As health insurance premiums for next year rise and threaten to push hundreds of thousands of Mississippians off plans, a “perfect storm” is brewing that could steer people towards riskier coverage options, experts warn. 

About 200,000 Mississippians are expected to drop their Affordable Care Act Marketplace coverage if Congress does not vote to extend the enhanced premium tax credits that make coverage more affordable for over 22 million Americans. Mississippi is expected to see one of the steepest dropoffs in health coverage among all states.

People who are seeking affordable coverage options may be drawn to plans that “walk and talk” like traditional health insurance, but don’t have to follow ACA rules, local and national experts told Mississippi Today. These alternatives — including short-term limited duration, fixed indemnity, Farm Bureau and health care sharing ministries — are not required to cover people with preexisting conditions and may not provide maternity, prescription or mental health services. 

These alternatives may seem like good options for lowering health costs, but could instead expose consumers to financial risks, leaving them vulnerable to losing coverage or not being able to afford care when they need it, said JoAnn Volk, a research professor at Georgetown University’s Center on Health Insurance Reforms. 

“They may seem more affordable in terms of the premium, but that’s because you’re going to pay more out of pocket or not have coverage at all,” Volk said.  

And they are often deceptively marketed to look like comprehensive health insurance, she noted, so that consumers don’t understand exactly what type of plan they are purchasing or the risks they are assuming. 

Because the plans are exempt from ACA regulations, they can choose to deny coverage, exclude certain services, retroactively cancel coverage after you submit a claim, set a dollar limit on your health benefits and don’t have to meet requirements for the portion of a customer’s premiums that they spend on medical services. 

Khaylah Scott, a program manager for Mississippi Health Advocacy Program, said the organization’s consumer assistance program has seen this scenario play out many times. 

“Consumers would purchase an ‘affordable’ plan, but later discover it’s of no-good use, either because a provider doesn’t accept it, or the services they seek aren’t covered,” she said in an email.

If enhanced premium tax credits are not extended by Congress, consumers who are insured through the Marketplace will pay more than double on average, according to KFF, though the rate changes will vary based on age, income and location. 

Republicans and Democrats have both proposed competing health care bills aimed at addressing the subsidies’ pending expiration. Democrats have proposed extending the subsidies for three years, while the Republican plan would replace the enhanced tax credits with new health savings accounts. The Republican-controlled Senate voted Thursday to reject both health care bills, reported the Associated Press. 

“It’s never too late to extend these subsidies,” said Volk. “But every day that goes by, there’s more damage done, people who went and looked at the price and walked away for good or took the bait and went to a substandard plan.” 

And as people leave the Marketplace in pursuit of lower-cost plans, costs may rise for those that remain. 

“Mississippians remaining in the ACA Marketplace can experience higher premiums because the insurers expect healthy people to leave for the cheaper, inadequate, short-term plans,” Scott said. 

One such plan — short-term limited duration health insurance — could gain traction as Marketplace plans become less affordable, especially after the Trump administration indicated earlier this year it is loosening restrictions.

Short-term limited duration health plans were designed to insure people with a short-term gap in coverage, like those who are between jobs. The plans are limited in length — up to three months plus renewals, according to current federal rules — and are often also limited in the types of services they cover. 

“Mississippians that buy these short-term policies risk being left with significant medical bills,” Scott said.

The Trump administration announced in August it will not prioritize enforcement of Biden-era consumer protections for short-term plans and will consider rule changes that could roll back those regulations. The strictness of regulations for the plans have seesawed back and forth between different administrations. 

“Until future rulemaking is issued and applicable, the Departments (of Labor, Health and Human Services and the Treasury) do not intend to prioritize enforcement actions for violations related to failing to meet the definition of ‘short-term, limited-duration insurance,’” read the announcement. 

Farm Bureau plans are similar in that they are less expensive than traditional health plans but often have restrictions on coverage. They usually cover primary care visits and most medical procedures, but aren’t required to cover people with pre-existing conditions or maintain coverage when people become ill. 

Fixed indemnity plans pay a predetermined amount for covered services and act as a supplement to health insurance. The plans give patients the option of going to the provider of their choice, but don’t always cover the full costs of care, saddling patients with high out-of-pocket costs.

The Obama administration issued a rule that fixed indemnity plans could only be sold to people with existing health insurance coverage in 2014, but two years later, the courts struck the rule down, arguing that the federal government could not restrict the sale of the plans.

The plans can be a helpful supplement used to pay for out-of-pocket health insurance costs, but they aren’t a substitute for a traditional plan, Volk said. 

“It’s when they’re sold instead of a comprehensive plan as if they provide good enough protection against unintended or unforeseen costs, that it’s problematic,” said Volk. 

Health care sharing ministries are a type of plan in which members, who often share a common religious belief, make monthly payments to cover the health expenses of other people enrolled in the ministry. But like the aforementioned alternatives to health insurance, plans offered within these ministries don’t have to follow the same rules as those that follow ACA standards. 

The ministries have come under increased scrutiny in recent years. 

One such organization, Sharity Ministries, filed for bankruptcy and dissolved in 2021, leaving about 10,000 families with $50 million in unpaid medical bills when it shut down. Former members were projected to receive only a small fraction of what they were owed after a liquidation plan was approved. 

The state of California sued the organization’s parent company in 2022, alleging it spent only 16 cents on the dollar of members’ monthly payments on health care. The case was settled in October 2025, barring the company from doing business in California and imposing a fine of $34 million. 

Marketing of these plans flourishes when health insurance coverage becomes less affordable for people, just like they will if the enhanced Marketplace subsidies expire at the end of this year, said Volk. 

During sales, brokers may withhold important information — like the subsidies people are eligible for through the ACA Marketplace, which prevent people from making apples-to-apples comparisons based on their premiums, she said. 

Secret shopper studies performed by researchers have shown that sales representatives sometimes use misleading tactics to pitch alternatives to comprehensive insurance. 

In about one out of four tests in a 2020 Government Accountability Office study, health insurance sales representatives engaged in potentially deceptive practices, such as claiming that a pre-existing condition was covered even when plan documents said otherwise. 

To protect yourself from deceptive marketing practices, Volk recommends working with a reputable health insurance broker in your community, ideally with a brick-and-mortar location, and asking for a summary of benefits or coverage, a document that is required for all insurance plans to help consumers compare their options. 

“If they’re holding back on information and especially if they can’t provide a summary of benefits and coverage, that is a sign,” she said.