About MyHealth Advisors

Private health insurance (U65) includes medical plans sold by private insurers to people who are not yet eligible for Medicare. These can be ACA-compliant Marketplace plans or non-Marketplace plans such as short-term medical, fixed indemnity, and other supplemental options.

ACA Marketplace plans must follow Affordable Care Act rules—covering essential health benefits, accepting all applicants regardless of health, and offering income-based subsidies.
Non-Marketplace plans (like short-term or indemnity plans) are usually cheaper but may not offer full comprehensive coverage and can underwrite based on health.

Subsidies (premium tax credits) are based on household income, family size, and location. Most people earning between 100%–400% of the federal poverty level qualify, and in many cases even households above 400% FPL may still receive reduced premiums depending on the benchmark plan cost.

If you aren’t eligible for ACA subsidies, a private plan outside the Marketplace—such as a short-term medical plan, hospital indemnity plan, or health-sharing plan—may offer more affordable alternatives. An advisor can help compare options based on your needs.

• ACA Marketplace plans: Yes, always.
• Short-term & other non-ACA plans: Not always. Many require medical underwriting and may exclude pre-existing conditions.

You can enroll in ACA plans only during Open Enrollment or with a qualifying life event (QLE).
Short-term and other private plans are available year-round.

Common QLEs include:

• Losing health coverage
• Moving to a new state or coverage area
• Marriage or divorce
• Having a baby or adopting
• Changes in immigration status
  A QLE usually gives you a 60-day window to enroll in an ACA plan.

Not always—but many people without subsidies find non-ACA private plans significantly less expensive. They trade lower cost for more limited coverage, so it’s important to understand the differences.

Short-term plans are flexible, lower-cost plans that cover major medical events and doctor visits but may not include ACA-required benefits like maternity, mental health, or preventive services. They are popular with healthy individuals who want affordable protection from big medical bills.

Many do, but coverage varies. ACA plans must include prescription benefits, while short-term or indemnity plans may offer limited or no prescription coverage unless added as optional riders.

It depends on the plan network. ACA Marketplace plans often use HMO or EPO networks, while many private plans have PPO networks with broader access. An advisor can help check your physicians and hospitals.

Premiums are usually based on:

• Age
• Zip code
• Tobacco use
• Plan type & network
• Subsidy eligibility
• Medical history (for non-ACA plans only)

The “best” plan depends on:

• Budget
• Expected medical usage
• Preferred doctors/hospitals
• Prescription needs
• Comfort with higher deductibles vs. higher premiums

MyHealthAdvisors.us can help compare plans across carriers to make sure you’re getting the right mix of coverage and cost.

Supplemental options like accident, critical illness, or hospital indemnity plans can reduce out-of-pocket exposure. They work well alongside both ACA and non-ACA plans.

Dental and vision coverage for adults is usually offered as a separate plan. ACA Marketplace medical plans only include pediatric dental and vision.

• ACA plans: Usually start the first of the following month after enrollment.
• Private non-ACA plans: Often start within 24–48 hours.