When shopping for health insurance in Florida, many people start with the Affordable Care Act (ACA) marketplace. What fewer people realize is that private health insurance plans—sometimes called off-exchange or non-marketplace plans—also exist and can be an option for certain individuals depending on income, health needs, and eligibility. Private health insurance can also be obtained through employers, making it accessible to many people as part of their employee benefits.
This guide explains what private health insurance is, how it differs from ACA plans, when it may make sense to compare options, and what to consider before choosing a plan.
What Is Private Health Insurance?
Private health insurance refers to a type of health plan that provides medical coverage purchased outside the ACA marketplace directly through insurance carriers or with the help of a licensed agent.
These plans:
- Are not subsidized by the federal government
- Are available year-round (not limited to Open Enrollment)
- May offer different network structures and benefit designs
Eligibility for private health insurance may depend on the service area, which is the geographic region where coverage is available and enrollment is permitted.
Private health insurance does not replace ACA plans, but it can serve as an alternative in specific situations.
Florida Health Insurance Plans
Florida’s health insurance market offers a range of plans, including family or single plans and varying levels of coverage. When selecting a plan, be sure to look for the minimum level of essential benefits offered by each plan, including prescription medications, hospital admissions, preventive health care, and physician visits. The Affordable Care Act mandates that all plans sold on the health insurance exchanges must include essential benefits, therefore providing access to adequate care for yourself and your family.
With the Florida health insurance marketplace, you have the ability to review multiple insurance plan options side-by-side and see which plan best meets your health care and budget needs. If you are eligible to receive tax credits due to your household income being between 100% and 400% of the federal poverty level, you will be able to take advantage of these tax credits to reduce your monthly premium payment if you purchase your health coverage through the marketplace.
Purchasing private insurance, either directly through an insurance company or with the assistance of a broker, provides you with additional coverage choices and provider networks. Generally speaking, if you qualify for premium tax credits, private insurance is likely to be more than marketplace plans when compared relative to the same coverage. As you evaluate the differences in the Florida health insurance marketplace, take time to evaluate your coverage needs, your out-of-pocket costs, and whether you prefer a larger number of providers to choose from or are willing to pay a lower premium for fewer provider options. Comparing health insurance plans will help you select one that best suits your needs and those of your family.
How Private Plans Differ From ACA Marketplace Plans
Recognizing the distinction between private and ACA Marketplace insurance plans helps us set realistic expectations from the start.
Many regulations govern the ACA and private insurance plans, affecting coverage and eligibility under different circumstances.
1. Enrollment Periods
- ACA Plans: Enrollment Periods only for Open Enrollment and qualifying life events.
- Private Individual Health Insurance Options: Private plans are usually available year-round.
People who do not complete ACA enrollment by the expiration date or experience a qualifying life event at another time can obtain coverage through private plans available year-round.
2. Subsidies
- ACA plans: May include premium tax credits based on income.
- Private plans: No subsidies available.
For individuals who don’t qualify for ACA subsidies, private plans are sometimes considered for cost comparison.
3. Provider Networks
Private plans often:
- Offer PPO-style access
- Provide broader provider networks, including a wider range of specialists.
- Allow out-of-network coverage (varies by plan)
ACA plans are more commonly:
- Use HMO or EPO structures.
- Have narrower networks to control costs.
4. Benefit Structure
ACA plans must include essential health benefits, such as maternity and mental health coverage.
Private plans:
- May offer customizable benefit structures.
- Can focus on major medical coverage.
- Vary widely in covered services.
Private plans may also include exclusions that differ from those in ACA plans, so it is important to review them carefully.
A licensed agent can explain what is and isn’t included in a specific plan.
Who Typically Explores Private Health Insurance in Florida?
Private plans are not for everyone, but certain groups often compare them:
Private health insurance may have specific eligibility criteria or coverage options for individuals with a disability, and may require proof of disability.
1. People Who Don’t Qualify for ACA Subsidies
If you make too much money to qualify for meaningful ACA assistance, marketplace premiums can become costly. Many people in this situation want to look at private plans to shop for lower monthly premiums and find out which networks are offered.
2. Self-Employed Individuals
Self-employed Floridians often have:
- Variable income
- Difficulty estimating ACA subsidy eligibility
- Changing coverage needs
For some, private plans may offer a more reliable price structure.
3. Early retirees who are not yet eligible for Medicare (age 65 or younger)
Those who retire earlier than their 65th birthday may look for the following from a private plan.
- Broader provider access
- Stable monthly premiums
- Year-round enrollment flexibility
4. Healthier Individuals Seeking Major Medical Coverage
Some private plans are designed to protect against larger medical events rather than routine care, which can affect pricing and benefit design.
Potential Advantages of Private Health Insurance
Depending on the plan and individual profile, private health insurance may offer:
- More flexible enrollment timing
- PPO-style networks
- Access to providers outside ACA networks
- Different deductible and premium combinations
- Potential cost savings for unsubsidized individuals
Private health insurance may also provide access to quality care by connecting members with high-quality doctors and hospitals.
These features vary by carrier and plan type and should always be reviewed carefully.
Important Limitations to Understand
The following are important considerations with regard to Private Health Insurance:
- Most plans do not cover any pre-existing conditions.
- There are significant variations in benefits across plan types.
- There are no income-based subsidies for any of the plans.
- All medically underwritten policies require the insurer to evaluate the prospective insured based on their medical history.
- Some private health plans do not provide preventive services that are covered by ACA-compliant plans.
These variations in coverage can significantly impact overall costs, depending on how much you use the plan. You need to compare plans in detail to see what each provides. To gain a full understanding of your options, contact each provider for complete information on their coverage, exclusions, and other aspects of their policies.
Health Care Options in Florida
Many types of health care are available in the state of Florida. Many Floridians can find health insurance that fits their needs and budget through the variety of options available in the state. Florida offers a wide variety of health insurance plans, from catastrophic plans designed to cover the worst-case scenario to full health care coverage. You can apply for a health insurance policy during the open enrollment period or at any time you qualify for a special enrollment period due to qualifying life events (e.g., marriage, birth of a child, or loss of other source of coverage).
You will want to evaluate multiple factors in order to choose the health insurance plan that is best for you. Factors to consider include your budget and the various plans. coverage options, and your desired benefits. The Florida health insurance marketplace is a great way to compare health insurance plans using these criteria, review plan premiums, co-pays, and deductibles, and find potential financial assistance based on income. Many Florida residents will qualify for additional programs outside the employer’s insurance policy, such as Medicaid and the Children’s Health Insurance Program (CHIP), which are specifically targeted for low-income families and individuals.
In addition to finding a health plan through a Florida health insurance marketplace, you may also find a private health insurance plan through a licensed insurance broker or through a direct purchase from an insurance company. Regardless of how you choose to obtain a health insurance plan, you should take the time to read and understand the insurance contract fully, including but not limited to, coverage levels, provider directories, and specific benefits. You will have the best chance of making an informed choice on what health insurance plan will work best for you and your family by comparing and reviewing policies.
Private Health Insurance vs ACA Plans: A Side-by-Side Overview
| Subsidies | Available based on income | Not available |
|---|---|---|
| Enrollment | Limited periods | Often year-round |
| Network Types | Often HMO/EPO | Often PPO |
| Pre-Existing Conditions | Always covered | Varies by plan |
| Benefit Standardization | Required | Varies |
| Best Fit For | Subsidy-eligible or high-usage | Unsubsidized or lower-usage |
This comparison helps clarify why some people explore both options before enrolling.
Private health insurance members may also have access to exclusive benefits or services not available through ACA plans.
Considerations When Selecting Between Options
Your choices regarding the ACA vs. Private Plans depend on many factors.
To learn more about the specific plans and eligibility requirements, please review the plan documents and/or the official sites with this information.
1. Your Income and Eligibility for Subsidies
Even a small change can mean a big difference in what you pay for an ACA plan.
2. Your Healthcare Usage
- You make appointments with your PCP frequently.
- You have ongoing medications that you need to take on a regular basis.
- You see a specialist regularly.
These factors will help determine whether an ACA plan is better than a Private Plan for you, based on their standard nature (ACA) vs. their ability to be tailored to your needs (Private).
3. Your Provider Preferences
Typically, private plans include doctors and hospitals that are not in any ACA Network.
4. Your Risk Tolerance
Unlike ACA plans (which provide standardized protections), private plans vary more in how they are structured.
Questions to Ask Before Choosing a Private Plan
Before enrolling, ask:
- Does this plan cover my existing conditions?
- Are my doctors and hospitals in-network?
- What are the deductible and out-of-pocket limits?
- Are prescriptions covered?
- How does emergency coverage work?
A licensed agent can help answer these questions clearly.
Frequently Asked Questions (FAQs)
Is private health insurance legal in Florida?
Yes. Private health insurance plans are legal and regulated, but they operate differently from ACA plans.
Can private plans be cheaper than ACA plans?
In some situations—especially for people who don’t qualify for subsidies—private plans may offer lower premiums. Results vary by individual.
Can I switch from an ACA plan to a private plan at any time?
Private plans often allow year-round enrollment. ACA plans generally require Open Enrollment or a qualifying event.
Do private plans cover pre-existing conditions?
Coverage varies by plan. Some plans include limitations that should be carefully reviewed.
Are private health insurance plans in Florida administered by affiliates?
Yes, some private health insurance plans in Florida are administered by affiliates or related companies. These affiliates may provide administrative services and support, but the specific roles and responsibilities can vary by plan. Always review plan details to understand which company is responsible for administration.
Who should stay with an ACA plan?
People with subsidies, chronic health conditions, or high medical usage often benefit most from ACA coverage.
Final Thoughts
Even though ACA coverage will not be replaced by private health insurance policies, some Floridians may benefit from looking at their private health insurance options in addition to ACA options. Comparing private health insurance plans to Marketplace plans will help ensure that a person has access to private health coverage that meets his/her overall health care needs, is appropriate for his/her financial circumstances, and allows access to a doctor of choice, etc. Also, some Florida private health insurance policies include Wellness Rewards and Services that provide members with access to exclusive discount rates on a wide range of health and wellness products/services.
Get personalized guidance—and choose with confidence.
Not sure whether an ACA plan or a private plan is the better fit? A quick conversation with a licensed Florida advisor can help you understand the differences, confirm your subsidy eligibility, and explore any private options that may align with your needs.
