Private Health Insurance vs. the ACA Marketplace: An Honest Guide for the Self-Employed

Ryan Michalek, Licensed Health & Life Insurance Agent, NPN 21043091. Last updated November 8, 2026 · Read my Google reviews

If you're self-employed, a 1099 contractor, or running a small business, health insurance is a confusing and expensive decision, and with no employer in the picture it's all on you. You've probably heard about "the marketplace," gotten sticker shock from ACA quotes, and wondered if there's another way, and there usually is. There's no single right answer, though, because the right plan depends on you, so let's walk through both paths and you can decide knowing how each one works.

What the ACA marketplace is

The ACA (Affordable Care Act) marketplace, which you'll also hear called Obamacare, is the public exchange where you can buy government-regulated health plans. In some states that exchange is state-run under its own name, so your state's marketplace may not say HealthCare.gov at all. Its biggest strengths:

• Guaranteed coverage. Plans can't turn you down or charge you more for pre-existing conditions.
• Subsidies for those who qualify. If your income falls in the right range, tax credits can lower your premium a lot.
• A full set of essential benefits. Every plan covers a federally defined set of services.

The trade-offs: outside of open enrollment (or a qualifying life event) you generally can't enroll, networks can be narrow, and the big one for the self-employed is that if you earn too much to qualify for a subsidy, the full-price premiums can be steep.

What private under-65 plans are

Private health plans are offered through licensed brokers (like me) rather than the public exchange, which is why this is often called off-exchange health insurance. For the right person, the advantages are real:

• Enroll any time of year. No waiting for open enrollment.
• PPO-style flexibility. Many offer broad, national networks with no referrals required.
• Worth comparing on price for healthy people who don't qualify for marketplace (ACA) subsidies.

The trade-offs: private plans aren't ACA marketplace plans, so they aren't subsidy-eligible. Many are also medically underwritten, meaning the insurer looks at your health history before deciding whether to accept you and what to charge, which is also why some plans may not cover pre-existing conditions the way an ACA plan does. They're built differently on purpose, so they fit some people well and others not at all.

Off-exchange health insurance: one phrase, two different products

"Off exchange" comes up on my calls a lot this fall, and it means two different things depending on who says it. Sorting that out first saves everyone a confusing comparison.

• An ACA plan bought off the exchange. Insurers also sell their marketplace-style plans directly. Federal rules require the same premium whether that plan is bought through the exchange, directly from the insurer, or through an agent (45 CFR 156.255(b), checked November 8, 2026). It follows the same ACA rules, guaranteed issue and the essential health benefits, and generally the same enrollment windows. What you give up off the exchange is the premium tax credit. Above the subsidy line you weren't getting one anyway, so this door is the marketplace plan by another route.
• A private, medically underwritten plan. This is what most people mean when they ask me about "off-exchange" or a "private PPO." It's a non-ACA plan, it can be applied for any time of year, and the insurer reviews health history before deciding whether to accept you and at what rate, so approval isn't automatic and pre-existing conditions may be handled differently. This is where the price and the network can genuinely differ from the marketplace.

So "is off-exchange cheaper than the marketplace?" has two answers. The same ACA plan costs the same on or off the exchange, minus any credit you would have gotten. A private underwritten plan is priced on your age and health, and for a healthy person over the subsidy line it's the one worth putting side by side. More on the product itself in what off-exchange health insurance is.

So which one fits you?

Private coverage tends to be a strong fit if you:

• Are relatively healthy and don't have major ongoing medical needs
• Earn too much to qualify for ACA subsidies (or saw your premium jump at renewal), including self-employed families over the subsidy cliff
• Want PPO flexibility: your own doctors, no referrals, coverage when you travel
• Need coverage now and missed open enrollment
• Are between jobs, losing COBRA, or retiring before 65

The ACA marketplace is usually the better path if you:

• Have significant pre-existing conditions or ongoing treatment
• Qualify for meaningful subsidies based on your income
• Want the guaranteed, comprehensive benefits the ACA mandates

That second list matters to me. If the marketplace is the better fit for your situation, I'll tell you that, even though it isn't what I place, because that's what an independent broker is for.

Over the subsidy line and paying full price? That's who I help. Call or text me at (813) 833-7448, book 15 minutes, or send the short form, and I'll put a private plan next to your marketplace option on your real numbers. If you qualify for a subsidy, I'll connect you with my partner who handles marketplace enrollment. I answer my own phone, evenings and weekends.

Can you still get a PPO in 2027?

Often not on the marketplace. In 17 of the states I’m licensed in, the 2027 marketplace in the largest city I checked offers no PPO at any metal level, only HMO and EPO plans that keep you inside a set network. Where marketplace PPOs do exist they can cost far more: in Tampa, Miami and Jacksonville the least expensive one runs roughly 78% to 113% above the benchmark silver plan for a 60-year-old.

If keeping your own doctors or having coverage when you travel matters to you, private under-65 plans built on a national PPO network are another path (here's how private PPO plans for the self-employed work). They’re medically underwritten, so approval isn’t automatic, and they work best for people who are generally healthy. I’ll lay both side by side so you can see what you’d actually give up or gain.

Public marketplace quotes checked October 31, 2026, non-smoker, no subsidy; the cheapest PPO can be any metal level. Prices and networks vary by county, so another city in the same state can differ. Alabama, Georgia and Kentucky checked November 1, 2026. Compare full prices by state on the 2027 cost page.

For every county in the 24 HealthCare.gov states, not just the largest city, see the 2027 marketplace by county.

Health sharing vs. ACA for the self-employed

When full-price marketplace quotes land, a lot of self-employed people start looking at a health-sharing ministry. The monthly amount can look appealing, but the two aren’t the same kind of thing, and the differences show up when you need them most.

• An ACA plan is insurance; a health share isn’t. A marketplace plan is a contract that has to pay covered claims. A sharing ministry passes members’ bills among members, with no guarantee any bill gets paid, and your state insurance regulator generally can’t step in.
• Pre-existing conditions. ACA plans are guaranteed-issue and cover them. Health shares often limit or phase in sharing for conditions you already have.
• Subsidies. If your income qualifies, only the marketplace plan can carry a premium tax credit. Above the subsidy cliff, you pay full price either way.
• Getting back in. A health share doesn’t count as minimum essential coverage, so leaving one generally doesn’t open a special enrollment window. Marketplace coverage usually has to wait for Open Enrollment.

There’s a third path some self-employed people miss: a private plan, which is insurance with a contract and a regulator, can be applied for any time of year, and is medically underwritten, so approval isn’t automatic. My full take on sharing is in the health sharing ministries guide, and in some states Farm Bureau health plans work in a similar non-insurance way. Which one fits depends on your health, your income and your doctors, and I’ll lay them out side by side at no cost.

My doctor is no longer in network: what can I do?

Contract disputes between insurers and doctors or hospital systems often take effect January 1. A provider leaving your network generally isn’t, on its own, a reason the marketplace lets you change plans mid-year, so the time to act is during Open Enrollment: check whether your doctors are in the network of the plan you’re renewing into, not just the one you have now. If you’re in the middle of treatment, federal rules generally give continuing-care patients up to 90 days of in-network coverage after a contract ends, so ask your insurer about that. Private under-65 plans built on a national PPO network can be applied for any time of year, subject to medical underwriting, which is why the PPO question above matters for people who won’t give up a specific doctor.

Can I get health insurance after being denied?

Being turned down for a plan doesn't mean you're out of options. It usually means you ran into how these two types of coverage work. Some private coverage is medically underwritten, so the insurer can decline an application based on health history. ACA marketplace plans work the opposite way: they're guaranteed-issue, can't turn you down or charge more for pre-existing conditions, and ask no health questions at all. So if an underwritten plan said no, the marketplace route is still fully open to you. The two paths trade off differently on cost, networks, and flexibility, so compare them side by side rather than treating one denial as the end of the road.

How I help

As an independent private health insurance broker, I compare your real options, private and otherwise, explain the trade-offs in plain English, and help you choose coverage that fits your life and budget. There's no fee to work with me, and I'm still here long after you're covered.

Still weighing the two? Michalek Health Solutions, an independent Tampa broker, can walk both paths with you before you decide.