Off Market Health Insurance – What is it? Where can you buy it? What do you need to know?

Individual and Family

Off Market Health Insurance – What is it? Where can you buy it? What do you need to know?

Published on December 15, 2018


What is “Off Market” Health Insurance?

The term “marketplace health insurance” is often used to define health insurance policies that meet the standards of the Affordable Care Act (ACA or Obamacare). The term “Off Market” insurance is increasingly being used to define alternatives to ACA coverage that are typically more affordable, but off limited coverage and often exclude pre-existing conditions.
The video outlines regulatory changes enacted in 2018 that go into effect for health insurance plans, in most states, in 2018.

The Trump Administration’s Latest Iteration of “Trumpcare.”

The Trump administration has made three attempts change or replace the Affordable Care Act (ACA or Obamacare).

Round 1 (Past) Round 2 (Present) Round 3 (Future)
The American Healthcare Act Extended Duration Short-Term Health Plans Association Health Plans & Health Savings Account Expansions

“Off Market” Short-Term Health Insurance Plans – The Present Version of Trumpcare

The Centers for Medicare and Medicaid Services (CMS) changed some of the rules that govern short-term (limited duration), or STLD, health insurance plans in August 1, 2018.
The new rules made it possible for people to stay on a short-term health plan for to up to 364 days starting in October of 2018. In 2019, short-term plans ay be available in some states for up to three years.
In 2017 the Obama administration limited the maximum duration of short-term health insurance plans from 364 days to 90 days. This new rule reverses the 90-day restriction, but states still have the authority to put restrictions on short-term plans, and many states have done just that.
Short-term health policies have limited benefits and are traditionally used to provide coverage for a fixed period of time.

  • Short-term plans provide many key benefits most consumers want,, but don’t typically cover specific benefits like maternity care, mental health, substance abuse, and pre-existing conditions.
  • Short-term plans are typically 80% cheaper than major medical plans.
  • The terms of coverage on short-term plans can range from three months to three years.


Other “Off Market” Health Insurance Alternatives: Healthcare Sharing Services

Healthcare Sharing Services are commonly known as cost-sharing ministries or faith-based cost-sharing services.

  • Healthcare sharing services are usually groups of like-minded people that agree to help each other pay medical bills. Most are organized around a common ethical or religious beliefs.
  • Healthcare sharing services are typically cheaper than an ACA plans. Most, however, can decline applicants who don’t subscribe the group’s belief system.


Other “Off Market” Health Insurance Alternatives: Fixed Benefit Plans

Fixed Benefit Plans or Fixed Indemnity plans and GAP plans pay a set cash benefit per specified hospital or physician service provided.

  • Unlike major medical or short-term coverage, that pay all qualified expenses after the deductible is met, fixed indemnity plans pay a flat fee for each service provided.
  • GAP plans are typically used with short-term or major medical plans to pay for out-of-pocket expenses related to an accident or critical illness.


Other “Off Market” Health Insurance Alternatives: Multi-Policy Coverage

Multi-Policy Plans are being offered by a growing number of insurers and brokers and typically include a combined package of insured and non-insured benefits.

  • These combinations provide more complete coverage than a non-major medical plan can provide.
  • Combinations usually include short-term for medical, GAP for deductible protection and association memberships for Rx discounts and mobile office visits.

The graphic shows all of the major “On Market” and “Off Market” Options

We’ll let you know when we publish anything new.