Affordable Care Act

What Is an Off Exchange Plan?

Updated on December 18, 2019


What is an off exchange plan?

The term off exchange plan describes a health insurance policy that you buy directly from an insurance carrier or through a licensed broker like eHealth outside of an official state or federal ACA Marketplace.
Some off exchange plans offer the same sorts of coverage that are available with ACA plans. These plans will adhere to the rules for qualified health plans, which include:

  • 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 nationwide for plans on the exchange, they can vary state by state if you look at an off exchange plan.
However, instead of being offered through the government Marketplace, or state-run marketplaces, these are available directly purchase directly from insurance companies or through independent brokers. In many cases, an insurance carrier will offer both an on exchange and off exchange plan with the same coverage. This is a choice made to increase consumer choice.
Off exchange plans that are not ACA-compliant
In addition to these major-medical qualifying plans, you can look at other coverage that may not be as robust. For instance, catastrophic insurance can be found among off exchange plan options. This insurance will not cover many basics such as check-ups or immunizations, but offers coverage for catastrophic events like major injuries and illnesses. In exchange, those who buy these plans will pay significantly lower premiums. Examples of eff-exchange plans that are not qualifies health plans (QHPs)—or in other words, all you can find on government exchanges:

  • short term health insurance
  • medical insurance packages (MIPs)
  • GAP insurance
  • Critical illness
  • Medical indemnity

These plans should only be considered by people who are in good health and who do not frequently use medical services. When medical services are mostly paid out of pocket, it can result in significantly higher costs overall. When picking a plan with a low premium (monthly costs) make sure you always check plan details and walk into it with the understanding that benefits might be cut compared to plans that are more expensive.
Visit eHealth to see more details on these plans and get free quotes.

Perks of choosing on exchange plans

When you buy a plan on the government Marketplace, you have a guarantee that what you are buying is a qualified health plan that meets the consumer protection requirements of the ACA. You can also quickly and easily compare the bronze, silver, gold and platinum insurance options in your state. On exchange plans often require less out of pocket, as these plans are eligible for subsidies that substantially cut insurance costs.
Keep in mind that you can also find these “on exchange” plans even outside of the government Marketplace—eHealth has a proxy agreement with the government where we can sell the same Qualified Health Plans (QHPs) they offer, but customers get to use our shopping experience.

Reasons to look at off exchange plan options

When individuals are shopping for insurance, it is a good idea to carefully look at many insurance options. Run some scenarios to estimate which will result in the best price for coverage for you. If you are someone who does not qualify for subsidies or who finds coverage with an off exchange plan that they cannot find on the exchange, an off exchange plan can be advantageous. Compare the off exchange plan and its cost throughout the year against an on exchange plan. Both on exchange and off exchange plans are offered at eHealth for easy comparison.
By thoroughly investigating your options, you can get a better idea of what a reasonable cost for insurance is for someone in your specific circumstances. This information, in turn, can help you find the best deal for your money and the coverage that best fits your lifestyle and your needs.

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