M&M Wealth Associates, Fountain Valley, CA
The Frustration Is Real
If you’re a small to mid business owner, freelancer, independent contractor, or early retiree, basically anyone who buys your own health insurance; you have likely felt or will feel the result of significant rising premiums.
With ACA subsidies set to expire at the end of 2025, millions of Americans are facing 2x, 3x, even 10x increases in their monthly premiums. For many, it is not just frustrating, it is unsustainable and unreasonable.
We are not here to vent, we’re here to help because while the healthcare system may be limited, your options are not. There are alternative options and solutions that are economically smarter and more human-centered to protect your health and your finances, and we are here to walk you through them.
Executive Summary, this guide covers:
- The healthcare affordability crisis affecting self-employed individuals and families
- Alternative coverage options like Direct Primary Care, cost-sharing memberships, and catastrophic plans with clear definitions and honest tradeoffs
- A hybrid strategy that combines affordable care access with financial protection, including policies with accelerated benefit riders aka living benefits
The Crisis We’re All Feeling
If you don’t have employer-sponsored health insurance, you’ve probably relied on the ACA marketplace. And until now, enhanced federal subsidies helped keep those premiums manageable.
These subsidies started during Covid but starting January 2026, those subsidies are gone and insurers have already priced in the change. This means:
- A plan that cost $200/month could now cost $2,000 or more!
- Deductibles are climbing past $9,000 per year
- Coverage gaps are widening, even as costs explode
These changes will hit hardest for:
- Entrepreneurs and small business owners trying to protect their families and their teams
- Freelancers and gig workers with unpredictable income and no HR department
- Early retirees who need coverage until Medicare kicks in
- Middle-income earners who make “too much” for subsidies but not enough to absorb $10K+ in annual premiums
It’s not just a financial problem. It’s an emotional one. And it’s forcing people to rethink everything.
Exploring Alternatives: What’s Out There?
Let’s define the most talked-about options and provide honest input about what they do and don’t cover.
Direct Primary Care (DPC): A membership-based model where you pay a flat monthly fee ($50–$150) for unlimited access to a primary care provider. No insurance billing. No copays. No surprise bills.
What it covers: Routine care, labs, telehealth, chronic condition management, and emotional continuity with your doctor.
What it doesn’t: Specialists, hospitalizations, emergencies, surgeries.
Cost-Sharing Memberships (e.g., Zion Health, Sedera): A community-based model where members share each other’s medical expenses. Not insurance, but often more affordable.
What it covers: Major medical events like surgeries, hospital stays, and accidents. Often includes negotiation support and flexible provider choice.
What it doesn’t: Guaranteed payouts. Pre-existing conditions may be excluded or delayed. Not ACA-compliant.
Catastrophic Insurance Plans: ACA-compliant plans designed for worst-case scenarios. Available to those under 30 or with hardship exemptions.
What it covers: Essential health benefits after a high deductible (often $9,000+). Includes preventive care and a few primary visits.
What it doesn’t: Routine care before the deductible. Flexibility. Affordability for many
High-Yield Savings Accounts (HYSA): A savings account earning 4–5% interest, used to self-insure or cover out-of-pocket costs.
What it covers: Whatever you choose to spend it on (such as deductibles, prescriptions, emergencies).
What it doesn’t: Protection against large, unexpected medical bills. It’s not insurance.
BONUS: Looking for more than just a savings account? For those exploring advanced strategies, there are tax-advantaged tools like Indexed Universal Life (IUL) or Whole Life (WL) policies that offer liquidity, protection, and long-term growth. These often have living benefits built in. We’ll explore these options in your strategy session to see if they’re a fit for your goals.
The Hybrid Strategy: Smart, Modular, Human-Centered
Here is the approach we believe deserves serious consideration, especially for those who feel priced out of traditional coverage.
The Hybrid Setup
First, DPC for routine care. This keeps you healthy, supported, and out of the ER
Second, cost-sharing membership or catastrophic plan for major events. This protects against financial ruin in case something big happens.
Third, term life insurance with living benefits. This provides insurance protection when you need it most allowing access up to 90% of your death benefit protecting your other savings
Fourth, HYSA or advanced cash value policy (IUL/WL) with living benefits. This bridges deductibles and unexpected costs with tax-advantaged growth
What Are Living Benefits?
Living benefits (also called accelerated benefit riders) are built into many modern life insurance policies. They allow you to access part of your death benefit while you’re still alive if you experience:
- Terminal illness (e.g., life expectancy under 12–24 months)
- Chronic illness (e.g., unable to perform 2+ activities of daily living)
- Critical illness (e.g., cancer, stroke, heart attack)
- Critical Injury (e.g. coma, severe burn, traumatic brain injury)
This income tax-free money can be used to:
- Pay your catastrophic deductible
- Cover out-of-network or alternative care
- Replace household income during recovery
- Fund long-term care without draining retirement assets
Living benefits inside of life insurance policies (term, WL, IUL) is not just another insurance policy, it is a financial tool that’s designed to safeguard your dignity; and it’s unfortunately often overlooked.
Our Final Thoughts
We know this is overwhelming. But you don’t have to navigate it alone.
At M&M Wealth Associates, we specialize in mapping out emotionally intelligent and financially resilient strategies for people who don’t fit the corporate mold such as yourselves: entrepreneurs, freelancers, early retirees, and families who want real protection without bloated premiums.
Whether you’re exploring DPC, worried about rising costs, or curious about how life insurance can protect your family beyond death, we’re here to help.
Book a complimentary strategy session today.
We’ll walk through your current setup, identify gaps, and recommend practical next steps including retirement planning, insurance structuring, and liquidity strategies tailored to your life.
Written by Michael Henry and Matthew Wu, MBA — Certified Retirement Counselors and life/health insurance licensed agents.