Most comparisons of these two markets never mention the number that actually decides it. It is not your age, and it is not your health — at least not first.
The Short Answer
Is private health insurance cheaper than the marketplace? It depends almost entirely on whether you qualify for a premium tax credit. If you do, the marketplace is usually cheaper even for a healthy person, because your credit is calculated on a mid-priced Silver plan but can be spent on the cheapest Bronze plan, which often brings the net cost well below anything an underwritten plan would offer. If you get no credit, that reverses, and a healthy applicant frequently pays less outside the exchange.
What That Looks Like With Real Numbers
Take Dallas County and a 40-year-old buying for themselves. This is the net monthly cost of the cheapest Bronze plan on the exchange after the credit is applied, at four different incomes, from the 2026 CMS filings:
| Single income | Cheapest Bronze, after credit | Which wins |
|---|---|---|
| $45,000 | $163 / month | Marketplace, comfortably |
| $55,000 | $260 / month | Marketplace |
| $62,600 | $323 / month | Marketplace, just |
| $65,000 | $474 / month | Underwritten, if healthy |
The jump between the last two rows is the subsidy cliff. $2,400 more income raises the premium by about $151 a month, because at $62,600 the credit stops completely rather than tapering.
Why the Marketplace Wins Below the Line
Why is a Bronze plan so cheap with a subsidy? Because of how the credit is calculated. Your premium tax credit is set by the second-lowest cost Silver plan in your county, but you may apply it to any metal tier. Spending a Silver-sized credit on a cheaper Bronze plan leaves a much smaller bill, and at some incomes that lands near zero. It is the single most under-used feature of the marketplace.
This is the part that catches people out. They compare an underwritten quote against the list price of a marketplace plan, conclude the private market is cheaper, and never work out what the Bronze plan would actually have cost them after the credit.
Where the Line Falls
At what income does private insurance start to make sense? Around the point where the premium tax credit runs out, which is 400% of the federal poverty level — about $62,600 for a single person in 2026. In the counties we checked, a healthy 40-year-old only starts beating the net marketplace price somewhere between $55,000 and $62,750 of single income, and in some counties not until the credit disappears entirely.
| County | Healthy 40-year-old starts winning above |
|---|---|
| Lorain, OH | $55,250 |
| Waukesha, WI | $57,500 |
| Davidson, NC | $59,750 |
| Dallas, TX · Seminole, FL · Jefferson, AL | $62,750 |
| Kent, MI | Not until the credit is gone |
Those thresholds are for a single filer. A couple’s cliff is about $84,600 and a family of four’s is about $128,600, so a household of four earning $90,000 is nowhere near it and should simply take the credit.
What Actually Changes Above the Line
Does being healthy get me a better price on the marketplace? No. Marketplace insurers are not allowed to ask about your health, so everyone your age in your county pays the same premium for the same plan. Being healthy only saves you money outside the exchange, where plans are medically underwritten and price on your answers. That is why your health matters to this decision only once you are above the subsidy cliff.
Put the two facts together and the rule is simple. Below the cliff you are buying a subsidised product and your health is irrelevant to the price. Above it you are paying full freight into a pool that cannot ask whether you need it — and if you do not, that is worth checking.
The Cost of Being Wrong About This
What do I give up by buying outside the marketplace? Underwritten plans can decline you, charge you more, or exclude a condition you already have, and they do not carry the ACA’s guaranteed-issue protection. No premium tax credit applies to them either, though that costs nothing if you were not getting one. If anyone in your household has a meaningful health history, those protections are the reason to stay on the marketplace and pay for them.
Which makes this a two-part question rather than one. Are you above the cliff, and is your household genuinely healthy? Both have to be yes. One yes is not enough.
Check which side of the line you are on → · How the $62,600 cliff works → · Options above the line →