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. 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. The end date is messier: it varies by state, and an ongoing court fight has made it a moving target on top of that. If you're reading this near enrollment season, text me and I'll tell you where your state's deadline currently stands.
What changed in 2026
For four years, 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. Average out-of-pocket marketplace premiums rose 58% this year, and the average marketplace deductible jumped 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.
Private 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 the medically underwritten plan, and this is the door most of my clients end up walking through. Underwritten means the application asks about your health, and the carrier decides whether to offer you a plan and at what price based on the answers. That's the trade at the heart of this whole guide: because the carrier can say no, the people it says yes to get pricing the marketplace can't match, and usually a PPO-style network instead of a narrow HMO. These plans also enroll year-round — no window, no qualifying event.
Now the honest part, because this is where a bad broker goes quiet. Underwriting cuts both ways. If you have ongoing health conditions, an underwritten plan may exclude them, price you up, or decline you outright. These plans are not standardized the way ACA plans are, which means the details vary and reading them matters. It's a real part of what I do before I put one in front of you. For the right person they're excellent. For the wrong person they're a trap, and the application is where you find out which one you are.
The real differences, side by side
| Marketplace (ACA) | Underwritten private | |
|---|---|---|
| Health questions | None — everyone accepted | Yes — carrier can decline or price up |
| Pre-existing conditions | Covered, day one | May be excluded or declined |
| 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 not something any private carrier will 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 the underwritten private PPO 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 the private 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 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 plan in July?
For underwritten 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. Is private 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, the private plan usually wins on premium and network both. The only way to know for your situation is to run both, which is the job.
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 some of it back in April. 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 underwritten plans exist so that healthy people can get better networks at better prices 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.