Private health insurance
Individual and family plans outside the Marketplace — with a straight explanation of when they're the right call and when they aren't.
"Private health insurance" gets used loosely, and the differences matter more than the label. Some private plans carry exactly the same protections as Marketplace coverage. Others are a different product entirely, with different rules about what they cover and who they'll accept.
We'll tell you which is which, in plain terms, before you buy anything. As an independent broker we compare across carriers — and when the Marketplace is the better route for you, we'll say so, even though it's the same work on our end either way.
The two things "private" can mean
Off-exchange ACA-compliant plans
These are individual and family medical plans sold directly by carriers rather than through the Marketplace. They carry the same core protections: they cover essential health benefits, they cannot deny you or charge you more for a pre-existing condition, and they count as minimum essential coverage. Sometimes a carrier offers a network or a specific plan off-exchange that isn't available on it.
The one thing they don't offer is financial help. Premium tax credits and cost-sharing savings are only available through the Marketplace. If you qualify for those, an off-exchange plan almost always costs you more for equivalent coverage.
Short-term and limited-benefit plans
These are a different product. They're designed to bridge a temporary gap — between jobs, waiting for new employer coverage to start, or after missing Open Enrollment without a qualifying life event.
They are not ACA-compliant. That means they can ask health questions and decline you, they can exclude conditions you already have, and they may not cover things a Marketplace plan must cover, such as maternity care, mental health treatment or prescriptions. They also don't count as minimum essential coverage.
Duration limits are set by federal rules and by your state, and several states restrict or prohibit these plans entirely. We'll tell you what applies where you live.
None of that makes them a bad product — it makes them a specific tool for a specific situation. Used for the gap they're designed for, they work. Used as a permanent substitute for major medical coverage, they leave people badly exposed.
When private coverage makes sense
- Your income is above the range that qualifies for Marketplace financial help
- A carrier offers a network or plan off-exchange that isn't available on it
- You need something in place for a defined gap of a few months
- You missed Open Enrollment, have no qualifying life event, and need some protection until the next window opens
When the Marketplace is the better route
If there's any chance you qualify for financial help, start there. It's free to find out, and for a lot of self-employed people the answer surprises them.
If you have an ongoing condition, take regular prescriptions, are pregnant or planning to be, the Marketplace protections matter and a short-term plan will likely leave you paying for exactly the care you need most.
And if you need coverage for the full year rather than a gap, a compliant plan is what you're looking for.
We'll check all of this with you before recommending anything.
What to check before buying a short-term plan
- Whether it covers prescriptions, and which ones
- Whether maternity and mental health care are included
- How pre-existing conditions are defined and excluded
- The duration, and whether it can be renewed in your state
- What happens when it ends, and when you can next enroll in a compliant plan
- Whether your doctors and hospital are in network
We go through every one of these with you. In writing, before you buy.
Who this is for
- People whose income is above the range for Marketplace financial help
- Anyone between jobs or waiting for employer coverage to begin
- Early retirees not yet eligible for Medicare
- People who missed Open Enrollment without a qualifying life event
- Anyone who wants a specific carrier network not offered on-exchange
How we help
We check your Marketplace eligibility first. It costs nothing and it's the fastest way to know whether private coverage is genuinely your best option or just the more expensive one.
We explain clearly which category a plan falls into, because the brochures rarely make it obvious.
We check your doctors, hospitals and prescriptions against each plan before you enroll.
And we tell you what a plan doesn't cover, not just what it does. That's the conversation that prevents a bad surprise at claim time.
Our guidance costs you nothing.
What to have ready
- Your best estimate of next year's household income
- Names, birthdates and ages for everyone to be covered
- Your doctors, hospital and current prescriptions
- Any ongoing health conditions
- Your coverage dates — when current coverage ends and when new coverage would begin
Frequently asked questions
What's the difference between a private plan and a Marketplace plan?
Off-exchange private plans can be fully ACA-compliant, with the same protections as Marketplace coverage — but they're never eligible for premium tax credits. Short-term and limited-benefit plans are a different product entirely: not ACA-compliant, able to decline you or exclude pre-existing conditions, and not counted as minimum essential coverage.
Can I get financial help with a private plan?
No. Premium tax credits and cost-sharing savings are only available through the Health Insurance Marketplace. If you qualify for them, a private plan will almost always cost you more for equivalent coverage — which is why we check your eligibility first.
Are pre-existing conditions covered?
On an ACA-compliant plan, yes — you can't be denied or charged more. On a short-term or limited-benefit plan, generally no; they can ask health questions, decline you, or exclude a condition you already have. This is the most important difference between the two.
Is a short-term plan real insurance?
Yes, it's a real product from a licensed carrier — but it's built for a temporary gap, not as a replacement for major medical coverage. What it covers is narrower, and what it excludes is broader. We'll show you exactly where the limits are before you decide.
How long can a short-term plan last?
Duration limits are set by federal rules and by your state, and several states restrict or prohibit these plans entirely. We'll tell you what applies where you live and what happens when the plan ends.
Does a private plan count as minimum essential coverage?
An ACA-compliant off-exchange plan does. A short-term or limited-benefit plan does not. That distinction can matter for other programs and situations, so it's worth knowing which you have.
Can I enroll any time of year?
Short-term plans can generally be purchased year-round, which is why people turn to them after missing Open Enrollment. ACA-compliant plans, on or off the Marketplace, follow the Open Enrollment calendar unless you have a qualifying life event.
Can I keep my doctor?
That depends on the plan's network, and networks vary widely between carriers and between plan types. We check your specific doctors and hospital before you enroll — never after.
Short-term and limited-benefit plans are not major medical insurance, are not ACA-compliant, and do not count as minimum essential coverage. They may exclude pre-existing conditions and may not cover essential health benefits. Availability, duration and renewal rules vary by state, and some states restrict or prohibit these plans. Plan availability, eligibility and terms vary by state and carrier. Please review your policy documents for complete terms.
Request your free quote
Not sure which category you need? Tell us your situation and we'll check your Marketplace eligibility first — free, with no obligation, even if the answer means you don't need us.
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