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.
Skip the Government Marketplace: How Private PPO Plans Actually Work
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.
Skip the Government Marketplace: How Private PPO Plans Actually Work
Prefer private, licensed-access coverage? Here’s the fast, practical guide—what it is, how it bills, and how to check if it fits your doctors, travel, and budget.
Why some people skip the Marketplace
- Keep specific doctors/hospitals. Many Marketplace options are HMO/EPO with referrals.
- Travel flexibility. Want nationwide, not just local networks.
- Fewer gatekeepers. Prefer no referrals for specialists or imaging.
- Income too high for meaningful subsidies—or you don’t want tax-credit involvement.
- If your income qualifies, Marketplace can be the cheapest route.
- Credits reconcile on your tax return; under-reporting income can create payback.
- Private PPOs skip subsidies entirely—pricing is based on age, ZIP, benefits, and network.
How Private PPO actually works
- Nationwide PPO access in eligible networks—keep your specialists and preferred hospitals.
- No referrals for specialists (typical), fewer hoops to schedule care.
- Enroll through a licensed agent; options vary by state and carrier.
- Premiums aren’t tied to ACA income credits.
- Your exact doctors and facilities are in-network (we check for you).
- Copays vs coinsurance on high-ticket items (imaging, outpatient surgery).
- Prescription tiers and any prior-auth on key meds.
- Out-of-pocket maximum is a number you can live with.
What drives price (non-subsidized)
The big levers
- Age rating for adults; kids usually add less than another adult.
- ZIP/county + network breadth.
- Deductibles, coinsurance, copays, and the out-of-pocket max.
Ways to keep it efficient
- Don’t overbuy—match benefits to how you actually use care.
- Choose networks that include your real providers (not just brand names).
- Use generics when clinically appropriate; we’ll check formulary tiers.
Who typically chooses Private PPO
Strong fit
- Self-employed/1099 families who want broad doctor choice.
- Frequent travelers or multi-state households.
- People who dislike referral bottlenecks.
Maybe not a fit
- Households whose main goal is max subsidies and the lowest possible premium.
- Anyone who does not have specific providers to keep and rarely needs out-of-area care.
Want the best non-Marketplace fit in your ZIP?
We’ll verify your doctors and meds, compare PPO options, and show clear costs. No pressure—just answers.
FAQ
Are Private PPOs the same as Marketplace plans?
Do Private PPOs need referrals?
Will I owe taxes if I’m not using subsidies?
How do I know if my doctor is covered?
How do we start?
This overview is educational, not tax or legal advice. Plan availability and rules vary by state and carrier. Eligibility and enrollment subject to underwriting/plan terms where applicable.
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
You want the truth without the fluff. Here it is: Marketplace (Government) can be cheapest when your income qualifies for savings. Private PPO (licensed-access) usually wins on keeping doctors, network size, and fewer hoops. We run both—then you choose.
Quick definitions
Marketplace (Government): Plans on Healthcare.gov or your state exchange. The monthly cost can drop with income-based savings. Networks tend to be HMO/EPO-heavy in many areas.
Private PPO (licensed-access): Off-exchange, available through licensed agents. Typically, broader PPO networks, out-of-network flexibility, and year-round availability.
👉 No guessing: We verify your doctors and prescriptions on both sides before you enroll.
Cost snapshot (realistic)
Marketplace: Price depends on income and household. Silver plans can unlock additional savings if you qualify.
Private PPO: Price isn’t income-based. You’re paying for network flexibility and smoother access.
Network & doctors (what actually matters)
Marketplace networks can be narrow. Great if your providers are in-network; painful if not.
Private PPOs typically offer national or near-national networks, along with out-of-network benefits .
We check your providers first—not after you enroll.
When Marketplace wins
Your income qualifies for strong savings.
You’re fine with a narrower network and staying in-network.
You want the lowest possible premium and rarely use care.
When Private PPO wins
You want flexibility with doctors and facilities
You want PPO flexibility for frequent travel
You’ve been burned by referrals/authorizations, and now you want fewer hoops.
The simple decision tree
Share your providers, prescriptions, and budget.
We verify both paths (Marketplace vs Private PPO) in your ZIP.
You pick the best fit. We enroll you quickly and compliantly.
Year-Round Health Insurance Options – How to Get Covered Outside of Open Enrollment
Enrollment Guides • Year-Round Options
Year-Round Health Insurance Options Outside Open Enrollment
Fast take: Missed Open Enrollment? You still have paths. Qualify for a Special Enrollment Period (life event or some income situations), or—if eligible—apply for a private, medically underwritten PPO that can start any month. We’ll verify doctors, prescriptions, and start dates to avoid gaps.
Path #1: Special Enrollment Period (SEP)
If you’ve had a Qualifying Life Event, you can enroll in ACA Marketplace coverage outside the normal window. Common QLEs:
- Loss of coverage: losing employer coverage, aging off a parent’s plan, COBRA ending.
- Household changes: marriage, divorce, birth/adoption, death.
- Residence changes: moving to a new ZIP/state with different plan options.
- Income changes: shifts that affect subsidy eligibility (varies by state and year).
Timing: Most SEPs last 60 days from the event. We’ll help confirm your documentation and the correct effective date.
Path #2: Income-based options (some situations)
In certain circumstances, income within specific ranges can create ongoing or monthly SEP eligibility. If your income is variable, we’ll model your estimated MAGI and confirm your current-year eligibility.
Path #3: Private, medically underwritten PPO (if eligible)
- Year-round starts: Many private PPOs offer effective dates any month after underwriting.
- Broader networks: Often nationwide PPO access—great for frequent travelers or multi-state households.
- Underwriting: Health questions apply; we pre-screen quickly and verify your doctors/hospitals.
Avoid gaps: simple checklist
- List your providers (names, locations) and prescriptions.
- Note your QLE date and keep documents handy.
- Share your target start date so we align deadlines and carrier cutoffs.
- We’ll show total annual cost (premium + likely usage) for each option.
Quick FAQs
How fast can coverage start?
What if I don’t have a QLE?
Can you confirm my doctors?
For education only; eligibility, plan availability, and dates vary by state and carrier. Always review official Marketplace and plan documents.
Open Enrollment 2026: Why Working with a Licensed Advisor is Essential
Open Enrollment 2025 is here. Don’t go it alone—licensed advisors know ACA vs. private PPO options, deadlines, and ways to save. Acting early avoids rate hikes and limited plan choices.
Enrollment Guides • Open Enrollment 2025
Open Enrollment 2025: The Hidden Costs of Doing It Alone
Fast take: Open Enrollment is your only chance each year to secure or update coverage—but going solo can cost you. Licensed advisors know deadlines, subsidies, and private PPO alternatives to help you avoid higher premiums and missed benefits.
Why working with an advisor matters
A licensed advisor not only has access to all available plans—including ACA Marketplace and private options—but also the expertise to evaluate your needs and recommend coverage tailored to your situation. Many unlicensed brokers push limited-benefit plans that don’t protect you when it matters most.
Key benefits of guidance
- Accurate info on what your plan covers.
- Verification of which doctors are in-network.
- Projection of maximum out-of-pocket costs.
- Strategies to maximize savings based on income & health.
How a licensed advisor may save you money
Private PPOs can reward good health with lower premiums—similar to car insurance rewarding safe drivers. ACA Marketplace plans offer income-based savings. By reviewing both, advisors help you avoid costly mistakes and secure the best value.
Quick steps to start enrollment with confidence
Open Enrollment runs November 1 – January 15, but acting early locks in better options:
- Nov 1: Open Enrollment begins.
How Biden’s 2025 Short-Term Insurance Rule Changes Affect You
Biden’s new short-term insurance rule cuts plans to 3 months with only a 1-month renewal. Self-employed workers and contractors may be at risk—see ACA, PPO, and employer coverage alternatives with RKA.
Health Insurance Updates • Policy Change
What Changed in Biden’s Short-Term Insurance Rule?
Fast take: Starting in September 2025, new federal rules limit short-term medical plans to 3 months, with just a 1-month renewal. This change reduces flexibility and leaves many—especially self-employed workers—needing new solutions.
Why the new rules put many at risk
Providers like Golden Rule, National General, Everest, and Pivot Health have offered short-term plans as flexible, stopgap coverage. Under the new rule, these plans are much less viable. Many households will need to reassess coverage options before losing protection.
Your alternatives: Marketplace vs. underwritten plans
ACA Marketplace Plans
These plans guarantee acceptance regardless of pre-existing conditions. Subsidies may reduce premiums, but networks and deductibles can vary widely.
Medically Underwritten Plans
For healthy individuals, private PPOs may provide lower monthly costs and nationwide access. Underwriting applies, but these plans often mean lower out-of-pocket exposure compared to unsubsidized ACA coverage.
Employer Coverage
If you’re eligible through an employer, group plans remain strong options. However, adding dependents can drive up costs—so review carefully.
Secure your coverage today
The new rules significantly reduce the flexibility of short-term plans. Acting now ensures you avoid gaps in coverage and rising costs. At RKA Insurance Advisors, we specialize in navigating these changes and finding the right coverage in 32 states.
Quick FAQs
When does the new rule take effect?
Can short-term plans still be useful?
How can RKA help?
For education only; eligibility, availability, and pricing vary by carrier and state. Always review official plan documents.