Living in a State That Bans STM: Your Four Real Alternatives
The four paths
1. ACA marketplace with subsidy math. Run the numbers before assuming it’s expensive — a 30-year-old at $38,000 income often nets a silver plan under $150 after credits, and bronze can approach $0. 2. Medicaid. In expansion states, incomes up to ~$21k (single) qualify year-round. 3. Association health plans and health share ministries — not insurance, and exclusions can be harsher than STM, but they fill gaps. 4. Fixed-indemnity mini-meds — still legal in ban states in many cases, paying cash per service rather than covering percentage of bills.
How to pick
If your income is under 250% of the federal poverty level, the marketplace after subsidies usually beats everything else. Between 250-400%, compare silver-after-subsidy against the cheapest legal gap product. Above 400%, ACA prices sting — which is exactly why ban-state residents build the fixed-indemnity + accident combo.
| Option | Typical cost | Type | Watch out |
|---|---|---|---|
| Marketplace (subsidized) | $0-250 | Full ACA benefits | Income-dependent |
| Medicaid (expansion) | $0 | Full coverage | Income cap ~$21k single |
| Health share / AHP | $90-200 | Membership model | Not guaranteed |
| Fixed indemnity | $40-90 | Cash per service | Huge gaps |
FAQ
Is health sharing legal in ban states?
Yes — sharing ministries are regulated as memberships, not insurance, so STM bans don’t reach them.
Can fixed indemnity replace real insurance?
No — treat it as a cash cushion layered on something else.
When does the ACA special enrollment window close?
Usually 60 days from the qualifying event; moving and losing coverage both qualify.