Additional Coverage:
- I’m shopping for a new healthcare plan for my middle-class family of 5. Most plans on the marketplace won’t work for us. (businessinsider.com)
Local Family Grapples with Healthcare Costs: A Tough Choice Between Healthshares and Marketplace Plans
A local family’s struggle to secure affordable and reliable healthcare highlights the complex landscape many in our community face. With fluctuating income and the looming uncertainty of federal subsidies, the Valdez family is weighing the risks and benefits of a community-based healthshare against traditional marketplace insurance.
Kris Ann Valdez, a local freelance writer and mother of three, is currently paying $518 a month for a healthshare plan, which covers medical costs after a $1,000 deductible per incident. While this has been a more budget-friendly option, the unregulated nature of healthshares has prompted her to explore other avenues for her family’s healthcare needs for 2026.
Valdez recalls a time when her husband’s unemployment qualified them for government health insurance, a period she describes as “the first time in my adult life, I didn’t worry about meeting deductibles for broken bones, surgeries, or other emergencies.” This sense of security, however, was short-lived. Just two days after switching to a healthshare, her daughter broke her collarbone, initiating their first experience with the new plan’s “per incident” deductible.
Healthshares operate on a community model where members contribute to a shared fund, which then helps cover medical expenses. While the Valdez family was reimbursed for $1,000 in physical therapy after meeting their $1,000 deductible, the lack of legal oversight compared to traditional insurance companies led Valdez to reconsider.
Her search for a new plan brought her to healthcare.gov, where she previewed marketplace options ahead of open enrollment on November 1. After inputting her family’s information, the site presented bronze, silver, and gold tier plans, with premiums ranging from $271 to $677 a month.
One plan, a Silver Elite Saver Plus HMO, initially caught her eye. Priced at $590.32 a month, it boasted a $0 family deductible (excluding a $400 drug deductible) and an $18,200 family out-of-pocket maximum. However, a deeper dive revealed the crucial role of a substantial estimated $905 a month tax credit.
Valdez contacted a private company, Obamacare-Registration, for clarification on these “subsidies.” She learned that these credits significantly reduce premiums for qualifying households.
The catch, however, lies in income fluctuations. As a freelancer with an unpredictable income, Valdez is concerned about the possibility of owing money back at tax time if her earnings increase mid-year.
Furthermore, these subsidies are set to expire at the end of the year unless Congress extends them. If they disappear, the silver plan Valdez found promising would skyrocket to $1,495 a month – a cost she likens to a “mortgage-sized premium.”
Given these financial uncertainties, the Valdez family is likely to continue with their Zion HealthShare, despite a forthcoming price increase in 2026. Their monthly payment will rise, and the “per incident” contribution will increase from $1,000 to $1,250.
“It’s unsettling to know reimbursement isn’t guaranteed, but it’s also nearly $1,000 a month cheaper than comparable insurance,” Valdez explained. “Coverage kicks in at $1,250 per incident, versus meeting much higher deductibles with many traditional plans. That’s a major difference for families like mine, and so far, our healthshare has honored its commitments to us.”
A representative from Zion HealthShare noted that “small adjustments are sometimes needed to maintain the long-term strength of the community” due to rising medical costs, emphasizing that it remains an affordable alternative. The Centers for Medicare & Medicaid spokesperson highlighted the commitment to affordable healthcare, stating that most HealthCare.gov enrollees will still have access to low-premium plans after applying premium tax credits in 2026.
For the Valdez family, however, the current landscape leaves them with a difficult choice, prioritizing affordability and a proven track record with their healthshare over the fluctuating costs and potential repayment risks of marketplace plans.