Cavin compares ACA Marketplace plans and private health insurance side by side — so you know exactly what you're choosing and why.
Federal and state health insurance plans available through the Affordable Care Act. Subsidies based on income can dramatically reduce your monthly premium — sometimes to $0.
Plans purchased directly from insurance carriers, outside the Marketplace. Often offer lower premiums or access to broader provider networks — depending on your health profile.
Temporary coverage for people between jobs, waiting for open enrollment, or in a coverage gap. Not a substitute for comprehensive coverage — but a real option when you need a bridge.
The categories above describe where a plan comes from. These four describe how the plan handles doctors: whether you need a referral, whether anyone outside the network is covered, and how much freedom you're paying for. Two plans at the same price can behave completely differently here, and it's the single most common reason people end up frustrated with coverage they chose themselves.
| PPO | HMO | EPO | POS | |
|---|---|---|---|---|
| Referral needed to see a specialist | No | Yes | No | Yes |
| Must name a primary care doctor | No | Usually | No | Usually |
| Out-of-network care covered | Yes, at a higher share | Emergencies only | Emergencies only | Yes, at a higher share |
| Network size | Broad, often national | Narrow and local | Moderate | Moderate |
| Typical premium | Highest | Lowest | Low to mid | Mid |
| Claims paperwork on you | More | Least | Less | More |
| Fits you if | You want to keep specific doctors, travel, or skip referrals | Premium is the priority and your doctors are already in one local network | You want lower cost without referral hassle, and stay in network | You want coordinated care with some out-of-network room |
Scroll the table sideways on a small screen.
If you have doctors you intend to keep, travel often, or don't want to ask permission before seeing a specialist, PPO-style plans are usually worth the higher premium — and that's most of what I write for self-employed clients and families. If your premium is the constraint and your care is already inside one local system, an HMO can be the smarter buy and I'll say so.
The honest answer is that it depends on your prescriptions, your doctors, and your budget together — which is a conversation, not a chart. There's more on network flexibility specifically on the PPO plans page.
Income, health history, where you live, how many people you're covering, and what you can spend monthly — all of it matters. That's why a 20-minute conversation is worth more than any online comparison tool.
Which of these fits also depends on who you are — a 1099 contractor, someone between jobs, and a family of four get different answers from the same plan menu. See the situation that matches yours.
State lines matter more than most people expect. Seven of the 29 states I'm licensed in run their own health insurance marketplace instead of healthcare.gov — Colorado, Georgia, Illinois, Kentucky, Maryland, Nevada, and Virginia — each with its own deadlines. Ten of them have not expanded Medicaid, which changes what's available to lower-income households. And short-term plan rules differ state by state. The right answer in Texas is often not the right answer in Maryland.
For 2027 coverage, ACA subsidies cut off completely above 400% of the federal poverty level — $63,840 for a single person, $132,000 for a family of four. Above that line you pay the full premium, and a non-Marketplace plan may genuinely cost less. Cavin runs both sets of numbers before recommending anything.
ACA plans cover pre-existing conditions — always. A private plan might not. That changes the math significantly.
Cavin checks before recommending a plan. Keeping your doctor matters, and it's part of the comparison process.
Correct. Brokers are compensated by the insurance carrier, not by you. The price of a plan is the same whether you use a broker or enroll directly.
That's exactly what the free call is for. 20 minutes and you'll know.
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