No subsidy? You may still qualify for a better plan for less.
If your household income is over the ACA limit, you're paying full price for Marketplace coverage. Healthy people under 65 can often qualify for private PPO plans with nationwide doctor networks, and many pay noticeably less.
- Nationwide PPO networks. See specialists without referrals
- Apply any time of year, not only during Open Enrollment
- An independent broker compares several carriers side by side
Are you over the subsidy cliff?
A 20-second check for 2027 coverage. Nothing is saved or sent.
Uses the 2026 HHS poverty guidelines for the 48 contiguous states and DC ($15,960 for one person + $5,680 per additional person), which set subsidy eligibility for 2027 coverage. Alaska and Hawaii use higher guidelines. Subsidies are based on Modified Adjusted Gross Income (MAGI). This is an estimate, not an eligibility decision.
The subsidy cliff is back, and it's steep.
From 2021 through 2025, extra federal help meant almost anyone could get a subsidy. That help expired at the end of 2025. Now, if your household earns even one dollar over 400% of the federal poverty level, you get no premium tax credit at all and pay the full sticker price.
This hits self-employed people, small-business owners, early retirees, and dual-income families hardest, especially people in their 50s and early 60s, because ACA premiums go up with age.
Sources: HHS 2026 Poverty Guidelines; KFF, “9 Things to Watch for the 2027 ACA Open Enrollment Period” (Oct 30, 2026).
| Household | Subsidy ends above |
|---|---|
| 1 person | $63,840 |
| 2 people | $86,560 |
| 3 people | $109,280 |
| 4 people | $132,000 |
| 5 people | $154,720 |
What a private PPO plan can offer
Private plans are sold outside the Marketplace by major carriers. Pricing is based partly on your health, so if you're in good health you're not paying to cover the whole risk pool.
Nationwide networks
Large national PPO networks, so you're covered when you travel or see doctors across state lines.
No referrals
See a specialist directly. You don't need a gatekeeper doctor's permission.
Rates based on your health
Healthy applicants often see lower premiums than full-price Marketplace plans with similar deductibles.
Apply year-round
Many plans accept applications any month, so you aren't locked into the Open Enrollment window.
Full-price ACA plan vs. private PPO
Neither is right for everyone. Here's how they generally compare for someone over the subsidy limit.
| ACA Marketplace plan (no subsidy) | Private PPO plan | |
|---|---|---|
| Who can enroll | Anyone, with no health questions | Must qualify. Health questions are part of the application |
| Pre-existing conditions | Always covered | May be excluded or limited. Read the plan details |
| How price is set | Age, ZIP, and tobacco use only | Age, ZIP, and your health. Healthy people often pay less |
| Network type | Often HMO or EPO with a local network | PPO with national network options |
| When you can enroll | Open Enrollment or a qualifying life event | Usually any time of year |
| Premium subsidy | None above 400% FPL | Not eligible for subsidies |
Is a private PPO right for you?
I'll tell you if a private plan isn't the right fit. Sometimes the ACA plan is the better buy, and I sell those too.
Usually a good fit if you…
- Earn more than 400% of the poverty level (see the calculator above)
- Are under 65 and in generally good health
- Are self-employed, a business owner, a 1099 contractor, or retired early
- Want to keep your doctors or need coverage that travels with you
- Missed Open Enrollment and don't have a special enrollment reason
An ACA plan may be better if you…
- Have an ongoing condition you're being treated for, or take costly medications
- Are pregnant or planning to be soon
- Need every essential health benefit guaranteed by law
- Can lower your income below 400% FPL, for example by contributing more to a 401(k) or HSA, and get your subsidy back
Three steps, no pressure
Tell me about your household
A two-minute form with ages, ZIP code, and a quick health snapshot. No Social Security number needed.
I compare the carriers
I'll line up the private PPO options you're likely to qualify for next to your best ACA option, so you can see the real difference.
You choose, I handle the rest
Pick a plan or don't. If you move forward, I'll walk you through the application and stay your contact after you enroll.
Built on the same integrity I brought to building engines
I'm Shaun Schance. Before health insurance I built engines, where a shortcut shows up sooner or later and doing the job right is the only way. I run my agency the same way.
As an independent broker, I don't work for one insurance company. I compare plans from several carriers, explain the fine print, and give you my honest recommendation, even when that means the cheaper plan isn't the right one.
Frequently asked
Why don't I qualify for a subsidy anymore?
The extra federal help that removed the income cap expired at the end of 2025. For 2027 coverage, premium tax credits generally stop once household income goes above 400% of the federal poverty level, which is $63,840 for one person or $132,000 for a family of four in most states.
Is a private PPO plan the same as an ACA plan?
No. Private plans aren't Marketplace “qualified health plans.” They may ask health questions, may exclude or limit coverage for pre-existing conditions, and may not include every benefit an ACA plan must cover. That's why I review the details with you before you apply.
Who usually qualifies?
Each carrier sets its own rules, but generally healthy people under 65 without major recent diagnoses, hospital stays, or ongoing treatment have the best chance. Answering the health questions honestly matters. Wrong answers can lead to denied claims or a canceled policy.
Will it really cost less?
For many healthy people over the subsidy limit, yes, but not always. I'll show you your best ACA option next to the private options so you can compare the numbers yourself.
Can I sign up outside Open Enrollment?
Many private plans accept applications any time of year, with coverage starting as soon as the next month. ACA plans need Open Enrollment (Nov 1 – Jan 15 in most states) or a qualifying life event.
Does working with a broker cost extra?
No. Brokers are paid by the insurance carrier. Your premium is the same whether you buy through me or directly.
See what you qualify for
Fill this out and I'll personally put together your private PPO options next to your best ACA option.
- ✓No Social Security number needed for a quote
- ✓Your info goes to me, not sold to a call center
- ✓Straight answers, even if the answer is “stick with ACA”
Got it. Thank you!
I'll review your info and reach out shortly with your options.