The short answer: no, you do not have to use the Marketplace. Open Enrollment is the Marketplace's sign-up window. Private health plans do not have one: they enroll year-round. If your income qualifies for a large subsidy, or a health condition means a private plan will not accept you, the Marketplace is usually the right call. If not, compare a private plan before you renew.
What Open Enrollment actually is
Open Enrollment is the yearly window for Marketplace (ACA) plans. In most states it runs November 1 through January 15 for coverage the following year, and you enroll by December 15 for a January 1 start. A few state-run exchanges use their own windows. Outside those dates, the Marketplace needs a qualifying life event to let you in.
Private plans work differently. They are not part of the Marketplace, they do not have an Open Enrollment window, and you can apply any month. For most private plans on our site, applications submitted by the 23rd of the month start on the 1st of the next month, if the carrier approves you.
When the Marketplace is the right call
- Your income qualifies for a large subsidy. When the government pays a big share of the premium, the Marketplace can be hard to beat, and we will tell you so.
- A health condition means a private plan will not accept you. Marketplace plans always cover pre-existing conditions, with no health questions. Have a health condition? Tell us first: depending on the condition, a private plan may still be an option.
When a private plan often wins
Marketplace plans are priced with the subsidy in mind. When your subsidy is small or zero, you pay the full sticker price, and for a healthy applicant a private plan's full price is often lower. That is what we see quoting both side by side. A private plan can also bring:
- Doctors where you are. Many private plans are nationwide PPOs: see doctors across state lines, no referrals. Many Marketplace plans are HMO or EPO, local to your county.
- Coverage that travels. A private plan goes with you when you move or work in another state. A Marketplace plan is tied to the state Marketplace you enrolled through.
- No income guessing. Marketplace savings are set from your estimate of next year's income. A private plan has no subsidy, so the price you sign up for is the price you pay. Why that guess is risky if you are self-employed.
Picture it
Your Marketplace renewal notice arrives in November. You are healthy, you earn a little too much for much help, and the new monthly price makes you wince. The notice makes it feel like your only choice is which Marketplace plan to renew into. So you pick the cheapest one you can stand, and spend the next year paying full price for a local network.
Now picture the other version. Before you click renew, you have both priced side by side. The private plan asks you a few health questions, you are approved, and the full price comes in lower than the Marketplace plan you were about to keep. If the comparison had gone the other way, you still had until December 15 to pick a Marketplace plan for a January 1 start. Either way, you chose with both prices in front of you.
What a private plan does, and what it does not
- What it does: often lowers the monthly cost for healthy people who get little or no subsidy, with broader networks and year-round enrollment.
- What it does not: it does not suit everyone. Private plans ask health questions and approval is the carrier's decision. Some private plans are limited medical, which is not the same as major medical, and we will always tell you which side of that line a plan sits on. How to tell the difference.
One thing to check if you switch late in the year
A calendar-year deductible resets every January 1, no matter when you enrolled. A plan-year deductible resets on your enrollment anniversary. If you are starting a new plan near the end of the year, that difference matters. A worked example of why the reset date matters.
How to decide before December 15
- Find out what your Marketplace subsidy would actually be. If it is large, the Marketplace may well win.
- If it is small or zero, price a private plan for your age and ZIP in the Plan Finder.
- Have doctors you love? We check them against the network before anything else.
- Or have us run both side by side. We do not push one carrier, and if the Marketplace wins, that is what you will hear.
Not sure which applies to you? Our ACA vs. private comparison puts the two side by side.
This is general education, not tax advice and not a guarantee of coverage or savings. Pricing, eligibility, enrollment dates and networks depend on your state, your location and underwriting.