We specialize only in private insurance solutions. We provide Medicare, Medicaid, or ACA marketplace coverage. Our focus is on flexible, private plans tailored to your individual or family needs.
However, we want to ensure you get the exact coverage you need. Here is a clear breakdown of the differences between Marketplace and Private Insurance to help you decide what is right for you:
1️⃣ Where You Get the Plan
Marketplace (ACA): Purchased through HealthCare.gov or your state exchange. Regulated under the Affordable Care Act (ACA).
Private Insurance: Purchased directly through a broker, carrier website, or private exchange. Not all plans are ACA-compliant.
2️⃣ Subsidies (Biggest Difference)
Marketplace: Eligible for premium tax credits (subsidies) based on income. May qualify for cost-sharing reductions. (Note: If you qualify for a strong subsidy, Marketplace is usually more affordable.)
Private: No income-based subsidies. The full premium is paid by the client.
3️⃣ Underwriting
Marketplace: No medical underwriting (guaranteed issue). Covers pre-existing conditions.
Private: Often requires health questions. Can deny coverage based on medical history or exclude pre-existing conditions.
4️⃣ Coverage Requirements
Marketplace: Must cover Essential Health Benefits (maternity, mental health, prescriptions, preventive care at $0). No lifetime or annual limits.
Private: May not cover maternity, may have benefit caps, and may limit certain services.
5️⃣ Networks
Marketplace: Often HMO or narrow networks with limited out-of-network benefits.
Private: Many options include PPO networks with broader, sometimes national, coverage.
6️⃣ Enrollment Periods