The individual health market is evolving rapidly, and for many agents, the Affordable Care Act (ACA) has become the foundation of their client strategy. But while ACA plans offer guaranteed issue coverage and essential health benefits, consumers are often faced with limited networks, very high deductibles, and soon, they are likely to see increased premiums. That’s why now, more than ever, agents need to broaden their approach.
Clients are facing complex financial and health care realities, and one-size-fits-all coverage no longer works. Whether it’s a gap in affordability, a lack of provider access, or specific supplemental needs, the ability to offer a diverse portfolio of plans helps agents stay competitive, build deeper client relationships, and protect their book of business from market shifts, and competing agents.
And a major shift is on the horizon. The enhanced subsidies introduced by the American Rescue Plan and extended through the Inflation Reduction Act are currently set to expire in 2026. If Congress does not intervene, millions of consumers who previously benefited from generous tax credits may find their ACA premiums unaffordable. That means agents must be prepared to present creative, budget-conscious options that meet client needs without breaking the bank.
These remain the gold standard for clients who qualify for subsidies or need comprehensive protection, especially those with pre-existing conditions. But for those priced out or not qualifying for financial help, alternative coverage may be more appropriate.
Short-Term Medical (STM) plans have evolved significantly in recent years and can serve as an excellent option for clients in a variety of situations. These plans typically offer lower monthly premiums than ACA coverage, with flexible enrollment year-round and next-day effective dates.
For healthy individuals who don’t qualify for subsidies, STM plans can provide meaningful protection against unexpected illnesses and injuries. They are ideal for clients who are between jobs, self-employed, aging off a parent’s plan, or waiting for employer coverage to begin.
STM plans also appeal to clients who prefer to pay out-of-pocket for routine care and want coverage in place only for serious medical events. Many STM options now include value-added features such as telehealth, mental health support, prescription discounts, and even limited preventive care benefits.
While these plans are not required to cover essential health benefits and may have eligibility requirements, they offer an important level of protection at a price point that may be more realistic for middle-income or uninsured consumers. With thoughtful positioning, STM can be a practical and empowering option for clients who value choice and affordability.
Fixed indemnity plans are one of the most flexible tools agents can offer. These plans pay set cash benefits directly to the policyholder for covered medical events, such as hospital stays, surgeries, doctor visits, or diagnostic services. Because the benefits are paid regardless of what the provider charges, clients can use the money however they choose, whether to pay a bill, cover a deductible, or simply keep their finances afloat during a health event.
These plans are especially helpful for clients with high-deductible health coverage, whether through an ACA or Group medical plan. They can also serve as a strong standalone option for healthy clients who want a safety net but may not need full major medical coverage.
The simplicity and transparency of indemnity plans make them easy to understand and sell. Clients appreciate knowing in advance what their benefits are, and agents appreciate the year-round sales opportunities and strong retention.
No one plans to break a leg or have a heart attack, but consumers can plan for the potential financial impact. That’s where accident and critical illness plans shine. These policies pay a lump-sum benefit when a covered event occurs, offering fast financial relief at a time when clients need it most.
These plans are highly affordable and can be layered on top of any health coverage, from ACA to STM. For younger individuals and families with active lifestyles, accident plans ensure that sports injuries, falls, or other unexpected mishaps, don’t turn into costly setbacks. Critical illness plans are particularly valuable for clients with a family history of serious conditions such as cancer, stroke, or heart disease.
What makes these plans stand out is their flexibility. Benefits can be used for medical bills, lost income, travel for treatment, or any other purpose. They’re also simple to quote and issue, and they open the door to meaningful conversations about financial protection, leading to stronger, long-term client relationships.
These ancillary products are consistently in demand, especially among families and older adults. Including them in a coverage package boosts client satisfaction and retention, and they are typically available to sell year-round.
With more remote workers, international students, and part-time expats, global coverage is gaining relevance. These plans are particularly helpful for digital nomads, snowbirds, or missionaries who need care across borders.
These programs are not insurance but can appeal to select clients seeking lower-cost options aligned with their beliefs or preferences. While not for everyone, understanding them allows agents to answer questions accurately and responsibly. Being knowledgeable about these and other alternative coverage options positions the agent as a well-rounded, trusted resource, someone who educates rather than sells and earns greater respect from clients as a result.
AHCP offers a full suite of individual health products across dozens of carriers, along with quoting tools, training, and marketing materials designed to help agents confidently offer bundled solutions. Whether your clients are subsidy-eligible or not, we can help you craft the right mix for their needs.
We also monitor and share select regulatory updates so you can stay ahead of subsidy changes, carrier updates, and compliance shifts.
As the individual market evolves and affordability challenges grow, agents who rely solely on ACA plans may find themselves losing clients. By offering a wider range of products, you can stay relevant, meet clients where they are, and thrive in any policy environment.
Now is the time to audit your portfolio, identify gaps, and prepare for what’s next. Clients are counting on you for options. Make sure you have them.