Private vs Marketplace Health Insurance
What is the difference between private and Marketplace health insurance?
Marketplace plans are sold through the government exchange, must meet Affordable Care Act requirements, and are the only place income-based financial help is available. Private plans are sold outside the exchange. Some private plans are ACA-compliant and some are not, which changes what they cover and how they handle pre-existing conditions.
The word 'private' describes where a plan is sold, not what it covers. That is the single most common source of confusion in this category.
ACA-compliant plans must cover a defined set of essential health benefits and cannot decline you or price you based on health history.
Products that are not ACA-compliant may apply medical underwriting, exclude pre-existing conditions, cap benefits or leave out entire categories of care. They can look inexpensive precisely because they cover less.
Important exceptions
- Availability of specific products varies by state.
- Financial help based on income is generally only available through the Marketplace.
- Enrollment timing rules differ between Marketplace and some non-Marketplace products.
Dave's perspective
“Before anyone compares prices, I want them to know whether the two plans in front of them are even covering the same things. Often they are not. [INSURANCE COMPLIANCE REVIEW]”
Dave Gagleard · Dave Knows Health
Related information
Plan availability, eligibility, benefits, exclusions, underwriting requirements, enrollment periods and coverage vary by carrier, product and state.