You didn’t retire early to sit still. Maybe it’s a few months in Florida every winter, a trial run in San Diego, an RV loop through the national parks, or six weeks in the Alps.

Then the question hits: will my health insurance work there?

For a lot of early retirees, the honest answer is “not the way you think.”

The short answer: Where you buy your plan and what kind of plan you buy decide where you’re covered. Private plans with nationwide networks work the same in every state. Most ACA plans are tied to one state’s network. Either way, the real risk on the road is a serious accident or illness, so protect against that with a supplement: a separate policy that fills gaps your main plan leaves, like care outside its network. Add travel insurance whenever you leave the country.

[VIDEO: insert the YouTube video here: https://youtu.be/XP1VJc871QQ]

Here’s what we’ll cover:

• Where your health insurance should “live” if you have two homes
• Why an ACA PPO may not cover you like your work PPO did
• Why your doctor’s network matters less than you think
• What actually protects you on the road
• What to do before you travel abroad

#1 Health insurance is sold state by state

Most people don’t realize that health insurance is regulated one state at a time. If Blue Cross Blue Shield sells a plan in Indiana and Illinois, those are two separate plans, each filed and approved in its own state.

So if you live in Indiana and spend winters in Florida, where should you buy? It depends on the type of plan:

• A private plan with a nationwide network. It works the same in both states. Get a quote in each state and buy the cheaper one.
• An ACA marketplace plan. You buy it in the state where you live, and its network is built around that state.

The ACA rule is about where you live and intend to keep living, not just where you visit. If you truly split your time between two homes, you may qualify in either state, but you still choose one plan.

An Indiana ACA plan generally only works with Indiana providers, outside of emergencies. If you spend three months in Florida, decide which state matters more for your care.

#2 An ACA PPO isn’t your work PPO

A PPO (preferred provider organization) covers you both in and out of network. You pay less in network and more outside it. That’s what most people had at work.

A handful of states, including Florida and Illinois, offer PPOs on the ACA marketplace. It’s tempting to think that solves the two-state problem. Look closer before you buy. Here’s what one Illinois marketplace PPO charged for out-of-network care:

Technically, that plan covers you in Florida. In practice, you could pay most of the bill yourself.

Always check the out-of-network column on a plan’s summary of benefits, not just the in-network one.

#3 Your doctor’s network matters less than you think

The question we hear most is “Will my doctor take this plan?”

Your doctor is running a business. Even if they’re out of network, you can still see them and pay cash. A routine visit is often $100 to $150, not much more than a copay. If you have a high-deductible plan, you’d likely be paying that much anyway.

See a doctor 10 times a year at $150 a visit and that’s $1,500. Nobody likes paying it, but it won’t wreck your retirement.

Health insurance exists to protect you from a catastrophic bill, not to pay for routine doctor visits. The question isn’t “will my Florida doctor take it?” It’s “if I’m seriously hurt in Florida, am I covered?”

#4 What actually protects you on the road

ACA plans must cover emergency care out of network at your in-network cost. Whether it counts as an emergency is judged by what a reasonable person would think from the symptoms, not by the final diagnosis. Since 2022, federal law has also protected you in most cases from surprise bills for hospital care after you’re stabilized.

That still leaves gaps:

• Ambulance bills. Federal surprise-billing protections generally don’t cover ground ambulances, unless your state adds them.
• Care after you can travel. Once you’re stable enough to reach an in-network provider, an out-of-network hospital can ask you to sign away your protections.
• Follow-up care. Physical therapy, specialists, and treatment back home still have to fit your plan’s network.
• Your deductible. Many ACA plans carry deductibles higher than $5,000.

That’s where a supplement comes in. Accident and disease supplements wrap around your ACA plan or private plan and work anywhere in the country. The ones we recommend typically have a $5,000 deductible, then pay 100% of covered care related to that accident or illness.

Say you break your leg on a hiking trip and the surgery, hospital stay, and physical therapy add up to $30,000. With that kind of accident supplement, you’d owe $5,000. It works at home, too, if an ambulance takes you to an out-of-network hospital. Coverage details vary by policy, so read what yours includes.

A supplement turns “probably covered” into a known limit on what a serious accident or illness can cost you.

#5 Traveling abroad: keep your plan, add travel insurance

Don’t assume your U.S. health insurance works overseas. For any trip abroad, short or long:

• Buy travel medical insurance. In our experience, it’s affordable because it only covers you for a set amount of time.
• Keep renewing your U.S. plan. You can’t pause health insurance; you can only cancel it. If you cancel, you’ll have to reapply when you get home, which can mean medical underwriting and reset waiting periods.
• Plan for coming home for care. Some travelers break a hip abroad and fly home to have it replaced by a surgeon they trust. Without U.S. coverage, your options shrink fast.

Unless you’re very healthy and gone for a very long time, keep your U.S. plan and add travel insurance.

Key Takeaways

• Buy an ACA plan in the state where you live, and know its network ends there.
• Read the out-of-network column before trusting any ACA PPO.
• Don’t pick a plan just to keep a doctor; plan for the big bills.
• Add an accident or disease supplement if you travel or split time between homes.
• Keep your U.S. coverage and add travel insurance for trips abroad.

Your Next Step

Every early retirement looks different. The right setup depends on your health, your income, and where you plan to spend your time. Plan Shaman’s free education program walks you through each option so you can build your bridge to Medicare with confidence.

FAQs

Can I use my ACA plan in another state?

Usually only for emergencies. Most ACA plans build their networks around the state where you bought them, so routine care in another state is often out of network.

Which state should I buy health insurance in if I have two homes?

For an ACA plan, buy in the state where you live and intend to keep living. For a private plan with a nationwide network, compare quotes from both states and take the better price.

Does my ACA plan cover emergencies out of state?

Yes. ACA plans must cover emergency care at an out-of-network hospital at your in-network cost. Ground ambulance bills and follow-up care can still leave you with large bills.

What is a health insurance supplement?

A separate policy that works alongside your main plan. Accident and disease supplements pay for care related to an injury or illness, often with no network restrictions.

Do I need travel insurance if I have health insurance?

For trips abroad, yes. Don’t assume U.S. coverage works overseas. Travel medical insurance covers you while you’re away, and keeping your U.S. plan covers you when you come home.

Sources

• Marketplace coverage when you have more than one residence (KFF Health News)
• Which state’s Marketplace to use (Georgetown Navigator Guide)
• Emergency and post-stabilization billing protections (CMS)
• Ground ambulance and surprise billing (CMS)
• The prudent layperson standard for emergency claims (Groom Law Group)
• Plan and network types (HealthCare.gov)

Originally published at https://www.planshaman.com.

You’ve done the hard part. You saved, you invested, and you can afford to retire early. Then someone asks the question that stops a lot of people cold: what are you doing for health insurance until Medicare?

For many early retirees, that one question keeps them working years longer than they need to. And the advice they hear, often from a trusted financial advisor, sounds reasonable.

It isn’t wrong. It’s incomplete.

The short answer: If you retire before 65, buy health insurance to protect your savings from a major medical bill, not to save on taxes or premiums. Many ACA plans won’t cover you outside their network, so pair your plan with a supplement: a separate policy that fills the gaps your main plan leaves, like care outside its network. And take COBRA only when it actually gets you to Medicare.

Here are the five misconceptions we see most often:

• Get an HSA-eligible plan
• Focus on the premium and out-of-pocket max
• Keep your income low for ACA subsidies
• The ACA is your only option
• Just take COBRA

#1 “Get an HSA-eligible plan”

An HSA is a great account. It’s a poor reason to pick a health plan at 60.

A health savings account (HSA) is triple tax-advantaged: money goes in pre-tax, grows tax-free, and comes out tax-free for qualified medical expenses. For 2026, you can contribute up to $8,750 for a family or $4,400 for yourself, plus a $1,000 catch-up at 55+.

But at 60, the math changes:

• Less time to grow.A few years of contributions won’t build much.
• You likely don’t need the tax break.You’re retiring early because you already saved well.
• It narrows your plan choices.You need a high deductible plan to contribute. On the ACA marketplace, that usually means a bronze plan, often with a narrow HMO or EPO network.

That last point is the real risk. Your work plan was probably a PPO that covered you almost anywhere. A narrow-network plan generally won’t cover you outside its network, except in an emergency.

The real threat to early retirement isn’t a missed tax break. It’s a $300,000 brain tumor you want treated at the Mayo Clinic, and a plan that won’t let you go there.

#2 “Focus on the premium and the out-of-pocket max”

At your job, those two numbers told you your worst case. On many ACA plans, they don’t.

On an ACA HMO, the out-of-pocket max only covers in-network care. Outside the network, your worst case is unlimited.

Before you compare premiums, ask what happens if:

• You get sick on vacation.Care away from home may be out of network.
• You spend winters in another state.An Illinois marketplace plan won’t cover three months in Florida.
• You want a top specialist.A second opinion at the Cleveland Clinic, MD Anderson, or the Mayo Clinic may not be covered.

This gap helps explain why insured people still go broke from medical bills. A 2019 study in the American Journal of Public Health found illness or medical bills contributed to 66.5% of bankruptcies. Earlier research by the same team found 77.9% of medically bankrupt filers had insurance when they got sick.

The problem usually isn’t a lack of health insurance. It’s the wrong health insurance.

The fix is a supplement that covers care outside your plan’s network. Medicare needs a supplement. So does the ACA.

#3 “Keep your income low for ACA subsidies”

The subsidy is a great deal when it fits your life. It shouldn’t run your retirement.

ACA tax credits can lower your premium enough to afford a supplement and still beat COBRA. In one client example, that saved about $1,000 a month. But the rules got stricter in 2026:

• The enhanced subsidies expiredon December 31, 2025.
• There’s a hard cutoffat 400% of the federal poverty level: no credit above $62,600 (single) or $84,600 (couple) for 2026 coverage.
• Guess wrong and you pay it back.If your income lands above your estimate, you repay the credit in full. One large withdrawal or Roth conversion can push you over.

If living off savings or a Roth IRA for a few years works for you, great. But if staying under the line means capping yourself at $4,500 a month, skip it. You didn’t retire early to pinch pennies, and full-price options exist.

#4 “The ACA is your only option until Medicare”

About half of the early retirees we work with never use the ACA.

Believing it’s “ACA or bust” keeps people working until 65 just to hold on to an employer plan, even when they have more than enough saved.

The ACA fits if you have a pre-existing condition, expensive medications, or qualify for a tax credit. Confirm your doctors, hospitals, and prescriptions are covered, add a supplement, and move to a Medicare Plan G at 65.

Look elsewhere if you’re healthy and don’t qualify for a tax credit. Private, non-ACA plans vary by insurer and state, but the ones we recommend typically offer:

• No network restrictions
• Lower premiums and deductibles than a full-price ACA plan
• Guaranteed renewable coverage, with no annual re-enrollment
• Pricing that ignores your income

They have two drawbacks. A supplement handles both:

Private plan drawback-With a supplement

12-month wait on serious pre-existing conditions — Waived for certain conditions, like blood pressure and cholesterol

$1 million annual cap — Removed

You won’t find these plans on HealthCare.gov or your state’s exchange. That’s why most people have never heard of them.

#5 “You can afford it, so just take COBRA”

COBRA lets you keep your work plan for up to 18 months. You pay the full premium plus a 2% fee. It feels safe because it’s familiar, but it’s the right call less often than people think.

Retiring at 63½ or older? Take COBRA. It bridges you to Medicare.

Can’t pass medical underwriting, income too high for a tax credit? Take COBRA. Use all 18 months, then move to the ACA.

Healthy, no tax credit? Skip COBRA. Go straight to a private plan.

You qualify for a tax credit. Skip COBRA. An ACA plan plus a supplement costs less.

Running out of COBRA opens a special enrollment period for the ACA. Dropping it early does not.

The risk of waiting: Say you’re 58 and healthy. In one client example, a private plan cost a couple $1,400 a month and COBRA cost $1,500. Taking COBRA first feels safer. But if you get sick during those 18 months, you may no longer qualify for the private plan. You’d land on a full-price ACA plan plus a supplement, for far more than COBRA cost.

A private plan is guaranteed renewable. Take it on day one, and it can carry you all seven years to Medicare, even if your health changes.

Key Takeaways

• Choose coverage to protect your savings, not to save on taxes.
• Check out-of-network coverage before you compare premiums.
• Pair an ACA or private plan with a supplement.
• Chase ACA subsidies only if the income limit fits your life.
• Take COBRA only if it gets you to Medicare or you can’t pass underwriting.
• Plan coverage for everyone in your household, all the way to 65.

Your Next Step

Every early retirement is different, and the right plan depends on your health, your income, and where you want to spend your time. Plan Shaman’s free education program walks you through each option, step by step, so you can build your bridge to Medicare with confidence.

Join Plan Shaman’s free education program →

FAQs

What health insurance should I get if I retire at 60?

It depends on your health and income. ACA plans with a supplement fit people with pre-existing conditions or tax credits. Healthy early retirees without a tax credit often do better with a private, guaranteed-renewable plan.

What is a supplement?

A supplement is a separate policy that works alongside your main health plan. It fills gaps your plan leaves, such as care outside its network, waiting periods, or coverage caps.

Does an ACA out-of-pocket maximum cover out-of-network care?

On HMO and EPO plans, generally no. Those plans usually don’t cover out-of-network care except emergencies, so your costs outside the network have no cap.

Can I switch from COBRA to an ACA plan?

Yes. When COBRA runs out, you get a special enrollment period. If you drop COBRA early, you have to wait for open enrollment.

What is the ACA subsidy cliff in 2026?

For 2026 coverage, households earning more than 400% of the federal poverty level get no premium tax credit. That’s $62,600 for one person or $84,600 for a couple.

Sources

• IRS 2026 HSA limits (Lockton)
• Bronze plans as HSA-eligible, IRS Notice 2026–5 (RSM)
• Plan and network types (HealthCare.gov)
• Medical bankruptcy study, AJPH 2019 (PNHP)
• Medical bankruptcy study, 2009 (PNHP)
• ACA subsidies after 2025 (healthinsurance.org)
• 400% FPL table (Vermont Legal Aid)
• Subsidy repayment rules (TaxGlobal)
• COBRA and Marketplace enrollment (KFF)
• COBRA premiums (University of Tennessee MTAS)

Originally published at https://www.planshaman.com.

You may be overpaying for ACA Marketplace coverage if:

• You do not qualify for a subsidy
• You do not have pre existing conditions

For healthy households paying full price, private health insurance alternatives can provide lower premiums and more flexible networks.

Millions of healthy self employed households are paying full price for ACA Marketplace plans that were not designed for their risk profile.

I am going to focus on those that are overpaying on the ACA Marketplace. There are more than 20 Million people on the ACA, and it is not a one size fits all.

The ACA goes by many different names; healthcare.gov, The Marketplace, ObamaCare, The Exchange, or your states variant.

The ACA Marketplace is the default for self employed households. It is the government sponsored program with all of the ads and the name recognition.

The companies that provide products on the ACA Marketplace are the names that you recognize; Anthem, Humana, Cigna, CareSource, United HealthCare. But these plans are very different from the employer plans offered through the same companies.

There are two key factors when it comes to the ACA Marketplace.

1. If your household income falls below a certain level, you receive financial help.
2. It covers pre-existing conditions from day one. No questions asked.

These are the two factors that determine wether or not the ACA Marketplace is the right fit.

How do I know if I will receive financial help?

This is the easy one.

As of 2026, if your household makes a dollar over 400% of the Federal Poverty Level then you receive no help from the government. Your ACA Marketplace plan will be full price.

If your household receives a tax credit — then price wise, the ACA is 100% the right route for you. See the chart below:

Household Size : Household Income

1 Person: $62,600

2 People: $84,600

3 People: $106,600

4 People: $128,600

5 People: $150,600

6 People: $172,600

If your household makes more than that, and you are on the ACA Marketplace, keep reading!

What Counts As A Pre Existing Condition?

The simple way to think about it:

If you are actively treating a medical condition or expecting ongoing care, private health insurance will either not approve coverage, or put a waiting period on the pre-existing condition.

Private plans ask a few basic health questions. If any of the situations below apply to you, the ACA Marketplace is usually the better fit.

Common examples include

• Recent hospitalization
• Cancer, heart disease, or stroke in the last 5 years
• Diabetes requiring medication
• Chronic conditions like COPD, kidney disease, or autoimmune disorders
• Pregnancy or upcoming medical procedures
• Living in assisted care or receiving home health services

If any of these apply to you, the ACA Marketplace exists for exactly that reason. It guarantees coverage regardless of health history.

The Two Signs You Are Overpaying on the ACA Marketplace

1. You do not qualify for a subsidy
2. You do not have pre existing conditions

If both apply to you, it is worth exploring private health insurance alternatives.

Your ACA Marketplace coverage designed for a different risk profile. The ACA Marketplace is expensive, covers many services that you will never use, and has narrow networks that limit your ability to see doctors out of network.

Private plan alternatives reward people for their good health with lower prices and more network flexibility. Are there downsides to these private plans? Of course, but it is protection designed just like any other insurance. Pick what you want covered and the amount you want it covered for.

If you receive subsidies or have pre existing conditions, the ACA Marketplace is the correct route for you.

But if you are healthy and paying full price, the system was not designed with your risk profile in mind.

That is where private health insurance alternatives begin to make sense.

First let’s get the right frame of mind, health insurance is… insurance!

If we think about health insurance like any other insurance product, there are three main factors that the insurance company needs to price the product.

• What are we covering?
• What is the risk of the individual?
• What is the maximum we are going to have to pay out on a claim?

We need to think about health insurance just like any other insurance

Let’s think about car insurance. They look at your driving history, the price of your car, and ask you if you want coverage for different options(uninsured motorist, comprehensive, personal injury protection).

Those pieces allow them to price their products appropriately. At the end of the day, they want to make money, and you hope you never have to use it!

Now imagine if we removed all three of those pricing levers.

The ACA Marketplace has removed those risk tools

Let’s peel the back the layers of the ACA Marketplace.

The Affordable Care Act removes the health insurance companies ability to calculate risk.

• You can have any condition, and they have to cover it from day one. No questions asked. A healthy person and a person needing a organ transplant have the same price!
• It automatically covers you for the ten essential benefits. This includes things like maternity, alcohol and drug abuse services, and prescription drug coverage. I am a man, and my price would be inflated by maternity even though I will never use it.
• After you hit your out of pocket maximum, it covers you for an unlimited amount of money. Yes, unlimited. Unlimited risk.

No private insurance market in history functions like that.

So will the ACA Marketplace collapse?

What we are seeing is uncontrolled risk, and that is why prices continue to skyrocket.

When pricing disconnects from risk, the lowest risk people leave first.

The ACA risk pool will continue to get riskier. If you are sick or needing healthcare for an ongoing condition, and you don’t get coverage through your job, you NEED the ACA Marketplace.

The government will continue to support those who need that coverage, and help people get coverage who rely on subsidies.

If you are healthy and make over 400% of the federal poverty level for your household, then the price you are paying for the service you are getting is misaligned. It is time to start looking at alternatives.

Will the ACA Marketplace collapse? It will not disappear, but we are already in the downward spiral. Prices jumped 21% on average in 2026, and healthy people are leaving. It will continue become more expensive, more concentrated, and more dependent on government support.