Health Insurance Education
What Is Private Health Insurance and Is It Right for You?
A lot of people have heard the term but are not exactly sure what it means. Let me break it down the way I explain it to clients every single day.
By Dan, Fullone Family Insurance · Fort Myers, FL · 10 min read
I get asked this question more than almost any other. People call me up and say something like “my friend told me to look into private health insurance but I have no idea what that even is.” And honestly that makes complete sense because the insurance world does a terrible job of explaining itself.
So let me just talk to you the way I talk to my clients. No jargon. No sales pitch. Just a straightforward explanation of what private health insurance actually is, how it works, and who it makes sense for.
The Basics
What Private Health Insurance Actually Means
Private health insurance is coverage that you purchase directly from an insurance carrier, completely outside of the government marketplace. It is not an ACA plan. It is not Medicaid. It is not Medicare. It is a policy you buy directly, and it operates on its own set of rules.
When most people think about health insurance they think about open enrollment, Healthcare.gov, and the plans you see advertised every fall. Those are ACA Marketplace plans. Private health insurance is a completely different category and it works very differently.
The most common type of private health insurance is a PPO plan, which stands for Preferred Provider Organization. A PPO gives you access to a network of doctors and hospitals at discounted rates. But here is the part people love: you are not locked into that network. If you want to see a specialist you just go. No referral required. No approval from a primary care doctor. You pick up the phone and book the appointment.
That flexibility is the main reason people choose private PPO coverage over marketplace plans, and it is the thing I hear clients talk about most once they make the switch.
The simplest way I explain it to clients: With a Private PPO Plan you are in the driver’s seat. You decide which doctor you see and when. Nobody is managing your healthcare for you or making you jump through hoops before you can get care.
Private vs ACA
How Is Private Health Insurance Different From an ACA Plan?
This is the question I spend the most time on with new clients because the differences are significant and they matter a lot depending on your situation.
ACA plans, also called Marketplace plans, are government regulated health insurance plans sold through Healthcare.gov or your state marketplace. They have open enrollment periods, they offer income based subsidies, and they guarantee coverage for pre-existing conditions with no waiting period. Those are genuinely powerful benefits.
Private plans operate outside of that government framework. They have different underwriting rules, different enrollment timelines, and different cost structures. Here is a side by side look at how the two compare:
Private PPO Plans
ACA Marketplace Plans
Available year round, enroll any time
Open enrollment Nov through Jan only, plus special enrollment periods
No income restrictions or subsidy calculations
Income based subsidies available if you qualify
Direct specialist access, no referrals needed
May require referrals depending on plan type
Nationwide networks, coverage wherever you travel
Networks often limited to local or regional providers
Pre-existing conditions may have waiting periods
Pre-existing conditions covered immediately, no waiting period
Premiums fixed regardless of income changes
Subsidies can fluctuate based on income, potential clawback at tax time
Highly customizable based on your health needs
Standardized plans with government mandated benefits
Neither one is automatically better than the other. What matters is your specific situation. If you qualify for significant ACA subsidies that bring your monthly cost down to almost nothing, that might be the smarter financial move. If you are self employed with a good income and you want the freedom to see any doctor without dealing with referrals and narrow networks, a private PPO might serve you much better.
That is exactly why I work with both. I am not here to push one product. I am here to figure out which one actually makes sense for you.
“I am not going to recommend something just because it pays me more. I am going to recommend whatever saves you the most money while giving you the best access to care.”
Dan · Fullone Family Insurance · Fort Myers, FL
Who It Works For
Who Is Private Health Insurance Best For?
Over the past year I have worked with a lot of different people across Southwest Florida and honestly there are some situations where private coverage is almost always the right call.
Self employed professionals and 1099 contractors are probably my most common clients for private coverage. If you are a freelancer, a real estate agent, a contractor, or anyone who works for themselves, you do not have an employer covering part of your premium. You are paying the whole thing yourself. Private PPO Plans give you stable, predictable costs every month without the income verification headaches that come with ACA plans. If your income goes up unexpectedly during the year you are not going to get hit with a subsidy clawback when you file your taxes.
People who travel frequently love private PPO coverage because the networks are nationwide. You are not limited to seeing doctors in Fort Myers. You could be in Nashville, Phoenix, or Salt Lake City and still have full coverage. ACA plans often have narrow regional networks that leave you scrambling for in-network providers when you are out of your home area.
Families who value direct specialist access are another group that tends to do really well with private coverage. If someone in your family has a specific doctor they trust, or if you want to be able to book a specialist appointment without waiting for a referral approval, a PPO gives you that freedom directly.
Higher income earners who do not qualify for ACA subsidies often find that private plans are competitively priced when you actually compare them side by side. The ACA benchmark Silver plan without subsidies can be expensive, and a private PPO with broader networks and no enrollment restrictions is sometimes a better deal when you run the actual numbers.
How It Works
What Does the Process Actually Look Like?
One thing I hear from people who have never worked with an independent broker before is that they expected the process to be complicated. It is really not.
When someone reaches out to me the first thing I do is ask about their doctors. Before we talk about anything else I want to know who you see, which hospitals you prefer, and whether there are any specialists you need regular access to. I verify that your preferred providers are covered before we go any further. There is nothing worse than enrolling in a plan and then finding out your doctor does not accept it.
After that I pull up your options. I look at Private PPO Plans from the carriers operating in your market and I compare them directly against your ACA Marketplace options. I calculate the total annual cost for each, not just the monthly premium, because the monthly premium is only part of the picture. Your deductible, your out of pocket maximum, and how much healthcare you realistically expect to use all factor into which plan actually costs you less over the course of a year.
Then we talk through the options together and you make the call. White Glove service means that if something is wrong or a client needs something taken care of, we will either handle it for them directly or personally guide them through every step to make sure it gets resolved. You get a real person who actually knows your situation, not a call center employee reading from a script.
And after enrollment I am still your contact. If you have a billing question, a claim issue, or you need to make a change to your coverage, you call me directly. I do not disappear after I get paid.
Here is something a lot of people do not realize: Working with an independent broker costs you nothing. Brokers are compensated by the insurance carriers, not by clients. You get expert guidance, plan comparisons, doctor verification, and full enrollment support completely free of charge. There is no reason not to use one.
Common Questions
Questions I Get Asked All the Time
Can I get private health insurance if I have a pre-existing condition?
It depends on the condition and the carrier. Private plans evaluate your health history during the underwriting process, which means some conditions may result in a waiting period before coverage kicks in, or in some cases a higher premium. If you have significant pre-existing conditions and need guaranteed immediate coverage with no waiting period, an ACA Marketplace plan is going to be the better fit. I work with both and I will always tell you which one actually makes sense for your health history.
How much does private health insurance cost?
It varies based on your age, your health, and the level of coverage you choose. For a healthy individual in their 30s or 40s in the Fort Myers area, Private PPO Plans can start under $200 per month. Families will pay more. The only way to get an accurate number for your situation is to get a quote, which I provide for free with no obligation at fullonefamilyinsurance.com.
Can I enroll in private health insurance outside of open enrollment?
Yes. That is one of the biggest advantages of private coverage. You can apply and get approved any time of year. There are no enrollment windows. If you need coverage today you can start the process today.
What carriers offer Private PPO Plans in Florida?
In the Fort Myers and Southwest Florida market the dominant private PPO carriers include Florida Blue, UnitedHealthcare, and Cigna. Each one has different networks and different cost structures. I work with multiple carriers so I can compare your options across all of them rather than being limited to just one.
What is the difference between a PPO and an HMO?
A PPO lets you see any provider in the network without a referral and gives you some coverage even for out of network care. An HMO requires you to choose a primary care doctor who manages all your care and gives referrals to specialists. HMOs are typically cheaper but much more restrictive. Most of my clients who prioritize flexibility and direct access to specialists choose PPO coverage.
Do private plans cover dental and vision too?
Dental and vision are typically separate policies from your health coverage, whether you have a private plan or an ACA plan. The good news is that dental and vision plans are generally affordable and I can bundle them together with your health coverage so everything is handled in one place.
Where We Serve
Serving Families Across Florida and Nationwide
I work with clients across Southwest Florida and throughout the country. Whether you are in Fort Myers, Estero, Naples, Cape Coral, or anywhere else, the process is the same. Free consultation, honest comparison, and personal support from start to finish.
Fort MyersEsteroNaplesCape CoralBonita SpringsSarasotaTampaOrlandoMiamiJacksonvilleGainesvillePort St. Lucie
Still Have Questions About Private Health Insurance?
I am happy to walk you through your options personally. No pressure. No sales pitch. Just an honest conversation about what makes sense for your situation.
Fullone Family Insurance
Fort Myers, FL · (239)-445-4761 · fullonefamilyinsurance.com
Licensed independent insurance broker serving Fort Myers, Naples, Estero, Cape Coral, Bonita Springs and clients across Florida and nationwide.
