What is private health insurance?
A private plan is medically underwritten: the insurance company looks at your health history and decides whether to approve you, and at what price. Your premium is based mostly on your age and health, not your income.
The private plans I work with most are limited benefit plans, often called fixed indemnity. Instead of paying a percentage of your bill after a deductible, they pay a set dollar amount for each covered service, like a doctor visit or a day in the hospital. They're usually paired with accident, critical illness and specified disease coverage.
Why some Texans choose a private plan
- You can apply any time of year. There's no Open Enrollment window.
- You can see any doctor. Benefits are paid no matter which provider you use, and a PPO network can get you discounted rates.
- Pricing is based on age and health. If you earn too much for a Marketplace subsidy and you're healthy, a private plan can cost less each month.
- Guaranteed renewable to 65 as long as premiums are paid. Premiums can change, but only for everyone in the same class.
When an ACA Marketplace plan is the better fit
Marketplace plans can't turn you down or charge you more for health conditions, and they cover maternity and ongoing care. If you qualify for a subsidy, have ongoing health conditions or are planning a pregnancy, a Marketplace plan is often the better choice. I'll compare both for your household and tell you which one fits.
Who it tends to fit
A private plan may fit
- Healthy individuals and families
- People who earn too much for a subsidy
- Self-employed people and 1099 workers
- Anyone who missed Open Enrollment
A Marketplace plan is often better
- People who qualify for a subsidy
- Ongoing or serious health conditions
- Planning a pregnancy
- Anyone who needs ongoing mental health care
Good to know: The private plans I offer are limited benefit policies (fixed indemnity). They pay set amounts for covered services, you're responsible for any costs above those amounts, and there's no out-of-pocket maximum. They aren't major medical insurance and aren't a substitute for ACA coverage. Pre-existing condition limitation: a condition you were diagnosed with, treated for or took medication for in the 12 months before your coverage starts isn't covered during your first 12 months.
Questions people ask
Is private health insurance the same as ACA insurance?
No. ACA plans must cover a standard set of benefits and accept everyone. Private plans are medically underwritten, and the ones I work with most are limited benefit policies that pay set amounts. They aren't a substitute for ACA coverage.
Can I buy private health insurance any time in Texas?
Yes. Private plans can be applied for year-round. Approval depends on underwriting, and coverage starts at least 7 days after enrollment on the plans I work with most.
Do private plans cover pre-existing conditions?
The private plans I work with most have a 12-month pre-existing condition limitation, and underwriting may exclude a condition, charge a higher rate or decline an application. ACA plans have no pre-existing condition waiting period.