ACA price hikes spark ‘alternative’ plan marketing blitz

Modern Healthcare – Tuesday, February 3, 2026
By Nona Tepper

Huge premium increases on the health insurance exchanges mean opportunity for companies selling cheaper, skimpier plans.

Companies such as UnitedHealth Group, Medi-Share, CrowdHealth and LendingTree flooded social media platforms, advertised on radio and promoted products such as short-term, limited duration plans and Christian sharing ministries. The campaigns targeted consumers, especially young adults, who found they couldn’t afford exchange coverage or don’t perceive value in comprehensive medical insurance.

These forms of health coverage don’t have to meet the benefit and coverage rules from the Affordable Care Act of 2010 and aren’t eligible for subsidies. But in an era of sky-high exchange premiums and a regulatory environment friendlier to ACA plan alternatives, they may play a growing role in the healthcare system.

The advertisements emphasize low monthly premiums, first-dollar coverage of at least some services, and the lack of prior authorizations and other irksome features of traditional insurance. They do not dwell on the facts that these plans can exclude people with preexisting conditions or charge them more, may not cover services such as maternity or mental health, and aren’t compatible with the ACA’s premium tax credits.

The expiration of enhanced subsidies for exchange plans this year is a major factor. Net premiums for subsidized enrollees more than doubled, according to an analysis from the health policy research group KFF.

Predictably, this has resulted in a drop-off in health insurance exchange enrollment, according to preliminary data the Centers for Medicare and Medicaid Services published last week.

Nearly 23 million people selected plans, down 5% from a year before, CMS reported. That figure doesn’t include complete tallies from several states and does not reflect what share of enrollees have effectuated their coverage with premium payments.

Some of those who opted out of exchange coverage looked elsewhere to avoid being entirely uninsured.

Short-term, hospital indemnity plans

UnitedHealth Group subsidiary UnitedHealthcare and others incentivized agents and brokers to direct consumers to short-term plans and hospital indemnity coverage.

UnitedHealthcare’s Golden Rule Insurance division ran a campaign dubbed “The Comeback,” which offered volume-based bonuses to marketers for selling those plans, according to a flyer the company distributed to brokers in September. They are paid more to enroll customers in these policies than in exchange plans. UnitedHealth Group did not respond to an interview request.

LendingTree also promoted short-term plans ahead of the exchange sign-up period, said Talon Abernathy, health insurance research analyst at the financial services clearinghouse website. The company had mixed results.

When the news about ballooning exchange premiums broke in August, visits to LendingTree’s short-term plans landing page doubled, Abernathy said. Then it tapered off, he said.

“It’s because short-term health insurance is an inferior product. It doesn’t come close to the coverage you get through the ACA,” Abernathy said. “Once people actually went on HealthCare.gov or a state health exchange, they see they’re not getting as good of a deal.”

Sharing ministries

Sharing ministries, typically Christian, pool money from members to pay health claims. This type of coverage typically costs less than health insurance. Members are not guaranteed that their bills will be covered, people with preexisting conditions can be excluded, benefits can be capped on an annual or lifetime basis, and members are required to adhere to Christian beliefs.

Medi-Share, a Christian sharing ministry, saw a chance to grow this year and targeted consumers in regions where rising premiums were mostly likely to drive people away from the exchanges, said Marq James, chief sales and marketing officer.

The sharing ministry produced radio segments and partnered with social media influencers to tout the alternative to exchange coverage, James said. The company also aimed its digital and print advertising toward consumers who searched from terms like “faith-based healthcare options,” he said.

“We had a great open enrollment, one of our best across our 30-plus years,” James said. Medi-Share’s membership grew to 350,000 members during the annual sign-up period, 60% above what the company projected, he said.

Crowdsourcing

Subscribers to the healthcare crowdfunding startup CrowdHealth more than doubled to 25,000 this year, founder and CEO Andy Schoonover said.

“Health insurance plans are treating their customers right now as if they are enemies and not their allies, and people are looking for alternatives to really expensive ACA-based health insurance,” Schoonover said. “There’s opportunities there.”

Exchange risk worries

Whatever the advantages and disadvantages of exchange plans versus alternate forms of coverage, people quitting the government-run marketplaces could have consequences, said JoAnn Volk, co-director of the Georgetown University Center on Health Insurance Reforms.

People with the greatest healthcare needs, who are the costliest to cover, are unlikely to go without comprehensive coverage, but younger adults who don’t utilize much healthcare may see a better value in plans with lower monthly costs.

That could prove troublesome for exchange insurers, who may see their risk pools worsen when other forms of coverage lure away their customers, Volk said. “By design, they are just going to select away healthier individuals,” she said.

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