COBRA vs Marketplace vs Private PPO: What to Do Right After You Lose Employer Coverage

COBRA vs Marketplace vs Private PPO: What to Do Right After You Lose Employer Coverage

Laid off, new job, or between jobs? Here’s the fast, practical guide—costs, networks, deadlines, and how to decide in minutes. We’ll verify your doctors and show clear costs.

COBRA (keep your old plan)

• Same network/benefits you already know.
• Usually most expensive (you pay full premium + 2%).
• Time-limited (18 months); retroactive if elected on time.
• Good when in treatment and changing plans is risky.

Marketplace (Government)

• May be cheapest if your income qualifies for credits.
• Many plans are HMO/EPO; referrals are common.
• Mid-year move allowed due to loss of coverage.
• Credits reconcile at tax time—under-reporting income can create payback.

Private PPO (Licensed Access)

• Nationwide PPO when eligible; keep specialists/hospitals.
• Typically no referrals; fewer hoops.
• Advance premium tax credits do not apply to Private PPOs.
• Pricing = age, ZIP, benefits, and network.
• Great when you travel or want doctor choice.

What tends to cost more—and why

Why COBRA is often pricey

• You pay the entire employer premium + 2% admin fee.
• Large-group plan designs can carry higher OOP maxes.
• No income-based help.

How non-Marketplace Private PPO prices

• Based on age, ZIP, network size, and benefits.
• Good fits: provider choice, travel, specialist access, fewer referrals.
• We verify your doctors before you switch.

How to decide in minutes

Pick COBRA if…

• You’re mid-treatment and can’t risk network changes.
• You can stomach short-term higher premiums.
• You need exactly the same plan and doctors right now.

Pick Private PPO if…

• You want nationwide PPO and typically no referrals.
• You travel, use specialists, or dislike gatekeepers.
• Credits don’t help you—or you prefer not to use them.

We’ll compare all three with your doctors and meds, then show clear side-by-side costs.

Want the best post-employer fit in your ZIP?

We’ll verify your doctors and meds, compare COBRA vs Marketplace vs Private PPO, and show clear costs. No pressure—just answers.

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FAQ

How long do I have to elect COBRA?

Generally 60 days from the notice. If elected in time, coverage can be retroactive to the loss date (you’d owe premiums).

Can I switch from COBRA to other coverage later?

Yes. Marketplace: during Open Enrollment (or another qualifying event). Private PPO: typically year-round if you’re eligible. We’ll time it so there are no gaps.

Do Private PPOs use ACA tax credits?

No. Private PPOs don’t use ACA advance premium tax credits (APTC). Marketplace plans do, and those credits reconcile at tax time—under-reporting income can create payback.

How do I know if my doctors are covered?

Send your provider list. We check your doctors against the specific plan network you choose so you know before you switch.

How do we start?

Share your doctors, prescriptions, and budget. We’ll map options and enroll you quickly and compliantly.

This overview is educational, not tax or legal advice. Availability varies by state and carrier. Eligibility and enrollment subject to plan terms.

Marketplace vs Private PPO: Costs, Networks, and When Each Wins

Coverage Options • Open Enrollment

Marketplace vs. Private PPO: Costs, Networks, and When Each Wins

Fast take: Marketplace (government exchange) plans can be cheapest if your income qualifies for subsidies. Private PPOs usually win on doctor access, nationwide networks, and fewer hoops. At RKA Insurance Advisors, we compare both—then you decide.

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Quick Definitions

• Marketplace (Government): Plans sold on Healthcare.gov or your state exchange. Prices drop with income-based subsidies. Networks are often HMO/EPO-heavy.
• Private PPO (licensed access): Off-exchange, available through licensed advisors. Broader PPO networks, out-of-network flexibility, and year-round enrollment.

👉 No guessing: We verify your doctors and prescriptions on both sides before you enroll.

Cost Snapshot

Marketplace

Price depends on income and household size. Silver-tier plans can unlock extra savings if you qualify.

Private PPO

Price is not income-based. You’re paying for broader networks and fewer restrictions.

Networks & Doctors (What Matters Most)

Marketplace networks can be narrow. Great if your providers are in-network; painful if they’re not. Private PPOs typically offer national or near-national PPO networks, plus out-of-network benefits.

We always check your providers first—not after you enroll.

When Marketplace Wins

• Your income qualifies for strong subsidies.
• You’re fine with a narrower network.
• You want the lowest possible premium and rarely use care.

When Private PPO Wins

• You want flexibility with doctors and facilities.
• You travel often and need PPO access nationwide.
• You’ve been frustrated with referrals and authorizations before.

The Simple Decision Tree

1. Share your providers, prescriptions, and budget.
2. We verify both Marketplace and PPO paths in your ZIP code.
3. You pick the best fit. We enroll you quickly and compliantly.

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Quick FAQs

Does Marketplace always cost less?

Only if your income qualifies for subsidies. Without subsidies, Private PPO may be more competitive.

Can RKA check my doctors in both networks?

Yes—we confirm providers and prescriptions for both Marketplace and PPO options before enrollment.

Is Private PPO available year-round?

Yes. Marketplace has strict Open Enrollment windows, but Private PPOs can often be enrolled year-round if you qualify.

Educational use only; eligibility and benefits vary by state and carrier. Always review official plan documents.

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