When looking to purchase healthcare coverage, you have two options: on and off exchange health insurance plans. On exchange health insurance requires you to shop for coverage at a government insurance marketplace, such as HealthCare.gov or a specific state-run entity. These types of marketplaces will typically have a wide range of healthcare options from different providers, allowing you to compare plans. On the other hand, an off exchange health plan has to be bought from the insurance carrier or licensed broker directly. 

If you want to learn more about off exchange healthcare plans, read on. We will provide an in-depth overview of what off exchange plans are, how they compare to on exchange  plans, their benefits, and more.

What Is an Off Exchange Plan?

So, what does off exchange mean in health insurance jargon? The term off exchange plan describes a health insurance policy that you buy directly from an insurance carrier or a licensed broker (like eHealth) outside of an official state or federal ACA (Affordable Care Act) Marketplace. Instead of going to the government marketplace, you will purchase your health insurance directly from the carrier or with the help of a broker who can explain the differences to you. Since you are not buying them on an exchange, they are called off exchange healthcare plans.

Some off exchange health insurance plans offer the same type of coverage as ACA plans. These plans will adhere to the rules for qualified health insurance, 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.

Before you decide on a plan, you should compare the benefits and drawbacks of each option. 

How Are Off Exchange Plans Different from On Exchange Health Plans?

While the criteria for qualified health plans are the same nationwide for plans on the exchange, off exchange plans can vary by state. 

Another difference is that off exchange coverage is only available through insurance companies and independent brokers. In contrast, on exchange  insurance is offered through the government Marketplace or state-run marketplaces. In many cases, an insurance carrier will offer both an on exchange  and off exchange plan with the same coverage. This is done to increase consumer choice. 

On exchange  plans also often require less out of pocket, as these plans are eligible for subsidies that substantially cut insurance costs. That is why a lot of people enjoy qualified health plans. On the other hand, subsidies are not available on off exchange plans. 

Off Exchange Plans That Are Not ACA-Compliant

In addition to 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 often does not cover the basics, such as check-ups or immunizations, but offers coverage for catastrophic events, including major injuries and illnesses. As a result, those who buy these plans will pay significantly lower premiums.

Here are a few examples of off exchange plans that are not qualified health plans (QHPs)—healthcare plans that do not comply with ACA requirements and are typically not found on government marketplaces.

• 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 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 the plan’s details and understand that the benefits might be less compared to plans that are more expensive.

The Benefits of an Off Exchange Health Plan

When you buy a plan on the government marketplace, you’re guaranteed a plan that meets the consumer protection requirements of the ACA. Federal and state-funded marketplaces also let you compare the bronze, silver, gold and platinum insurance options to help you identify the best type of coverage for you. 

Keep in mind that you can also find these on exchange  plans outside the government Marketplace—eHealth has a proxy agreement with the government where we can sell the same QHPs they offer, but customers get to use our modern and easy-to-navigate shopping platform. This is one of the most significant benefits of going with a plan that cannot be found on the government exchange. You can get the same low prices found on the exchange and a more extensive range of options.  

Shopping for a healthcare plan outside the federally funded marketplace can also ensure a much better shopping experience. This is because you’re buying directly from an insurance provider or broker, so agents are more knowledgeable on the plans available and can provide great customer support. As a result, it may be easier for you to find the ideal plan for yourself and your family.

What to Consider When Choosing an Off Exchange Health Plan

When individuals are shopping for insurance, it is a good idea to carefully look at the many insurance options available. Run some scenarios to estimate which will result in the best price and coverage for your lifestyle. If you are someone who does not qualify for subsidies or who finds their ideal coverage outside the marketplace, an off exchange plan can be advantageous.

Compare the off exchange plan and its cost throughout the year against an on exchange  plan and ensure it can cover your healthcare needs. Both on exchange  and off exchange plans are offered at eHealth for easy comparison.

Is Off Exchange Health Insurance Right for You?

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. In turn, this information can help you find the best deal for your money and the coverage that fits your lifestyle and needs the most. 

You should not have to worry about visiting different websites to find the right health insurance plan for yourself or your family. With the help of eHealth, you can compare insurance premiums, deductibles, co-pays, and more on a single platform. Try eHealth and find the ideal on or off exchange coverage today.