My 2026 Marketplace Premium Went Up. Should I Switch to Private Health Insurance?

Q: Should people with pre-existing conditions stay on marketplace?

Marketplace coverage is often the safer default for people with ongoing care needs, regular prescriptions, or conditions that would create underwriting problems.

Q: What is the fastest way to know which path fits?

Book a no-cost coverage fit check with Mary Jones. She will tell you if marketplace is still the right answer.

If your 2026 marketplace premium jumped, the first question is not "what is the cheapest plan?"

The first question is: what changed, and which options are actually safe for your situation?

I'm Mary Jones. I'm a licensed independent health insurance broker based in Henderson, Nevada, and I work with clients in 38 states. A lot of the calls I'm getting right now start the same way: someone opened a renewal notice, saw a number that did not feel possible, and wondered whether they were supposed to just accept it.

Sometimes there is a better option. Sometimes there is not. Before I'd tell anyone to switch, I want to look at income, health history, prescriptions, doctors, family size, and what kind of care they actually use.

That is the difference between a cheaper plan and a plan that actually fits.

What changed in 2026

For the past several years, enhanced premium tax credits made many marketplace plans less expensive than they would have been under the original Affordable Care Act structure. Those enhanced credits were extended through the end of 2025, but they were not permanent. KFF's analysis explains how the enhanced credits lowered what many marketplace enrollees paid out of pocket and made some people above 400% of the federal poverty level newly eligible for tax credits through 2025.

When those enhanced credits expired, two things mattered at the same time.

First, the subsidy cliff came back. HealthCare.gov uses income between 100% and 400% of the federal poverty level as the range for premium tax credit eligibility. For 2026 marketplace calculations, 400% of the federal poverty level is about $62,600 for one person and about $128,600 for a family of four. If your household income is just over the line, you can lose the premium tax credit entirely. Not a smaller one. None.

Second, premiums went up across the board. KFF reported that marketplace insurers requested a median 18% increase for 2026, with insurers citing the expected loss of healthier enrollees if enhanced credits expired. Nevada's approved average increase for 2026 individual-market plans was 22.3% before subsidies.

That is why the number on your renewal may feel so different. Your health may not have changed. Your income may not have changed. But the assistance changed, and the underlying premium changed too.

What I mean by "private health insurance"

This matters, because the words get used loosely.

When I say "private" in this article, I mean underwritten private health coverage. That means the carrier asks health questions before approving the policy. It is not the same thing as every plan sold outside the marketplace. Some non-marketplace products are comprehensive. Some are limited. Some are short-term. Some are fixed indemnity. Some are not meant to replace major medical coverage at all.

Underwritten private health coverage can be a fit for some healthy people who do not qualify for marketplace subsidies. It can be a bad fit for people with ongoing conditions, expensive prescriptions, or doctors they cannot afford to lose.

That is why I do not start by asking, "Do you want marketplace or private?"

I start by asking what can go wrong if we get it wrong.

Marketplace and underwritten private coverage solve different problems

Marketplace coverage is guaranteed-issue. The carrier cannot decline you or charge you more because you have a health condition. Marketplace plans also cover pre-existing conditions and include the essential health benefits required under the Affordable Care Act.

That protection matters. For some people, it matters more than the premium.

Underwritten private health coverage works differently. The carrier asks about medical history, prescriptions, diagnoses, hospitalizations, and sometimes height and weight. If the application is approved, a healthy person may be offered a lower premium than what they are seeing on the marketplace.

But approval is not automatic. The quoted number at the start is not always the final number. The carrier can rate the policy differently after underwriting, decline the application, or offer a plan that does not make sense for the person's actual care needs.

That is the trade-off.

Marketplace protects access. Underwritten private coverage may reward low risk. Which one is better depends on the person.

The three profiles I see most often

Most premium-shock calls fall into one of three groups.

Profile 1: Healthy, higher income, minimal prescriptions

This is often a self-employed person, a consultant, a contractor, a real estate professional, or someone buying coverage without an employer plan.

You are healthy. You take maybe one routine medication or none. You have not had a major hospitalization in years. You make too much to qualify for meaningful marketplace help. Your renewal is $900, $1,200, $1,500, or more per month, and you barely use the plan.

For this person, underwritten private health coverage is worth comparing.

Not because it is automatically better. Because the math may finally line up. If your health history is clean and you are not getting marketplace help, underwriting may work in your favor. Some underwritten plans also use broader PPO-style networks or age-band pricing, depending on the carrier and state.

This is where I slow people down. Before I would recommend a switch, I would check the application questions, your prescriptions, your doctors, your hospitals, and what happens if you need care six months from now.

The premium is only one piece.

Profile 2: Family above the subsidy cliff

This is the family that gets hit hardest by the "you make too much" problem.

Maybe you are a family of three or four. Maybe one parent is self-employed. Maybe both parents are healthy. Maybe household income is just above the subsidy line. You are not "rich" in the normal sense of the word, but the marketplace calculation treats you as if you do not need help.

I worked with a family in this situation earlier this year. Family of four. Parents in good health. Two kids. Their marketplace premium was close to $1,500 a month.

After we ran through the underwriting questions, checked the doctors, and confirmed the plan type, one underwritten private option came back at roughly half of what they were paying. That was their case. It is not a promise for every family above the cliff. It worked because the health history, network, prescriptions, and plan design all lined up.

That breathing room changed more than the premium. Mom had been putting off a medication her doctor wanted her to start because everything felt too expensive on top of the monthly premium. With the lower cost in that specific case, she had room to start it.

That is the kind of outcome that can happen. It is also the kind of outcome you do not assume until the boring checks are done.

If you want the deeper explanation of why that number can look lower for healthy buyers, I wrote it out here: why underwritten private health coverage can be cheaper than marketplace for some people.

Profile 3: Pre-existing conditions, regular medication, or complex care

This is where I tell people not to switch.

If you are managing diabetes, autoimmune disease, ongoing cancer follow-up, significant mental health treatment, heart issues, recent surgery, or multiple prescriptions, marketplace may still be the safer answer even if the premium hurts.

That is not because marketplace is cheap. It may not be.

It is because marketplace coverage does not ask you health questions before accepting you. It covers pre-existing conditions. It gives you a defined structure for essential health benefits. If you need ongoing care, those protections matter.

For this person, the conversation is different. We look at whether you are on the right marketplace plan, whether your income is reported correctly, whether a Silver plan with cost-sharing reduction applies, whether your prescriptions are handled well, and whether a supplemental product could help with exposure without replacing your core coverage.

I do not move people off coverage that is protecting them just because another premium looks better on paper.

Quick fit check

Not sure which profile sounds like you?

That is what a coverage fit check is for. It is not a quote engine. It does not promise savings. It walks through the same basic questions I would ask before recommending anything:

Who needs coverage?
What changed with your premium?
What is your household income range?
Are there ongoing health conditions or prescriptions?
Are there doctors or hospitals you need to keep?
What matters most: lower premium, lower out-of-pocket cost, or predictable access?

Start here: Book a free Coverage Fit Check.

What I ask before I would recommend a switch

When someone calls me about a premium increase, I do not start with a carrier name.

I start with the person.

Here are the questions I want answered before I would recommend anything:

What is your household income, and how many people are in the household? Who needs to be on the plan? What are the ages of the adults and dependents? What are you paying now? What is your deductible? Have you actually used the plan in the last year? What medications do you take regularly? Any conditions that require ongoing care? Any surgeries, hospitalizations, or major diagnoses in the last few years? Which doctors or hospitals matter to you? Do you travel between states? When does your current coverage end?

Those answers decide whether we compare underwritten private coverage, stay marketplace, or look at a different way to reduce risk.

Without those answers, anyone telling you to switch is guessing.

When underwritten private coverage is not actually cheaper

A lower premium can still cost more if it breaks the parts you need.

Here are the situations where I usually slow down or recommend staying where you are.

You qualify for cost-sharing reduction. If your income qualifies you for cost-sharing reduction on a Silver marketplace plan, your deductible and out-of-pocket exposure may be much lower than they look on a regular marketplace plan. A private premium may look better monthly and still leave you worse off when you use care.

Your prescriptions are expensive. A cheaper plan that does not handle your medication is not cheaper. Before switching, I want to know the medication names, dosage, and whether there are savings programs or formulary issues.

You have a procedure coming up. If you already have a surgery, specialist visit, imaging, or treatment plan scheduled, switching mid-year can create problems with networks and deductibles. Sometimes the right answer is to finish the year on the plan you have and revisit during open enrollment.

You are close to Medicare age. This page is written for people looking at individual and family health coverage before Medicare. If you are close to Medicare eligibility, the timing changes the conversation. I do not publicly market Medicare, and this article is not Medicare guidance.

You have doctors you cannot lose. Network matters. I would rather have you stay on a plan that keeps the doctor you need than move you to a cheaper option that makes care harder.

FAQ

Is underwritten private health coverage the same as marketplace coverage?

No. Marketplace plans are guaranteed-issue and must follow Affordable Care Act requirements. Underwritten private health coverage asks health questions before approval. Some people may qualify for lower premiums. Some people may not qualify at all, or the plan may not fit their needs.

Does a higher marketplace premium automatically mean I should switch?

No. It means you should compare carefully. The right answer depends on your income, health history, prescriptions, doctors, and how you use care.

Can underwritten private coverage deny me?

Yes. Underwritten coverage can ask health questions and may decline an application or offer terms that do not make sense for you. That is why I do not recommend switching until underwriting and plan details are reviewed.

Should people with pre-existing conditions stay on marketplace?

Often, yes. Marketplace coverage is usually the safer default for people with ongoing care needs, regular prescriptions, or conditions that would create underwriting problems.

What is the fastest way to know which path fits?

Book a no-cost coverage fit check with me. I will tell you if marketplace is still the right answer.

What to do next

If your premium went up and you think you might be in Profile 1 or Profile 2, book a free Coverage Fit Check. It will not give you a carrier quote. It will help you understand whether underwritten private health coverage is worth a real conversation.

If you think you are in Profile 3, or you are not sure, I would rather you talk to me than guess. A no-cost coverage fit check is exactly that: a fit check. Sometimes the answer is "stay where you are." Sometimes the answer is "let's compare." Either way, you leave clearer than you came in.

You can book a 20-minute call at app.ringy.com/book/JonesTrue or call me directly at (702) 379-9084.

The marketplace got more expensive in 2026. That does not automatically make underwritten private coverage the answer. It means it is worth checking which side of the line you are on.

Sources

Mary Jones is a licensed independent health insurance broker based in Henderson, Nevada, licensed in 38 states. Underwritten private health coverage may use health underwriting and is not the right fit for everyone, especially individuals with significant pre-existing conditions, ongoing care needs, or regular prescriptions. This information is general education and not a recommendation specific to your situation. Coverage decisions should be made after a personalized review of your health, income, family size, state, doctors, prescriptions, and current medical needs.