I didn’t lose my health insurance because I stopped needing it. I lost it because I could no longer afford the price tag.
The email arrived the way these things usually do. Quietly, buried among other notices I didn’t have time to deal with right away. My health insurance plan was renewing, and the monthly premium for 2026 would be dramatically higher. High enough that it stopped being a question of budgeting and became a question of feasibility.
For the past several years, I’d relied on health insurance purchased through the ACA’s Healthcare Marketplace. Federal subsidies made that coverage possible, keeping my premiums within reach while I managed routine care, prescriptions and specialist visits. When Congress allowed those enhanced subsidies to expire at the end of 2025, the math changed almost overnight, and staying insured meant absorbing a cost increase that simply wasn’t possible.
Across the country, millions of people are confronting the same reality. Premiums are rising as insurers adjust to higher costs and the loss of federal assistance, forcing enrollees into impossible tradeoffs: cutting back on care, switching to plans with higher deductibles, or dropping coverage altogether. For some, the decision threatens long-term health or financial stability.
I came to this moment with advantages many people don’t. I have a Master of Science in public health and I’ve worked for the local affiliate of a major national healthcare nonprofit. I’ve spent years navigating insurance plans, benefits language and coverage rules. And still, when I began trying to figure out what came next, I felt overwhelmed. That overwhelm was familiar. As a member of the LGBTQ+ community, I have learned that access to care is never just about cost. It is also about whether I feel safe asking questions and being honest. Even before a single appointment, the process of finding care can carry its own weight.
Losing my insurance for 2026 didn’t just mean finding a replacement plan. It meant confronting how little transparency exists around the actual cost of care, and how much of the system depends on people knowing what questions to ask, who to call and how to pay upfront. As I moved through that process, I felt increasingly frustrated by an insurance industry that is not designed to help people navigate care, but to protect profit margins and deliver returns to investors. The Affordable Care Act was created, in part, to push back against that imbalance, to protect consumers and expand access to care. Without that protection, the cracks in the system became impossible to ignore.
So, I started making calls. I called my doctors. I called my pharmacy. I asked what everything would cost if I paid out of pocket. I documented everything, including self-pay rates and the use of prescription discount tools. What I found surprised me. Even without insurance, my medications would cost significantly less than they had under my ACA plan. The cost of an annual physical and routine bloodwork was roughly equivalent to a single month’s premium from my 2025 plan. Several providers offered financial assistance, sliding scale pricing or significant discounts if I paid at the time of my appointment. None of this information was hidden, but none of it was volunteered either. I only learned about it because I knew to ask.
That realization forced me to rethink what insurance is supposed to do. Coverage is meant to make care more accessible and predictable, yet here I was finding that direct payment and upfront transparency could sometimes be more affordable for routine care. That discovery pushed me to explore options outside the traditional system, including models like Direct Primary Care, which operate without insurance and rely on flat monthly fees paid directly to providers. These alternatives are not a solution for everyone, and they come with real limitations, but for people suddenly priced out of the marketplace, they are increasingly becoming part of the conversation.
There is no single replacement for coverage, just a patchwork of workarounds that live alongside the marketplace. Prescription discount tools like GoodRx can lower medication costs. Mecklenburg County Public Health maintains a directory of free and low-cost clinics. For people who need periodic care, organizations like Remote Area Medical operate volunteer-driven pop-up clinics that provide free medical, dental and vision services.
Some of these resources are designed as safety net care, others are discount programs, and others operate through alternative payment structures. Direct Primary Care is where I landed.
Direct Primary Care, or DPC, is a membership-based model where patients pay a flat monthly fee directly to a primary care provider instead of billing insurance for each visit. In exchange, practices limit the number of patients they see and offer longer appointments, same or next day scheduling, and direct communication with the doctor. The membership covers preventive care, chronic disease management, and acute visits for common issues. Labs are offered at discounted cash prices, with no copays or surprise bills.
What ultimately made this model workable for me was how closely it aligned with the care I actually use. Most of my healthcare needs fall under primary care: routine visits, managing ongoing conditions, addressing issues before they escalate, and having a doctor who knows my history.
This is not for everyone. Direct Primary Care is not insurance, and it does not replace coverage for emergencies, hospitalizations, advanced imaging or most specialty care. It is also not accessible to everyone, and it does not solve the broader failures of the U.S. healthcare system. I did not choose Direct Primary Care because it is a perfect solution, but because, after being priced out of the marketplace, it was the most realistic way for me to maintain consistent, relationship-based care.
Cost and access are not the only considerations. How care is delivered, and whether it feels safe to seek it, matters too. When I spoke with my new Direct Primary Care provider for the first time, she immediately made me feel at ease. The questions she asked reflected an awareness of gender identity and sexual orientation that was thoughtful and affirming without being performative. I didn’t have to explain myself, correct assumptions or brace for discomfort. We’ll see how it goes, but for LGBTQ+ people, even that initial interaction is meaningful.
There is no right answer. Losing insurance now often means having to make decisions quickly, with incomplete information, and without any guarantee that the next option will actually work for them. Direct Primary Care is one way I’m navigating that uncertainty for now. Others will make different choices.
What feels unsustainable is how much of this depends on individual effort rather than a system designed to support people when they need care. As a member of the LGBTQ+ community, access to healthcare has never been just about cost. It has always included questions of safety, trust, and whether I will be understood without having to explain myself. Those considerations do not sit apart from affordability. They are part of what makes the system harder to navigate and part of what people are being asked to manage on their own.
For now, I have a doctor and a plan, but I am still waiting for a system that values my health more than its own bottom line.