Private Health Insurance: What It Is and How to Get It
HSChange Editorial Team
Health Policy Research Team, Consumer Health Guidance
Reviewed by Dr. Sarah Mitchell, MD, MPH, Board-Certified Internal Medicine
Last updated: April 4, 2026
Private health insurance is any coverage that isn't a government program. It's not Medicare, Medicaid, or CHIP. About 67% of Americans have some form of private coverage, either through an employer, the ACA Marketplace, or bought directly from an insurer.
Four Ways to Get Private Coverage
Employer-sponsored plans are the most common source. Your employer selects the plans, negotiates group rates, and usually pays a large share of the premium. About 156 million Americans get coverage this way.
The ACA Marketplace (Healthcare.gov or your state's exchange) is the main option for people without employer coverage. A record 21.3 million enrolled for 2025. Premium subsidies based on income make plans affordable for most. You can only enroll during open enrollment or with a qualifying life event.
Direct purchase from an insurer is possible year-round for some plan types, but these plans may not qualify for ACA subsidies. Short-term plans fall into this category.
Through a licensed broker, who can compare plans from multiple carriers and help you enroll at no cost to you.
What Private Insurance Must Cover
ACA-compliant private plans must cover 10 essential health benefits, cannot deny you for pre-existing conditions, cannot set annual or lifetime benefit caps, and must cover dependents up to age 26. These protections apply to all marketplace plans and most employer plans. Short-term and grandfathered plans may be exempt from some of these requirements.
Who Qualifies for Subsidies
Premium tax credits on the marketplace are available based on household income. Enhanced subsidies from the Inflation Reduction Act cap premiums at 8.5% of income, and about 4 out of 5 enrollees can find a plan for $10 a month or less. If you earn too much for subsidies, you can still buy marketplace plans at full price or shop directly with insurers.
Private vs. Government Insurance
The main government programs are Medicare (65+ and disabled), Medicaid (low-income), and CHIP (children). You might qualify for more than one type. Some people have both Medicare and a private supplement (Medigap). Others have employer coverage plus dental bought privately. The lines aren't always clean.