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.
Understanding Insurance Networks: A Key Component of Your Health Coverage
HMO, PPO, EPO, POS—your plan’s network determines which doctors you can see and what you’ll pay. Learn the key differences, when referrals apply, how out-of-network care works, and which network type best fits your doctors, prescriptions, and travel needs.
Guide • Networks & Access
Understanding Health Insurance Networks: HMO vs PPO vs EPO vs POS
Fast take: Your network determines where you can get care and what you’ll pay. If you have must-keep doctors, travel frequently, or want nationwide access, choose your network type first—then compare deductibles and copays.
The four common network types
HMO — “Stay in the circle”
- Primary Care Physician (PCP) and referrals usually required.
- No out-of-network coverage (except emergencies).
- Often lower premiums; tight local networks.
PPO — “More flexibility”
- No referrals needed to see specialists.
- Out-of-network benefits (higher costs); national networks vary.
- Good for travelers or multi-state families.
EPO — “HMO-like, no referrals”
- Referrals typically not required.
- Little to no out-of-network coverage beyond emergencies.
- Popular on ACA Marketplace; check local access.
POS — “Hybrid”
- PCP + referrals for in-network care.
- Some out-of-network benefits at higher cost.
- Useful when you want a PCP gatekeeper with flexibility.
Key rules to check before you enroll
- Provider verification: Search by doctor name + NPI and confirm at the practice level.
- Facility alignment: A doctor can be in network while their preferred hospital is not—verify both.
- Prior authorization: Imaging, infusions, surgeries, and some meds may need pre-approval.
- Rx formulary & tiers: Confirm your drugs, quantity limits, and preferred pharmacies.
- Out-of-area care: If you travel or have college students away from home, read the away-from-home rules.
Which network should I choose?
- Keep local doctors, low cost: HMO/EPO may work—verify providers and prior-auth rules.
- Travel frequently / multi-state family: PPO or a plan with nationwide access is usually safer.
- Want a coordinating PCP but some flexibility: POS can balance referrals with out-of-network options.
Quick FAQs
Are urgent care visits covered out of network?
My doctor says they “take” my plan—am I safe?
Can I change networks mid-year?
For education only; benefits and eligibility vary by carrier and state. Always review official plan documents.
Time is Running Out: The Open Enrollment Deadline for Health Insurance Quotes is December 15th!
Open Enrollment 2026: Enroll by Dec 15 for Jan 1 or by Jan 15 for Feb 1. We’ll compare Marketplace vs Private PPO and verify your doctors first.
Open Enrollment • 2026 Deadlines • Written by Robert Adams
Open Enrollment 2026: Last Day for Jan 1 Coverage Is Dec 15 — Don’t Miss It
The 2026 window runs Nov 1 → Jan 15. Enroll by Dec 15 for a Jan 1 start, or by Jan 15 for a Feb 1 start. Prices are up in many ZIPs, so compare Marketplace vs. Private PPO (if eligible) before you lock in the wrong plan.
Key 2026 dates
- Nov 1: Open Enrollment starts.
- Dec 15: Deadline for Jan 1 coverage.
- Jan 15: Final day to enroll for a Feb 1 start.
Am I eligible for savings?
Most households qualify for some level of credit on Marketplace plans based on income, household size, and ZIP. We’ll run the numbers and show your net premium—then compare against a private, medically underwritten PPO if you’re eligible (often lower premiums for healthy applicants).
- • Can be cheapest if you qualify for credits.
- • Many plans are HMO/EPO; referrals are common.
- • Credits reconcile at tax time.
- • County/ZiP options vary, networks differ.
- • Often no referrals; broader networks.
- • Pricing isn’t tied to ACA credits.
- • Great fit when keeping doctors/hospitals matters most.
What to do right now (5 minutes)
1) Send basics
ZIP, ages, household/income range.
2) List doctors & meds
We verify networks + prescriptions.
3) Compare 3 paths
Marketplace • Private PPO • COBRA exit if needed.
Beat the Dec 15 cutoff for Jan 1 start.
We’ll show your net premium with credits, verify your doctors, and stack it against a Private PPO if you’re eligible.
Quick FAQs
What happens if I miss Dec 15?
You can still enroll by Jan 15 for a Feb 1 start. After that, you’ll need a Qualifying Life Event—or see if a Private PPO is available.
Will my doctors be in network?
We verify your providers and prescriptions for both paths before you enroll.
Are Private PPOs cheaper?
For healthy households that qualify, they can be competitive vs. unsubsidized Marketplace plans. We’ll show both.
Robert Adams
RKA Insurance Advisors • 561-806-9913 • robert@rkainsuranceadvisors.com
Telemedicine Benefits: Save Time, Cut Costs, and Skip the Waiting Room | RKA Insurance Advisors
See a clinician by phone or video—often at $0 copay. When telemedicine works best, what’s covered, and how to get plans with $0 virtual visits.
Health Guides • Updated • Written by Robert Adams
Telemedicine Benefits: Faster Care, Lower Cost, Less Hassle
Fast take:
Telemedicine lets you meet with board-certified clinicians by phone or video, usually in minutes. It’s great for common issues, refills, and follow-ups—often at $0 copay on many plans. You save time, avoid waiting rooms, and cut costs without sacrificing quality.
- • See a clinician from home, work, or travel—no waiting room.
- • Perfect for minor illnesses, refills, and quick follow-ups.
- • Visits typically run ~15 minutes.
- • Fewer germ exposures vs. urgent care/ER waiting areas.
- • Helpful for immunocompromised, pregnant, and elderly.
- • Triage contagious symptoms before in-person care.
- • Family, internal, and pediatrics: easy follow-ups and check-ins.
- • Manage hypertension, diabetes, asthma, mental health, more.
- • Many platforms offer 24/7 access.
- • Many plans cover telehealth at $0 or low copay.
- • Cash-pay telehealth is typically cheaper than in-office rates.
- • Using telehealth for non-emergencies avoids costly ER bills.
Good uses vs. go in-person
Use telemedicine for
- Cold/flu, sore throat, sinus/ear issues
- Minor skin rashes, pink eye
- Medication refills & follow-ups
- Mild GI upset
Go in-person for
- Chest pain, severe shortness of breath
- Serious injury, heavy bleeding
- Neurologic symptoms (stroke signs)
- Anything emergent → ER
Want $0-copay telehealth on your plan?
We’ll verify your network, show real costs, and compare Marketplace vs. Private PPO options for your ZIP.
Quick FAQs
Is telemedicine covered?
Many plans cover telehealth at 100% for non-emergency visits. We’ll confirm your exact copay and vendors.
Can telehealth prescribe meds?
Yes—for appropriate conditions. Controlled substances typically require in-person evaluation per state rules.
Does telehealth replace my PCP?
No. It complements primary care and urgent care for quick, non-emergency needs.
Robert Adams
RKA Insurance Advisors • Private & Marketplace Health Coverage • 561-806-9913 • robert@rkainsuranceadvisors.com
Health Insurance “Hacks”
Real, easy health insurance “hacks” that actually save time and money — use telehealth, urgent care, stay in-network, and compare Marketplace vs. Private PPO options.
Health Insurance Guides • Updated Nov 5 • Written by Robert Adams
Health Insurance “Hacks” — Real Tips That Actually Save Time & Money
Fast take:
Skip the gimmicks. Use telehealth for routine issues, choose the right site of care (Urgent Care vs ER), stay in-network to avoid surprise bills, and—if you’re generally healthy—ask about private, medically underwritten PPO options that can drop premiums. When in doubt, have us review your plan and show a side-by-side comparison.
- • Most plans include telehealth/telemedicine with low or $0 copay for common ailments.
- • Typical visit: ~15 minutes by video/phone—no waiting room.
- • Great for colds, rashes, UTI screens, refills, minor issues.
- • Non-emergencies → Primary Care or Urgent Care (faster, lower copays).
- • True emergencies → ER. Otherwise, ER = big bill + deductibles.
- • Ask your plan for preferred Urgent Care centers near you.
- • HMO/EPO: out-of-network = not covered (except emergencies).
- • PPO: out-of-network allowed, but you’ll pay more.
- • Call us—our team will verify your providers are in-network.
- • Medically underwritten PPOs can offer lower premiums for healthy applicants.
- • Often no referrals; broader access for specialists/hospitals.
- • Not for everyone—get a side-by-side with Marketplace plans.
Quick decision guide
Choose Telehealth if…
It’s routine/minor, you want fast care, and your plan shows $0–low copay visits.
Choose Urgent Care if…
It’s same-day non-emergency (stitches, x-rays, infections) and you want to avoid ER costs.
Call us if…
You’re unsure about networks, copays, deductibles, or whether a private PPO could save money.
Want us to check your “hacks” against your actual plan?
We’ll verify your doctors, map Urgent Care options, and compare Marketplace vs. Private PPO side-by-side.
Quick FAQs
Is telehealth really covered?
Most modern plans include it; many charge $0–low copays. We’ll check your specific policy.
How do I confirm a doctor is in-network?
Send us the doctor’s name and location—we’ll verify against your plan’s current network file.
Who should consider private PPO?
Applicants in good health who want broader access and potentially lower premiums. Not everyone qualifies—we’ll show a clean comparison.
Robert Adams
RKA Insurance Advisors • Private & Marketplace Health Coverage • 561-806-9913 • robert@rkainsuranceadvisors.com