Private Health Insurance

Coverage Beyond the Marketplace

Your Premier Choice for Flexible and Robust Health Coverage

While the Affordable Care Act (ACA) Marketplace serves millions of Americans well, it’s not the only option for securing high-quality health insurance. Private Health Insurance, also known as “off-exchange” coverage, offers a vital alternative for individuals and families who may not qualify for ACA subsidies, who missed the Open Enrollment period, or who seek greater flexibility and choice in their healthcare plans. At Nancy Cline Insurance, we are experts in the full spectrum of health coverage, and we can help you navigate the private market to find a plan that delivers the specific benefits and provider access you demand.

What is Private Health Insurance?
Private Health Insurance refers to plans purchased directly from an insurance carrier or through an agent like us, rather than through the government-run HealthCare.gov or state marketplaces. While these plans are still regulated and must meet certain standards, they operate outside the ACA’s subsidy structure. This market offers a different set of options and can be the ideal solution for many people.

A common misconception is that “private” plans are somehow less comprehensive. In reality, many of these plans offer robust coverage, often with broader provider networks and a wider array of plan designs than what might be available on the exchange in certain areas. They are still required to cover the 10 Essential Health Benefits mandated by the ACA, ensuring you have protection for hospitalization, prescription drugs, emergency services, and preventive care. The primary difference lies in how you purchase them and who they are best suited for.

Who Should Consider Private, Off-Exchange Health Insurance?

The private market is not for everyone, but it is the perfect fit for specific circumstances. You might be an ideal candidate if:

• Your Income is Too High for a Subsidy: The ACA’s premium tax credits are based on household income. If your income exceeds the threshold (typically 400% of the Federal Poverty Level, though this has been temporarily expanded), you won’t receive financial assistance. In this case, you should compare all available plans, both on and off the exchange, to find the best value, as a private plan may offer better features for a similar price.
• You Value Network Freedom: Perhaps the most significant advantage of the private market is access to different, and often larger, provider networks. If keeping your specific doctors, specialists, and hospitals is your top priority, an off-exchange PPO (Preferred Provider Organization) plan may be your best bet. Marketplace plans in many regions are dominated by HMOs (Health Maintenance Organizations) with more restrictive networks.
• You Missed Open Enrollment: Outside of the annual Open Enrollment Period, you need a Qualifying Life Event (QLE) to enroll in a Marketplace plan. The private market sometimes offers more flexibility, including short-term medical plans that can bridge gaps in coverage until the next Open Enrollment or until you secure other insurance.
• You Seek Simplicity: For those who find the Marketplace website and subsidy calculations cumbersome, purchasing a plan directly can be a more straightforward process, especially with the guidance of a knowledgeable agent.

Understanding Your Private Plan Options: PPO, HMO, and More

When you explore the private market, you’ll encounter different plan structures. Understanding them is key to making the right choice.

• PPO (Preferred Provider Organization): This is often the most sought-after plan type in the private market. PPOs offer the most flexibility, allowing you to see any doctor or specialist you choose, both in and out of network, without a referral. You’ll pay less when you stay in-network, but you have the freedom to go outside the network if needed. This is ideal for those who travel frequently or want unrestricted access to a specific healthcare system.
• HMO (Health Maintenance Organization): HMO plans are typically more budget-friendly but require you to use a specific network of doctors and hospitals. You must also select a Primary Care Physician (PCP) and get a referral from them before you can see a specialist.
• EPO (Exclusive Provider Organization): An EPO is a hybrid model. Like an HMO, it requires you to use a designated network of providers. However, like a PPO, it usually does not require you to get a referral to see a specialist within that network.
• Short-Term Medical Plans: These are temporary insurance solutions, not ACA-compliant. They do not cover pre-existing conditions and lack the 10 Essential Health Benefits. However, for healthy individuals needing to bridge a short gap in coverage (e.g., between jobs), they can be a very low-cost and immediate option. We can help you understand if this is an appropriate risk for your situation.

The Nancy Cline Insurance Advantage in the Private Market

Navigating the private health insurance world on your own can be confusing. As your dedicated agent, we provide clarity and value at no extra cost to you.

• Comprehensive Market Analysis: We don’t just look at one carrier. We have access to a wide array of on- and off-exchange plans from all the major insurers in your area. We can run a single, comprehensive comparison to see which plan—ACA or private—offers the absolute best combination of price, benefits, and network access for you.
• Network Verification: The biggest pitfall in choosing a plan is discovering your doctor isn’t covered. We will personally verify that your preferred doctors, specialists, and hospitals are in-network for any plan you are considering.
• Expert Guidance: We understand the nuances of underwriting, plan designs, and carrier reputations. We translate the insurance jargon and help you weigh the pros and cons of each option, empowering you to make a confident decision.
• Application and Service: We handle the entire application process for you, ensuring it’s completed accurately and efficiently. And our service doesn’t stop there; we are your advocate and point of contact for any questions or issues that arise throughout your policy year.

Don’t limit your options. Your perfect health plan might be waiting outside the Marketplace. Contact Nancy Cline Insurance today for a free consultation and a complete review of all your health insurance choices.