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Covered California vs Private Insurance 2025

Should you buy through the Covered California marketplace or directly from an insurance carrier? The answer depends on whether you qualify for subsidies and what plans you want access to.

Key Differences

Feature Covered California Private/Off-Exchange
Premium Subsidies Available Not Available
Cost-Sharing Reductions Available (Silver) Not Available
Same Insurance Plans Yes - identical plans from same carriers
ACA Compliant Always If ACA plan
Enrollment Period Open/Special Enrollment Open/Special Enrollment (same)
Income Verification Required for subsidies Not required
Key Point: The plans themselves are identical—the same Kaiser Gold 80 plan costs the same whether you buy through Covered California or directly. The only difference is whether you receive subsidies.

How Subsidies Change the Equation

Premium subsidies can save you hundreds of dollars per month. Here's an example:

Example: Single Adult, Age 40, $45,000 Income

Full Price (Private):

  • Silver plan: $520/month
  • Annual cost: $6,240

With Subsidy (Covered California):

  • Silver plan: $520/month
  • Tax credit: -$280/month
  • Your cost: $240/month
  • Annual cost: $2,880

Annual Savings: $3,360

Who Qualifies for Subsidies?

  • Income between 138% and 400% of Federal Poverty Level
  • Not eligible for Medicare, Medicaid, or affordable employer coverage
  • File taxes as US resident
  • Not claimed as dependent by another taxpayer

Plan Availability

Most ACA-compliant plans are available through both channels:

Covered California
  • 11 insurance carriers
  • Standardized plan designs
  • Bronze, Silver, Gold, Platinum
  • All ACA-compliant
  • Can compare and switch carriers
Private/Direct
  • Same carriers and plans
  • Some carriers offer non-standard plans
  • Short-term plans available
  • Health sharing ministries
  • May have different enrollment process

Which Should You Choose?

Use Covered California If:
  • You might qualify for subsidies
  • Your income is under 400% FPL
  • You want Cost-Sharing Reductions
  • You want easy carrier comparison
  • You prefer one-stop enrollment
Go Private If:
  • You definitely don't qualify for subsidies
  • You want a non-standard plan option
  • You prefer direct carrier relationship
  • You want to avoid income verification
  • You're getting employer coverage mid-year
Recommendation: If there's any chance you qualify for subsidies, enroll through Covered California. The plans are identical, but you could save thousands of dollars.

Not Sure About Subsidies?

Our agents can help you determine if you qualify for subsidies and guide you through either enrollment path.

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