Turning 26 Health Insurance, State by State

Private health insurance

Most people I help end up on a private plan, not a Marketplace plan. Private, medically underwritten health insurance is priced on your age, zip code and health instead of your income, so a strong year never raises your premium and there is no tax credit to pay back in April.

Why people leave the Marketplace

• Premiums keep climbing. Marketplace premiums are rising again for 2027.
• The subsidy cliff. Above 400 percent of the poverty level ($63,840 for one person, $132,000 for a family of four) you pay full price.
• Surprise tax bills. Underestimate your income and you repay the tax credit in April.
• Narrow networks. Many plans are local HMOs or EPOs that need referrals and cover little outside the area.
• High out-of-pocket costs. 2027 out-of-pocket maximums reach $12,000 per person and $24,000 per family.
• One window a year. Outside open enrollment you need a qualifying life event to enroll or switch.

What a private plan does differently

• Start any month. If approved, coverage can begin the first of next month, with no wait for open enrollment.
• Networks that travel. Many private plans use national PPO networks, which can give you in-network doctors outside your home state too. Networks vary by plan.
• Can cost less than full-price Marketplace plans for some healthy applicants above the subsidy line.
• Accident coverage the Marketplace does not offer. A private plan can be paired with accident coverage, a separate policy. What it includes varies by plan.
• Approval is based on health. You answer health questions, and acceptance is not guaranteed.

With a significant health condition, or income low enough for a large tax credit, a Marketplace plan can be the better fit, and I will tell you if it is. Either way you see both side by side.

Private plans are not ACA Marketplace plans. Benefits, exclusions and pre-existing condition rules differ by plan and by state, so review the plan details before you enroll.

Learn more: coverage not based on income · how underwriting works · private vs Obamacare · PPO plans for individuals · switching from the Marketplace