The short answer
You can buy your own coverage two ways. The ACA marketplace takes everyone, whatever their health, and can lower your premium with a tax credit based on income, but you enroll only during open enrollment or after a qualifying life event. Private-market plans are sold directly by carriers, and most of the ones I place have a PPO-style network. Many aren't ACA plans, so you can apply for them any time of year, and approval is based on your health answers up front. I look at the private market first if you qualify and the marketplace second, though if your income earns a strong credit or you need a condition covered from day one, the marketplace is usually the answer.
When people say "Obamacare" or "the exchange," they mean the ACA marketplace. That's healthcare.gov in most states, though some states run their own exchange sites (the plans follow the same federal rules either way). It's the door most people know about. But there's a second door: plans sold directly by carriers, outside the marketplace. Most of my clients end up walking through that one, and almost none of them knew it existed before we talked. Here's what's behind each.
The marketplace, in plain terms
The marketplace is the government-run shop for ACA plans. Every plan on it follows the same rules: nobody can be turned down or charged more because of a medical condition, pre-existing conditions are covered from day one, and every plan covers a standard set of essential benefits. Adult dental and vision aren't on that list, so for adults they're something you add on purpose, as the dental and vision guide explains. If your household income falls in the right range, you get a tax credit that lowers your monthly premium, and that credit is the whole reason the marketplace works the way it does.
The catch most people feel: the plans themselves. Marketplace shelves lean heavily toward HMOs and EPOs with narrow networks, and in a lot of states a marketplace PPO barely exists anymore. If you read my plan types guide, you know what that means. Your doctors either take that specific plan or you're paying cash.
The other catch is timing. The marketplace has a window. Open enrollment starts November 1 in nearly every state, and if you miss it, you need a qualifying life event (losing a job, moving, getting married, having a baby) to get in mid-year. For 2027 coverage, open enrollment on HealthCare.gov runs November 1 to January 15, and December 15 is the last day for a January 1 start. States that run their own marketplace set their own dates, and an appeal is still pending, so if you're reading this near enrollment season, text me and I'll tell you where your state's deadline currently stands. I have written this up state by state for Georgia, which runs its own marketplace, and for Texas, which uses HealthCare.gov.
What changed in 2026
From 2021 through 2025, pandemic-era rules made the subsidies bigger and stretched them above the old income cap. Those rules expired at the end of 2025, and the marketplace snapped back to its original math: the tax credit phases out as income rises, and above roughly four times the federal poverty level it stops entirely. That edge is called the subsidy cliff, and it's a real cliff. One dollar of income over the line and the credit is gone.
The numbers tell you what that did. Nationally, what marketplace enrollees pay each month after tax credits rose 58% in 2026, from an average of $113 to $178, per KFF, and the average marketplace deductible rose about a thousand dollars as people traded down to bronze plans to keep premiums manageable. If you're self-employed and having a good year, there's a decent chance the marketplace now offers you a narrow-network HMO at full price. That's the situation a lot of my clients are calling me about.
Too much for a subsidy in 2027? Where the line is
For 2027 coverage, you may qualify for the tax credit when your household income for the year is between 100% and 400% of the federal poverty level for your household size, per the IRS. The temporary rule that lifted the cap covered tax years 2021 through 2025, so under current law there is no credit above 400%. The IRS's 2027 percentage table, in Rev. Proc. 2026-26, stops at "not more than 400%."
Which poverty numbers count? For the tax credit, the IRS uses the most recent guidelines published on the first day of open enrollment, so 2027 coverage runs on the 2026 HHS poverty guidelines. Multiply by four and you have the line:
| Household size | 2026 poverty guideline | 400% line for 2027 coverage |
|---|---|---|
| 1 | $15,960 | $63,840 |
| 2 | $21,640 | $86,560 |
| 3 | $27,320 | $109,280 |
| 4 | $33,000 | $132,000 |
These are the numbers for the 48 contiguous states and D.C. Alaska and Hawaii have their own, higher guidelines. One dollar over your line and the credit is zero for the year.
Above the line, the marketplace is full price, and that's when it's worth comparing it with a private-market plan outside the ACA. These aren't ACA plans, and many base approval on your health answers. If your health qualifies you and you're above the line, one often costs less than the full-price marketplace plan, and many are PPOs with a broader network than the cheapest bronze and silver plans, which are mostly HMOs. Whether your hospital is in network depends on the plan. The local pages list the hospital systems people ask about in Brandon, Clearwater and St. Petersburg, Jacksonville and St. Augustine.
Private-market plans, in plain terms
"Private" covers two different animals, and it matters which one you're looking at.
The first is an ACA plan bought directly from the carrier instead of through the marketplace. Same protections, same essential benefits, same enrollment windows. The only real difference: no tax credit. If you qualify for a credit, buying off-exchange means leaving money on the table, so this route mostly makes sense for people the credit doesn't reach anyway.
The second is a private-market plan that isn't an ACA plan, and this is the door most of my clients end up walking through. Many of these are medically underwritten: the application asks about your health, and the carrier decides whether to offer you a plan and at what price based on the answers. For a healthy applicant, a private-market plan outside the ACA can price below the marketplace, and it usually has a PPO-style network instead of a narrow HMO. They cover things differently, so compare the benefits, not just the price. These non-ACA plans also enroll year-round. No window, no qualifying event.
Here's how to tell whether one fits you. Approval comes from your answers to the health questions, so these plans fit best when your health qualifies you. If you have an ongoing condition, a plan may exclude it or price it in, and then the marketplace is often the better home for you. These plans are not standardized the way ACA plans are, so the details vary and reading them matters. That reading is a real part of what I do before I put one in front of you. The questions I ask are in my private-market plan checklist. For the right person they're excellent, and the application is how we find out whether you qualify.
The real differences, side by side
| Marketplace (ACA) | Underwritten private | |
|---|---|---|
| Health questions | None. Everyone accepted | Yes. Approval and price based on your answers |
| Pre-existing conditions | Covered, day one | Reviewed on the application; may be excluded |
| Tax credit available | Yes, income-based (ends above ~4× poverty level) | No |
| When you can enroll | Open enrollment or qualifying event | Any day of the year |
| Typical network | Narrow HMO/EPO | Broader, usually PPO-style |
| Benefits | Standardized essential benefits | Varies by plan. Read before you buy |
How this actually plays out with clients
A few patterns cover most of the people who call me.
If your income qualifies you for a strong tax credit, or you have a health condition that needs coverage from day one, the marketplace is usually the right answer and I'll tell you that in the first ten minutes. The credit is real money and guaranteed acceptance is something only ACA plans are required to give you. I'd rather you take the HMO with a subsidy than pay full price for a network you don't need.
If you're healthy, self-employed, and your income has climbed past the cliff, this is where a private-market PPO outside the ACA earns its reputation, and it's most of what I write. You weren't getting a credit anyway, so the marketplace's one big advantage doesn't apply to you, and that plan often comes back cheaper with a network that includes your doctors.
And if you're somewhere in the middle, the answer is twenty minutes of quotes, not a guess. I run both doors side by side, same screen, and the numbers make the decision for us. Sometimes the marketplace wins. Either way, you know before you buy.
Questions people actually ask
Can I get the tax credit on a private-market plan?
No. The credit only exists through the marketplace. That's the marketplace's biggest advantage, and for anyone who qualifies for a meaningful credit it usually settles the question.
Can I really sign up for a private-market plan in July?
For private-market plans that aren't ACA plans, yes. They enroll year-round, no qualifying event needed. Marketplace plans and off-exchange ACA plans both still require open enrollment or a qualifying event.
I have a pre-existing condition. Are medically underwritten plans off the table?
Often, but not automatically. It depends on the condition, and the application is how we find out. What I won't do is put you in an underwritten plan that excludes the thing you need covered. That's a marketplace situation, and I'll say so.
Which one is cheaper?
For subsidized households, the marketplace, almost every time. For healthy people above the subsidy cliff, a private-market plan outside the ACA usually wins on premium and network both. The only way to know for your situation is to run both, which is the job.
What income is too much for a subsidy in 2027?
Under current law, anything over 400% of the federal poverty level for your household size. For 2027 coverage that's $63,840 for one person, $86,560 for two, $109,280 for three and $132,000 for four, using the 2026 HHS guidelines for the 48 contiguous states and D.C. Alaska and Hawaii are higher.
What happens if my income changes mid-year?
It matters more than people think. The marketplace credit is reconciled on your tax return, so earning more than you estimated can mean paying the difference back in April, with no cap from 2026 on. It's one of the things I check when we run your numbers.
Want the numbers for your situation?
I run both doors side by side, same screen, and the numbers make the decision for us. Free, no pressure.
Get my options →The bottom line
The marketplace exists so that anyone can get covered regardless of health, with help based on income. Private-market plans outside the ACA exist so that healthy people can get better networks at better prices, often in exchange for answering health questions. Neither is the right answer for everyone. I hold both doors open, run the numbers side by side, and it costs you nothing to find out which one is yours. Text or call and we'll do it in one conversation.