Starting a New Business? Here's Your Health Insurance Game Plan
Starting a new business with unpredictable income? Private underwritten PPOs eliminate subsidy reconciliation hassles and may offer plans with deductibles as low as $0—often beating ACA high-deductible plans with healthier risk pools and supplemental coverage.
Starting a New Business? Here's Your Health Insurance Game Plan
Fast take: Left your job to start a business? Your health insurance strategy matters as much as your business plan. With unpredictable first-year income, private underwritten PPOs eliminate subsidy reconciliation hassles and may offer plans with deductibles as low as $0—often beating high-deductible ACA plans with better networks and lower total costs.
Just went full-time on your business?
We'll compare COBRA, ACA, and private PPO options—and verify your doctors stay covered while you build.
Get Free Quotes Book a CallYour coverage options when starting a business
COBRA (Bridge Option)
✓ Keep your old employer plan
✓ Same doctors and networks
✗ Usually most expensive
✗ Time-limited (18 months max)
ACA Marketplace
✓ May be cheapest with subsidies
✓ Loss of job = Special Enrollment
✗ Often HMO/EPO networks
✗ Income reconciliation at tax time
✗ High deductibles ($7,000-$9,000+)
Private Underwritten PPO
✓ May qualify for deductibles as low as $0
✓ Nationwide PPO access
✓ Year-round enrollment
✓ No income reporting
✓ Healthier risk pools
Why unpredictable income is a nightmare with ACA subsidies
The income estimation trap
When you enroll in ACA, you estimate your 2026 income in advance. First-year business? You're guessing.
✗ Estimate too low → subsidy payback at tax time
✗ Estimate too high → overpay premiums all year
✗ Business takes off mid-year? You owe thousands back
Private PPO eliminates the guessing game
Your premium is based on age, ZIP, and plan—not income.
✓ Make $50k or $500k? Premium stays the same
✓ No Form 8962 reconciliation at tax time
✓ Budget with confidence from day one
Why private underwritten PPOs beat high-deductible ACA plans
Many entrepreneurs think high-deductible Marketplace plans are their only affordable option. That's rarely true for healthy business owners.
ACA high-deductible plans
✗ $7,000-$9,000+ deductibles common
✗ You pay 100% until deductible is met
✗ Risk pool includes all applicants (healthy + unhealthy)
✗ Often HMO/EPO with referral requirements
✗ Premium jumps if income rises
Private underwritten PPOs
✓ May qualify for deductibles as low as $0
✓ Copays often start immediately (office visits, Rx)
✓ Risk pool = healthy small business owners/employees
✓ Nationwide PPO networks, no referrals
✓ Premium never changes with income
The risk pool advantage: Why private plans cost less for healthy entrepreneurs
ACA Marketplace risk pools
Guaranteed issue = everyone accepted regardless of health
Risk pool includes:
• Healthy applicants
• Chronic conditions
• High-cost ongoing treatments
Result: Higher premiums spread across everyone, including you
Private underwritten risk pools
Medical underwriting = healthier risk pool through association memberships
Risk pool includes:
• Healthy business owners
• Small business employees
• Self-employed professionals
Result: Lower premiums for healthy applicants, better benefits, lower deductibles
Supplemental coverage: Offsetting out-of-pocket costs
Even with low-deductible private PPOs, you can further reduce financial risk with supplemental coverage:
Hospital indemnity insurance
Pays cash benefit per day of hospitalization
✓ Use cash for deductibles, copays, or lost income
✓ Low monthly cost ($30-$80/month typical)
Accident insurance
Covers ER visits, urgent care, broken bones, imaging
✓ Pays lump sum or per-service benefits
✓ Complements your major medical plan
Critical illness insurance
Lump-sum payment if diagnosed with covered condition (heart attack, stroke, cancer)
✓ Use for medical bills, travel, mortgage—anything
✓ Peace of mind for catastrophic events
Strategy: Layer your protection
Private PPO with low deductible + hospital indemnity ($500/day) = near-zero financial risk
Total monthly cost often less than ACA high-deductible plan alone
Why entrepreneurs choose private PPO plans
No income reconciliation headaches
Your premium doesn't change when your business revenue fluctuates. No Form 8962, no tax-time surprises, no subsidy payback.
Travel-friendly nationwide networks
Client meetings in Austin? Conference in Denver? PPO access means you're covered wherever business takes you—no network restrictions.
Direct specialist access
No primary care referrals. No waiting weeks for authorization. See specialists when you need them without bureaucratic delays.
Lower total annual costs
Low-deductible PPO often costs less annually than $8,000 deductible ACA plan when you factor in total out-of-pocket exposure.
Common mistakes new business owners make
❌ Staying on COBRA too long
COBRA is expensive and time-limited. It's a bridge, not a long-term solution. Compare alternatives within 60 days.
❌ Underestimating income for subsidies
Business takes off? You'll owe subsidy money back at tax time. Estimate conservatively or skip subsidies entirely with private PPO.
❌ Accepting high deductibles as inevitable
ACA high-deductible plans aren't your only option. Private underwritten PPOs may offer plans with deductibles as low as $0 for healthy applicants.
❌ Not considering supplemental coverage
Hospital indemnity and accident insurance can eliminate remaining out-of-pocket exposure for less than $100/month.
Decision guide: Which option fits your business?
Choose ACA Marketplace if...
✓ Your first-year income will be very low (under $35k individual)
✓ You qualify for strong subsidies and cost-sharing reductions
✓ Your income is stable and predictable
✓ You're comfortable with high deductibles and HMO networks
✓ You don't mind annual tax reconciliation
Choose Private Underwritten PPO if...
✓ Your income is variable or growing (startup revenue unpredictable)
✓ You're healthy and pass medical underwriting
✓ You want lower deductibles and immediate copays
✓ You travel frequently for business
✓ You prefer nationwide PPO access with no referrals
✓ You want to avoid subsidy reconciliation at tax time
Your launch timeline: Health insurance edition
Before you leave your job
✓ Document your last day of employer coverage
✓ Get COBRA election notice
✓ List your current doctors and prescriptions
✓ Estimate your Year 1 business income range (low and high scenarios)
First 60 days after leaving
✓ Compare COBRA vs ACA vs private PPO costs and deductibles
✓ Verify provider networks for all options
✓ Get quotes for supplemental coverage (hospital indemnity, accident)
✓ Enroll in your long-term solution before Special Enrollment window closes
First year in business
✓ Track actual income monthly (if on ACA, update estimates)
✓ Keep records for self-employed health insurance tax deduction
✓ Set aside emergency fund for deductibles and out-of-pocket costs
✓ Review supplemental coverage needs as business stabilizes
Annual review
✓ Reassess coverage during Open Enrollment (or anytime with private PPO)
✓ Compare costs as your income stabilizes
✓ Verify doctors are still in-network
✓ Adjust deductible level based on actual business cash flow
How RKA helps entrepreneurs
Fast transition planning
We map your options before your last day of work—COBRA bridge strategies, Special Enrollment timing, and private PPO alternatives with accurate underwriting pre-screening.
Network verification
We confirm your doctors and hospitals are in-network across all options—ACA, private PPO, and supplemental plans—before you commit.
Total cost analysis
We model multiple income scenarios and compare: premiums + deductibles + expected usage + supplemental coverage = your true annual cost.
Supplemental layering strategy
We show you how hospital indemnity, accident, and critical illness coverage can eliminate remaining out-of-pocket exposure affordably.
Launching your business? Lock your health insurance first.
We'll compare COBRA, ACA, and private underwritten PPO options—verify your doctors—and layer supplemental coverage to eliminate financial risk.
Get Free Quotes Book a CallQuick FAQs
Why is private underwritten PPO cheaper than ACA high-deductible if I'm healthy?
Risk pool matters. ACA pools include everyone regardless of health, spreading costs across healthy and unhealthy. Private underwritten plans pool healthy small business owners, employees, and self-employed professionals through association memberships, resulting in lower premiums and better benefits.
What if my business income is unpredictable?
Private PPO eliminates the guessing game. Your premium is based on age and ZIP—not income. Make $50k or $500k, your premium stays the same. No subsidy reconciliation, no Form 8962, no tax-time surprises.
How does supplemental coverage work with my major medical plan?
Supplemental policies (hospital indemnity, accident, critical illness) pay cash benefits directly to you—use the money for deductibles, copays, lost income, or anything else. They stack on top of your major medical plan to eliminate financial risk.
For education only; consult a tax professional for deduction advice. Eligibility for private underwritten plans subject to medical underwriting. Benefits vary by carrier and state. Always review official plan documents.
Guarantee Issue Private PPOs: Year-Round Coverage Without Medical Underwriting | RKA
Guarantee issue private PPOs now available in select markets—year-round enrollment, nationwide networks, no medical underwriting required. Perfect if you missed Open Enrollment or need coverage with pre-existing conditions. We check availability in your ZIP.
Guarantee Issue Private PPOs Now Available – Year-Round Coverage Without Waiting for Open Enrollment
Fast take: New guarantee issue private PPO options are available in select markets—year-round enrollment, broad nationwide networks, and no medical underwriting required. If you need coverage outside Open Enrollment and don't have a Special Enrollment Period, this may be your path. We'll verify providers and show clear costs before you commit.
Need coverage now without waiting for Open Enrollment?
We'll confirm if guarantee issue PPOs are available in your ZIP, verify your doctors, and enroll you quickly.
Get Free Quotes Book a CallWhat makes guarantee issue PPOs different
For years, private PPO plans required medical underwriting—health questions that could result in denial or exclusions if you had pre-existing conditions. Guarantee issue private PPOs solve this problem by combining the best features of ACA Marketplace plans (no medical questions, guaranteed acceptance) with the advantages of private PPO networks (broader access, fewer restrictions, year-round availability).
Guarantee Issue
✓ No medical questions
✓ No health exams
✓ Cannot be denied
✓ Pre-existing conditions covered
✓ Coverage starts immediately
PPO Network Benefits
✓ Nationwide provider access
✓ No referrals for specialists
✓ Out-of-network coverage
✓ Major hospital systems included
✓ Travel-friendly coverage
Year-round enrollment
These plans are available outside the standard November-January Open Enrollment period. You can apply and start coverage any month of the year without needing a Qualifying Life Event.
Perfect if you:
✓ Missed the January 15 deadline
✓ Don't have a qualifying life event
✓ Need coverage immediately
✓ COBRA is too expensive
✓ Want to switch plans mid-year
Great for:
✓ Frequent travelers
✓ Multi-state households
✓ Specific doctor requirements
✓ Higher income (no subsidies)
✓ Pre-existing conditions
How guarantee issue PPOs compare
| Feature | Guarantee Issue PPO | ACA Marketplace | Underwritten PPO |
|---|---|---|---|
| Medical questions | None | None | Yes (can deny) |
| Enrollment window | Year-round | Open Enrollment only | Year-round (if approved) |
| Network type | Nationwide PPO | Often HMO/EPO | Nationwide PPO |
| Subsidies | No | Yes (if eligible) | No |
| Pre-existing conditions | May have exclusions & limits | Covered day 1 | Covered if approved & disclosed |
Simple next steps
1. Check availability
Not offered in all states or ZIP codes. We'll confirm immediately if these plans are available in your area.
2. Verify providers
Send your doctor list. We'll check network participation before you commit—even PPOs don't cover every provider.
3. Compare costs
We'll show total annual cost: premiums + deductibles + expected usage across all your options.
4. Enroll fast
Most plans start on the 1st or 15th of the month. We'll time your application to avoid coverage gaps.
Quick FAQs
Are guarantee issue PPOs available in all states?
No—availability varies by carrier and market. We'll check your specific ZIP code and confirm which options exist in your area.
How do premiums compare to Marketplace plans?
Often similar to unsubsidized Marketplace plans, but with PPO flexibility instead of HMO/EPO restrictions. If you qualify for Marketplace subsidies, the subsidized plan will almost always be cheaper.
Can I switch from a Marketplace plan to a guarantee issue PPO mid-year?
Yes, if you're willing to give up subsidies (if you have them). We'll compare total costs—including lost subsidies—before you make the switch to ensure it makes financial sense.
What if I have a serious pre-existing condition?
Guarantee issue means exactly that—no one can be turned down. Pre-existing conditions may have wait periods or exclusions.
For education only; availability and benefits vary by carrier, state, and ZIP code. Always review official plan documents.
MISSED ENROLLMENT? WHAT'S NEXT - PRIVATE OPTIONS
Missed Open Enrollment? Special Enrollment Periods after life events and year-round private PPO options can get you covered outside the Jan 15 deadline. We check your eligibility, verify doctors, and compare ACA vs private PPO options fast.
Missed Open Enrollment? Here's What's Next – Private PPO Options & Special Enrollment Periods
Fast take: Missed the January 15 Open Enrollment deadline? You still have options. Qualify for a Special Enrollment Period after a life event, or—if eligible—apply for a private, medically underwritten PPO that can start any month. We'll verify doctors, prescriptions, and timing to avoid gaps.
Missed Open Enrollment? Let's find your path to coverage.
We'll check if you qualify for an SEP, compare income-based options, and review private PPO alternatives—then enroll you quickly.
Get Free Quotes Book a CallYour coverage options after January 15
Missing Open Enrollment doesn't mean you're stuck without coverage for the entire year. There are legitimate pathways to get health insurance outside the standard enrollment window—you just need to know which one applies to your situation.
Path #1: Special Enrollment Period (SEP)
If you've experienced a Qualifying Life Event (QLE), you can enroll in Marketplace coverage outside Open Enrollment. The government recognizes that life doesn't wait for enrollment windows, and certain events create immediate coverage needs.
Common Qualifying Life Events:
- Loss of coverage: Losing employer coverage, aging off a parent's plan at 26, COBRA ending, losing Medicaid eligibility
- Household changes: Marriage, divorce, legal separation, death of a spouse
- New dependents: Birth, adoption, foster care placement
- Residence changes: Moving to a new ZIP code or state with different plan options (not just moving addresses within the same service area)
- Income changes: Gaining or losing eligibility for premium tax credits or cost-sharing reductions
- Other coverage changes: Gaining citizenship, release from incarceration, enrollment errors by the Marketplace or insurer
Timing matters: Most SEPs last 60 days from the date of your qualifying event. You'll need documentation (termination letter, marriage certificate, birth certificate, lease agreement, etc.) to prove your QLE.
We'll help you determine if your situation qualifies, gather the right documentation, and set the correct effective date so there are no gaps in coverage.
Path #2: Private, medically underwritten PPO
Private PPOs operate outside the ACA Marketplace system and are available year-round for applicants who pass medical underwriting. These plans offer significant advantages for the right people:
Key features of private PPOs:
- Year-round enrollment: Apply any month—no need to wait for Open Enrollment or have a qualifying life event
- Broader networks: Often nationwide PPO access with major carriers, great for travelers or multi-state households
- No referrals: Typically direct access to specialists without PCP gatekeeping
- Flexible start dates: Many carriers offer 1st or 15th of the month effective dates after approval
- Competitive pricing: For healthy applicants, premiums can be lower than unsubsidized Marketplace plans
Medical underwriting requirements:
Unlike ACA Marketplace plans (which are guaranteed issue regardless of health status), private PPOs require you to answer health questions. Approval depends on:
- Pre-existing conditions and their severity
- Current medications and dosages
- Recent hospitalizations or surgeries
- Overall health profile and risk factors
We pre-screen applications quickly (usually within 24 hours) to let you know if you're likely to be approved before you formally apply. This saves time and avoids unnecessary declinations on your record.
Path #3: Income-based Marketplace options
In certain situations, changes in income can create Special Enrollment Period eligibility, even without a traditional qualifying life event. This typically applies when:
- Your income drops below 150% of the Federal Poverty Level and you become newly eligible for enhanced subsidies
- You gain or lose access to employer coverage due to income changes affecting your job status
- You move and your new location affects your subsidy eligibility
If you're self-employed or have variable income (1099 contractor, gig worker, commission-based), we can model your expected 2026 MAGI and determine if income-based SEP rules might apply.
How to decide which path fits you
Choose SEP if…
✓ You had a qualifying life event in the past 60 days
✓ You qualify for Marketplace subsidies
✓ You need guaranteed issue coverage regardless of health
✓ Your doctors are in Marketplace networks
Choose Private PPO if…
✓ You're in good health and can pass underwriting
✓ You want nationwide PPO access
✓ You don't qualify for meaningful subsidies
✓ You need coverage to start quickly
Consider short-term if…
✓ You need temporary coverage for 1-3 months
✓ You're between jobs or waiting for employer coverage
✓ You understand limited benefits and exclusions
✓ You're healthy and have minimal ongoing care needs
Simple coverage checklist
To get started, gather this information so we can move quickly:
- Your providers: Names and locations of your doctors, specialists, and preferred hospitals
- Current prescriptions: Medication names, dosages, and frequency
- QLE documentation (if applicable): Termination letters, marriage certificates, birth certificates, lease agreements
- Target start date: When you need coverage to begin
- Health summary: Major conditions, recent surgeries, current treatments (for private PPO pre-screening)
We'll verify which path you qualify for, confirm your providers are in-network, model total annual costs, and enroll you with the correct effective date.
Quick FAQs
How fast can coverage start?
Marketplace SEP plans typically start the 1st of the month following enrollment (if you enroll by the 15th). Private PPOs can start on the 1st or 15th after underwriting approval, depending on the carrier—usually 3-7 business days.
What if I don't have a qualifying life event?
If you don't qualify for an SEP, private PPO options may still be available if you pass medical underwriting. We'll pre-screen your health profile and let you know quickly if it's a viable path.
Can you confirm my doctors are in-network?
Yes. Send us your provider list (names, specialties, locations) and we'll verify participation across both Marketplace SEP plans and private PPO networks before you enroll.
What if I get declined for a private PPO?
We'll explore other options immediately—checking if you qualify for any SEP pathways, Medicaid eligibility, or short-term coverage as a bridge until next Open Enrollment.
For education only; eligibility, plan availability, and dates vary by state and carrier. Always review official plan documents.
FINAL DAY: Open Enrollment Ends Tonight | Act Now
Open Enrollment ends tonight at 11:59 PM. If you don't enroll or update your plan by midnight, you're locked out until next year. Don't let auto-enrollment cost you thousands—compare all options before the deadline.
FINAL DAY: Open Enrollment Ends Tonight at Midnight
Fast take: Open Enrollment for 2026 health insurance ends tonight at 11:59 PM. If you don't enroll or update your plan by midnight, you're locked out until next year—unless you qualify for a Special Enrollment Period. Don't let auto-enrollment cost you thousands.
⏰ DEADLINE: TONIGHT AT MIDNIGHT
We'll compare your options, verify networks, and walk you through enrollment in minutes—before time runs out.
Get Free Quotes NOW Book Emergency CallWhat happens if you miss tonight's deadline
No coverage
✗ No health insurance for 2026
✗ Pay full price for all medical care
✗ Can't enroll again until November 2026
✗ No protection from surprise medical bills
Auto-enrollment trap
✗ Stuck in current plan at higher 2026 rates
✗ Miss cheaper plan options
✗ Doctors may no longer be in-network
✗ Could overpay thousands annually
If you don't have coverage: Do this NOW
Contact us immediately
We'll pull all available plans in your area, calculate your tax credit if you qualify, and show you every option side-by-side in minutes.
Compare plans fast
We'll focus on monthly premium, deductible, out-of-pocket maximum, and whether your doctors are in-network. Having coverage is better than having no coverage—we'll help you decide quickly.
Enroll before midnight
We'll handle the enrollment process and make sure everything's completed before 11:59 PM tonight. You can always change plans next year, but you can't go back and enroll today once the deadline passes.
If you have Marketplace coverage: Review before auto-enrollment locks you in
We'll review your current plan
Plans change every year—networks shift, premiums adjust, benefits get redesigned. We'll check if your current plan is still the best option or if better alternatives exist.
Update your income for accurate subsidies
If your income changed from last year, this recalculates your tax credit and shows your true monthly cost. We'll update this for you and compare all available plans based on your actual 2026 pricing.
Compare every available plan
We'll look at total annual cost—not just premium. We factor in deductible, copays, out-of-pocket maximum, and expected usage based on your health needs. We also verify your doctors and prescriptions are still covered.
Actively select your plan
Don't rely on auto-enrollment. It's designed for convenience, not savings. We'll help you select the best plan and can save you hundreds or thousands of dollars in 2026.
If you're paying full price: Consider private health insurance
If you don't qualify for subsidies or your income is above 400% of the federal poverty level, you're not required to use Marketplace plans.
- Private PPOs often cost less: For those paying full premium, private plans frequently offer better value with broader networks
- Year-round enrollment: Private plans aren't limited to Open Enrollment periods for ACA-compliant coverage
- Nationwide networks: Many private PPOs offer coast-to-coast access without referrals or HMO restrictions
- Direct specialist access: No primary care gatekeepers—see specialists when you need them
If Marketplace premiums jumped significantly and you're receiving minimal or no tax credits, we'll show you private options before midnight.
Why tonight's deadline matters
Open Enrollment ends at 11:59 PM tonight. Not tomorrow morning. Not next week. Tonight.
Once the deadline passes, you're locked out until November 2026 unless you experience a qualifying life event like losing other coverage, getting married, or having a baby.
Medical costs don't care if you missed the deadline. Emergency room visits can cost thousands. Routine prescriptions add up fast. Doctor appointments, specialist visits, lab work—all of it comes out of your pocket without insurance.
Stop reading. Call us now.
We'll compare your options and walk you through enrollment in minutes—before midnight tonight.
Get Free Quotes NOW Book Emergency CallFAQ
What if I miss tonight's deadline?
You're locked out until November 2026 Open Enrollment unless you qualify for a Special Enrollment Period due to losing coverage, marriage, birth, adoption, or moving to a new state.
Can you still help me enroll tonight?
Yes—contact us immediately. We'll walk you through your options and complete enrollment in minutes before the deadline.
Are private PPOs cheaper than Marketplace plans?
If you don't qualify for subsidies, private PPOs can offer lower total costs with broader networks—especially for healthy applicants. We'll compare both options for you.
For education only; eligibility and benefits vary by carrier and state. Always review official plan documents.
Marketplace Premium Change Notifications: What They Mean & How to Respond
Marketplace premiums are jumping for 2026. If you received a rate increase notification, don't auto-renew without comparing options. We verify your doctors, compare ACA vs private PPO plans, and show total annual costs before the January 15 deadline.
Marketplace Premium Change Notifications: What They Mean & How to Respond
Fast take: If you received a Marketplace premium change notification, your 2026 rate is likely increasing—sometimes significantly. Don't auto-renew without comparing options. We'll verify your doctors, compare ACA plans vs. private PPOs, and show total annual costs before you commit.
Got a premium increase notice?
We'll compare your current plan against new Marketplace options and private PPOs—and verify your doctors stay in-network.
Get Free Quotes Book a CallWhat your notification means
Premium increase
✓ Your monthly cost is going up for 2026
✓ Increase can range from 10-30%+ depending on your state
✓ Driven by medical inflation, drug costs, and policy changes
Plan changes
✓ Network may have changed—verify your doctors
✓ Deductibles and out-of-pocket maximums may be higher
✓ Prescription formulary tiers may have shifted
Why premiums are jumping for 2026
- Medical inflation: Hospital and provider costs continue rising faster than general inflation
- Specialty drugs: GLP-1 medications and other high-cost drugs are pushing claims higher
- Subsidy uncertainty: Enhanced ACA subsidies may expire, raising net costs for middle-income families
- Carrier adjustments: Insurers are repricing based on 2024-2025 utilization patterns
What to do right now
1) Don't auto-renew blindly
If you do nothing, your current plan will automatically renew at the higher 2026 rate. You have until January 15 to switch plans during Open Enrollment.
2) Verify your provider network
Marketplace plans frequently change networks. Your current doctors may no longer be in-network for 2026—check before you commit.
3) Compare total annual cost
Don't just look at premium changes. Factor in:
- New deductible amounts
- Copays and coinsurance changes
- Out-of-pocket maximum increases
- Expected usage based on your health needs
4) Check alternative options
If your Marketplace premium is jumping significantly and you don't qualify for strong subsidies, private PPO options may offer:
- Lower total annual costs for healthy applicants
- Broader nationwide PPO networks
- Fewer referral requirements and restrictions
How to decide in minutes
Stay on Marketplace if...
✓ You qualify for strong income-based subsidies
✓ Your doctors are still in-network for 2026
✓ A different Marketplace plan offers better value
✓ You're comfortable with HMO/EPO restrictions
Consider Private PPO if...
✓ Your premium jumped 20%+ and subsidies are minimal
✓ You want nationwide PPO access and flexibility
✓ You travel frequently or need specialists
✓ You prefer direct access without referrals
How RKA handles premium increase notifications
- Network verification: We confirm your doctors are in-network for 2026—before you commit
- Side-by-side comparison: Current plan vs. new Marketplace options vs. private PPOs
- Total cost projection: Annual costs including premiums, deductibles, and expected usage
- Fast enrollment: We'll switch you to the best option before the January 15 deadline
Don't pay more without comparing options
We'll verify your doctors, compare all available plans, and show clear annual costs—before January 15.
Get Free Quotes Book a CallFAQ
Can I switch plans after getting a premium increase notice?
Yes—during Open Enrollment (through January 15), you can switch to any Marketplace plan or explore private PPO options if eligible.
Will my doctors still be covered in 2026?
Not necessarily. Networks change annually. We verify your specific providers before you commit to any plan.
Are private PPOs always more expensive than Marketplace?
No. If you don't qualify for subsidies, private PPOs can offer lower total costs with broader networks—especially for healthy applicants.
For education only; eligibility and benefits vary by carrier and state. Always review official plan documents.
Extended Open Enrollment 2026: Final Days Before January 15 Deadline | RKA
Open Enrollment 2026 closes January 15. Enroll by Dec 15 for Jan 1 coverage, or by Jan 15 for Feb 1 coverage. Don't auto-renew into higher 2026 rates—compare ACA Marketplace plans vs private PPOs and verify your doctors are covered.
Extended Open Enrollment 2026: Final Days to Lock Coverage – Deadline January 15
Fast take: Open Enrollment 2026 runs through January 15 in most states. If you enroll by December 15, coverage starts January 1. Enroll by January 15, coverage starts February 1. This is your last window to compare ACA Marketplace plans vs. private PPOs and secure your 2026 rate.
Need help choosing the best plan before Jan 15?
We'll verify your doctors and prescriptions, compare ACA vs. PPO options, and show clear costs—no pressure, just answers.
Get Free Quotes Book a CallKey dates to remember
Open Enrollment Window
Nov 1, 2025 → Jan 15, 2026
(most states)
Enroll by Dec 15
Coverage starts Jan 1, 2026
Enroll by Jan 15
Coverage starts Feb 1, 2026
What to do before the deadline
1) Verify your providers
Marketplace networks can be narrow—HMO/EPO-heavy with referral requirements. Private PPOs often offer broader access. We'll confirm your doctors are in-network before you enroll.
2) Compare total annual cost
Don't just look at premiums. Factor in deductibles, copays, coinsurance, and out-of-pocket maximums with your expected usage patterns.
3) Check subsidy eligibility
Income-based tax credits can dramatically lower Marketplace premiums. We'll estimate your 2026 subsidy eligibility and show net costs.
4) Consider private PPO alternatives
If you don't qualify for subsidies or need nationwide PPO access, private medically underwritten PPOs may offer lower total costs and fewer restrictions.
How to decide in minutes
Pick an HMO or POS if…
✓ You want lower premiums and you're comfortable staying within a local network.
✓ You prefer having one doctor coordinate all care and provide referrals.
✓ You rarely travel or need specialists outside your area.
Pick a PPO or EPO if…
✓ You want the freedom to see specialists without referrals and value a larger network.
✓ You travel often or need access to doctors across multiple states.
✓ You're willing to pay higher premiums to avoid network restrictions or referrals.
How RKA helps with last-minute enrollment
- Fast comparisons: ACA vs. PPO side-by-side with your providers
- Network verification: We confirm your doctors before you commit
- Clean enrollment: We'll hit the deadline and set your correct effective date
Quick FAQs
What if I miss the January 15 deadline?
You'll need a Qualifying Life Event for a Special Enrollment Period, or you'll wait until next Open Enrollment. Private PPOs may still be available year-round if eligible.
Can I change plans if I already enrolled?
During Open Enrollment, you can switch plans. After January 15, changes require an SEP.
Will my 2025 plan auto-renew?
Yes, but you may pay more in 2026. Many insurers raised rates significantly—review before auto-renewal hits.
Missing the deadline doesn't mean you're out of options. Our licensed advisors help you explore marketplace plans, private PPO options, and special enrollment opportunities year-round. Get coverage options now.
For education only; eligibility and benefits vary by carrier and state. Always review official plan documents.
HMO vs PPO vs EPO vs POS: Which Network Fits Your Needs?
Confused by HMO, PPO, EPO, and POS health plans? This guide breaks down the differences in networks, referrals, flexibility, and costs so you can choose the best fit in minutes.
HMO vs PPO vs EPO vs POS
Which Network Fits Your Needs?
Health Insurance Guides • Enrollment Help • Sep 7, 2025 • Written by Robert Adams
Confused by health‑plan acronyms? In this guide we break down HMO, PPO, EPO and POS plans—networks, referrals, premiums and flexibility—so you can decide in minutes. We’ll verify your doctors and medications, compare plans side by side and show clear costs.
HMO (Health Maintenance Organization)
- ✓ You must choose a primary care doctor (PCP) in the network who coordinates your care and provides referrals.
- ✓ Coverage is limited to network providers except for emergencies; out‑of‑network care typically isn’t covered.
- ✓ Premiums are usually lower, and some plans have low or no deductible options.
PPO (Preferred Provider Organization)
- ✓ Lets you see any doctor in the network without referrals and offers the option to go out of network at a higher cost.
- ✓ Provides flexibility if you travel or want a wide choice of specialists.
- ✓ Premiums and deductibles tend to be higher because of broader access.
EPO (Exclusive Provider Organization)
- ✓ You can see any doctor within the network; no referral is required to see a specialist.
- ✓ No out‑of‑network benefits; care outside the network is generally not covered.
- ✓ Deductibles may be higher but monthly premiums are often lower than a PPO.
POS (Point‑of‑Service)
- ✓ Combines features of HMO and PPO: you have a primary doctor who gives referrals.
- ✓ Some out‑of‑network coverage is available, but you’ll pay more compared with in‑network care.
- ✓ Good compromise if you want occasional out‑of‑network flexibility without paying full PPO premiums.
How to Decide in Minutes
Pick an HMO or POS if…
- ✓ You want lower premiums and you’re comfortable staying within a local network.
- ✓ You prefer having one doctor coordinate all care and provide referrals.
- ✓ You rarely travel or need specialists outside your area.
Pick a PPO or EPO if…
- ✓ You want the freedom to see specialists without referrals and value a larger network.
- ✓ You travel often or need access to doctors across multiple states.
- ✓ You’re willing to pay higher premiums to avoid network restrictions or referrals.
Still undecided? We’ll compare all four plan types with your doctors and medications in mind and show clear, side‑by‑side costs—so you can choose quickly and confidently.
Need help choosing the best plan in your ZIP?
We’ll verify your doctors and meds, compare HMO vs PPO vs EPO vs POS and show clear costs. No pressure—just answers.
Get Free Quotes Book a CallFAQ
What’s the main difference between an HMO and a PPO?
HMOs require you to pick an in‑network primary care doctor who refers you to specialists. PPOs let you see doctors in or out of network without referrals but come with higher premiums.
Do EPOs cover out‑of‑network care?
EPOs typically only cover care within the network; there are no benefits for out‑of‑network doctors except in emergencies.
Do POS plans require referrals?
Yes. POS plans combine elements of HMOs and PPOs—you have a primary doctor and need referrals for specialists, but you still have some out‑of‑network coverage.
Which plan type is best for frequent travelers?
If you travel often or need a large network, a PPO provides broader access and doesn’t require referrals, though an EPO can work if you stay in network.
How can I find out whether my doctor is covered?
Use the insurer’s provider search tools or work with a licensed advisor who can verify that your doctors and medications are in the network before you enroll.
COBRA vs Marketplace vs Private PPO: What to Do Right After You Lose Employer Coverage
Quick guide to COBRA vs Marketplace vs Private PPO—costs, networks, and when each wins. We’ll verify your doctors and show clear prices.
COBRA vs Marketplace vs Private PPO: What to Do Right After You Lose Employer Coverage
Laid off, new job, or between jobs? Here’s the fast, practical guide—costs, networks, deadlines, and how to decide in minutes. We’ll verify your doctors and show clear costs.
- Same network/benefits you already know.
- Usually most expensive (you pay full premium + 2%).
- Time-limited (18 months); retroactive if elected on time.
- Good when in treatment and changing plans is risky.
- May be cheapest if your income qualifies for credits.
- Many plans are HMO/EPO; referrals are common.
- Mid-year move allowed due to loss of coverage.
- Credits reconcile at tax time—under-reporting income can create payback.
- Nationwide PPO when eligible; keep specialists/hospitals.
- Typically no referrals; fewer hoops.
- Advance premium tax credits do not apply to Private PPOs.
- Pricing = age, ZIP, benefits, and network.
- Great when you travel or want doctor choice.
What tends to cost more—and why
Why COBRA is often pricey
- You pay the entire employer premium + 2% admin fee.
- Large-group plan designs can carry higher OOP maxes.
- No income-based help.
How non-Marketplace Private PPO prices
- Based on age, ZIP, network size, and benefits.
- Good fits: provider choice, travel, specialist access, fewer referrals.
- We verify your doctors before you switch.
How to decide in minutes
Pick COBRA if…
- You’re mid-treatment and can’t risk network changes.
- You can stomach short-term higher premiums.
- You need exactly the same plan and doctors right now.
Pick Private PPO if…
- You want nationwide PPO and typically no referrals.
- You travel, use specialists, or dislike gatekeepers.
- Credits don’t help you—or you prefer not to use them.
Want the best post-employer fit in your ZIP?
We’ll verify your doctors and meds, compare COBRA vs Marketplace vs Private PPO, and show clear costs. No pressure—just answers.
FAQ
How long do I have to elect COBRA?
Can I switch from COBRA to other coverage later?
Do Private PPOs use ACA tax credits?
How do I know if my doctors are covered?
How do we start?
This overview is educational, not tax or legal advice. Availability varies by state and carrier. Eligibility and enrollment subject to plan terms.
Losing employer coverage creates options most people don't know about. Our licensed advisors compare COBRA, marketplace plans, and private PPO alternatives to find the best fit for your situation. Compare your options now.
New to Texas? Health Insurance—Fast Guide (Marketplace vs Private PPO)
Texas health insurance, made simple: Marketplace credits vs Private PPO, how networks differ, start dates, and what to verify first. We’ll check your doctors and show clear costs.
New to Texas? Health Insurance—Fast Guide (Marketplace vs Private PPO)
Just moved to TX? Here’s how coverage works, what proof you’ll need, and how to keep your doctors. We’ll verify providers and show clear costs—no pressure.
- Can be cheapest if your income qualifies for credits.
- Many plans are HMO/EPO; referrals are common.
- Options vary by county/ZIP.
- Move = special enrollment (time-limited). Credits reconcile at tax time.
- Nationwide PPO access when eligible; keep key doctors/hospitals.
- Typically no referrals; fewer hoops for specialists.
- Pricing isn’t tied to ACA income credits.
- Good for travel, provider choice, and specialist access.
What to do first (takes 5 minutes)
1) Gather quick proof
- New TX address (lease, closing docs, utility, USPS change).
- Prior coverage details if switching.
2) List providers & meds
- Doctors, specialists, hospitals you want to keep.
- Current prescriptions (name + dosage).
3) Decide priorities
- Lowest premium vs. broad network.
- Referrals OK or prefer no referrals?
- Travel out of state?
What drives cost in Texas
Marketplace
- Income & household size (for tax credits).
- Plan level & network (HMO/EPO common).
- County—options can change across county lines.
Private PPO
- Age, ZIP, benefit level, and network size.
- No ACA credits; premiums are straightforward.
- Great when keeping providers is the priority.
Simple decision guide
Choose Marketplace if…
- Your income qualifies for strong credits.
- You’re OK with HMO/EPO rules & referrals.
- Lowest premium is the top priority.
Choose Private PPO if…
- You want broad, often nationwide PPO access.
- You prefer no referrals to see specialists.
- Keeping specific doctors/hospitals matters most.
New to Texas? Let’s lock the best fit in your ZIP.
We’ll verify your doctors and meds, compare Marketplace vs Private PPO, and show clear costs. No pressure—just answers.
FAQ for recent Texas moves
Do I get a special enrollment window when I move to Texas?
What proof of my move do I need?
When will coverage start?
Can I keep my current doctors?
What if I’m coming from COBRA?
This overview is educational, not tax or legal advice. Availability and rules vary by carrier and county. Eligibility and enrollment subject to plan terms.
New to Florida? Health Insurance—Fast Guide (Marketplace vs Private PPO)
Fast guide for Floridians who just moved—how coverage works, proof to have ready, and how to keep your doctors. We compare Marketplace vs Private PPO and show clear costs.
New to Florida? Health Insurance—Fast Guide (Marketplace vs Private PPO)
Just moved to FL? Here’s how coverage works, what proof you’ll need, and how to keep your doctors. We’ll verify providers and show clear costs—no pressure.
- Can be cheapest if your income qualifies for credits.
- Many plans are HMO/EPO; referrals are common.
- County-based options; networks vary by ZIP.
- Move = special enrollment (time-limited). Credits reconcile at tax time.
- Nationwide PPO access when eligible; keep key doctors/hospitals.
- Typically no referrals; fewer hoops for specialists.
- Pricing isn’t tied to ACA income credits.
- Good for travel, provider choice, and specialist access.
What to do first (takes 5 minutes)
1) Gather quick proof
- New FL address (lease, closing docs, utility, USPS change).
- Prior coverage details if switching.
2) List providers & meds
- Doctors, specialists, hospitals you want to keep.
- Current prescriptions (name + dosage).
3) Decide priorities
- Lowest premium vs. broad network.
- Referrals OK or prefer no referrals?
- Travel out of state?
What drives cost in Florida
Marketplace
- Income & household size (for tax credits).
- Plan level & network (HMO/EPO common).
- County—options can change across county lines.
Private PPO
- Age, ZIP, benefit level, and network size.
- No ACA credits; premiums are straightforward.
- Great when keeping providers is the priority.
Simple decision guide
Choose Marketplace if…
- Your income qualifies for strong credits.
- You’re OK with HMO/EPO rules & referrals.
- Lowest premium is the top priority.
Choose Private PPO if…
- You want broad, often nationwide PPO access.
- You prefer no referrals to see specialists.
- Keeping specific doctors/hospitals matters most.
New to Florida? Let’s lock the best fit in your ZIP.
We’ll verify your doctors and meds, compare Marketplace vs Private PPO, and show clear costs. No pressure—just answers.
FAQ for recent Florida moves
Do I get a special enrollment window when I move to Florida?
What proof of my move do I need?
When will coverage start?
Can I keep my current doctors?
What if I’m coming from COBRA?
This overview is educational, not tax or legal advice. Availability and rules vary by carrier and county. Eligibility and enrollment subject to plan terms.
Marketplace vs Private PPO: Costs, Networks, and When Each Wins
Fast guide to non-Marketplace Private PPOs—how they bill, who they fit, and what to verify first. We’ll confirm your doctors, compare options, and show clear costs
Coverage Options • Open Enrollment
Marketplace vs. Private PPO: Costs, Networks, and When Each Wins
Fast take: Marketplace (government exchange) plans can be cheapest if your income qualifies for subsidies. Private PPOs usually win on doctor access, nationwide networks, and fewer hoops. At RKA Insurance Advisors, we compare both—then you decide.
Quick Definitions
- Marketplace (Government): Plans sold on Healthcare.gov or your state exchange. Prices drop with income-based subsidies. Networks are often HMO/EPO-heavy.
- Private PPO (licensed access): Off-exchange, available through licensed advisors. Broader PPO networks, out-of-network flexibility, and year-round enrollment.
👉 No guessing: We verify your doctors and prescriptions on both sides before you enroll.
Cost Snapshot
Marketplace
Price depends on income and household size. Silver-tier plans can unlock extra savings if you qualify.
Private PPO
Price is not income-based. You’re paying for broader networks and fewer restrictions.
Networks & Doctors (What Matters Most)
Marketplace networks can be narrow. Great if your providers are in-network; painful if they’re not. Private PPOs typically offer national or near-national PPO networks, plus out-of-network benefits.
We always check your providers first—not after you enroll.
When Marketplace Wins
- Your income qualifies for strong subsidies.
- You’re fine with a narrower network.
- You want the lowest possible premium and rarely use care.
When Private PPO Wins
- You want flexibility with doctors and facilities.
- You travel often and need PPO access nationwide.
- You’ve been frustrated with referrals and authorizations before.
The Simple Decision Tree
- Share your providers, prescriptions, and budget.
- We verify both Marketplace and PPO paths in your ZIP code.
- You pick the best fit. We enroll you quickly and compliantly.
Quick FAQs
Does Marketplace always cost less?
Can RKA check my doctors in both networks?
Is Private PPO available year-round?
Educational use only; eligibility and benefits vary by state and carrier. Always review official plan documents.
Ready to compare your options? Our licensed advisors provide side-by-side comparisons of marketplace and private PPO plans based on your doctors, budget, and health needs. Get personalized quotes.
Preparing for Open Enrollment 2026: Key Steps Every Consumer Should Know
Open Enrollment 2026 runs Nov 1, 2025 – Jan 15, 2026. Learn key deadlines, cost trends, and smart moves to compare ACA Marketplace vs. private PPO options. Get guidance from RKA Insurance Advisors to lock the right coverage before prices ju
Preparing for Open Enrollment 2026: Dates, Deadlines, and Smart Moves
Fast take: For most states, Open Enrollment runs Nov 1, 2025 – Jan 15, 2026. Enroll by Dec 15 for a Jan 1 start; enroll by Jan 15 for a Feb 1 start. We compare Marketplace (government) vs. Private PPO (licensed access) side-by-side, verify doctors & prescriptions, and lock 2026 costs—no pressure, just answers.
Need help choosing the best fit in your ZIP?
We’ll verify your doctors and medications, compare Marketplace vs. Private PPO, and show clear costs—no pressure, just answers.
Why costs are climbing
- Medical inflation: Hospital, physician, and facility prices continue to outpace wage growth.
- Rx trend: Specialty drugs (including GLP-1 therapies) are widening spend.
- Higher utilization: Delayed care is catching up, pushing claims higher.
- Plan design shifts: Employers may raise deductibles/copays or adjust contributions.
What to compare during open enrollment (October–December)
Marketplace (Government)
- Premium tax credits available if income qualifies.
- HMO/EPO networks are common; referrals often required.
- County-based networks; choices vary by ZIP.
- Available during Open Enrollment or a qualifying life event.
Private PPO (Licensed Access)
- Broad PPO access; referrals typically not required.
- Medically underwritten—can be lower-cost for healthy households.
- Often better for travel, provider choice, or specialist access.
- Available year-round (subject to eligibility and effective-date rules).
Key 2026 enrollment timing
- Enroll by Dec 15, 2025 for coverage starting Jan 1, 2026.
- Enroll by Jan 15, 2026 for coverage starting Feb 1, 2026.
- State-based exchanges may vary—ask us to confirm your state’s exact dates.
How RKA helps (no pressure—just answers)
- Side-by-side comparisons: Marketplace vs. Private PPO, matched to your doctors and prescriptions.
- Network & Rx checks: We confirm providers and tiers up front to prevent surprises.
- Year-round support: We stay with you for renewals, plan changes, and claims questions.
Want a side-by-side Marketplace vs. Private PPO analysis?
We’ll verify networks and medications, compare plans in your ZIP, and show clear costs—no pressure, just answers.
Quick FAQs
Is the employer plan always best?
Not always. If spousal or child premiums are high, placing them on Marketplace or Private PPO can cut total household cost while keeping access. We’ll model both paths.
Can you verify our doctors and hospitals first?
Yes. We confirm providers and prescriptions up front so you avoid out-of-network surprises or Rx tier shocks later.
Can we switch mid-year?
Generally only with a qualifying life event. Otherwise, Open Enrollment is your main window. Private PPOs may offer licensed access year-round if eligible.
Educational use only; benefits and eligibility vary by employer, carrier, and state. Always review official plan documents.
2026 Open Enrollment Changes: What’s New, What’s Driving Cost, and What to Do Now
Major 2026 Open Enrollment updates: Premiums up, out-of-pocket limits higher, and subsidy extensions uncertain. Compare Marketplace vs Private PPOs before it’s too late.
Enrollment Help • Nov 5 • Written by Robert Adams
2026 Open Enrollment Changes: What’s New, What’s Driving Cost, and What to Do Now
Fast take:
The 2026 open enrollment is bringing significant shifts — premium hikes, higher out-of-pocket caps, and subsidy uncertainty all combine to change the game from previous years. If you’re qualifying for coverage for 2026, it’s time to compare [Marketplace](chatgpt://generic-entity?number=0) vs. private medically-underwritten PPOs vs. COBRA exit strategies and pick your right window **before the clock runs out**.
- • Premium filings show increases for 2026 in many states.
- • Max out-of-pocket limits are rising — you may pay more if you use care.
- • Subsidy changes are unconfirmed — if enhanced credits fade, your “net” cost could jump.
- • Not tied to federal subsidy legislation — pricing is independent.
- • Often broader PPO networks and fewer referral restrictions.
- • Eligibility required, but it’s a powerful option when Marketplace costs spike.
What’s new for 2026 open enrollment
The landscape has shifted in part due to macro-factors and in part due to policy. Here’s what’s driving the changes:
- Carrier cost-trend is higher → claims, drugs, and specialty care all escalate and carriers file accordingly.
- Higher out-of-pocket maximums → The yearly cap is creeping up again, meaning more financial risk for members.
- Subsidy uncertainty → If enhanced credits aren’t extended or phase down, even a stable income could leave you paying more.
- COBRA exposure remains extreme → If you’re losing employer coverage, staying on COBRA might cost more than shopping alternatives now.
What this means for you and your family
For example: a 45-year-old couple with two children saw a typical Bronze Marketplace renewal jump from $1,250 / mo in 2025 to around $1,650 / mo in 2026. The max out-of-pocket climbed from $8,700 to $10,000. That means:
- • You’ll pay a higher premium just to stay in the same segment.
- • If you or a family member use care early in the year, you’ll hit higher OOP sooner.
- • If subsidies are reduced, your net cost could rise again — even if your plan looked okay today.
That’s why we tell households: don’t renew blind. Compare Marketplace vs Private PPO vs COBRA alternative to see your real cost before you lock in.
What to do next: Your 3-step checklist
1) Submit your details
ZIP, ages, income estimate — so we can test all paths for you.
2) Verify your doctors & prescriptions
Network changes in 2026 are real. Let us check before you pick a plan.
3) Compare your three paths
Marketplace vs Private PPO vs COBRA exit — pick the one that fits your risk-level and timing.
Let’s lock the right 2026 plan for your ZIP.
We’ll run Marketplace vs Private PPO vs COBRA escape for your exact family, verify your doctors, and tell you which enrollment window you’re actually in.
Quick FAQs
Will I automatically see higher 2026-costs if I stayed in the same plan?
Often yes — even if your benefits didn’t change. Because premiums and OOP maximums are rising across the board.
What if enhanced subsidies get extended again?
Great if they are — but don’t bet on it. We prepare your plan assuming worst-case and then re-run if credits improve.
Can I switch mid-year if I pick wrong?
Maybe — but limited. That’s why we use a licensed advisor to match your timing, plan, and risk exposure before you enroll.
Robert Adams
RKA Insurance Advisors • Private & Marketplace Health Coverage • 561-806-9913 • robert@rkainsuranceadvisors.com
Why Health Insurance Matters in 2026: Protection & Costs
Staying uninsured is risky. A single ER visit or surgery can create years of debt. The right health plan protects your health, your family, and your wallet by covering everyday care and unexpected emergencies.
Why Health Insurance Matters
Staying uninsured is risky. A single ER visit, surgery, or specialty medication can create years of debt. The right health plan protects your health, your family, and your wallet—before and after something serious happens.
Think of health insurance as a financial safety system: it keeps everyday care affordable, caps your worst-case bills in a bad year, and gives your family more stability when life changes unexpectedly.
Everyday care that stays affordable
- Helps with sick visits, labs, imaging, and prescriptions.
- Uses copays or in-network discounts instead of full price.
- Makes preventive care easier to keep up with.
Protection from “worst-case” bills
- Turns unpredictable hospital bills into capped costs.
- Uses deductibles and out-of-pocket maximums to limit damage.
- Helps you avoid long-term medical debt after an emergency.
Financial stability for your family
- Reduces the chance a surprise bill blows up your savings.
- Helps protect your credit and long-term goals.
- Gives you more control over how you budget for health care.
What tends to cost more—and why
Staying uninsured
- You pay full retail cost for ER visits, imaging, and surgery.
- Hospitals can bill tens of thousands of dollars for a single event.
- No out-of-pocket maximum to cap how bad a year can get.
Having the wrong-fit plan
- Too-high deductible or out-of-pocket max for your budget.
- Networks that don’t include your main doctors or hospitals.
- Drug coverage that doesn’t line up with your medications.
How to decide in minutes
Stay the course if…
- Your current plan is affordable and covers your doctors and meds.
- You’ve already met your deductible and have upcoming care.
- You understand your out-of-pocket max and it fits your savings.
Review options with RKA if…
- Your premiums jumped or you’re worried about 2026 increases.
- You’re not sure if ACA Marketplace or private PPO fits better.
- You want someone to verify doctors, hospitals, and medications for you.
Our role is to remove the guesswork. We map out what you actually use—doctors, prescriptions, budget—and then show how different plan types handle those needs.
Want a plan that actually fits your life?
We’ll verify your doctors and prescriptions, compare ACA Marketplace and private PPO options in your ZIP, and show clear costs—no pressure, just answers.
FAQ
Do I really need health insurance if I’m young and healthy?
Yes. Insurance is designed for the unexpected—accidents, new diagnoses, or sudden surgeries. When you’re healthy, you still benefit from low-cost preventive care and protection if something changes.
What’s the biggest risk of going without coverage?
One major event—such as an ER visit, imaging, or a short hospital stay—can create bills that take years to pay off. Without a plan, there’s no out-of-pocket maximum to cap how bad the year can get.
How do ACA Marketplace plans and private PPOs fit into this?
Marketplace plans use income-based credits and standardized benefits. Private PPOs can offer $0 deductibles, nationwide networks, and different pricing for healthy households. We compare both side-by-side so you’re not guessing.
What does it cost to work with RKA Insurance Advisors?
There is no extra cost to you. We’re paid by the carriers, so you get expert guidance and support with the same or better pricing than going direct—plus help during enrollment and if issues pop up later.
This overview is educational, not tax or legal advice. Availability and eligibility vary by state and carrier. Benefits, networks, and pricing are subject to change. Always review official plan documents before enrolling.
IMPORTANT OPEN-ENROLLMENT INFO AND DEADLINES
Open Enrollment only comes once a year—and missing a deadline can lock you into the wrong plan or higher premiums for all of 2026. Here’s a clear breakdown of the dates, what changes, and how we compare Marketplace vs private PPO options with your doctors and meds.
Enrollment Help • Open Enrollment 2026
Written by Robert Adams
Important Open Enrollment Info & Deadlines
Open Enrollment is your once-a-year chance to update, compare, or switch your health insurance. Deadlines, changes in income, or network shifts can impact your premium and benefits. Here is what you need to know to avoid unexpected costs or gaps in coverage.
Key Deadlines for Open Enrollment 2026
Open Enrollment Start
- Starts November 1st
- Best time to compare plans before rates increase
First Major Deadline
- December 15th
- Last day for January 1st start
Final Open Enrollment Deadline
- January 15th
- Last chance to change or enroll until 2027 (unless SEP applies)
Why These Dates Matter
- Plans and premiums change every year.
- Your income may push you into a new tax-credit bracket.
- Networks, deductibles, and prescriptions may shift.
- If you do nothing, you may auto-renew into a more expensive or worse plan.
Marketplace vs Private PPO: What to Review
Marketplace Changes (ACA)
- New premiums updated yearly
- Tax-credit amounts may shift
- Many plans are HMO/EPO only
- Doctor networks change frequently
Private PPO Updates
- Nationwide PPO access
- No referrals required
- Premiums based on age, ZIP, and network
- Great for frequent travelers or specialists
Want the best plan for your ZIP?
We’ll verify your doctors, prescriptions, and compare Marketplace vs Private PPO options.
Get Free Quotes Book a CallFAQ
Do I have to update my income each year?
Yes. Incorrect income can cause large tax-credit paybacks at tax time.
Can I change plans after December 15th?
Yes — you have until January 15th. But changes after 12/15 start February 1st.
Can you confirm my doctors?
Absolutely. We verify every doctor, hospital, specialist, and medication before you enroll.
OPEN ENROLLMENT IS HERE
Open Enrollment is open. 2026 premiums, networks, and deductibles are changing again. Here’s what to check now to avoid paying more or losing your doctors.
ENROLLMENT HELP • OPEN ENROLLMENT 2026
Written by Robert Adams
Open Enrollment Is Here: How to Avoid a Bad 2026 Plan
Open Enrollment is the short window each year when you can reset your coverage for the next calendar year. For 2026, premiums, deductibles, and networks are all shifting again. If you simply let your plan auto-renew, you could end up paying more, losing doctors, or getting stuck with the wrong deductible. Here’s what to do while Open Enrollment is open.
Key Dates While Open Enrollment Is Active
Open Enrollment Window
- Normally runs November 1st through mid-January
- Best time to compare plans before 2026 rates fully kick in
Priority Deadline
- Mid-December cutoff for a January 1st start
- Miss this and your new plan may not start until February
Final Change Deadline
- Last day of Open Enrollment is usually mid-January
- After this, changes typically require a qualifying life event (SEP)
Why You Shouldn’t Just Auto-Renew
- Your 2025 plan can come back in 2026 with new premiums and out-of-pocket costs.
- Doctor and hospital networks can quietly change—your provider may no longer be in-network.
- Prescriptions may move to a different tier or require new prior authorizations.
- If you don’t actively review options, you could pay more for less coverage all year long.
Marketplace vs Private PPO: What to Check Right Now
If You’re on the ACA Marketplace
- Re-run your income and household size—tax credits can change year to year.
- Confirm your doctors and main hospitals are still in-network.
- Review deductibles, copays, and out-of-pocket maximums for 2026.
- Watch for HMO/EPO restrictions and referral rules.
If You Qualify for Private PPO Options
- Check nationwide PPO access if you travel or live in more than one state.
- Confirm no referral requirements for specialists when eligible.
- Compare total cost: premium + expected usage, not just the monthly price.
- Good fit for self-employed, 1099, and families who want provider flexibility.
Want the right 2026 plan for your ZIP?
During Open Enrollment, we’ll verify your doctors and prescriptions, compare Marketplace and Private PPO options, and lay out the numbers in plain English before you decide.
FAQ
Do I have to re-apply every Open Enrollment?
What if I miss the mid-December deadline?
Can you help me compare Marketplace vs Private PPO?
Open Enrollment 2026 • health insurance deadlines • ACA Marketplace plans • Private PPO plans • health insurance quotes • RKA Insurance Advisors • self-employed health coverage
Robert Adams
https://www.RKAInsuranceAdvisors.com