Health Insurance That Is Not Based on Your Income

What "not based on income" actually means

A private, medically underwritten plan is priced from three things: how old you are, where you live and what you report on a health questionnaire. There is no income estimate on the application, no tax credit to reconcile and no reason to call anyone when a bonus lands or a contract ends. The rate you are quoted does not move because you earned $70,000 this year or $700,000.

That is why a private plan is the first thing I price for healthy people who buy their own insurance. It can also start the first of any month once you are approved, so you are not waiting on a calendar to get covered.

Private plans are not ACA Marketplace plans, and benefits and pre-existing condition rules vary by plan. I spell out what that means further down, because it is the trade you make for a price that ignores your income.

Six Marketplace drawbacks to weigh for 2027

The Marketplace ties nearly everything to one number: your projected household income for the year. For 2027 that link creates real problems for a lot of households.

• Another round of rate increases. In KFF's review of preliminary filings from 276 insurers, the median proposed Marketplace increase for 2027 was 15 percent, on top of a steep jump for 2026. Final rates vary by state and insurer.
• The subsidy cliff. The 2027 credit stops at 400 percent of the poverty level: $63,840 for one person, $86,560 for two, $109,280 for three and $132,000 for four. One dollar over the line and the credit is gone, not trimmed. The 2027 subsidy cliff guide shows how sharp that edge is.
• Paying the credit back at tax time. The advance credit rests on an estimate. If your actual income comes in higher, you repay the difference when you file, using IRS Form 8962. Finish the year above the 400 percent line and you repay the entire advance credit.
• Narrow networks. In many counties, most or all Marketplace choices are HMOs or EPOs, which pay nothing outside the network except emergencies.
• A high ceiling on costs. The 2027 out-of-pocket maximum is $12,000 for one person and $24,000 for a family.
• One window a year. Open enrollment for 2027 runs November 1, 2026 to January 15, 2027, and you must sign up by December 15 for a January 1 start. Outside that window you need a qualifying life event.

None of this makes the Marketplace a bad program. It makes it a program built around income, and if your income is high or unpredictable, you carry the risk of guessing wrong.

Who gets the most from pricing that ignores income

Some households feel the income link more than others. Private, underwritten coverage tends to be a good fit when you are healthy and you fall into one of these groups:

• Earners already past the cliff. If your household is above 400 percent of the poverty level, you pay the full Marketplace premium with no help. The guide to earning too much for a subsidy covers that spot in detail.
• People who sit close to the line. A strong year, a home sale or a large capital gain can push you over without warning, and the repayment shows up months later.
• Commission, bonus and contract earners. When pay arrives unevenly, one income estimate made in December is hard to get right.
• Early retirees living on investments. IRA withdrawals, Roth conversions and asset sales all count as income for Marketplace purposes, so a retirement decision can quietly change what you pay for coverage.
• Self-employed owners and partners. Business profit can swing widely from one year to the next. The private versus Marketplace guide for the self-employed goes deeper on that choice.

The honest part: underwriting can say no

A price based on health means the insurer looks at your health. That is the trade, and it is better to know it before you apply.

• Applications can be declined. A recent cancer diagnosis, heart disease, a planned surgery or several ongoing conditions can lead an underwriter to turn an application down.
• Pre-existing conditions can be excluded or limited. Some plans approve you but leave out care for a condition you already have, or apply a waiting period before it is covered.
• Benefits are not standardized. Marketplace plans must cover a federal list of essential benefits. Private plans set their own lists, so maternity care, mental health visits or certain prescriptions may be handled differently from one plan to the next.
• Your answers matter. Underwriters can check prescription and medical records. An incomplete answer can put a later claim at risk, so I go through the questions with you one at a time.

What you pay also depends on more than health, including the deductible you choose and who is on the policy. The private health insurance cost guide breaks down each factor.

When the Marketplace is still the right answer

If you or someone on your policy has a significant health condition, the Marketplace is the guaranteed option. Every Marketplace plan must accept you and cover pre-existing conditions from the first day, at the same price as a healthy person your age. No underwriter can decline you or carve out a diagnosis.

It can also win when your household stays comfortably below the 400 percent line all year, because the credit may bring the premium under a private quote. And if you lose job-based coverage, you get a 60-day special enrollment period, so you are not stuck waiting for November.

Some families split the difference: healthy members on a private plan and a member with a serious condition on a Marketplace plan. If your household is mixed, that setup is worth pricing.

How to compare without guessing

A clean comparison takes one conversation by phone or video.

1. Share the ages, zip code and a short health summary for each person you want covered.
2. I price private, underwritten options first and tell you honestly how underwriting is likely to view your history.
3. I pull the Marketplace plans for your county, with and without any credit, using a realistic income range instead of a single guess.
4. We compare the full-year picture, including deductible and out-of-pocket maximum, and check the network around your doctors.
5. If a private plan wins and you are approved, coverage can begin the first of the next month.

I am licensed in 31 states, including Florida, Texas and Georgia. When you are ready, get a quote or call or text (786) 218-2384.