he Marketplace offers set plans during Open Enrollment. Private insurance can be different.
Broader Plan Choices:
Instead of being limited to a few standardized options, you can often choose from a wider variety of deductible and copay structures to match your budget and health needs.
Different Network Types:
You might find plans with larger PPO networks, giving you more freedom to see specialists without a referral or to find in-network doctors if you travel frequently.
Life doesn’t always happen between November and January.
If you miss the annual Open Enrollment period and don’t have a "qualifying life event" (like losing job-based coverage), private plans might be available year-round.
Important Note: Be very careful with plans like short-term coverage. They are often much less comprehensive and can deny claims for pre-existing conditions. Always understand the trade-off.
Marketplace subsidies are income-based. If you earn too much, you pay full price.
If you don’t qualify for financial assistance, shopping privately can help you find a competitively priced plan that may offer better network access or different benefits than the full-price Marketplace plans.
Private insurance can sometimes offer tailored solutions.
This could include pairing a high-deductible plan with supplemental coverage (like hospital indemnity or critical illness insurance) to create a custom safety net.
It can also be useful for finding plans that include specific doctors or hospitals not covered by Marketplace networks in your area.
Consider private insurance if:
You need coverage now and it’s outside of Open Enrollment.
You’ve compared plans and a specific private plan has your doctors at a better price.
You don’t get subsidies on the Marketplace and want to explore all options.
Proceed with caution if:
You have pre-existing conditions (you’ll want a fully ACA-compliant plan).
You prioritize comprehensive essential health benefits (like maternity care or mental health services).
You qualify for significant Marketplace subsidies (these often provide the best value).
The key is to compare carefully. "Off-Marketplace" doesn’t automatically mean "better" or "worse"—it means different. My role is to help you navigate these options side-by-side with Marketplace plans, so you can see the real-world differences in cost, coverage, and network.
Don’t shop in the dark. Whether it’s a Marketplace plan or a private option, I help you find coverage that’s not just available—it’s right for you.