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Marketplace plans (ACA) are government-regulated, come with subsidies for those who qualify, and have standardized benefits. Private plans are offered outside the Marketplace and can provide more flexibility, but they’re not subsidy-based.

Subsidies are based on household income and family size. In 2025, enhanced subsidies are still in place, but beginning in 2026, the income cap returns—meaning those earning above 400% of the Federal Poverty Level won’t qualify.

Private plans often offer broader PPO networks, lower deductibles, and more customization. They're ideal for healthy individuals, business owners, or families who value flexibility.

Yes, but coverage details vary. It’s important to work with a licensed advisor who can confirm if your needs—like prescriptions or ongoing treatments—are fully covered.

Not necessarily. While Marketplace plans may look cheaper with subsidies, many private plans offer strong benefits at competitive rates—especially for healthier applicants.

It’s worth reviewing. Many of my clients already had insurance when we first spoke, but after reviewing their benefits, they found gaps like unpaid claims or plans that weren’t truly comprehensive.

If your insurance card shows 'N/A' next to co-pays or deductibles, it's a red flag. Always review the Summary of Benefits and Coverage (SBC) to see what's actually included.

Yes, you can switch, but it depends on qualifying life events (QLEs). Private plans usually offer year-round enrollment, while Marketplace plans are limited to open and special enrollment periods.

It depends on income. Lower-income self-employed individuals may benefit more from Marketplace subsidies, while higher-income business owners often prefer private PPOs for tax deductions and better flexibility.

Yes, comprehensive private plans have annual out-of-pocket maximums, just like ACA plans. However, make sure your plan isn't a 'limited benefit' policy, which could leave you vulnerable to high costs.

The enhanced subsidies from the American Rescue Plan and Inflation Reduction Act are set to expire. This will reduce subsidy amounts, bring back the subsidy cliff, and potentially increase out-of-pocket costs for many enrollees.

We review both Marketplace and private options to find what's best for you. Our goal is to help you avoid common pitfalls and provide lifetime support for your policy.