Side by side · all four markets
The same questions, asked of all four.
This is roughly the sheet I build for every client, minus your actual numbers. Nothing here is a sales argument. Three of these four columns are ones I'd happily send you to.
Read down a column to understand one market. Read across a row to see what decides it for you. The four are different systems that happen to pay for the same doctor, not four versions of one product.
| Question | Private (underwritten) | ACA Marketplace | Employer / COBRA | Medicare / Medicaid |
|---|---|---|---|---|
| What sets your price | Your health, age and state | Your household income and age | Your employer's arrangement | Set by law, not by your health |
| Can you be turned down? | Yes | No | No | No, if you qualify |
| Pre-existing conditions | May be excluded, rated or declined | Covered from day one | Covered from day one | Covered from day one |
| Typical network | Usually broader PPO-style | Often narrow, sometimes HMO | Varies, often good | Original Medicare takes most doctors; Medicaid plans are often narrow |
| What comes bundled | Often accident, critical illness, telehealth, dental and vision alongside the medical | The ten essential benefits; adult dental and vision usually bought separately | Varies by employer, dental and vision often offered | Original Medicare leaves out most dental, vision and hearing; Medicaid varies by state |
| When you can enroll | Most of the year | Open enrollment, or a qualifying life event | On hire, at open enrollment, or a life event | Medicaid any time; Medicare in a window around your 65th birthday |
| Can you leave? | Any month, no term and no penalty | Any month, but you're out until open enrollment | Yes, on your employer's timing and COBRA rules | Medicare plan choices change each fall; Medicaid ends when you stop qualifying |
| Subsidy available | No | Yes, income-based | Employer contribution instead | Publicly funded, with extra help at low income |
| Best case for | Healthy people earning above the subsidy band | Anyone in the subsidy band, or with real health history | Anyone whose employer pays a decent share | Anyone 65 or older, on disability, or on a low income |
| Where people get burned | Signing without reading the exclusions | Guessing income wrong and owing it back | Paying full COBRA for months without checking alternatives | Missing Medicare's first window, and owing a Part B penalty for as long as they have it |
General guidance only. Availability, networks, pricing and rules vary by state and by carrier, and your own situation decides which column wins. That's what the call is for.
How a plan works, line by line
Premium, deductible, copay, coinsurance and the out-of-pocket maximum, on one example plan, explained as you scroll it.
Walk through a planThe reality of coverage
Why the market is built this way, who each system was designed for, and where the trade-offs are.
Read itWhich column is yours
Four questions, then I build this same sheet with your state, your household and your actual prices in it.
Get my optionsOne conversation
Twenty minutes now, or another year of guessing.
Worst case, you find out you were already on the right plan and you can stop wondering.