The coverage I place, and who each kind is really for
Marketplace or private? I place both, plus dental, vision and life, so I have no reason to steer you toward one door.
Free. Never a fee. 7 days a week, 8 a.m.–10 p.m. ET.
Which door is right for you
| What matters | ACA Marketplace plan | Private underwritten plan |
|---|---|---|
| Who it fits | Anyone, especially with medical history or income under the cap. | Healthy people, often above the cap. |
| Pricing basis | Age, ZIP code, tobacco use. Income sets any credit. | Age, ZIP code and your health. |
| Pre-existing conditions | Covered. No decline, no surcharge. | Can be declined, rated up or excluded. |
| When you can apply | November 1 to January 15, or after a qualifying life event. | Year-round. |
| Subsidy possible | Yes, when household income is within the credit range, which tops out at 400% of the poverty level. | No. |
When the Marketplace wins
Any condition, regular prescriptions, or income under the credit line. The Marketplace cannot turn you down, and a credit can cut the premium hard.
When a private plan wins
Healthy, above the credit line, and full Marketplace price is more than you want to pay. A private plan prices your health. Not guaranteed issue, not ACA coverage.
The longer version: ACA Marketplace vs private health insurance in 2026.
Private underwritten health plans
A private plan is priced on your health, not just age and ZIP code. You answer medical questions, and the carrier can approve you, decline you, charge more, or exclude a condition. That is what underwritten means, and why a healthy person can pay less than full Marketplace price.
Short-term plans are a different product. A short-term plan is limited coverage for a gap of months. It is not ACA coverage, it usually excludes pre-existing conditions, and it can skip things a Marketplace plan must cover. Florida allows initial terms under 12 months (Florida statute, checked February 13, 2026). I place one only when it is honestly the right tool, such as a known gap with an end date, and never as a replacement for real health insurance.
Two things I say every time. These plans are not guaranteed issue, and they are not ACA coverage. Applications are open year-round.
If you have real medical history, this is not your door. The Marketplace was built for you.
WHO IT FITS
Healthy, paying full price
Above the credit line, no regular prescriptions, and you want a lower premium with a real network.
WHO IT DOES NOT FIT
Anyone with a condition
Ongoing treatment, a recent diagnosis or a prescription list usually means a decline or an exclusion.
ACA Marketplace plans
Marketplace plans through HealthCare.gov cover pre-existing conditions with no medical questions, and a premium tax credit can lower the price based on household income.
The credit rules changed for 2026. The enhanced pandemic-era credits expired December 31, 2025, and Congress did not extend them, so the original cap of 400% of the federal poverty level is back: $62,600 for one person, $84,600 for two, $128,600 for a family of four. Above it, full price. Source: KFF and the 2025 HHS poverty guidelines, checked September 14, 2026.
Open enrollment for 2027 coverage runs November 1, 2026 to January 15, 2027 (HealthCare.gov, checked September 14, 2026). Enroll by December 15 for a January 1 start. Losing employer coverage, marriage, a move or a baby opens a special enrollment period any other time.
WHO IT FITS
Medical history, or a credit
Anyone with a condition, and anyone under the cap. For the self-employed, the Marketplace counts net profit after expenses plus any other household income; your tax preparer can confirm the number.
WHO IT DOES NOT FIT
Healthy and above the cap
It still works, it just may cost more than a healthy person needs to pay. I put a private quote next to it so you can compare both numbers.
Dental and vision
Most health plans, Marketplace or private, leave out adult dental. A standalone dental plan adds it, with a small premium, a dentist network, and a yearly cap on what it pays.
What matters is the waiting period on major work like crowns, and whether your dentist is in network. I check both before you enroll. More in the SmartHealthMatch dental and vision guide.
A vision plan covers a yearly eye exam and puts an allowance toward glasses or contacts. Premiums are small, and it is often bundled with dental.
WHO IT FITS
Cleanings, glasses, occasional big work
You see a dentist twice a year, someone in the house wears glasses or contacts, and you want a discount when something bigger comes up.
WHO IT DOES NOT FIT
A major procedure next month
Waiting periods usually mean a plan bought today will not pay for that crown.
Life insurance
Life insurance comes in two families. Term coverage runs for a set number of years and pays a set amount if you die during that term. Permanent coverage lasts your whole life and builds cash value, at a much higher premium.
I help with life insurance, and for most families a simple term policy covering the mortgage and the years the kids are at home is where I start. If your situation calls for something more, I will say so.
WHO IT FITS
Someone depends on your income
A spouse, kids, a business partner, or a mortgage that would land on someone else.
WHO IT DOES NOT FIT
Nobody depends on your income
No dependents and no debt someone else would inherit. Put the premium toward health coverage.
How working with me goes
A real conversation. About 15 minutes on your health, income, doctors and what you had before. No forms first.
I run the numbers both ways. A Marketplace plan with any credit you qualify for and, if you are healthy, a private quote beside it.
You decide, I enroll you. I handle the application, confirm your doctors, and stay your contact for claims, renewals and life changes.
Straight answers
Do you charge a fee?
No. The carrier pays me after you enroll. Your premium is the same whether you use me or apply on your own.
Can I keep my doctors?
If they are in the plan’s network, yes. I check your doctors and prescriptions before you enroll.
Deductible, out-of-pocket max, copay, coinsurance. What do they mean?
Deductible: what you pay before the plan shares costs. Out-of-pocket max: the most you pay in a year. Copay: a flat amount. Coinsurance: a percentage. Two short explainers: deductible vs out-of-pocket max and copay vs coinsurance.
Is my premium tax deductible if I am self-employed?
The self-employed health insurance deduction exists on IRS Schedule 1. Ask your tax professional whether it applies to you.
Tell me your situation. I will tell you which door.
One call, both sets of numbers, a straight answer.
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