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.
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.
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.