How to Shop for Health Insurance: 4 Ways to Buy Coverage (and Which One Wins)

Most people think there is one place to buy health insurance. There are actually four, and the gap between them can be hundreds of dollars a month for the exact same person. Here are all four ways to shop, the honest pros and cons of each, and which one usually wins if you are healthy and buying your own coverage.

Way 1: Employer Group Plans

If your job offers health insurance, this is the default choice for a good reason: your employer pays a large share of the premium, and the plan is guaranteed issue, meaning your health history does not matter and nothing can be excluded.

• Best for: W-2 employees whose company covers a meaningful part of the premium.
• Pros: Employer subsidy, guaranteed acceptance, covers pre-existing conditions, payroll deduction with pre-tax dollars.
• Cons: Only available if your employer offers it, tied to your job, one-size-fits-all plan design, and family coverage is often expensive because employers frequently subsidize the employee only.

If you are a business owner rather than an employee, this is a tool you can offer your team, see our small business group health insurance options.

Way 2: The ACA Marketplace

The Affordable Care Act marketplace (Healthcare.gov and off-exchange equivalents) is where most people without a job-based plan shop. Its defining feature is that it is guaranteed issue and covers pre-existing conditions, and if your income qualifies, you may receive a premium tax credit.

• Best for: People with pre-existing conditions, and anyone who qualifies for meaningful subsidies (generally under 400% of the federal poverty level).
• Pros: Cannot deny or price you on health, comprehensive essential benefits, subsidies for those who qualify. Use our free subsidy calculator to estimate yours.
• Cons: Since the enhanced subsidies expired at the end of 2025, premiums jumped and anyone over 400% of poverty lost subsidies entirely, so an unsubsidized ACA plan can be very expensive. Networks are often narrow. Here is what changed and why.

Way 3: Short-Term Plans

Short-term health plans are exactly what they sound like: temporary, lower-cost coverage meant to bridge a gap, for example, between jobs or before a new plan starts. They are medically underwritten (they ask health questions) and are cheap because they cover less.

• Best for: A short, defined gap in coverage when you are healthy and need something in place fast. See coverage between jobs.
• Pros: Low premiums, fast approval, flexible start dates.
• Cons: Not comprehensive, they typically exclude pre-existing conditions, cap benefits, and may not cover essentials like maternity or prescriptions. They are a bridge, not a long-term home.

Way 4: Medically Underwritten Plans

This is the option most people have never had explained to them, and for a healthy buyer, it is often the one that wins. A medically underwritten plan asks about your health history up front and prices your coverage based on your actual health. Because a healthy applicant is a lower risk, the insurer can offer a substantially lower premium than a guaranteed-issue ACA plan, frequently with strong, comprehensive benefits and broader national networks.

• Best for: Healthy individuals and families, especially self-employed workers, owner-operators, and 1099 drivers who earn too much to get meaningful ACA subsidies and are tired of paying full, unsubsidized marketplace rates.
• Pros: The lowest premiums available to a healthy person, often richer benefits and wider networks than short-term plans, and real coverage you can keep, not just a temporary bridge.
• Cons: You answer health questions to qualify, so it is best suited to people without significant pre-existing conditions. It is not the right fit for everyone, which is exactly why it should be compared against a marketplace plan before you decide.

⚡ Not sure which fits you? Take the 60-second quiz →

The Four Ways, Side by Side

How to Actually Choose

You do not have to figure this out alone, and you should not try to, because the right answer depends on two things that are personal to you: your health and your income. The process is simple with a broker:

1. We look at whether you qualify for a meaningful ACA subsidy. If you do, and especially if you have health conditions, a marketplace plan may be your best value.
2. If you are healthy and earn too much for real subsidy help, we run a medically underwritten plan alongside it and compare the actual numbers.
3. You pick the winner. Same coverage goals, lowest real cost.

Because we are an independent brokerage, we are not tied to one carrier or one type of plan, and our help is free to you, because carriers pay us, not you.

Frequently Asked Questions

What are the ways to shop for health insurance?

There are four main ways to buy coverage: through an employer group plan, through the ACA marketplace (on or off exchange), through a short-term plan, or through a medically underwritten plan. Employer and ACA plans are guaranteed issue; short-term and medically underwritten plans ask health questions but can cost far less for a healthy applicant.

What is a medically underwritten health insurance plan?

A medically underwritten plan asks about your health history before you enroll, and prices your coverage based on your actual health. For a healthy applicant, that usually means a significantly lower premium than a guaranteed-issue ACA plan, often with strong benefits. The tradeoff is that it is best suited to people without significant pre-existing conditions.

Which type of health insurance is cheapest?

For a healthy person who does not qualify for large ACA subsidies, a medically underwritten plan is often the lowest-cost comprehensive option, because underwriting lets the insurer offer healthy applicants a better rate. If you qualify for significant ACA subsidies or have major health conditions, a marketplace plan may cost less overall. A licensed broker can compare both for you, free.

Is a medically underwritten plan better than the ACA marketplace?

For healthy, self-employed people and owner-operators who earn too much to get meaningful ACA subsidies, a medically underwritten plan is frequently the best value, lower premiums and solid benefits. For people with significant pre-existing conditions, or those who qualify for large subsidies, an ACA plan is usually the safer choice because it cannot deny or exclude based on health. The right answer depends on your health and income, which is exactly what a broker checks.