With Congress struggling to reach an agreement on extending Affordable Care Act subsidies and the enrollment window already closed, many Americans are beginning the new year without the financial help that once made health insurance affordable.
For some, this is a sudden change. For others, it’s familiar territory.
People who relied on enhanced ACA subsidies may now face premiums they simply can’t manage. At the same time, many individuals who never qualified for subsidies because of income levels — but still found coverage unaffordable — remain uninsured or underinsured. As costs rise, more people are asking the same question:
If full insurance isn’t realistic right now, what are my other options for getting care?
While none of the alternatives fully replace comprehensive insurance, several models can help people stay connected to care, manage routine health needs, and reduce costs — especially for those who are relatively healthy but still need medications, preventive care, or treatment for common illnesses.
Direct Primary Care: Paying for Access, Not Insurance
One option gaining attention is Direct Primary Care (DPC). Instead of billing insurance, patients pay a flat monthly fee directly to a primary care doctor, typically ranging from $60 to $120 per month.
That fee usually covers office visits, preventive care, basic labs, and chronic condition management. For people who need regular care for conditions like high blood pressure, diabetes, or asthma, DPC can offer predictable costs and easier access.
However, DPC does not cover hospital care, emergency services, or surgery. Many patients use it alongside catastrophic insurance — or on its own, accepting the risk of major medical expenses.
Limited-Benefit and Wellness Programs
Another category includes limited-benefit or wellness-based programs, often offered through associations, chambers of commerce, or employers. These programs typically bundle services such as telehealth access, mental health support, pharmacy discounts, and care navigation. Some also include supplemental insurance products like accident, critical illness, or life coverage.
These plans can help reduce everyday health expenses and provide support when navigating care, but they are not ACA-compliant insurance and do not cover hospitalization or major medical events. The key for consumers is understanding exactly what is — and is not — included before enrolling.
Urgent Care and Retail Clinics
For relatively healthy people who only need care occasionally, urgent care centers and retail clinics remain a common fallback. These clinics can treat colds, infections, minor injuries, and basic illnesses, usually on a self-pay basis.
Costs vary but often range from $75 to $200 per visit. While this pay-as-you-go approach avoids monthly premiums, expenses can add up quickly without ongoing care or discounts for medications.
Community Health Centers
Federally Qualified Health Centers (FQHCs) and community clinics continue to play a critical role for uninsured and underinsured patients. These nonprofit clinics offer care on a sliding scale based on income and provide primary care, preventive services, and some mental health support regardless of insurance status.
Access can depend on location, and wait times may be longer, but for many families, these clinics are the most affordable way to receive consistent care.
Telehealth Subscriptions
Telehealth-only subscription services have also expanded. For a modest monthly fee or per-visit charge, patients can access virtual care for common illnesses, prescription refills, and basic mental health support.
These services are best suited for people who rarely need in-person exams and want quick access for straightforward issues. They are not appropriate for emergencies or complex medical needs.
Managing Medication Costs
For people whose biggest expense is medication, pharmacy discount programs can offer meaningful savings. Programs such as discount cards, online pharmacies, and transparent pricing models can reduce costs for many generic medications — sometimes dramatically.
These programs don’t replace medical care, but they can make prescriptions more affordable for people managing chronic conditions without insurance.
A Patchwork Reality — For Now
As Congress debates whether to revisit ACA subsidies after its break, millions of Americans are left making short-term decisions in a system that often requires patchwork solutions.
None of these options provide the full protection of comprehensive insurance. But for people navigating higher premiums, lost subsidies, or long-standing affordability challenges, understanding the differences can help prevent gaps in care — or costly misunderstandings.The most important step is clarity: knowing whether a program provides medical care, financial protection, or simply access and discounts. In an uncertain policy environment, informed choices matter more than ever.