Private/Off-Market Coverage

Flexible Health Insurance Options Outside the Marketplace

Private health coverage (also called off-Marketplace coverage) includes plans purchased directly through insurance carriers rather than through the ACA Marketplace.

These plans may offer flexible structures, alternative pricing options, and year-round availability depending on your situation.

Not every client qualifies — and not every plan fits every need. Our role is to help you understand the differences clearly before making a decision.

Who Private Coverage May Be Right For

Private coverage is often considered by:

Individuals who do not qualify for ACA subsidies
Self-employed individuals
Those in good health who may qualify for underwriting
Individuals seeking alternative plan structures
Clients between employer plans
Those needing temporary or transitional coverage

Each case is unique.

How Private Coverage Differs From ACA Plans

Private plans may:

Require medical underwriting (health questions)
Be approved or declined based on health history
Offer flexible benefit structures
Not qualify for income-based government subsidies
Have different coverage rules than ACA-compliant plans

ACA Marketplace plans, by contrast, are guaranteed issue and include standardized essential health benefits.

We review both options when appropriate so you understand the trade-offs.

Types of Private Plans We Review

Depending on eligibility, we may evaluate:

Underwritten major medical plans
Short-term medical plans
Fixed-benefit or indemnity plans
Supplemental coverage (accident, hospital, critical illness)
Health-sharing programs (when appropriate)

We explain what each plan covers — and what it does not.

Important Considerations

Private coverage:

May not cover all essential health benefits required under ACA plans
May exclude pre-existing conditions
May have waiting periods (such as for maternity)
Does not include federal premium tax credits

Coverage details vary by carrier and state.

Our Process

Review your income and eligibility
Discuss health history (if underwriting applies)
Compare Marketplace and private options
Verify doctors and prescriptions
Explain total cost and potential risk exposure
Help you make an informed decision

Our role is to provide clarity and structure so you can move forward with confidence.

A Strategic Approach to Coverage

We do not default to one solution.

We evaluate:

Monthly cost
Deductibles and out-of-pocket exposure
Network access
Long-term sustainability

Health coverage should align with your broader financial plan — not create unexpected gaps.

Quotes and plan information provided are estimates only. Final premiums, eligibility, subsidies, underwriting decisions (if applicable), and plan availability are determined by the insurance carrier or Marketplace at the time of official application and approval.

Private Coverage FAQ

What is private or off-Marketplace coverage?

It is health insurance purchased directly from a carrier instead of through the ACA exchange.

Is private coverage cheaper?

It can be — especially for healthy individuals who do not qualify for ACA subsidies. However, pricing and value depend on your situation.

Can I enroll anytime?

Most private plans are available year-round, subject to approval.

Do private plans cover pre-existing conditions?

Many require medical underwriting and may exclude certain conditions. ACA plans do not deny coverage based on health history.

Do private plans include maternity?

Often not, or they may include waiting periods. We review this carefully if maternity coverage is important.

Can I switch to an ACA plan later?

Yes — during Open Enrollment or if you qualify for a Special Enrollment Period due to a life event.

CONTACT US

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Mailing Address:

Peterson Insurance Solutions
6650 Rivers Ave. STE 100

Charleston, SC 29406

Serving Aiken, South Carolina and clients nationwide by phone and virtual appointments.

Call:

(803) 346-5848

Email:

[email protected]

Site:

https://www.PetersonInsuranceSolutions.com

Insurance & Coverage Disclosure:

All premiums, plan benefits, provider participation, prescription coverage, underwriting outcomes, and financial assistance estimates presented on this website are for informational purposes only and are not guarantees of coverage or final pricing.

Final eligibility, subsidy amounts, effective dates, underwriting approval (if applicable), and plan availability are determined solely by the applicable insurance carrier, Marketplace, employer group administrator, or government agency at the time of application and enrollment.

Plan offerings, eligibility requirements, and regulatory guidelines may vary by state, county, age, income, health history, employer coverage status, and other applicable factors.

Private, supplemental, short-term, and non-ACA-compliant plans may not include all essential health benefits required under federal Marketplace plans.

Coverage becomes effective only upon carrier approval and confirmation.