Q:  I'm single, self-employed, and buy my health insurance on my state's ACA exchange. Next year, my premiums on the Bronze plan I'm considering will be $517 a month—more than double what they were in 2016—with a $6,200 annual deductible. I don’t qualify for subsidies. I'm healthy, and think I could save money by skipping insurance on the chance that the penalty gets repealed. Am I taking a risk?—A. Kaufman, Maryland

A: It's true that Congressional Republicans, as part of their tax overhaul legislation, are considering repealing the individual mandate, which requires most people to buy health insurance or pay a fine. All the uncertainty makes decisions about health insurance for next year even more complicated.

If the mandate stays in place, a single person like you would have to pay a penalty of $695 a year or up to 2.5 percent of your income (but no more than the total annual premiums you'd pay on a Bronze plan), whichever is higher. 

When you rarely go to the doctor, going without pricey health insurance is pretty enticing. Premiums alone will cost you more than $6,000 a year for something you're not using much. So, the penalty may seem like a small price to pay. 

More About Health Insurance

But keep in mind that if you go without health insurance, you could rack up tens or hundreds of thousands of dollars in medical bills if you have a major health issue. 

If you have insurance that meets the standards for coverage set by the Affordable Care Act, the total amount of money you are required to pay for in-network care in a single year is capped at $7,350 as a single individual. That doesn't include the premiums that you pay. 

But if you don’t have health insurance, there is no limit on your out-of-pocket costs for your medical care.

Before you decide to go without insurance, check out these options for ways to make health insurance more affordable for you. 

Go Off-Exchange

You might find a more affordable option buying off-exchange—directly from an insurance broker or insurance provider. That’s especially true this year. After the Trump administration cut off funding for subsidies that insurance companies must pay to help low-income consumers afford insurance, some insurers boosted premiums the most on plans they are required to subsidize on the ACA exchanges. As a result, plans sold off-exchange with the same coverage may be cheaper.

Plans sold directly from brokers or insurance companies must meet all the same minimum coverage standards as plans sold on the exchanges to be compliant with the ACA.

But there's a wide variation in premiums for insurance plans sold on the exchanges. Whether a plan sold directly by a broker or insurer is cheaper than a plan you buy on an ACA exchange will depend on where you live.

While the national average premium on a mid-level Silver plan is 34 percent higher for 2018 than 2017, the average premium in Maryland is 22 percent higher.

Compare plans at sites like ehealthinsurance.com and healthpocket.com. You can find health insurance brokers through HealthCare.gov’s Local Help finder.  

In Maryland, where you live, like most states, you must sign up for health insurance by midnight on Dec. 15 if you want coverage in 2018. 

Confused about choosing a health insurance plan for 2018? Send us your questions about signing up for job-based insurance, Medicare, or a plan sold on the ACA exchanges this open enrollment season.

Join a Group

You may be able to buy a less expensive group plan through a professional association, trade group, or other membership organization such as an alumni group. You will be pooled in with the other members of the organization, so your premiums may be lower based on a group rate.

The National Association for the Self Employed and the Alliance for Affordable Services, whose members include small business owners and entrepreneurs, offer access to group health insurance. That might be a good option since you work for yourself. Check with your local Chamber of Commerce for more options.

Adjust Your Income

If your income is close to the cutoff for getting a subsidy to help pay your premium, look for a way to lower your income so you can qualify. You can be eligible for financial help to pay your premiums if your modified adjusted gross income is $48,240 or less a year (the cutoff is $64,960 for a two-person household and $98,400 for a family of four). Check here to find out whether you qualify.

Since you are self-employed, you may have more flexibility to adjust your income than someone who is employed by a company. For example, you can take deductions related to business expenses, so you could lower your income by investing in new equipment such as computers by the end of the year.  

You can also lower your income by contributing to an individual retirement account. In 2018, you can put away $5,500 a year in an IRA. If you are self-employed you can set aside a lot more in a simplified employee pension (SEP): 25 percent of your net earnings, up to $55,000 in 2018.  

Put Money in an HSA

Since you're considering buying a high-deductible health plan—that’s a plan with a deductible of at least $1,350 a year for an individual—you would be eligible to put money into a health savings account, which can also lower your adjusted gross income. You can put $3,450 a year pretax for 2018. Having money in an HSA is also a good way to cover some of your healthcare expenses including deductibles, copayments, and bills not covered by insurance, such as dental care.  

Consumer Reports is working with WNYC-New York Public Radio to educate consumers about their options during open enrollment. Find out more at We’ve Got You Covered.

Deduct Your Premiums

If you don’t have access to an employer-sponsored plan, you can deduct 100 percent of your health insurance premiums on your taxes.

There is also a medical expenses deduction that allows people with especially high healthcare costs to deduct that spending. To qualify, you must spend at least 10 percent of your income on medical expenses.

But that deduction may be changed depending on the outcome of Congressional Republican tax reform plans. Currently, the House legislation would get rid of the medical expense deduction altogether, while the Senate preserves it and would make it more generous.  

See If You Qualify for a Catastrophic Plan

If you are under 30 years old, you can buy a kind of high-deductible plan known as catastrophic coverage on the ACA exchanges.  Catastrophic health plans have lower premiums than other plans on the exchanges and cover the same minimum health benefits as ACA-compliant health plans. But you must pay for all your healthcare costs upfront until you meet a high annual deductible.

Only after your out-of-pocket spending reaches the deductible does your plan begins to pay for most covered healthcare services. If you don't go to the doctor much, that can be less costly but still cover you for a major medical problem.

Understand Limited Insurance Options

Consumers struggling to afford health insurance are increasingly being pitched short-term health insurance plans as a less costly alternative to ACA-compliant insurance.  These policies have lower premiums than plans with more comprehensive coverage. But they have very limited benefits and may not cover you if you have a pre-existing condition or a costly illness.

Under current health insurance rules, you’ll also still owe a penalty for not having ACA-qualifying health insurance. So, understand what you're getting if you choose an alternative insurance plan.

See If You Can Get a Hardship Exemption

If you do decide to go without health insurance, you may be able to qualify for a hardship exemption.  The penalty is waived if you don’t qualify for financial help and would have to pay more than 8.16 percent of your household income for coverage from either your employer or the cheapest ACA Bronze plan available in your area. Here’s how to know if you have an exemption to the penalty