it’s so expensive you can’t afford that I bet. Let’s look over here at this other coverage that’s going to be so much cheaper.’”

But Killelea said the reality is, health insurance that is cheaper than what you can find on Healthcare.gov or your state’s exchange, the holy grail that so many people are looking for right now, does not exist. 

The various options that might seem like alternatives — short-term limited-duration plans, direct primary care, health care sharing ministries, or fixed indemnities — do not offer comprehensive medical coverage, Killelea said, nor do they protect you from massive medical bills should the worst happen. 

According to Lucy Culp, vice president of state government affairs at the nonprofit Blood Cancer United, people often don’t realize that. 

“With all of these plans, we see marketing that really is confusing,” she said. “They use a lot of the same words, they use words like premiums, like deductibles, like cost sharing, co-pays, co-insurance, all of the terms that we’re used to seeing in comprehensive insurance we might get through an employer, but they really are like a completely different type of thing.”

Take “excepted benefit” or “fixed indemnity” plans, which Killelea has had brokers offer up as a cheaper alternative to an ACA plan. 

“These are things that were kind of originally designed to be like a supplement,” Culp said. “So, if you were hospitalized, that plan would pay you to help with those out-of-pocket costs that your insurance might not cover.”

But if you just bought a fixed indemnity plan and didn’t otherwise have insurance, it might pay you a set amount per night, maybe $100 or a few hundred dollars if you were admitted to the hospital, but it wouldn’t pay your actual hospital bills — you would be on the hook for those, which could easily be many thousands of dollars. 

Then there are short-term, limited duration plans, which were designed to tide you over for a few months if you were maybe between jobs. Now, in many states, you can buy them for longer periods, so they can seem, on the surface, like a cheaper, viable alternative to an ACA health plan.

“But because they aren’t subject to the ACA’s patient protections,” Culp said, “they have pretty limited benefits, they can deny coverage for pre-existing conditions.”

ACA plans cannot deny coverage for pre-existing conditions. They also have to cover ten essential health benefits, including preventive screenings, maternity care, emergency room visits and prescription drugs. Short-term plans do not.

Joshua Brooker, a broker in Pennsylvania, and chair of the individual markets at the National Association of Benefits and Insurance Professionals said, “the big thing I always try to explain: anything outside of the Affordable Care Act means that it unchecks something.”

Meaning it won’t cover one, or all, of those essential health benefits we have all come to expect from insurance. 

And with alternatives far outside of the insurance world, like health care sharing ministries, where you pay into a pot with lots of other people and then submit medical bills and ask the group to pay them, Brooker said there are no guarantees, and no recourse if your bills do not get paid.

Amy Killelea at Georgetown understands why people are looking for cheaper options outside the marketplaces, especially now, with ACA premiums rising, but said buying anything other than a traditional health insurance plan would be taking a big risk. 

“That one, your insurance product, whatever you bought, is what it says it is, that you were sold something that you understood what it was, and it is what you think it is,” she said.

And two, that nothing major is going to happen to you: no cancer diagnosis, no heart attack, no car accident. 

“That’s an order of one too many risks for me,” Killelea said. “I think I would choose, still, the regulated markets.”

However imperfect and expensive they may be. 

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