The Real Difference Between Marketplace and Private Market Health Insurance

Claire Jaramillo
3 days ago
3 min read

If you’re looking for health insurance in Hampton Roads, you’ve probably run into this question:

Should I go through the Marketplace, or are there better options elsewhere?

For most people, the Marketplace feels like the default. It’s heavily advertised, easy to find online, and set up by the government. But here’s the truth: Marketplace plans aren’t always your best option — especially going into 2025.

Let’s break down the real differences between Marketplace and private market health insurance, and why knowing them could save you money and frustration.

1. Cost Isn’t the Whole Story

Marketplace plans for 2025 are going up in price. But the coverage isn’t improving to match the higher premiums. That means you could be paying more every month without actually getting better benefits.

Private market plans, on the other hand, give you more flexibility. Because I work with over 100 insurance companies, I can often find plans that cost less and fit your needs better than the Marketplace’s one-size-fits-all options.

2. Coverage That Fits Your Life

Marketplace plans are designed to be broad — but broad isn’t always better. Maybe you don’t need maternity coverage, or maybe you want stronger protection for prescriptions or specialist visits.

Private market plans let you be more selective. We can match coverage to your lifestyle:

A freelancer in Virginia Beach with irregular income
A small business owner in Norfolk who wants to protect his family
A newly divorced military spouse in Chesapeake navigating life after Tricare

No matter your situation, private plans can be tailored in ways the Marketplace doesn’t allow.

3. Networks That Actually Work for You

Have you ever picked a Marketplace plan only to realize your preferred doctor or local hospital isn’t included? That happens all the time.

With private market plans, we start with your doctors, prescriptions, and medical needs first — then find the plans that cover them. It’s coverage designed around you, not the other way around.

4. Ease of Understanding the Difference Between Marketplace and Private Insurance

Marketplace plans bury you in jargon: coinsurance, tiers, essential health benefits. Most people don’t fully understand what they’re signing up for.

When you work with a local broker like me, I break it down in plain English. We sit down, look at your real needs, and compare options side by side. No guessing, no hoping you picked the right plan.

A Real Hampton Roads Example

A Norfolk HVAC business owner came to me last year. He thought the Marketplace was his only option for covering himself and helping his employees look into coverage.

After we reviewed private plans, he found a policy that was less expensive and covered his specific medical needs better than the Marketplace option. He not only saved money but also avoided the stress of navigating the system alone.

Why This Matters for 2025

Marketplace costs are rising, and many people don’t realize it until it hits their wallet. The sooner you compare private plans, the sooner you can avoid overpaying.

Whether you’re self-employed, running a small business, or transitioning from military coverage, private market health insurance may give you more value and less stress than sticking with the Marketplace.