Off Exchange Health Insurance: Many Americans get their health insurance from their employer. If you’re one among them, you most likely have an alternative of many completely different plans you’ll sign on for throughout open enrollment every year, and your employer could subsidize a number of your premium prices.
But if you aren’t lined through associate degree leader, you’ll have to buy health insurance on the individual market to avoid the penalty.
The individual insurance market has modified a great deal in recent years due to the passage of the Affordable Care Act (ACA), which is additional popularly referred to as ObamaCare. In fact, many folks who get insurance on the individual market currently purchase coverage through state exchanges or through federal exchanges.
What is an off exchange plan?
The word off exchange plan defines a package of health insurance that you buy directly from an insurance carrier or through a licensed broker such as eHealth outside an official state or federal ACA marketplace. Some off-trade plans offer the same kind of coverage available with ACA plans. All programs must follow the guidelines for eligible health plans, including:
clear communication of information that includes premium, deductibles and other out of pocket costs.
meeting the network adequacy standards established by the respective state exchange.
providing a summary of benefits and uniform coverage summaries before the beginning of open enrollment.
While the criteria for qualified health plans are the same across the country for exchange plans, if you look at an off exchange plan, they can vary from state to state.
However, they are available directly from insurance companies or through independent brokers instead of being offered through the government marketplace or state-run marketplaces. In many cases, an insurance company will offer a plan with the same coverage both on exchange and off exchange. This is a choice made to increase consumer choice.
Off exchange plans that are not ACA-compliant
You can also look at other coverage that may not be as robust as these major-medical qualifying plans. Catastrophic insurance, for example, can be found among options for off-exchange plans. This insurance does not cover many basics such as check-ups or immunizations, but provides coverage for catastrophic events such as major injuries and diseases.
In exchange, those who purchase these plans will pay lower premiums significantly. Types of non-qualified health plans (QHPs) insurance programs— or, in other words, everything you can find on government exchanges:
short term health insurance
medical insurance packages (MIPs)
Only people who are in good health and who do not frequently use medical services should consider these plans. It can result in significantly higher overall costs because medical services are mostly charged out of pocket.
When choosing a low premium plan (monthly costs), make sure that you always check the details of the plan and go into it with the understanding that benefits can be reduced compared to more expensive plans.
Perks of choosing on exchange plans
You have a guarantee when you buy a plan on the government marketplace that what you buy is a qualified health plan that meets the ACA’s consumer protection requirements.
The bronze, silver, gold and platinum insurance options in your state can also be quickly and easily compared. Exchange plans often require less out of pocket, as they are eligible for subsidies that significantly reduce insurance costs.
Keep in mind that these “on exchange” plans can also be found outside the government marketplace— eHealth has a proxy agreement with the government where we can sell the same Qualified Health Plans (QHPs) that they offer, but customers can use our shopping experience.
Reasons to look at off exchange plan options
When shopping for insurance, it’s a good idea to look carefully at a lot of insurance options. To estimate which will result in the best coverage price for you run some scenarios.
If you’re someone who doesn’t qualify for subsidies or finds coverage with an off-exchange plan they can’t find on the exchange, an off-exchange plan can be beneficial.
Compare the off exchange plan and its cost to an on exchange plan throughout the year. For easy comparison, both shared and off exchange plans are available at eHealth.
By thoroughly checking your options, you can get a better idea of what a reasonable cost for insurance is for someone in your specific circumstances. This information can in turn, can help you find the best deal for your money and the coverage that best fits your lifestyle and your needs.
What to Look for in an Off-Exchange Plan
You’ll want to look at total costs, including premiums, deductibles, and coinsurance costs, when determining whether to buy an on-or off-exchange health plan.
If you need to see a specific doctor, you should also examine whether any on-exchange or off-exchange policies consider this “in-network” doctor. Once you have a broader understanding of your coverage needs, you can compare on-exchange bronze, silver, and gold plans, as well as off-exchange plans, to see what’s right for you.
The good news is, you don’t need an off-exchange policy to do it if you want to go through an insurance broker for help. A mechanism called direct proxy registration allows brokers or other third parties to transmit your information to Healthcare.gov so you can get on-exchange coverage, but still get the help you need from your insurance agent.
With each off-exchange and on-exchange plans, you must get pretty comprehensive coverage that gives the insurance advantages you’d expect.
In sum, you generally should purchase a plan from an exchange if you may need subsidies and off-exchange if you definitely won’t get subsidies and can find a cheaper or more comprehensive plan that best fits your desires.