Introduction
When is open enrollment for health insurance? If you’re asking yourself this question right now, you’re not alone and you’re exactly where you need to be. Open enrollment 2025 is your annual window to explore health coverage options for you and your family. But here’s what most people don’t realize: the Marketplace isn’t your only choice and for many Texas families, it’s not even the best choice. I’m Richard Monello with Custom Health Plans, and I’ve been helping Texas families find affordable health insurance for over 30 years right here in Plano. As a licensed broker representing major carriers like Aetna, UnitedHealthOne, Blue Cross Blue Shield of Texas, Humana, and Cigna. I’ve seen just about every scenario you can imagine. While many brokers focus exclusively on Marketplace plans, I focus on helping self-employed individuals, 1099 contractors, freelancers, and small business owners find private market alternatives particularly Private Nationwide PPO Plans with nationwide PPO networks that offer more flexibility and better doctor access than typical Marketplace HMO plans. In this complete guide, you’ll learn everything you need to know about open enrollment health insurance for 2025-2026, including both Marketplace options AND private market alternatives that most brokers won’t tell you about. We’ll cover the critical dates, compare Marketplace plans with Private Nationwide PPO Plans, explore PPO versus HMO networks, and help you determine which type of coverage truly fits your needs, especially if you’re self-employed or run a small business. Let’s get you covered the right way.What Is Open Enrollment & Your Coverage Options
Open enrollment is the specific time each year when you can sign up for health insurance, change your existing plan, or renew your coverage. But it’s not just about the Health Insurance Marketplace. It’s also the perfect time to explore all your options, including private market alternatives.Understanding Your Coverage Options
Most people think “open enrollment” automatically means “Marketplace plans,” but that’s only part of the picture. Here’s what’s actually available:- Federal Marketplace Plans (ACA/Obamacare)
- Income-based subsidies available through premium tax credits
- All plans in Texas are HMO networks (limited provider access)
- Must enroll during open enrollment period (November 1 – January 15)
- Good option IF you qualify for significant subsidies
- Private Market Alternatives (Available Year-Round)
- Private Nationwide PPO Plans with nationwide PPO networks
- More doctor and hospital choices (in-network and out-of-network coverage)
- No enrollment period restrictions
- Often more affordable than Marketplace plans (especially for healthy individuals)
- Ideal for self-employed, 1099 contractors, and small business owners
Types of Enrollment Periods
Understanding which enrollment period applies to you is essential:| Type | When It Occurs | Who It’s For |
|---|---|---|
| Federal Marketplace | November 1 – January 15 | Individuals buying Marketplace coverage |
| Private Market Plans | Year-round | Self-employed, small business owners, anyone wanting PPO flexibility |
| Employer Coverage | Varies by company (typically fall) | Employees enrolling through work |
| Medicare | October 15 – December 7 | People 65+ or with disabilities |
| Medicaid/CHIP | Year-round | Low-income individuals and families |
Key Terms You Should Know
HMO (Health Maintenance Organization): A network type that requires you to choose a primary care physician and get referrals to see specialists. All Texas Marketplace plans are HMOs with limited network providers. PPO (Preferred Provider Organization): A network type that allows you to see any doctor without referrals and provides nationwide access. Most private markets and Private Nationwide PPO Plans offer PPO networks. Private Nationwide PPO Plans (AHP): Private group health insurance available through professional or trade associations, offering PPO networks and often more affordable rates than Marketplace plans. Special Enrollment Period (SEP): An exception to the regular enrollment period triggered by qualifying life events like losing coverage, getting married, or having a baby.Critical Dates & Deadlines
Open Enrollment 2025 Dates
The official open enrollment 2025 dates for Marketplace plans run from November 1, 2025, through January 15, 2026. This is when most people start thinking about health insurance and it’s the perfect time to compare ALL your options, not just Marketplace plans.The December 15 Open Enrollment 2025 Deadline
If you want Marketplace coverage to start on January 1, 2026, you must enroll by December 15, 2025. This is the critical open enrollment 2025 deadline for Marketplace plans. Miss it, and coverage won’t begin until February 1. However: Private market alternatives, including Private Nationwide PPO Plans, are available year-round with no enrollment deadlines. You can enroll anytime and typically start coverage within 1-15 days.Coverage Start Dates: Marketplace vs. Private Plans
Marketplace Plans:| If You Enroll By | Coverage Starts |
|---|---|
| December 15, 2025 | January 1, 2026 |
| December 16 – January 15, 2026 | February 1, 2026 |
- Available year-round
- Coverage typically starts 1st or 15th of the following month
- No waiting for open enrollment
- No deadline stress
When Is Open Enrollment for Health Insurance 2025 Texas?
For Marketplace plans, Texas uses the federal Health Insurance Marketplace through Health Sherpa, which means Texas residents follow the same open enrollment 2025 dates as the rest of the country. The Texas health insurance marketplace isn’t a separate state exchange; instead, Texans access the federal marketplace at Health Sherpa. All 254 Texas counties participate, so whether you’re in Plano, Houston, El Paso, or anywhere in between, these Marketplace dates apply to you. But here’s the key: While Marketplace plans have strict enrollment periods, private market alternatives available through the Texas health insurance marketplace are accessible year-round.What If You Miss the Marketplace Deadline?
Missing the January 15 deadline means you typically cannot get Marketplace coverage until the next open enrollment period. This is one major advantage of private market alternatives: you don’t have to wait. Your options for how to get health insurance after open enrollment include:- Private Market Plans: Private Nationwide PPO Plans and PPO alternatives available immediately
- Short-term health plans: Temporary coverage (30 days-3 years) with next-day start, ideal for bridging gaps until you can get comprehensive coverage
- Special Enrollment Periods: If you experience a qualifying life event (job loss, marriage, birth, moving), you can enroll in Marketplace plans within 60 days
- COBRA insurance Texas: Continuation of employer coverage if you recently lost coverage
- Short-term health plans: Limited coverage available in Texas
- Medicaid: Year-round enrollment if you qualify based on Medicaid eligibility
Looking Ahead: When Is the Next Open Enrollment for Health Insurance?
When is the next open enrollment for health insurance after this year? Expect open enrollment 2026 to run from approximately November 1, 2026, through January 15, 2027. Again, private market alternatives don’t follow these restrictions. Can I get health insurance anytime of year through private plans? Yes, absolutely.Marketplace vs. Private Market: Understanding Your Options
Before enrolling, let’s clarify the two main pathways because understanding your options is the first step to making the right choice.
Option 1: Federal Marketplace Plans (ACA/Obamacare)
Pros:- Premium tax credits available if you qualify (based on income)
- Cost-sharing reductions for lower incomes
- Cannot be denied for pre-existing conditions
- All essential health benefits covered
- All Texas Marketplace plans are HMOs (limited networks, require referrals)
- Many doctors don’t accept Marketplace plans (network restrictions)
- Only available during marketplace open enrollment 2025 (Nov 1 – Jan 15)
- Can take weeks to start coverage
- People with lower incomes who qualify for significant subsidies
- Those with pre-existing conditions who need guaranteed coverage
- Families earning under 400% of Federal Poverty Level
Option 2: Private Market Alternatives (Private Nationwide PPO Plans & PPO Plans)
What They Are: Health insurance plans available through professional associations and private carriers, offered outside the Marketplace during healthcare marketplace open enrollment and year-round. Pros:- Nationwide PPO networks(see any doctor, no referrals needed)
- More doctors accept these plans(better access to care)
- Often more affordablethan Marketplace plans (especially for healthy individuals)
- Available year-round(no waiting for enrollment period
- Fast approval and coverage effective date (typically 1-15 days)
- Flexible plan designs
- No premium tax credits or subsidies
- May have health questions or underwriting
- Some plans may not cover certain pre-existing conditions immediately
- Self-employed individuals and 1099 contractors
- Small business owners (2-50 employees)
- Freelancers and independent professionals
- Families who want PPO flexibility
- Healthy individuals who don’t qualify for significant subsidies
- Anyone who values doctor choice and nationwide access
PPO vs. HMO: The Critical Difference
| Feature | HMO (All Marketplace Plans) | PPO (Private Market Plans) |
|---|---|---|
| Network | Limited local network | Nationwide network |
| Primary Care Doctor | Must choose PCP | Optional |
| Referrals | Required for specialists | Not required |
| Out-of-Network | Not covered (except emergency) | Partial coverage available |
| Flexibility | Low | High |
| Doctor Acceptance | Many doctors don’t accept | Widely accepted |
How to Enroll: Step-by-Step
Path 1: Enrolling in Marketplace Plans
Step 1: Create your Health Sherpa accountStep 2: Complete application (income, household size)
Step 3: Review eligibility for premium tax credits and cost-sharing reductions
Step 4: Compare available HMO plans by metal tier (Bronze, Silver, Gold, Platinum): Select coverage and pay first premium Timeline: Coverage starts January 1 (if enrolled by Dec 15) or February 1 (if enrolled Dec 16-Jan 15)
Path 2: Enrolling in Private Market Plans (The Easier, Faster Way)
Step 1: Contact me directly for a free consultation Step 2: Review your options Private Nationwide PPO Plans, private PPO plans Step 3: Compare plans side-by-side:- Monthly premiums
- Deductibles and out-of-pocket maximums
- Network coverage (nationwide PPO access)
- Prescription drug coverage (formulary”>)
- Total annual costs
Why 95% of My Clients Choose Path 2
Self-employed professionals, 1099 contractors, freelancers, and small business owners choose private market alternatives because:✓ Better doctor access (PPO networks vs. HMO limitations)
✓ Year-round availability (no enrollment period stress)
✓ Faster coverage start (days, not months)
✓ More affordable (often lower premiums than Marketplace)
✓ Nationwide coverage (great for travelers)
✓ No referral requirements(see specialists directly)
Texas-Specific Information
Texas Marketplace Overview
Texas uses the federal Health Insurance Marketplace (healthcare.gov). The Texas health insurance marketplace serves all Texas residents through the federal website, and all 254 Texas counties have access. Key Facts About Texas Marketplace Plans:- All are HMO networks (no PPO options available)
- Limited provider acceptance
- Subsidies available based on income
- Must enroll during open enrollment period
Major Carriers in Texas
Marketplace Carriers (HMO only):- Blue Cross Blue Shield Texas plans (HMO options)
- Ambetter, Molina Healthcare, Oscar Health
Texas Cost Comparison
Average Monthly Premiums (Individual, Age 40, DFW Area):| Plan Type | Marketplace HMO (Unsubsidized) | With Subsidies | Private Market PPO |
|---|---|---|---|
| Bronze/Basic | $450-$550 | $50-$150 | $300-$450 |
| Silver/Standard | $550-$700 | $100-$200 | $400-$550 |
| Gold/Comprehensive | $650-$850 | $150-$300 | $500-$700 |
- If you qualify for significant subsidies, Marketplace may be cheaper
- If you don’t qualify for subsidies, private market is often more affordable
- Private market gives you PPO flexibility at competitive prices
How to Choose the Right Plan
Step 1: Determine Which Market Is Right for You
Choose Marketplace Plans If:- Your income is under 400% of Federal Poverty Level ($60,240 for individuals, $124,800 for family of 4)
- You qualify for significant premium tax credits
- You have pre-existing conditions and need guaranteed coverage
- You don’t mind HMO network restrictions
- You’re self-employed or a 1099 contractor
- You own a small business (2-50 employees)
- You want PPO flexibility and nationwide access
- You don’t qualify for significant subsidies
- You need coverage outside open enrollment
- Your doctors don’t accept Marketplace HMOs
Step 2: Understanding Plan Types
For Marketplace Plans: Metal Tiers| Metal Tier | Insurance Pays | You Pay | Best For |
|---|---|---|---|
| Bronze | ~60% | ~40% | Healthy individuals, lowest premium |
| Silver | ~70% | ~30% | Most people; only tier with cost-sharing reductions |
| Gold | ~80% | ~20% | Regular medical needs |
| Platinum | ~90% | ~10% | Significant medical needs |
Step 3: Calculate Total Annual Cost
Total Annual Cost Formula: (Premium × 12) + Deductible + Expected Copays/Coinsurance + Prescription Costs Example Comparison: Marketplace Silver HMO (with subsidies):- Total: $6,700/year
- Limited to HMO network
- Total: $8,200/year
- Nationwide PPO access, see any doctor
Can I Change My Health Insurance Plan After Enrollment?
It depends: Marketplace Plans: Cannot change until next open enrollment (November 2026) unless you have a qualifying life event. Private Market Plans: More flexibility during annual renewal; can switch carriers (subject to underwriting).Costs & Financial Assistance
Marketplace: Premium Tax Credits
Premium tax credits (subsidies) lower your monthly Marketplace premium based on your modified adjusted gross income (MAGI) and household size. 2025 Federal Poverty Level Guidelines:| Household Size | 100% FPL | 400% FPL |
|---|---|---|
| 1 person | $15,060 | $60,240 |
| 2 people | $20,440 | $81,760 |
| 4 people | $31,200 | $124,800 |
- Single adult, age 35, income $35,000
- Silver HMO: $450/month → $95/month after subsidy
- But: Limited HMO network
Private Market: No Subsidies, But Often More Affordable
Private market plans don’t qualify for premium tax credits. However, they’re often more affordable than unsubsidized Marketplace plans. Private Market Example:- Single adult, age 35, income $65,000 (no subsidies)
- Marketplace HMO: $450/month
- Private PPO: $340/month
- Saves $1,320/year with better access
Private Nationwide PPO Plans: Group Rates for Individuals
Private Nationwide PPO Plans allow self-employed individuals to access group insurance rates:- Lower premiums than individual Marketplace plans
- Better rates than solo coverage
- Group buying power
- Ideal for self-employed, 1099 contractors, small business owners
Common Mistakes to Avoid
1. Assuming Marketplace Is Your Only Option
The Mistake: Thinking open enrollment means you must buy Marketplace coverage. How to Avoid It: Always compare both Marketplace AND private market alternatives.2. Focusing Only on Premium, Ignoring Network
The Mistake: Choosing the cheapest premium without checking if your doctors accept the plan. How to Avoid It: Verify your doctors are in-network before enrolling.3. Not Considering PPO vs. HMO Differences
The Mistake: Underestimating how much HMO restrictions will affect your care. How to Avoid It: If flexibility matters, seriously consider private market PPO plans.4. Not Exploring Private Nationwide PPO Plans
The Mistake: Self-employed individuals not realizing they can access group rates. How to Avoid It: Ask about Private Nationwide PPO Plans this is what I specialize in.5. Ignoring Private Market Because You Think It’s More Expensive
The Mistake: Assuming private market plans are always more expensive. How to Avoid It: Get quotes for both Marketplace and private market before deciding.Frequently Asked Questions
When is open enrollment for 2025?
Open enrollment 2025 runs November 1, 2025 – January 15, 2026 for Marketplace plans. Private market alternatives available year-round.Can I get health insurance outside of open enrollment?
Can I get health insurance anytime of year?- Marketplace: No (only with qualifying life event)
- Private Market: Yes (365 days a year)
- Private Nationwide PPO Plans: Yes (year-round)
What’s the difference between HMO and PPO?
HMO (All Marketplace): Must choose PCP, referrals required, limited network PPO (Most Private Market): No PCP required, see any doctor, nationwide networkDo I qualify for subsidies?
Subsidies (premium tax credits) only available for Marketplace plans if income is 100-400% of FPL. Private market plans don’t qualify for subsidies but are often more affordable without them.What if I’m self-employed?
This is my specialty. Self-employed, 1099 contractors, and small business owners have excellent private market options: Private Nationwide PPO Plans with group rates, PPO networks, year-round enrollment, better provider access.Can I change my health insurance plan after enrollment?
Can I change my health insurance plan after enrollment? Marketplace: No (until next year). Private Market: More flexibility.How much will it cost?
Average Texas costs:- Subsidized Marketplace: $50-$300/month
- Unsubsidized Marketplace HMO: $450-$850/month
- Private Market PPO: $300-$700/month
Ready to Get Covered? Let Me Show You ALL Your Options.
I help self-employed professionals, 1099 contractors, freelancers, and small business owners find private market alternatives that give them better coverage, better access, and often better prices than Marketplace HMOs.Here’s What You Get:
✓ 30+ years of Texas health insurance experience ✓ Specializing in Private Nationwide PPO Plans and private PPO options ✓ Complete comparison: Marketplace AND private options ✓ Nationwide PPO networks (not just limited HMOs) ✓ Year-round enrollment (never wait for open enrollment periods) ✓ Zero cost to you: Insurance carriers pay me Perfect For:- Self-employed professionals
- 1099 contractors and freelancers
- Small business owners (2-50 employees)
- Anyone wanting PPO flexibility
Contact Me Today:
📞 Call or Text: 469-361-4032 📧 Email: rmonello@customhealthplans.com 🌐 Website: www.customhealthplans.com 📍 Office: Plano, TX Office Hours: Monday – Friday: 9:00 AM – 6:00 PM Saturday: 10:00 AM – 2:00 PM (during open enrollment) ⭐ A+ Rating with Better Business Bureau ⭐ 300+ Five-Star Google Reviews ⭐ 30+ Years Serving Texas Families Don’t settle for limited HMO networks when better PPO options exist.About Richard Monello Richard is a licensed Texas health insurance broker with 30+ years of experience specializing in private market alternatives, Private Nationwide PPO Plans, and PPO options for self-employed individuals and small businesses. Based in Plano, TX and representing major carriers including Aetna, UnitedHealthOne, Blue Cross Blue Shield of Texas, Humana, and Cigna, Richard provides personalized, no-cost assistance to Texas residents statewide. While Richard can help with Marketplace enrollment, 95% of his business comes from helping clients find better private market alternatives with PPO flexibility and superior provider access.
